I recently wrote a piece titled “Acupuncture Can Spread Tuberculosis, Researchers Warn,” which began:
A new study has found an unusual risk in acupuncture: tuberculosis, which kills over 1 million people each year. While pulmonary tuberculosis is the best known and most common form, the infection can also be spread through skin contact. Acupuncture, the traditional Chinese treatment of placing of needles in the body, is said to cure people of various ailments. Proponents believe that the needles control energy fields in the human body and treat medical issues. However, the energies that acupuncturists claim to manipulate have never been proven to exist and cannot be detected by any scientific instrument.
The article was published last week on the open-access journal PLoS-ONE and titled “Analysis of 30 Patients with Acupuncture-Induced Primary Inoculation Tuberculosis.” In it the researchers described “Seven confirmed and 23 suspected, total 30 patients (13 male and 17 female) with primary inoculation tuberculosis were selected from the same clinic in Wenzhou City, China that specialized in treatment of muscle and soft tissue pain and osteoarthritis of the knee…. Patients ages ranged from 31 to 71 years… had all undergone acupuncture and electrotherapy, administered by the same clinician, once every two days for about two weeks for the treatment of neck, back, elbow, wrist, hip, knee and ankle pain. The procedures took place between May 2011 and August 2011.
I then expanded the discussion to include the overall evidence for acupuncture:
Of course all medical treatments involve risks, so the question becomes one of a cost/benefit analysis: Do the benefits of acupuncture outweigh the risks? The fact is that there is real question in the medical community about whether acupuncture is effective at all. Consumer advocate Dr. Steven Novella of the Science-Based Medicine website explains that the scientific evidence for acupuncture is inconsistent. Some studies show some small effect for a limited number of conditions (such as pain relief and anxiety), but many others don’t. Furthermore, the conditions that acupuncture is most effective for are those that respond well to the placebo effect. In other words, acupuncture is no more or less effective than a sugar pill with no active ingredient. Patients feel slightly better because they expect to feel better, not because needles were inserted into special points on their skin to redirect unknown energies. When a drug or treatment works no better than a placebo, in the field of medicine that means it doesn’t work.”
As was expected, acupuncture defenders sprang to attack in the comment section.
One person wrote: “This is exactly why acupuncturists in the united states use DISPOSABLE, one-time use needles, and practice the STANDARD in the states: ‘Clean Needle Technique’. I’m not sure why you are comparing practices in china with our very different practices here. It really shows poor reporting because this information is irrelevant to the practice of acupuncture in america.”
I replied, starting with her quote: “I’m not sure why you are comparing practices in china with our very different practices here.” You seem to have misread the piece; no one compared practices in China to practices in America. In fact there is no discussion at all of acupuncture in America; the new study was of patients in China. Furthermore the article states that the source of the contamination could not be established, therefore you don’t know that it was due to dirty needles.”
She replied back, apparently acknowledging that she misread or misunderstood the piece, but adding another fallacy: “Nevertheless, I spoke with a doctor and TB is actually spread by respiratory droplets….so it looks like someone in that office had TB…My doctor friend said that it couldn’t even be transmitted by blood unless its very far progressed. The missing link in this study, friend?”
I gamely and politely replied: “I don’t mean to be rude, but you really should read the study linked to at the top of the piece above, because your doctor friend is wrong. The second sentence reads, “While pulmonary tuberculosis is the best known and most common form, the infection can also be spread through skin contact.” I don’t know why your doctor friend has never heard of any other type of tuberculosis, but I hope he or she is not a communicable disease specialist. Do a quick Google search for “cutaneous tuberculosis” and see if you find any form of TB that is not spread by respiratory droplets.”
Apparently forced to admit that not only had she misunderstood what I wrote but that she had been clearly misinformed by her doctor that I was wrong, she didn’t reply.
Another person stepped up with: “After decades of research and more than 3,000 trials, acupuncture researchers have failed to reject the null hypothesis, and any remaining possible specific effect from acupuncture is so tiny as to be clinically insignificant. In layman’s terms, acupuncture does not work-for anything.” -NOPE! Next time you want to write about a subject, contact someone with a doctoral degree in that subject. This article and those whom it quotes are both utterly ignorant of current research…”
Again, I politely corrected the misinformation: “Next time you want to write about a subject, contact someone with a doctoral degree in that subject.” The person quoted, Dr. Steven Novella, is a board-certified medical doctor, a clinical neurologist, and assistant professor at Yale University School of Medicine. His analysis of acupuncture appeared in a peer-reviewed medical journal, “Anesthesia and Analgesia.” Just because you disagree with him doesn’t mean he doesn’t know what he’s talking about.”
In response he wrote: “I didn’t say or imply that Novella, “doesn’t know what he’s talking about.” My point is that he does not have a degree in acupuncture and make comments that are directly contradicted by current evidence. Had you spoken with someone educated in the subject matter, they may have given you accurate information. The sources I gave you are all published in peer-reviewed journals as well. The idea that research has determined that acupuncture doesn’t work for anything is shown to be false in the high-quality critically appraised sources I provided. Shouldn’t you at least provide context by mentioning what people with actual degrees in this subject have to say? Not to mention that your sources are from cases in China…hardly US standards. I’m just letting you know this for the next piece you write. You might not have even known that there were people with degrees in acupuncture. A neurologist isn’t an expert on acupuncture. A doctor of acupuncture (DAOM) is.”
Again, I did my best to correct this person’s misunderstanding of science: “You seem to be confusing the individual practice of acupuncture with interpretations of meta-analysis of studies of acupuncture. A person does not need to be a doctor of acupuncture to review and interpret the results of studies of acupuncture. That falls into the area of clinical research design, which Dr. Novella is fully qualified to do. Your argument is like saying that your local pediatrician is better qualified to interpret the results of 18,000 pediatric studies than, say, an epidemiologist at the CDC. The fact that the evidence for acupuncture’s effectiveness is inconclusive at best has nothing to do with whether Novella has a doctorate in acupuncture. The studies are there, for anyone to see. You have cherry picked a handful of positive studies, and there are just as many (in fact far more) studies that show no effect at all. That’s the whole point. The fact that no medical test or analysis can show the existence of the so-called “energy fields” that acupuncturists claim to manipulate to improve patient health doesn’t help matters.”
Another person wrote, “I have issues with this article. As an acupuncturist practicing in the US I this article to be vastly misleading. Both accounts of risks sited in this article were in different countries to begin with. Those cou
ntries have different laws, one main difference being that we here in the US, we are required by law to use only disposable needles, so the fear of spreading anything is equivalent if not less than any other clinic. Secondly, many of the studies done currently, particularly ones funded by Western medicine are flawed studies. A lot of times they insert 1 or 2 needles using the same points, in individuals to see if there is an effect. The problem with this is, thats not how the medicine works! Its same as giving the same medication to a group of people and if there are any inconsistencies labeling the medication as placebo or not medically valuable. Acupuncture is a HOLISTIC medicine, meaning it treats patients as individuals. Every treatment should be customized for a case by case situation to yield the best results. In my opinion, western medicine should learn from that as opposed to attacking something they don’t understand. So typical to bash something one doesn’t understand…”
Again, I gamely replied, aware that thousands of people may be reading the comments and trying to understand the situation: “Thanks for commenting. You wrote that “many of the studies currently done are flawed,” which is an interesting comment given that another acupuncturist commented below cites those same studies and seems to think they are valid! Furthermore, clinical studies published in journals are conducted by professional acupuncturists, not untrained laypeople, so you are basically saying that acupuncturists in the research (who you say don’t know “how the medicine works”) don’t know what they are doing. This is hardly a ringing endorsement of acupuncture. The fact is that if acupuncture works, there should be plenty of data to prove it. And as for the comment that acupuncture is “holistic, meaning it treats patients as individuals,” that is exactly how Western medicine works. All effective medicine and medical treatment is tailored to the individual and treats patients as individuals. That’s why doctors spend a lot of time learning about the patient’s history and conditions, so they can decide the best course of treatment for a given patient’s condition. The idea that Western medicine doesn’t treat the whole patient is a myth.”
This person responded with even more logical fallacies and flawed assumptions: “Studies can be paid off and doctors bought and who know who these studies hire as “professional acupuncturist.” Even in holistic medicine there are quacks (ie. every infomercial that has a Dr. appear it). If you read the full studies and have an understanding of acupuncture it is very obvious which ones are legit and which ones aren’t. I just ask that you and the general public do more research as opposed to just reading glimpses of such biased articles. At the end of the day acupuncture has been around for over 5,000 years, you would think that if it didn’t work it’ll be rendered obsolete, not increasingly integrated into hospitals worldwide and accredited by the World Health Organization.”
Again, I did my best to correct some misunderstandings: “Okay, I see where you’re going with this… any studies that show acupuncture is effective were conducted by knowledgeable, trained acupuncturists. Studies that show that acupuncture is NOT effective were flawed and done by researchers who were “paid off,” and couldn’t be because they show that acupuncture doesn’t work. That’s an interesting conspiracy idea. It may be true that acupuncture has been around for a few thousand years, but that doesn’t mean it’s valid or effective. In fact that’s an example of a logical fallacy called “argument from antiquity,” saying that because X was used centuries or millennia ago, it must work. Leeches and bloodletting were also used for thousands of years–before modern science showed that diseases were not caused by imbalances in bodily fluids like bile, blood, etc. So the “anything used for thousands of years must work” bit is another myth. That also raises another question: Since acupuncture has been used for so long, why isn’t there better scientific evidence that it works? This isn’t a pill or treatment that came on the market in 1990 and hasn’t had a chance to be fully tested or proven. And for that matter, why can’t science or doctors find or quantify these human energy fields (qi) that acupuncturists claim to manipulate? If medicine can’t show it exists after 5,000 years, it’s probably not there…”
There was more to this back-and-forth, but you get the idea… Normally I wouldn’t have bothered to address and correct the misunderstandings (dealing with alternative medicine believers can be similar to dealing with creationists, in terms of moving goalposts, fuzzy terms, and the like). But in this case I realized that this was a very public forum, and that if I (or another knowledgeable skeptic) didn’t respond, many would come away thinking thinking that the acupuncture defenders were making valid points. It was worth about an hour of my time to offer a more science-based perspective, and hopefully educate the public about scientific research design, the placebo effect, and the unprovable basis behind acupuncture.