This article originally appeared in The Skeptic, Volume 6, Issue 6, from 1992.
Although acupuncture continues to be practised all over the world by some medically qualified doctors, I had thought that at last in the 1990s the practice was beginning to be abandoned by the medical profession in the U.K. A sort of epitaph for it was recently published in The Lancet:
Whilst careful scientific research can never entirely exclude the possibility that a dwarf is hiding in the corner of the room, many western researchers may now conclude that the existence of the dwarf approaches asymptotically to zero (Editorial, 1990)
This editorial article examined the evidence for the therapeutic efficacy of acupuncture that had been published in more recent years, and found it sadly flawed. Western medicine has indeed had several periods of dabbling in acupuncture during the past two centuries, but in the last half century scientific method has elbowed its way, against some powerful opposition, into medicine, and acknowledgment of the placebo effect has now attained official recognition.
It was with some surprise, therefore, that on visiting my GP recently I found a folder marked ‘Acupuncture’ on display in the waiting-room for patients to consult. This medical group-practice has the policy of providing its patients with a wealth of popularly written books and folders in the waiting-room which present all sorts of guides to healthy living, and discussion of such topics as asthma, contraception and constipation.
I looked at the ‘Acupuncture’ folder expecting it to give an informed and balanced account of acupuncture. Not a bit of it; all that the folder contained was material that was simply a glowing puff for acupuncture, such as might be issued by any commercial advertising agency.
Uninformed lay people might well suppose that acupuncture is a tried and tested technique approved by the British Medical Association, and therefore they should be as prepared to spend their money on lay acupuncturists, just as they might on any orthodox private medical practitioners The folder contained three leaflets, plus a list of ‘Useful Addresses’: Acupuncture in the UK Today, published by the British Holistic Medical Association (BHMA); Introductory Leaflet on Acupuncture, also published by the BHMA; and Traditional Acupuncture, published by the Traditional Acupuncture Society. I will describe these three leaflets individually.
Acupuncture in the UK Today is by Richard James, Director of the Isis Centre for Holistic Health. He has genuine medical qualifications, but he also writes some letters after his name that presumably refer to qualifications in acupuncture. He informs his readers that “Acupuncture is now established as a profession independant (sic) of medicine in the UK”. The leaflet tells us that
a growing number of doctors are doing very short courses (one weekend) and then taking up the practice of acupuncture. They are then entitled to become Full Members of the British acupuncture Society (MBAS) whose list is circulated to Family Practitioner Committees with the recommendation that GP’s (sic) should refer to acupuncturists on this list and no other.
Thus, if Necromancy is a profession independent of medicine in the UK (as I’m sure it is ) any GP who wants to earn a little extra income can take a weekend course in it, and thus join the profession, write B. Nec. after his or her genuine medical qualifications, and then practise it in the surgery.
The leaflet goes on to inform us that:
This exclusivist position has been pursued aggressively, to the extent of refusing membership to doctor acupuncturists who associate with ‘Quackupuncturists’. The BMAS membership list is also available directly to the public, something for which the BMAS has severely criticised the BAAR in the past.
The BAAR is apparently the British Acupuncture Association, to which non-medical acupuncturists belong, and which touts for custom, as they are entitled to do, along with iridologists, rediesthetists, reflexologists, naturopaths etc, etc. It is significant that they are being labelled as ‘Quackupuncturists’ by the weekend-course doctors, perhaps to make it quite clear that they, the medical acupuncturists, are not ‘quacks’, as some people might suppose.
The second leaflet, entitled What is Acupuncture, sets out to inform lay people of the nature of acupuncture in very few words, and gives addresses of societies, both medical and non-medical, where they may apply for treatment. The third leaflet is issued by the Traditional Acupuncture Society, which is non-medical, and sets out to explain the nature of Chinese Medicine. It makes the point that:
The Traditional Acupuncture Society requires members to have achieved a comprehensive understanding of the theory of Chinese Medicine and a high standard of clinical competence before beginning to practice as members of the Society.
It does not outline how students receive their training, but presumably those who apply to its Registrar (whose address is given) receive details of how they may set about their studies in order to be accepted as members, and entitled to write various letters after their names. Here is a clear bid to set up the profession of Chinese medicine in the West as an alternative to that which has grown up here over the centuries, and has its roots in Greek and Arab science.
The leaflet that I obtained from my local GP surgery is over printed at the foot with the address of the local Traditional Acupuncture Clinic, and gives the names of the four non-medical persons who are its staff. Presumably my local doctors pursue a policy of friendly co-operation, instead of outlawing these people as ‘Quackupuncturists’.
Recent history
The resurgence of medical interest in acupuncture in the UK was strongly associated with Dr Felix Mann‘s book Acupuncture: The Ancient Chinese Art of Healing (Mann, 1962) which was published at a time when various forms of alternative therapy were attracting attention, and the medical profession was concerned about its status. A considerable boost to acupuncture was given by those interested in pain control, for even though such oddities as diagnosis by means of 12 separate pulses could be dismissed as mere fantasy, it appeared that acupuncture actually could inhibit pain, and this was of considerable theoretical importance.
Researchers such as Melzack and Wall were striving to get their new look gate control theory of pain (Melzack and Wall, 1965) accepted in the face of the conservative opposition of those who favoured the old specificity theory of pain that still featured in most medical textbooks (Schmidt, 1972). Pain-control by means of acupuncture seemed to fit in very nicely with many of the new ideas, and Melzack in a series of publications (Melzack, 1973a; 1973b; 1973d) gave it new respectability among many scientifically oriented people, and with the lay public. His colleague, Patrick Wall, was not so keen to relate acupuncture to gate control theory, and in the course of an article in which he confused mesmerism with hypnosis (a very common confusion) he gave his opinion:
Let us turn from the traditional acupuncture treatment of general disease, for which we have as yet no proof of therapeutic advantage, to examine acupuncture as a method of anaesthesia in surgery. We have now all heard evidence that it is dramatically successful. My own belief is that, in this context, acupuncture is an effective use of hypnosis (Wall, 1972).
The evidence that acupuncture is ‘dramatically successful’ in producing anaesthesia or analgesia, raises some hollow laughs today. Felix Mann, who bears much responsibility for originally promoting acupuncture in the medical world, has been obliged to recant on much of his earlier work, and after 20 years he wrote:
Acupuncture anaesthesia (really analgesia) works only, in my experience (though others who are experts disagree) in the hyperstrong reactor. In 1974 I reported the results of a hundred experiments in acupuncture analgesia and came to the conclusion that it worked reasonably, though not perfectly, in 10% of patients. Since then I have come to the conclusion that the criteria I used were a little optimistic, and the figure should be revised to a mere 5% (Mann, 1983, pages 44-45).
When Melzack and Wall jointly revised the former’s book (Melzack, 1973a) and issued it as The Challenge of Pain (Melzack and Wall, 1982), they made no mention of the two articles I have cited earlier (Melzack 1973b, 1973c), and they admitted that:
It became evident that the use of acupuncture to produce analgesia for surgery is relatively rare and undependable. In China, it is used for no more than five to ten per cent of surgical operations, and it is carried out on selected patients who have been thoroughly exposed to acupuncture methods (Melzack and Wall, 1982, p. 322).
In contrast to the acceptance of acupuncture analgesia as a valid field for study by scientists such as Melzack and his colleagues, and by many clinicians who were less scientifically orientated, there was outright rejection of it by others. In the USA Sweet (1981), after a careful review of the available evidence, dismissed acupuncture as clinically worthless. Skrabanek launched an outright attack on acupuncture, stating:
By ‘rediscovering’ the five vital principles of Chinese Medicine (equivalent to the four humours of the ancient Greeks) and Chinese acupuncture (equivalent to European bloodletting) we degrade medicine to shamanism. If we can now treat obesity or smoking addiction with a staple in the ear, why not a copper bracelet or red flannel for rheumatism next? Let us leave quackupuncture to quacks and let us tell the misinformed patient the truth, so that he or she can choose (Skrabanek, 1984, p.1171).
With regard to what evidence there is that acupuncture can sometimes inhibit pain, Skrabanek points out that there is nothing new, or foreign to Western medicine, in the practice of needling to produce analgesia. It was known and written about in the nineteenth century by doctors who had no interest in Chinese medicine.
In modern times the gate control theory of pain would explain it by the fact that if a large-diameter non-nocioceptive sensory nerve fibre is stimulated, it will have an inhibitory effect on the different neural messages that produce the perception of pain. The same is true of ice-massage, transcutaneous electrical stimulation, and other methods that Melzack and Wall refer to as hyperstimulation analgesia, and are not related to the theory of acupuncture. In addition to the physiological effect of such methods, what they all have in common is the placebo effect that any impressive method will have on a patient in pain.
We may ask why medical journals such as The Lancet still trouble to print articles and letters that mention acupuncture. Occasionally there are angry protests from correspondents such as Dr Day who writes: “Having read The Lancet for 60 years, I feel I have a right to criticise your editorial on acupuncture… I am sorry that you dignify this charlatanism by an editorial” (Day, 1987, p. 387). Occasionally there are letters in the medical press that treat the whole matter as a huge joke, a source of fun that lightens the serious world of medicine. One such lighthearted letter treats acupuncture as though it were a form of witchcraft:
Sir – I am surprised that some of your correspondents still feel compelled to assert the efficacy of acupuncture… Not only does it work, but it works at a distance. During the 1950s the senior medical staff of a hospital with which I am acquainted kept in secret a small wax image of the then group secretary, into which from time to time sharp needles were inserted and waggled about. This practice was abandoned when it became clear that its only observable effect was to keep the so-and-so in the best of health (Zuck, 1984, p. 175).
But Skrabanek is serious, and makes an outright attack on the mercenary motives of his colleagues who persist in claiming that acupuncture is of general therapeutic value in the treatment of diseases, including “viral hepatitis, malaria, hereditary ataxia, infantile paralysis, hydrocephalus, mammary hyperplasia… deafness… schizophrenia.” He writes that, “since the popular demand for acupuncture is great, it is not surprising that medically qualified acupuncturists are afraid of ‘non-professional’ competitors in the lucrative market”(Skrabanek, 1984, p. 1170).
Is it all a financial racket then, in which mercenary doctors conceal the known truth from their patients, and con them into spending money on a useless treatment? It is not as simple as that.
First, we must consider that no-one likes to admit to having been duped. The propaganda for acupuncture that emanated from Maoist China was sufficiently impressive to induce serious Western doctors to make the long journey East and visit their hospitals. Not all doctors are very good scientists, or adept in observing phenomena with the careful eye of a skeptic, so that sincere doctors such as Brown (1972) reported that perhaps as high a proportion as 90 per cent of Chinese patients underwent surgical operations depending solely on acupuncture analgesia. Now they are licking the egg off their faces, but naturally maintain that, still, there must be something valuable in Chinese medicine that the West could learn.
Again, the charge of being moved by mercenary motives can hardly be levelled at the doctors in the practice I attend who actually advertise the local Traditional Acupuncture Clinic, where none of the staff is medically qualified. What is the truth of the matter? I shall attempt, as a non-medical man, to sum up the attitude of a skeptical doctor who permits, even encourages, the odd patient to try acupuncture for his ill-defined disorders:
‘We live in an age of unreason where the public at large are sold on all sorts of superstitious ideas, and there is really nothing much we doctors can do about it. They come to us expecting miracles and refusing to accept the plain fact that we don’t know what’s wrong with a lot of them, and probably never will know, for many of their ills are engendered by their imagination, and the silly way they conduct their lives. We would like to operate within the bounds of rational medicine, but they demand that we act as shamans and priests. Medicine has done wonders for the population at large, but they want the impossible – always to be free of all pain and sickness. A lot of them privately sneer at the limitations of conventional medicine and want something better, hence their ignorant demand to have their Chi manipulated, and their yin balanced with their yang. They have read about it in some magazine. Well, if they want acupuncture, let them have it – and pay through the nose for it. If we keep it to ourselves, and discourage patients from going to lay acupuncturists, at least our medical colleagues will operate with aseptic needles and not give them hepatitis, AIDS or some other filthy disease. Also, they will be better able to diagnose when patients are really suffering from some recognisable disease, and not try needling them for miliary tuberculosis. But if we pursue this policy, then we are accused of pursuing restrictive practices, and selfishly stopping patients from receiving the benefits of all these lay acupuncturists who prattle on about yin and yang, feeling their twelve pulses, and calming the ‘triple warmer’. Perhaps a middle course is better; to shunt off all these hypochondriacal bores that clutter up our surgeries with nothing much wrong with them to local quack acupuncturists and let’s see whether the placebo response can help them. Meanwhile, we will get on with our proper job of promoting the health of those we can help.’
Well, what is an ethical course for the honest doctor to pursue in a society that is riddled with superstition?
References
- Brown. P.E. ( 1972) Use of acupuncture in Major surgery. The Lancet. i. 1328-1330.
- Day, R.L. (1987) Acupuncture, The Lancet, i, 397. Editorial (1990) Many points to needle.The Lancet, ii, 20-21.
- Mann, F. (1983) Acupuncture: The Ancient Chinese Art of Healing. London: Heinemann.
- Mann, F. ( 1983) Scientific Aspects of Acupuncture. London: Heinemann. Melzack, R. (1973a)The Puzzle of Pain.
- Harmondsworth: Penguin Books. Melzack, R. (1973b) How acupuncture can block pain.Impact of Science on Society, 3, 65-75.
- Melzack, R. (1973c) Why acupuncture works. Psychology Today, 1, 28-37,
- Melzack, R. and Wall, P.D. (1965) Pain mechanisms: a new theory. Science, 150, 97 1-979.
- Melzack, R. and Wall, P.D. (1982) The Challenge of Pain. Harmondsworth: Penguin Books.
- Schmidt, R.F. (1972) The gate control theory of pain: an unlikely hypothesis. In J.P. Payne and R.A.P. Burt (eds.) Pain. London: Churchill-Livingston.
- Skrabanek, P. (1984) Acupuncture and the age of unreason. The Lancet, i, 1 169-1 171.
- Sweet, W.H. (1981) Some current problems in pain research and therapy (including needle puncture, ‘acupuncture’). Pain, 10, 297-309.
- Wall, P. (1972) An eye on the needle. New Scientist, 20 July.
- Zuck, D. (1984) Letter, The Lancet, ii, 175.
