Acupuncture is not a placebo effect

As acupuncture and alternative medicine in general continue to be utilized by a growing number of people, more skepticism and criticism naturally emerge as well.  There are a number of western oriented sites and blogs that claim acupuncture, if it works at all, is nothing more than a placebo effect.

There is a whole discussion to be had with regards to the inherent bias against acupuncture that many Western doctors and researchers have.  It is virtually impossible to do the gold standard double blind type studies with acupuncture.  A very brief summary is that 1) a holistic system does not match well to reductionist methods 2) sham acupuncture is a very poor control 3) many studies are designed and performed by people with no experience whatsoever with acupuncture or eastern medicine and in effect are almost guaranteed to produce a negative result.  I’ll get more into that in another post.  The emphasis here is to demonstrate that acupuncture is not in fact merely an elaborate ritual to evoke the placebo effect.

I’ll start off with my own clinical experience.  It goes without saying that I do not believe that positive clinical outcomes from using acupuncture is nothing more than placebo effect.  The vast majority of the patients I've seen had experienced at least some improvement in their condition, more often than not significant improvement.  This doesn't necessarily show that acupuncture is more than placebo however so let me talk a bit about some more specific instances that very strongly suggest it is not.

It is not terribly uncommon for some new patients to be highly skeptical that acupuncture can do anything to help them.  Their doubt essentially creates the potential for the nocebo effect (the opposite of placebo).  The vast majority of these patients return with improved symptoms and often profess near astonishment at the difference they felt given that they didn't believe acupuncture would do anything in the first place.  In fact, somewhat ironically, my clinical experience has shown that many of the most skeptical patients actually get slightly better relief than some of the most believing patients.  Logically, if acupuncture is nothing more than a placebo effect than the results would scale to some degree with patient belief and those patients that had no belief or expectation of acupuncture working should not show any improvement.  My clinical experience shows otherwise, specifically that even when patients have no expectation of any positive outcome they still experience a clinical benefit.

There is another trend I've noticed in my clinical practice that further supports acupuncture is not just placebo.  The placebo is relatively specific, i.e. this treatment is for this specific condition and the greater belief that the treatment will help the condition the greater the effect.  It is not uncommon for patients to focus on only one or two main complaints and not mention other health issues they are having.  I see this most often with pain.  It is quite common for patients who come in primarily for pain relief to later mention, hey my sleep has been much better lately...or my appetite is much better...my libido has returned to normal… etc.  If acupuncture were only a placebo effect it would be difficult to explain how patients, without disclosing these other conditions and without having any expectation of improvement of these conditions, show a positive clinical result.

Of course any critic will point out clinical experience doesn't have the same validity as well controlled scientific studies which are published in peer reviewed magazines.  To that end, the scientific evidence comes from various studies involving animals.  It is widely accepted that animals are not susceptible to the placebo effect.   There are a number of studies using rats or mice that have conclusively demonstrated that acupuncture can induce very specific physiological effects that are effectively impossible to explain as the result of placebo (for example 1,2,3,4).  A review from the veterinary world concludes acupuncture is both safe and effect for pain and “should be strongly considered” (5).  Acupuncture has even been reviewed in zoological settings and has been found to be highly beneficial (6,7). It is in fact difficult to find any animal studies involving acupuncture that do not show a positive result.  The overwhelming scientific results showing acupuncture on animals induces both physiological effects and clinical benefits very strongly indicate that acupuncture is not, in fact, merely a placebo effect.