When Placebo Can't Be Controlled

Acupuncture has been practiced for thousands of years and with such age a practice gathers many strong believers. There are undoubtedly millions, possibly billions, of people in the world who believe that acupuncture administered by a knowledgeable practitioner can heal a wide variety of maladies... so how does the institution of Western intelligentsia scientifically evaluate a methodology that has produced results for millennia? There are plenty of theories concerning the pathway by which acupuncture effects its positive health results; some say acupuncture prevents pain perception by saturating certain neurological "gates"; others propose that stimulating the efferent vagus nerve elicits a parasympathetic down-regulation of inflammatory players like tumor necrosis factor alpha and proinflammatory interleukins; while always looming in the background is a crowd of critics screaming that acupuncture is pure placebo.

The majority of acupuncture research has been refuted by the scientific community as "poorly designed" or "biased." To be fair, it is not easy to put together a double-blind placebo-controlled study involving sticking people with sharp objects, but serious skepticism must be applied to every publication on acupuncture due to its inherently subjective nature. Challenges to the objectivity of testing acupuncture include the source which determines needle placement (Confucius says poke here versus Laozi says poke there), the concept of diffuse noxious inhibitory control (DNIC) set off by needle pricks at irrelevant sites, the possibility of a dose-response relationship, and the inadequate blinding via sham procedures.

DNIC is the scientific way of explaining counter-irritation, like when your dad offered to punch your arm to make your headache feel better. In acupuncture, it is proposed that needle pricks release endogenous opioid neuropeptides and monoaminergic neurotransmitters that send a message to the lower brain stem that result in anti-inflammatory actions. In the 1980's, Fauve et al. showed that in mice, local inflammation could reduce distant inflammation better than glucocorticoids. Cool concept... but there has yet to be a methodology set forth that is acceptable to the scholarly world as accounting for DNIC's potential reliance on the placebo effect. If acupuncture works because of DNIC, does needle placement matter? If placement doesn't matter, then any sham needle use will elicit a response that cannot be separated from the response to needle use in traditionally prescribed area.

Kavoussi's article begins with a quote from physicist/philosopher Thomas Kuhn, "There are many fields--I shall call them proto-sciences--in which practice does generate testable conclusions but which nevertheless resemble philosophy and the arts rather than the established sciences... incessant criticism and continual striving for a fresh start are primary forces, and need to be." So where is our fresh start on acupuncture? Is it reasonable to discard the obsession with ruling out placebo in our medical research paradigm? At some point, I think there has to be a concession by the scientific community that it cannot fully elucidate the incredibly complex interplay of physical, mental, emotional, and spiritual wellbeing in human subjects. The patient seeking acupuncture therapy must believe that acupuncture has some kind of power, be it physical or otherwise, but is that "placebo" necessarily a demerit to the efficacy of acupuncture?

Kavoussi, Ben, and B. Evan Ross. "The Neuroimmune Basis of Anti-inflammatory Acupuncture." Integrative Cancer Therapies. September 2007, vol. 6, no. 3. pp. 251-257.

Interestingly, after writing this article alongside a Licensed Acupuncturist, Ben Kavoussi has written extensively as a critic of acupuncture... a list of his articles can be found here: http://www.sciencebasedmedicine.org/?author=1346