What a sham? Making up our minds about acupuncture. Issues on research with alternative medicine; what can we learn from acupuncture in neuroscience?

Some say that hitting thirty makes people start to change their lifestyles. Many take up vegan diets, hangovers become unbearable, gained weight sticks around and newborn parents throw themselves into health topics such as how to deal with a cold during pregnancy. If you haven’t yet crossed that line, you will and you too will be faced with the art of aging. Luckily though, modern life allows us a luxurious gamut of cross-cultural health frills for a mix-and-match approach to this problem. However far out there Kambo of the Amazonian frog, Color Therapy or Reiki Masters can sound, there certainly is a market for endless therapies and approaches. Health at times is about finding what works for each person. But how can we know if it will works for us? Maybe this is what is meant by Even though I don’t believe in witches, I do know they fly

By the pricking of my thumb: How acupuncture is used

Many non-western therapeutic approaches have found their way into the annals of science while others are often used clearly due to their power as placebo, or anything which appears to be a real treatment. Acupuncture seems to sit on both sides of the fence. For some uses it has been thoroughly studied and prescribed, while for others it has been recommended only because it might help and has minimal side effects.

Common uses for acupuncture are allergies, fertility, depression, sleep, weight-loss, addictions, asthma and pain management. In America, some states allow insurance to cover the cost for a wide variety of purposes. In others, as is the case in Germany, mostly mechanical issues, like back pain, are covered. We often hear about it from general practitioners; Berlin alone has at least 661 medical doctors who offer it as part of their specialty, aside from the many Heilpraktiker (health practitioners). Austria for example, only allows medical doctor’s to treat with acupuncture. To make things more confusing, often the state promotes its use at the level of human service agencies while also regulating coverage on the other. In the end regulation and implementation of this two thousand year old practice in healthcare can be almost as disconcerting as the names for diagnoses it produces, take for example Phlegm Misting the Heart.

Making sense of what is there, how does neuroscience support acupuncture?

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Source by Eliricon from Noun Project CC BY 3.0 US

 

We should not be surprised that neuroscience too has not answered all of our questions on acupuncture. After all, whether in healthcare or research, we are tailoring acupuncture to western standards and we ought to keep in mind a first impression on it from philosopher Focault. If Traditional Chinese Medicine (TCM) gives its best results when following its own logic, how do we extend this into science? For this author Kaptchuck believes needling without necessarily following the philosophy behind it, is what runs us into some problems. Some ideas around this are easier to grasp, for example how one symptom can be approached in multiple ways. Conversely, needling several locations gives would result in a great number of interactions and responses or patterns of brain activity, that are the specific signature of each individual for a given occurrence. This is not new however, we understand that there are differences between people and how they react, the question is can we stop following the mold for pharmaceutical trials, maybe finding how a majority responds is much more fleeting. The idea behind the practice is that treatment helps patients approach energetic equilibrium, since disease arises from these disharmonies. On the other hand there must be a way to study it, random cannot forever be the case, especially because classifying symptoms and finding what the patterns are, comprises the bulk of the practitioner’s work. Studies usually focus on isolatable outcomes from psychology or other allopatric medicine constructs while seldom selecting participants according to TCM definitions. For this we would at least need participants to have the same complaint, be characterized by the same governing pattern, symptom and practitioner. This of course would complicate studies by requiring larger sample sizes, which is impractical considering that most studies are not that extensive.

Another source of mystery is in regards to the effects of acupuncture on the nervous system, we seem to be a long way from extracting the true effect or way it operates; most conclusions use statements such as maybe, seems to be, appears, may be of value or findings are cautious. However, since 1997 the National Institute of Health has concluded that acupuncture is helpful for at least some scenarios and continues to hold ground at least in relation to pain. The first imaging study on acupuncture soon followed in 1998, but was later retracted by authors in 2006. However specificity for point location has been otherwise observed, and this back-and-forth can remind us of the prevalence of both bias and chance in studies. What we have to date are descriptive results which taken altogether weigh on the side of verum treatment compared to the placebo.

 

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Phantom needle experiment setup (Leem, 2016) CC 4.0 International License

 

Randomized Control Trials (RCT) became the standard in the 60’s and to this day give way to how we incorporate science into therapeutic practices. According to again author Kaptchuck , “this may suggest that the methodology of the RCT can most easily detect efficacy when acupuncture intervention is well defined and discrete, which might create a simple ‘drug-like’ replicable model.” Furthermore this may be the case for some common treatments or in depression studies where we see positive differences in brain region activation for same treatments during imaging studies. RCT studies should provide answers more easily, unfortunately that is not the case. When it comes placebo effects, even simpler experiments could be better suited, but overall we seem to tread water. Often sham acupuncture is used (inserting partially as well as fully outside therapeutically effective energetic channels or meridians), while others use placebo acupuncture (non-penetrating device or laser) and at least one study attempted a phantom method.  A literature review from 2015 summarizes positive differences in brain activity for acupuncture points in 29 out of 33 trials. This at least should raise our curiosity and want us to find out if there is more to it than the effect of an painful needle. Nonetheless we should keep in mind that placebo works not just by absence of treatment or pill, but because of rituals, suggestions, cues in the environment or anything else that could lead the participant to expect recovery.

Yang: the sunny side of a slope

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Maverick Rock (left) by EloyBr 

Most scientific work on this topic is published on western journals, which makes one wonder about other sources of information. In Taoist philosophy Yang is referred to as the sunny side of the slope, a term of action and contraction whereas Ying refers expansion and passivity. Scouring the Internet for new publications makes evident there continues to be plenty of support for China’s Central Committee resolve back in 1958, to include acupuncture for medical treatment. Many articles do not figure into the main journals in part because better science is lacking or the research is biased. So where do we draw the line, and does it work? To that we can say some studies, including the most comprehensive clinical trial done in Germany, show that it does, at least in some respects. The question really is what can it do for us, how much do we believe in it and how can we use to enhance other treatments and not as a sole source.

As for the cognitive and behavioral sciences, we can expect more imaging and physiological studies many specific to psychological conditions. In time too, we might uncover neural representations for TCM dialectics whether they be meridians, Zang-Fu organs or five element diagnoses, to address specific emotional and psychological states independent of major illness. It is at this level that we can also expect brain functionality to be highlighted. The two philosophical terms Ying and Yang are more than opposites, they define each other, so too can science and acupuncture continue to spark interest and curiosity to say the least.

 

 

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