For critics of acupuncture, last week’s headlines provided ready ammunition.
News reports revealed that hundreds of NHS patients undergoing the treatment have suffered complications including fainting and dizziness.
A study said there were 325 reports of patients coming to harm after having acupuncture on the NHS in just two years.
These included 100 cases of needles being left inside the body, and five patients who suffered collapsed lungs after a needle accidentally penetrated their chests.
Proof, according to acupuncture’s critics, that its claims to be an effective form of pain relief are not just mumbo-jumbo, but dangerous mumbo-jumbo. But is that the whole story?
Many would argue that all treatments have side-effects — especially if mistakes are made — and that the number of problems reported was relatively small.
Now a major analysis, published yesterday, suggests the sceptics are also wrong about acupuncture’s benefits: it really does control pain.
Practitioners claim that by inserting fine needles at 400 specific points on the skin, they can affect the ‘meridians’ — channels of energy that run up and down the body, blocking pain. Critics claim any relief comes purely from the placebo effect.
The new report, the largest analysis of acupuncture ever conducted, involved nearly 18,000 patients and doctors from eight universities and hospitals in the UK, the U.S. and Germany.
They found that traditional acupuncture worked better than a placebo.
In fact, in conditions such as arthritis and chronic headache, acupuncture was twice as effective as the drugs and exercise recommended by most doctors, according to the analysis published in the authoritative Archives of Internal Medicine.
Acupuncture originated in China more than 2,000 years ago. It was brought to Europe in the 1500s by French missionaries.
The Lancet medical journal first ran an article about it in 1823.
Then it faded from the medical map until the Seventies following U.S. President Nixon’s historic visit to China and dramatic reports of operations with acupuncture as the only anaesthetic.
Experts have always disagreed about its benefits, though there are 15,000 doctors and physiotherapists working in the NHS trained to deliver it.
The National Institute for Clinical Excellence (NICE) recommends it for back pain and arthritis, but is considering whether to add headache.
Patients can have it on the NHS for other conditions if their doctor prescribes it.
When Sally Wright asked her GP to refer her for treatment, he laughed.
‘He told me it was a waste of time, but agreed to refer me if I wanted,’ says the 37-year-old office administrator from Essex.
‘I’ve had bad headaches and migraine since I was a teenager.
‘I tried all sorts of painkillers and my doctor prescribed calcium blockers, antidepressants, beta-blockers and migraine drugs called triptans. But nothing really helped.’
By the time she was 30, Sally was having three or four attacks a month.
‘I was afraid to drive because my vision suddenly went strange,’ she says.
In 2006 her consultant said he was going to put her on a much more powerful drug, with potentially strong side-effects, but Sally was keen to try other options, such as acupuncture.
‘I had two sessions a week for two weeks, then one a week and finally one a month,’ she says.
Within a couple of months, her attacks had virtually disappeared.
‘It was extraordinary. I haven’t stopped telling people about it.’
Sally has a few sessions on the NHS every couple of years to keep her headaches at bay.
But sceptic Professor David Colquhoun, a pharmacologist at Imperial College London, is a vehement opponent.
He has described talk of energy and meridians as ‘pure gobbledygook’ and campaigned for university acupuncture courses to be closed on the grounds that they should not ‘teach such nonsense’.
One common medical view is that if it does work, it is only because of the personality of the acupuncturist — the placebo effect.
‘That’s not medicine, that’s showbiz!’ said one GP recently.
Several major trials in the past few years seem to support this. These found that acupuncture is better than standard treatment — possibly because of the care and attention given by the practitioner — but there’s only a small difference between pseudo acupuncture (a placebo), which could involve pricking points at random on the body, and the traditional version.
So what makes this latest piece of research any more authoritative than the thousands of previous studies?
To begin with, its size. Researchers analysed the results from 29 high quality trials involving 17,922 patients.
All the patients had different sorts of chronic pain — arthritic, back and neck, headaches and shoulder pain — and were already being treated for it by their doctors; the acupuncture was an added treatment.
‘At the start, an average patient would reported a pain level of 60/100, that’s pretty bad,’ says lead author on the paper, Dr Andrew Vickers, an expert in biostatistics and research methods at Memorial Sloan-Kettering Cancer Center in New York.
‘It’s known that just being in a trial makes people feel better so, as expected, the average pain rating went down to 43.
‘Getting sham acupuncture lowered the rating further to 35. But patients who got traditional acupuncture with all the needles carefully inserted into the correct point on a meridian over several weeks rated their pain at 30.
‘That means they felt it was half as bad as it had been with standard treatment.’
You don’t have to be an expert in statistics to see that the difference between sham and traditional isn’t that big.
But partly because the number of patients is so large it’s unlikely to have happened by chance. Statisticians call such a result ‘significant’.
‘The difference between traditional and sham acupuncture in this study is greater than the difference between painkilling aspirin-like drugs and a sham pill or placebo,’ says Professor George Lewith, head of the complementary medicine research unit at the University of Southampton and another author on the paper.
All music to the ears of acupuncture supporters — but there was a twist.
Even though acupuncture came out with flying colours, researchers say it looks as if it doesn’t work in the way traditionalists think it does.
Inserting the needle at just the right point on a meridian or putting it in to precisely the right depth made a significant difference, but it was not massive.
So does this mean acupuncture is still mumbo-jumbo? Or could it be that simply putting a needle into the body, whether in a meridian or at random, helps beat pain?
Past studies have already shown that just giving an injection makes a difference to those in pain, regardless of what the jab contains.
But Vitaly Napadow, professor of radiology at Harvard Medical School, who has run a number of studies on the way the brain changes in response to acupuncture, is convinced that there’s more to it.
He has reported that sham and traditional acupuncture affect different areas of the brain.
The latter stimulates pathways that are involved with producing endorphins, natural painkillers.
‘Areas of the brain that process pain are stimulated by traditional acupuncture, not by sham,’ he says.
‘So, it does look as if something extra is going on, but exactly why and how is still unclear.’
And what of the risks?
‘The risk of puncturing the lung is well-known and anyone trained by us is trained to warn about it,’ says Dr Mike Cummings, medical director of the British Medical Acupuncture Society.
‘What the study didn’t tell us is how many people get acupuncture on the NHS. A German study found there were just two cases of a punctured lung out of 2.2?million treatments.
‘We aim to keep harm to an absolute minimum but it looks as if the benefits outweigh the risks.’
In the meantime, the latest report may help change attitudes towards use of the treatment.
‘This study certainly forms a good basis for expanding the use of acupuncture,’ says Professor Lewith.
‘It could become a routine part of physiotherapy and with funding, GPs could do it in their surgeries. It’s effective and the cost is well below the NICE threshold for approving treatments.’
‘These results are robust evidence that it’s not just a placebo,’ says statistican Dr Vickers.
‘I hope clinicians will feel more comfortable using it in the future and encourage more research to find out what is going on.’