Research in Acupuncture: An Oxymoron?

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Research in Acupuncture: An Oxymoron?
March, 2003
By James Kimber Rotchford
Acupuncture Today

My answer to the above question is no. However, it is of didactic value to argue that research in acupuncture is, at present, of questionable value. Other sources devoted to improving methodologies of clinical acupuncture research are widely available,1-3 so this paper will not review specific methodological issues pertinent to improving research in acupuncture.

Instead, this brief discussion will simply question the role of some conventional research methodologies in evaluating acupuncture.

The goal of clinical research in acupuncture should be the promotion of improved health outcomes in people seeking medical care. This goal is met through the provision of sound epidemiological evidence to guide our clinical decisions.

Initial problems in meeting this goal arise in the definition of terms. What constitutes improved health? What constitutes acupuncture? The World Health Organization's (WHO) definition of health reflects the subjectivity and contextual aspect of health definitions:

"Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity."4

I recently co-authored a paper describing the difficulties in precisely defining acupuncture.5 It is impossible in this present space to give justice to the difficulty in defining our terms. If we can't precisely define our terms, however, how valuable is the research that studies them?

Before providing further theoretical reasons why clinical research in acupuncture is problematic, let me ask the following question: What evidence supports the hypothesis that current clinical research in acupuncture is of limited value? The most glaring evidence, I believe, is the discrepancy in acupuncture's long-term acceptance all over the world, including the United States, and the lack of evidence demonstrating its clinical utility. The 1997 consensus conference that reviewed most of the world literature on acupuncture on the standards of evidence-based medicine found only a handful of conditions for which it was proven effective.6 As of 2002, one could argue that, despite further funding of acupuncture research, the list of evidence-based interventions with acupuncture has changed little. Note as well that in the 20 years or so of my clinical practice in acupuncture, I have only rarely treated patients with postoperative or chemotherapy-induced nausea and vomiting or post-dental extraction pain. Nonetheless, these are the only conditions for which acupuncture has "proven" efficacy.

Likewise, I have used acupuncture to help many patients stop smoking, while acupuncture for smoking cessation has been demonstrated in the research literature to be ineffective.7 This is the experience of countless clinicians providing acupuncture care to patients who have failed to respond to other interventions. Standard explanations for this discrepancy include the pragmatic fallacy that is committed when one argues that something is true because it works. For example, astrology works; numerology works; therapeutic touch works. What "works" means here is not clear. At the least, it means that one perceives some practical benefit in believing that it is true, despite the fact that the utility of a belief is independent of its truth-value. At this level, "works" seems to mean "I'm satisfied with it," which in turn might mean, "I feel better" or "It explains things for me." At most, "works" means "has beneficial effects" even though the evidence may be very weak for establishing causality.

I recognize two problems with the pragmatic fallacy explaining the above discrepancy. The first is that the pragmatic fallacy theory denies the relevancy and importance of the WHO's definition of health, which recognizes the importance of a sense of well-being. Second, in the case of stopping smoking with the help of acupuncture, the self-reported reduction or cessation of smoking is significant (greater than 60 percent in my experience, and with a number of colleagues). I think smoking less is a clear benefit for my patients.

As to the criticism of a lack of evidence for causality, perhaps acupuncture doesn't lend itself to research methodologies that evaluate causality. Traditional acupuncture theories emphasize contextual issues and individualized treatment. This aspect of acupuncture care is not consistent with simple cause-and-effect interventions that can be extrapolated to large populations. Of note, most interventions associated with addiction emphasize the importance of a contextual, individualized intervention. This may help explain why smoking cessation interventions with acupuncture have failed to show any objective benefit.

All Rights Reserved, Acupuncture Today, 2007.

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