Chinese Medicine Demystified (Part I): A Case of Mistaken Identity

Hi Jesse,

The placebo is indeed an interesting subject, and I’ll be writing an entire series of posts on it in the future.  It’s something I have a strong personal interest in and I’ve done a significant amount of research and writing about it in school.

Here’s the thing.  Researchers today estimate that placebo accounts for between 30-50% of the therapeutic effects of any treatment.

But not all treatments get the same placebo effect.  There are two requirements for the placebo effect to kick in.  The first is the belief that a treatment will work, and the second is a strong desire to get better.

In this country, we’re raised in the religion of western medicine.  We’re bombarded with advertisements that tell us to “see your doctor” when we get ill.  We’re one of only two countries that allows direct-to-consumer drug advertising.  Our belief in western medicine is deeply ingrained, whether we know it or not.

The same can’t be said for Chinese medicine.  Most people don’t understand it at all.  It’s not part of our cultural paradigm.  Many who go to get acupuncture not only don’t believe it will work, they are downright skeptical.  This means acupuncturists are not getting the same placebo effect for their treatments that western doctors get for theirs.

Sure, there are a few alternative types that really believe in the energy model explanation of acupuncture.  They’ll get the placebo effect.  But the rest of the skeptical majority are missing a key element (the belief that the treatment will work), so the placebo won’t be as big a part of their therapeutic response.

The fact that acupuncture is as effective as it is without getting that extra 30-50% boost from placebo is remarkable.  Contrast that with certain classes of drugs like antidepressants, which have recently been shown to be no more effective than placebo.   These drugs are almost universally believed in by patients and doctors alike.  And yet they don’t work any better than sugar pills.

There’s a lot more to say on this subject, but I’ll save it for the future series.  I’ll end by suggesting the possibility that the placebo effect is not something to be derided and avoided.  It’s something to be respected and cultivated.

If you could choose between a completely non-invasive treatment with no side effects that works by supporting your body’s own sophisticated, innate healing ability, or between taking a dangerous drug for the rest of your life with severe side effects and complications, what would you choose?

A physician who can support the body’s natural healing ability, which is one way of describing the placebo effect, is a far superior physician in my book to the one who relies on comparatively crude methods like drugs and surgery. I’m not arguing that the effect of acupuncture is all placebo. Quite the contrary, as you’ll see in the next few articles in this series. I am saying that we should be learning how to get more of the placebo effect, not less.

I appreciate your point of view, John, but I think the two are somewhat different. For any idea, philosophy or practice to survive it must offer some benefit. Religion offered benefits to those who practiced it, so it survived. Chinese medicine would have never survived if it didn’t offer any benefit. Now, we can argue about whether that benefit was due to placebo, or whether it was due to clear physiological mechanisms not dependent upon belief in the treatment. This is another question I’ll address in future posts.

The Chinese were performing detailed dissections as far back as the 6th Century BC. Similar procedures weren’t performed in the West by Greek physicians until the 3rd Century BC. Historical evidence suggests that the practice of bloodletting preceded acupuncture in China. As I’ve argued in this series of posts (this is only the first – read the next two if you haven’t already), the concept of a “meridian” that had no basis in human physiology was created by a French bank clerk in the early 1900s, not by the Chinese. If the Chinese were bloodletting, and they had performed dissections, they clearly understood that what they were bleeding were blood vessels – not meridians.

The Chinese were obviously not conducting randomized clinical trials on the effectiveness of their medicine 2,000 years ago. They had a practical system. Doctors in China only got paid if the patient got better. You might argue that the improvement could have been placebo, and that is possible. We’ll discuss placebo more in a future post. But once you understand the mechanisms of acupuncture as described by recent research, you won’t have any trouble understanding how it cured common health conditions. Acupuncture relieves pain, reduces inflammation and restores homeostasis. This is well understood in the scientific literature. Pain, inflammation and disturbance of homeostasis are characteristics of nearly every common condition. If acupuncture can address those features, which research indicates it can, then it can treat those conditions.

I’ll be writing more about placebo in future posts.  My response to those accusations is to point out that placebo is better understood as “self-healing”.  I ask them this question: if you had to choose between a treatment that stimulated your body’s innate healing mechanisms to address the root cause of your problem, and did this with little cost and no side effects, or a treatment that merely suppresses the symptoms and has significant costs, side effects and risks (i.e. drugs and surgery), which would you choose?

The answer is obvious.  I believe that in the future we’ll come to respect – instead of scorn – the power of placebo and those who are able to successfully invoke it.

I’m not saying that the effects of acupuncture are limited to placebo.  In fact there is strong evidence that acupuncture consistently outperforms placebo, with an average of a 70% response rate in trials.  I’m just saying that placebo is nothing to scoff at – it’s quite simply the power of the body to heal itself.

Jesse,

I’m aware of that study, and others like it.  Here’s what I think (and I’m not alone – several very well-respected luminaries of Chinese medicine in China have said the same thing): acupuncture by nature is mostly non-specific and doesn’t target any particular pathology, but instead restores homeostasis by stimulating the body’s innate healing mechanisms.  From this perspective it makes sense that inserting a needle just about anywhere would create a treatment response.

Acupuncture is a far more elegant approach than using drugs or surgery to suppress symptoms, which is what western medicine does.  The immune system is the most complex and sophisticated ecology we’re aware of.  We have the ability to spontaneously heal injuries, fight infection and regenerate tissue without any conscious awareness or participation on our part.  Drugs and surgery are like children’s toys when compared to the regulatory mechanisms of the immune system.  And although we’ve made great strides in understanding how it works, we have only barely scratched the surface.

So I don’t see the nonspecificity of acupuncture as a problem.  I see it as an advantage.  Acupuncture stimulates the body’s self-healing ability. When you go in to get an acupuncture treatment for elbow pain, not only will your elbow pain go away, you’re digestive problem will improve, you’ll start sleeping better, and your chronic sinus issue will clear up.  Nothing in western medicine can do this.  Drugs can’t do this.  Surgery can’t do this.  And acupuncture does it at a minimal cost, with virtually no side effects and risks.

Gordie,

I agree with your points about placebo and how it can confound research. However, as I mentioned above acupuncture has consistently outperformed placebo in clinical trials.

The question that is harder to answer is whether point selection has any bearing on the outcome of a treatment.  The research suggests not, but my personal experience and that of many other practitioners and patients suggests otherwise.  I wouldn’t make an argument here because my observations are just anecdote, but mention it for whatever it’s worth.

One would think.  But as any acupuncturist can tell you, giving yourself a treatment doesn’t seem to have quite the same effect.  I’m not sure how to explain this, but it’s true in my experience as well.

And, as I mentioned, although studies don’t show that points selection matters many acupuncturists would disagree.  (Of course they would, you say.)  Many patients disagree as well.  It’s not uncommon for a patient to see one acupuncturist, not get a good result, and then see another and have their problem cured.  Now we can’t say that point selection made the difference, but we can’t rule it out either.

Finally, many acupuncturists are also trained in Chinese herbalism, nutritional medicine, and other therapeutic and preventative modalities.  Acupuncture is just one aspect of Chinese medicine.  Kind of like the “physical therapy” of western medicine, only far more powerful.  But don’t ignore the other parts of Chinese medicine.  In some cases they can be even more helpful.