Comments on "acupuncture is not a placebo"

thanks so much for send me your article, now I´m going to read it and learn of it. In my opinion, we must continuous research and improve quality our paper and researches, in the way of western world and integrative MTC way.

Now, I´m working in the University of Murcia in a project about low back pain and acupuncture, effects and results. If you want, we can keep contact and send you ideas and results about it.

Dr. Wang 您好. 昨天收到您的短訊,對您努力為爭取中医針刺功能的學術性給您一點資料. 我個人認為中医針刺穴位的發現是很有價值.十數年前在台湾教學時曾做過一些有趣實驗. 例如给麻醉猫点刺类似人中穴部位,見猫的血庄升高,這意味針刺人中穴位有神經生理反應. 又有一次採用麻醉過量的＂死亡''大白鼠(已無心跳),再在它身上刺激到一個穴位令其張開眼睛看着我.我當時非常高興,但沒有人相信我.本人十多年前在温哥華一中医学院讀中医時,有一次本人用艾炙给自己治療感冒流鼻涕反而使已有多年的气喘疾患消失,已有十年未有復發. 加上在治療病患肩部疼痛的良好反應,我是相信針刺是有其治療作用. KK W0NG.

I do agree with you about the frequency and intensity discrepancy between eastern and western acupuncture approaches.

To share with you my earlier RCT published in:

Pain. 2002 Oct;99(3):509-14. The effect of high and low frequency electroacupuncture in pain after lower abdominal surgery.

Lin JG¹, Lo MW, Wen YR, Hsieh CL, Tsai SK, Sun WZ.

In my study, all groups of patients received needle insertion with or without EA 20 min before anesthesia. Your suggestion in conducting EA under general anesthesia is also proven by our animal studies, published in 2007 & 2011

Eur J Pain. 2011 Jul;15(6):600-7. doi: 10.1016/j.ejpain.2010.11.002. Epub 2010 Dec 4.Electroacupuncture analgesia, stress responses, and variations in sensitivity in rats anesthetized with different sub-MAC anesthetics.

Kung HH¹, Hsu SF, Hung YC, Chen KB, Chen JY, Wen YR, Sun WZ.

Eur J Pain. 2007 Oct;11(7):733-42. Epub 2007 Jan 10.A minimal stress model for the assessment of electroacupuncture analgesia in rats under halothane.

Wen YR¹, Yeh GC, Shyu BC, Ling QD, Wang KC, Chen TL, Sun WZ.

You may find them helpful for your future study in human subjects.
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Thank you for your message and I think this should open up nice discourse. Being trained in Ayurvedic medicine myself, I do see how it is important to communicate clearly. I would be interested in speaking more with you if you have time.

The research for dermatology shows that acupuncture is positive and should be continued to be studied in more detail.

You should submit your points to a peer-reviewed journal to get your perspective out there. Would be happy to speak with you further.

A: Thanks for your positive comments. Yes, acupuncture works well for skin problems too. I have client even 2 hours ago with chronic eczema. I have acupuncture every day for three days (with herbs) and he felt much better (no night itch now, of course we need to be conservative for the movement).

I would be happy to talk with you whenever you need my help.

Thank you for your email. I have read your article. It's great. We need more voices to support us. Thank you for doing so.

I appreciate your work. I teach naturalistic research methods to students at the New England School of Acupuncture, as well as participating in work on what the placebo effect actually is as part of the Program in Placebo Studies at Harvard Medical School. I agree with your statements and my own work has been to support that. For example, the paper attached.

The question whether acupuncture is a placebo effect or not has been solved several years ago.
A: Thanks for your comments. Actually, the idea that acupuncture is a placebo effect is still overwhelming in the internet (please check the key words: acupuncture and placebo). I know that there is some paper that argue against this comments, but it seems that these articles cannot answer why the negative results can come out again and again. They still contribute the negative results as placebo, not due to the failure of the treatment per se. Both sides seem insist themselves. Yesterday, one comment said that a man with name of Ted, who supposes to be in the acupuncture area too, insists, even yesterday, does not believe what we explained. So, I do not feel that this is a solved augment among professionals. It is still a frustrated question to us acupuncturists in China. Today, one doctor in China told me that they are going to start a study to test the placebo effect again!

My text message has been send to almost all acupuncturists in Canada. Many response said that they do get question from their clients whether acupuncture is a placebo effect. The clients usually said they knew this from internet.

Apparently the influence of the idea that acupuncture is placebo is still there and it affects our daily acupuncture practice. I had a client. I solved his gout. He wanted to introduce his friend (colleague) to come to try acupuncture, but that friend said he will not, because the cure of the pain, even if it is completely subsided, is still a placebo effect. The friend does not want to spend money on something "cheating".

I am glad to get your referred article and see if I can include it into my paper and introduce it to more people, so to stop the wrong comment to acupuncture and let more acupuncturists feel that what they are doing is not a placebo.

Thanks for your comments.

Dr. Martin
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11. Comments:

Don't need to care about what these people thought. Acupuncture is still used more and more in US and Canada. If the government and insurance companies know that acupuncture actually saved their money, they should have no reason to stop acupuncture.

Even if acupuncture works to save money for government and insurance company, it would be interpret as a placebo effect. Save money does not mean it is not a placebo effect. There is a sham surgical operation (on the knee) study that showed that patients in a sham group felt pain-less for 2 years!

Then it would be big question: should we use placebo to treatment patients? If patients know that they get a placebo treatment from acupuncturist, do they still want to pay money to acupuncturists? If placebo can be used for real clinic, why people need to have 3-4 years in acupuncture school just to learn a "cheating" therapy? Why we should use needle to play the "cheating"?

If we do not solve the question where acupuncture is a placebo effect, any healing effect from acupuncture treatment would be regarded as placebo effect. Please remember: placebo almost means "cheat". Does Chinese introduce to the world a "cheating" therapy?

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12. Comments:

Agree with dr. ma and dr. wang completely. we should not waste time and energy on the old argument. it is better to move forward.

I think If we can design research project to make a comparison of effect (long-term and short-term) acupuncture and physiotherapy after injury to prove it save money for government and insurance, it will be on a good path to let TCM be primary care for ICBC and WCB in long run.

It is nice to meet you online, several months ago I read an article, should be from your website, it is a really good article.

I suggested you, or with me, rewrite this article into several papers and publish them. Let more people read them. Currently your paper does not have enough exposure.

I have already sent the same message to all of the acupuncturists in Canada, many in US;

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"What is the correct acupuncture"? What kind of "correct" acupuncture are you going to introduce to acupuncture researches in the western world?

Answer:

There are different styles of acupuncture. The requirement to get the best acupuncture healing effect could be different among these styles.
I am not going to recommend a "correct" acupuncture. Rather, I would like to recommend the researchers to follow the exact need by each style of acupuncture, so as to be able to repeat it's claimed healing effect.
The acupuncture researchers in the western countries mostly study the text-book style of body acupuncture system. I have paid attention that in most articles, it was indicated that the acupuncture conductors had tried to get the Deqi sensation. They also kept the needle in the spots for more than 20 to 30 min after the Deqi sensation. So, it is hard to find anything wrong in there hands for each acupuncture session. However, what we noticed is that they had acupuncture only once or twice a week for about totally 10 to 12 times in most studies. This is quite different from the way in China: once a day for 5-6 days in a week, for more than 12 (mostly 20-30 times) of treatment. According to our own clinic experience, the acupuncture should be conducted in a close schedule. Other wise it does not work as expected. So much data and clinic experience suggest that a sufficient amount of acupuncture stimulation is very important to get a high healing effect. Limited data from the western world, including those studies from physiotherapy studies using TENS or laser, has also suggest that high treatment frequency is related to higher healing effect in the treatment group and less healing effect in a sham group. Therefore, what I want to remind the researchers is to adapt the Chinese way of acupuncture with high treatment frequency, not by what they called western acupuncture. So far the acupuncture studies from the western world remind all of us that, low treatment frequency may yield a positive data, but it is also easy to produce a negative data. To have acupuncture once every other day seems to be a minimum requirement to produce a positive data to distinguish from a sham group, but it is still not the test way to produce a consistent positive data. The best way is still to have acupuncture once a day, though I know this is hard for US life style.

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15. Comments:

Yes, I agree with you, but it might be hard to convince those who insists that acupuncture is a placebo effect.

My aim to alert researchers in the western world, to use proper schedule for acupuncture treatment (high frequency, more total session numbers, with/without electro-acupuncture to standardize the stimulation dose for each session), so as to be able to increase the healing effect from the acupuncture group, but (maybe) also reduce that in a sham group. Such studies are not many in the western countries yet.

To tell if acupuncture is a placebo effect or not is not too difficult: to test the body parameters during an anesthesia (acupuncture starts after anesthesia). In such condition, patient has no consciousness, how can we suspect any placebo effect?

I feel that my paper is valuable for researcher to apply research founding to repeat acupuncture studies with the new suggested way. After a while and after we have accumulated more positive data, those of people who suspect acupuncture might be convinced. At least, their negative voice would not be so strong and not to retard the development of acupuncture in the western countries. For this reason, we do not need to be hurry to convince any people to change mind now, but we need to encourage them to repeat acupuncture again in different way (the same way as acupuncturists in China).

Yes, I also got several comments that they did acupuncture study with the low frequency is because it is hard for the participate to come every day. However, this should not be the excuse to use low frequency acupuncture. Otherwise, we should bear in mind that the way of acupuncture the study is not exactly what the way by which the acupuncturist in China do, and we should comment in the paper that "the data should be interpret with big care it might not represent the acupuncture in reality".

I believe that we need to educate our patients for what is the correct way for acupuncture treatment. Such as in special cases, patients even need to stay in hospital for the treatment, and patients need to take medicine three times a day - all depend how we tell patients what the proper way for healing. If you always tell them to come for acupuncture once a week, they will take it granted that it is the proper way for acupuncture. But, it is not.

All means that we need to educate our patients. If we do not convince them, we cannot expect good results.

In our clinic, we ask clients once a day for three days. For most conditions, it can reduce symptom down to near 50%. If so, we let them come once every other day for 2-3 times. If the symptom goes further down to 20% to 30%, we ask them come twice a week. This way is not hard for clients to follow. Of course we need to use more than acupuncture for the treatment. We combine acupuncture with cupping, moxi, Tuina massage, and Chinese herbal therapy.

For acupuncture research, if the participants can not follow such treatment schedule, it is better not to launch the study. You can try to do it in China by cooperating with acupuncturists in China . They have a lot of possible participants who have no problem to attend acupuncture once a day for 10 to 20 days.

If we want to test the effect of some thing, we need to test it as IT IS. For example, if we want to tell if the Chinese curry-beef dish is delicious, we cannot cook it without adding curry in it (because it is out of your stock), serve people with such no-curry dish, and ask people if the curry-beef delicious.

Did you consider publishing in NAJOM (Canada base) or Journal of Chinese Medicine from UK? I read them both as well as I am a member and I recommend them to my colleagues. The next NAJOM one will be all about integration Western and Eastern medicine.

Originally I did not consider to publish it in any journal. I want to keep it in internet, so that I can update new data again and again. I feel that there should be some positive webpage there to defense acupuncture (in Google, if people click the key words of "acupuncture and placebo"). Right now, there are much more negative webpage there and very little positive page. Also, this article is too long (too many reference, more than 1500, and too much attachment more than 20, and each attachment is very long). I wonder if there is any journal wants to publish such a summary-like article. I may consider the publication if the editors can find a proper way to deal with such long article. Thanks so much for your offer.

Because it is not for publication at this movement, I will send the same text message to ALL journals in the western world and in China. I wish to remind those who deal with acupuncture that, it is not difficult to prove that acupuncture is not a placebo effect. It can work in many cases, but it should be done in proper way - as everything should be done in proper way. I would be happy if acupuncture researchers in the western countries can continue the research and pay attention to the treatment schedule to increase success rate. Acupuncture research needs to go ahead, not just go around with positive result and negative result again and again. It appears that the editor in the journal PAIN has lost patience to publish research paper on acupuncture.

In china, many acupuncturists have realized that the placebo effect of acupuncture should be considered. The effect of acupuncture should include placebo effect and specific effect of acupoints and stimulations. For different conditions,

the placebo effect of acupuncture is different. We are trying to design appropriate clinical studies to confirm the above conclusions.

Thank you for your work in preparing this case to refute the placebo hypothesis. One of the biggest problems we have in acupuncture research is the frequent lack of difference or small differences between real and sham acupuncture arms in studies. There is ample evidence I think that this is partly due to sham acupuncture being active, not inert, but also partly due to real acupuncture protocols being suboptimal. Personally I would identify the main shortcomings in real acupuncture (especially in the West) being inadequate frequency and duration of treatment, poor point selection and lack of training/experience/skill of practitioners. Typically this is mainly due to the history of research funding in the West where medical practitioners with little or no acupuncture knowledge and skill could easily obtain public funding for research but well-trained traditional acupuncturists could not. In Australia, at least, this has changed a lot now that acupuncturists are registered by the same body which regulates medical practitioners and other health professionals, and the National Health and Medical Research Council (NHMRC, our peak government body for medical research funding) is more willing to fund acupuncture research by registered acupuncturists. My PhD study on acupuncture for allergic rhinitis was funded by the NHMRC.

At the Society for Acupuncture Research conference at Harvard Medical School in Boston last October, I spoke to members of the SAR board and suggested to them that they write a detailed paper explaining the problems with placebo acupuncture since it is such a major issue for us. They did not seem to be very interested. So I was very glad to see your paper and to see that someone is raising this very important issue.

There are three very obvious differences generally between acupuncture research in China and the West. The first two have already been mentioned, namely that Western medical practitioners with little acupuncture knowledge and skill often design and conduct acupuncture research very poorly, especially regarding inadequate point selection and frequency and duration of treatment. The third issue is that while some Chinese researchers have raised their publication standards to a level where they can be accepted in high impact medical journals in the West, most Chinese researchers still lack the ability to construct and report studies to meet Western medical journal publication standards. This is a great pity because it means that many excellent studies will never be read outside of China.

Thank you again for putting so much effort into this article. It is a very important issue for all acupuncturists. I look forward to reading your work in detail when I have less time pressure in a couple of weeks time.

Many thanks for your email well received today. I Have a great interest in this very important subject. I will read your paper and get back to you.

Thank you for sending me your article. I'm a clinical Chinese medicine practitioner as well as having a background in acupuncture and Chinese herbal medicine research. I think your ideas are sound. There are more issues to consider when critiquing acupuncture studies, which I'm sure you are aware of, however your point about frequency of treatment is an important one.

Thank you so much for your efforts. I got this mail yesterday from my colleague. That's very impressive that your article integrates so many important studies and information.
I will use as a defense when I meet challenges like that.

I appreciate your hard work! I looked it up briefly, and I highly agreed your perspective on this article. I will do my best to spread the article.

Thank you sharing this mater with me, but as you know and I have 35 years medical practitioner experience , there is no %100 cure from any kind of medical related treatments, and they work for some one and may not for others..

I am a registered acupuncturist for more then 15 years and i had very successful result from lots people then somebody ells. Massage therapy help for relaxing the massage only (even it is not treatment) but most of insurance company cover them even %100, or physiotherapy the same (even it dose not work temporary as well as massage), their association send them for couple of " WEEKENDS" (20 - 30 hours) training and they call them self "certified acupuncturist", using needle and give them receipt as" physiology treatment (fake) to Insurance companies..... for sure we do much better because of 3,600 hours study !!!.

I do not believe acupuncture is Placebo, it work much better than some other treatments and has less side effect that them with around 5,000 years experience.

Thanks for your positive comments. I agree with you.
Thanks for your time to tell me your story.

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I will read and past it to my friends that does acupuncture. Problem with western research on acupuncture is I feel from my own experience is that they are poorly design on assessing acupuncture and on giving it a fair chance.

For eg. When they compare acupuncture to western care, they will do too little frequency eg. 10 sessions once a week to see if it helps cancer patients whereas if they see an Oncologist or herbalist or Naturopath. They would treat them eg. IV Vit C or Hyperthermia 3x/wk for 3 to 6 mth. Or chemo for 6 mths to 3 yrs.

Thanks for your positive comment and I agree that, one of the major weakness for acupuncture studies in the western countries is too low frequency of the acupuncture treatment. The acupuncture does not work well, so no matter how they tested the effect of acupuncture effect, they tend to get negative results.

I appreciate your time very much. We need as much people as possible to know this weakness.

Dr. Martin

谢谢你的电子邮件。我同意你的观点。我已经看了你们的网页。你们的网页很专业。

Our association ATCMA already did lots job on it . If you want to know more , contact our office .

I will support any further action to improve our industry! Thanks lots for your concern and contact .

Thanks to let me read your articles. I agree with you that the low frequency of acupuncture treatment and possible low quality of the acupuncturists in the study might be the major reasons for those of negative papers towards acupuncture. Both topics have been fully discussed in my paper.

I feel that we may need to let more people to be aware of the weakness in the current acupuncture researches.

To our acupuncturists (Canada, US, Australia, and whole Europe): we do not need to feel frustrated if our clients asking if acupuncture is placebo effect: the studies so far bears many weaknesses. The negative conclusion is too early. Acupuncture is shown by Chinese to the world, we should follow the Chinese way of acupuncture to test if it works or not, instead of using modified or imaged "western way".

To the western journal editors: the editors should pay attention if the acupuncture study is performed in a proper way: high frequent acupuncture treatment. They also need to organize a meeting to discuss which result we should trust more, the one from high placebo susceptibility participants (e.g. the healing effect in sham group is high, such as 30%), or from low placebo susceptibility participants (e.g. the healing effect in sham group is low, such as 23%), if both studies are well designed, organized and well performed as well? Also, they need to clear if the specific healing effect of acupuncture can be simply calculated by subtracting the effect of a sham group from an acupuncture group. That means, if the following is correct: Acupuncture specific effect = effect of acupuncture group – effect of sham group.

This is critical to evaluate the effect of acupuncture. Our participants might be highly placebo sensitive, or not sensitive. The susceptibility will definitely influence how we will interpret the study results. I feel that, with high frequency acupuncture treatment, the effect of sham group could be less, while that of acupuncture group will go up, so to enlarge the difference between the sham and the acupuncture group. However, this is critical to western drug or operation studies involving sham group: we can not increase the dose of the drug or to repeat the times of the surgical operation to enlarge the treatment group with the sham group.

To acupuncture researchers in the western countries (I will send the text message to all of authors involving in acupuncture research from 2015-2016, from Medline, and ResearchGate), remind them to take high frequency treatment schedule (following Chinese style). To standardize the stimulation dose in each session, better to use electrical acupuncture first, then try to find a high quality acupuncturist to repeat the study. To answer if acupuncture is placebo effect or not, better to do acupuncture when patients are under anesthesia. This is a very simple and easier way and quickest way to finish a study, while the study would be so important for the current acupuncture research.

To Chinese journal editor: they do not need to worry to push Chinese acupuncture researchers to have a sham group. Keep doing whatever they are doing. Finally, western researchers will prove that the acupuncture is not a placebo effect. What they are doing if valuable to acupuncture society even if they did not have a sham group for many years.

To acupuncture researchers in China (I will send the email to all of the authors who published study on acupuncture from 2015-2016 in Chinese medical journals): they do not need to be frustrated by hardly explaining the placebo effect from acupuncture studies done in western world. High frequency acupuncture treatment by high quality acupuncturist will solve this problem. The placebo effect would be a big problem for western medicine study and surgical operation studies, but not for acupuncture studies. Be ready to cooperate with western researchers so or later, for acupuncture and also for herbal therapy too.

My idea is: once we get sufficient data, by research data, showing that acupuncture works independent on placebo effect, and that it is simple, safe and cheaper (for a long run, not only comparing the first year costs), together the efficiency of Chinese herbal therapy, then we can ask a reform of medical system: once western medicine cannot solve the disease by surgical operation, or once the disease has been in a chronic condition (chronic means that it cannot be solved by western medicine), or once the western medicine can only give patients pain killer, sleeping pill, or sedative… no radical treatment… they should refer the patients to acupuncture (TCM doctor).

Acupuncture is only a branch of Chinese medicine. In many cases, we use herbal therapy. The combination of the acupuncture and herbal therapy will allow us feel much more confidence to take over the above patients for the treatment (Of course, the healing effect of the herbal therapy also largely depends on which style of herbal therapy too. We need to go step by step.)

I am not a researcher now. I am an acupuncturist in my clinic. I wrote the article because I feel that there is not many people like me to do this job: a person knows western medicine research, western medicine clinic experience and acupuncture experience, knowing both English and Chinese. If no one makes a contribution as such, it would be too late after the government and insurance company take over the opinion that acupuncture is a placebo effect. I feel that, if people in the western countries do not care, or try to escape from, the data in China, they would be confused by the acupuncture studies in the western countries. Once we keep a peaceful mind to compare the two sides, it is so easy to find the difference in methodology by the two sides. It is as easy to break a window paper. What I did is to tear the window paper and let the light come into the room.

Hello Dr. Wang, Thank you for sharing! I will posts online. Are you on the FB group "Acupuncturists Online"? There are about 10,000 members in that group.

I have heard about this issue, there have always been skeptics. However, the focus of other practitioners using cupping and dry needling have overshadowed this topic. It seems that there are so many studies giving evidence that acupuncture works. Can you tell me more about why you think we should be concerned at this point? My concern would be that we are phased out and other practitioners take over our modalities in a less productive and possibly dangerous manner. I will be happy to help in anyway I can!

I am not familiar with the FB group. Would you please post the article there for me, if you know how to do it? Thanks a lot.

(1), It is hard to allow reviewers to make a clear summary for acupuncture studies. This might be the most confusing research area in scientific researches. We need concrete day to approve the effect of acupuncture therapy as a solid therapy, not a “cheating” therapy. Some editors seem to feel weary to continue any research on acupuncture. If acupuncturists want to come into the mainline of official medical services, we need concrete data to convince the medical authority, government, as well as public.

(2). Such wrong opinion is still spreading online, which affect our clinic work now: someone refuses to try acupuncture because they heard from the internet that acupuncture is a placebo effect. They do not want to waste money on a “cheating” therapy. They questioned why your guys spend 3-4 years to learn a “cheating” therapy? Is a “cheating therapy” so difficult to learn? This is an actual case in my clinic.

(3). If we accept that acupuncture effect bears much placebo effect, though some part is its specific effect, researchers always need to include a sham group in the research. It is hard for the research and also hard to interpret the study results, as it is now. If we can clear that acupuncture is not a placebo effect, by study as I recommend here, to test acupuncture effect in coma, shock, during anesthesia, in such conditions where patients are out of consciousness, we should be able to omit the sham group in future studies. We can just compare the acupuncture with western medicine, surgical operation, physiotherapy, chiropractic, massage. If acupuncture works equally to, or better than those therapy, we should accept it.

Some physiotherapist or chiropractic also use acupuncture. This is true. We cannot prevent it since they get learn for acupuncture and they have acupuncture license too. This is a trend that the alternative medicine would mix together soon or later. We, professional acupuncturist, should update our acupuncture skill, as well as update to apply Chinese herbal therapy. The personal skill in the herbal therapy would be much larger among practitioners.

I would also suggest that a very good piece of evidence that acupuncture is not placebo is the paper by Rick Harris on mu-opioid receptors. He found that verum acupuncture created more mu opioid receptors in the brain versus sham acupuncture which released more endogenous opioids but didn’t create the receptors. This finding can explain why sham acupuncture has an immediate effect similar to verum but it does not sustain the effects.

On a different note, I think that it is untrue to say that acupuncture doesn’t also have a placebo effect. It is my experience (both as a researcher and an acupuncturist) that an acupuncture visit is a very potent placebo that any practitioner who is interested in healing should maximize to his advantage. We should really be working to destigmatize placebo as it is nothing more than engaging the body’s natural ability to heal.

Answer:
(1), I will check the font soon. Thanks for remind.
(2). I have tried not to include any basic research data in my paper. If in clinic, we cannot find how comes that the effect of sham group and the acupuncture group are pretty much the same (as in many articles), the acupuncture is "pretty much functionally" as a placebo effect. I know lots of such basic data that can support the idea that acupuncture is not a placebo effect.
I believe that, only after we can show in clinic that the difference between the sham group and the acupuncture group, showing its usefulness in clinic, showing the specific effect of acupuncture, then more basic research data in the structural, biochemical, signal translation.. between the sham and the acupuncture group becomes more "supporting' evidence.
This is the reason that I did not include the basic research data in the paper, otherwise, it would be expanding into a book (book might be prepared soon).
(3). I, of course, agree that there is a placebo, even a nocebo effect during the acupuncture treatment. This is true for every kinds of therapy. I have indicated this comment in the article. This is well known by Chinese that the healing effect of a old TCM doctor could be better than a young TCM doctor, though they prescribed exactly the same herbals for the treatment. Saying that “acupuncture is not a placebo effect” means “acupuncture is not entirely a placebo effect”, not means that “acupuncture treatment does not bear any placebo effect”. However, acupuncture can also work by itself without any placebo effect, such the healing effect of acupuncture in shock, coma, persistent vegetative state, under general anesthesia, etc. This is emphasized in my article in much detail.

In our clinic, we tell our client to come for acupuncture once a day for three days in the beginning. We tell them this is the best schedule for acupuncture. We said If they come for acupuncture only once a week, it wound work properly. This is also a hint (placebo effect). Client will feel that they will get much better if they actually come every day for three days. We know it.

Thank you for your email regarding the results of acupuncture studies in the Western countries. Recently, a number of acupuncture clinical trial projects mainly conducted by conventional scientists have generated many negative results. I agree your suggestion “Acupuncture study should be in a correct way, so to be able to get correct answer.” I have published a paper to compare differences between acupuncture clinical practices and the trial studies, which include "acupuncture technical principles", "acupuncture clinical trial design", and "acupuncture practice based on the theory of traditional Chinese medicine". The paper is attached for your reference.

Regarding the possible reasons to placebo effect of acupuncture, another major problem is that too many psychiatrists conduct funded acupuncture projects. Due to limitation of NIH funds, many psychiatrists changed their direction to apply grants from the National Center for Complementary and Integrative Health (NCCIH). Attached is a Meeting Poster from NCCIH Study Section. You can see how many reviewers are from department of psychiatry or department of psychology, and they are NCCIH funded investigators in the study of complementary and alternative medicine. It is no doubt that psychiatrists particularly interest placebo effect, but it is a wrong conclusion for effect of acupuncture.

You correctly pointed out that the augment from China seems unsuccessful to explain the failure of acupuncture studies in the Western countries. Strong research evidence is needed to demonstrate physiological effects of acupuncture. I have submitted several projects to NCCIH for studying biochemical physiology of acupuncture but failed to be funded due to too many reviewers are psychiatrists. I will continue to try.

Dr. Wang I was unable to down load the articles but there are many studies that show acupuncture works for pain and mood disorders and many other conditions so I do not know what you are talking about.... Thanks. Steve c

Please go to: www.acupuncture123.ca to see the paper. Question: the idea of acupuncture placebo is overwhelming in the internet (check key words "acupuncture and placebo". Also, potential clients started to refuse to come for acupuncture because they believe that acupuncture is placebo!

Thanks for making me aware I had never googled acp. And placebo. There is a bunch about that. In my state of north Carolina the right wing is always trying to undermine natural health practices. They are backed by the pharmacy companies and AMA. They do not want natural health practices to work....

How does acupuncture work in veterinary medicine if it is placebo? Sounds like poor research model altogether.

Double blind placebo studies, which are the hallmark of “Western science” do not work in acupuncture. It is impossible to do fake of sham acupuncture. You wind up doing acupressure and that control. Acupressure has a similar effect but to less of a degree. Improper control. Empirical studies show that acupuncture works all the time. I have been getting results with patients for over 15 years. No one can tell me I have had 15 years of good results because of placebo. And if that is true, great! I will keep doing effective placebo medicine and my patients will love my results.

If you follow the money, you will find out why acupuncture research will always be debunked by interested parties that want the marketplace to use medicine that is more profitable. That is the real reason these studies come out trying to disprove acupuncture’s effectiveness.

Ask the PTs why they want to do acupuncture and call it dry needling, because it is effective!

Actually, I don’t believe you are correct. Moers and Shakers in America use acupuncture regularly. The Daoist priest who was the Dean of our acupuncture school was asked by President Clinton to be his personal physician. (He declined.) Also, the US military is the biggest researcher into acupuncture ! They have not commercial pressures, they make their choices based on what sells, not what makes money for the medical industry.

It is NOT placebo effect, of course I know this. I am an acupuncturist. What you’re wrong about is that it will hurt acupuncture to have Western researchers unable to show acupuncture’s full results. Their medical model is entirely materialistic, acupuncture and Chinese medicine is NOT purely materialistic. That’s what I mean.

You do not believe that to show healing effect of acupuncture during general anesthesia. in coma, shock, persistent vegetal state, is good enough to convince people that acupuncture is not a placebo effect? In which way you can convince the researchers that acupuncture is not a placebo effect?

I did the acupuncture for almost 50 years. Thank you for letting me know and I will share this article to my friends.

Thank you for sending me your article! I too, am passionate about acupuncture research. I believe that the fMRI research showing key changes in functional connectivity patterns in the brain also provides great value toward explaining acupuncture's effects on neurophysiology. My research focus is on the use of acupuncture for modulating cerebral blood flow following traumatic brain injury. I hope one day, this will contribute to the acceptance of acupuncture as an important modality with measurable effects on the neuro-vascular and autonomic systems in the body.

Hallow dr. Wang! Yes, yes, I understand your frustrations completely! My father is a retired heart surgeon and my retired mon a nurse –ever so challenging to get point across. I visited China in 1980 and saw the highly refined character of arts and crafts and discipline of people and KNEW then that Chinese medicine is more refined and subtle and that the west would eventually catch up –hopefully SOON!!!

I'm not sure what action you are looking to do. Insurance participation in USA is about $$. Currently the insurance companies are realizing that they are having larger profits paying acupuncturists instead of surgical intervention. I think that THAT will keep acupuncture alive

Thank you for contacting me about the current discussions on the placebo effect of acupuncture. To let you know a little about me I am a practitioner in New York on Long Island. I work with Southampton Hospital with the breast cancer center, senior citizens and regular patients.

It is an everyday struggle to be able to practice TCM as I was taught by my professors especially in New York state. I completely agree with you that we need to stop the effort to discount the benefits and effectiveness of acupuncture in treating patients.

I will read the article in total. This weekend I am attending a continuing education workshop in NYC and I will bring your information with me to share with other acupuncturist.

我的专业是工程热物理，研究的是流动与传热。但由于自幼身体虚弱，因此找了很多种方法来健身，但效果都不是很好，直到我在27岁的时候开始练习打坐，至今有20年了，现在每天双盘坐（跏趺坐）40～50分钟，收到了很好的成效。但健康有时也会出现波动，我就在想这里面的原因是什么？一直也喜欢传统文化，听了《黄帝内经》方面的讲座，自己也看了相关的书籍。然后，自己来解释，最后就提出了“中医经络呼吸辅助系统假说”，在Journal of Acupuncture and Meridians Studies上发表的论文我想您也看到了。这个理论在我的身上一直都是被验证正确的。

我不是中医专家，但可以从我的理论假说出发来谈谈针灸是否心理作用。

首先，我认为针灸的作用是真实的作用、不是心理作用，但针灸产生的效果需要非常精准的技术、且效果因人而异。经络呼吸辅助系统假说认为经络是人体组织间隙自然形成的通道，新陈代谢产生的小部分CO2经这个通道由皮肤毛孔排出体外，从而起到调节气血的作用。穴位处存有较多的CO2，针刺时可以将其排出，降低组织压力，利于毛细血管的浸透，从而降低血管内的压力，促进血液流动。人体的血液循环是一个网络，脏腑间的血流会相互影响。生病时，整个血液循环网络的平衡会被破坏，而针灸是要恢复这个平衡，要通过有限的穴位针刺来达到这个目的对针灸师的要求是非常高的。

其次，这个假说可以解释针刺时的补与泄。同样是针刺，为何有补和泄的差别，差别在于穴位中的气是多或是少，多则表明代谢强，少则表明代谢弱。例如炎症的初期，由于神经和内分泌的作用，代谢会加强，经络中的气会多；但久之，血瘀会使代谢减弱，从而使经络中的气变少。经络穴位中的气多时针刺则是排掉多余的气，因而是泄；气少时针刺也是排气，但目的是通过排气来促进血液循环加强代谢产生更多的气，因而是补。

最后，谈一下西方人与东方人的区别。经络呼吸辅助系统假说认为，经络的气是从毛孔排出，这在《黄帝内经》上有描述。西方人的毛发多、毛孔粗，因而他们经络的调节能力是要强于东方人的。这也可能是西方人体质优于东方人的一个原因。同时，这个原理还可以解释日光浴和桑那的健身作用，毛孔的开合起到了如针刺般的作用。而且，打坐也使我的经络的调节作用比以前有很大的提高，一个表现是经络非常敏感，轻轻拨弄手前背上的毫毛，只需几秒钟我的呼吸会自动的变得缓慢。

With all due respect, if physical therapists are co-opting our profession with 30 hours of training, they know it is not a placebo effect. MDs are prescribing acupuncture, and hospitals are sending nurses for acupuncture training so they get the institutional acupuncture jobs. They know it is not a placebo.

I suggest interviewing them first, because is we are discussing WHETHER or not our four-to-five year excellent trainings really works while our profession is being stolen from under our feet, the question of placebo is just a distraction while we lose our standing.

The best question is, why are physical therapists thinking acupuncture is valuable enough to use—and therefore NOT a placebo—but not to get legitimate training? You should be interviewing physical therapists to get that answer. We do not need placebo distractions. We need to hold our place.

PTs are working on getting dry needling codes for acupuncture-by another-name, which they can use to bill insurance companies. So physical therapists along with insurance companies, are even usurping acupuncture through institutional payment systems. This is much, much more dire than placebo effect issues. I would not be surprised if they are doing the research you are concerned about under “dry needling ‘, rather than giving acupuncture the legitimate place it deserves, begin done with legitimately trained acupuncturists.

Calling the effects of acupuncture a placebo effect is a distraction while others move in on our several thousand years old medicine. The bigger question than “whether’ it is a placebo is “why” they are pursuing that course. Nothing works for thousands of years if it is a placebo. It works because it works.

Dr. Wang, thank you for your message. The department of labor just assigned acupuncture a labor code, which is a major step forward for our profession. In my state, we are about to pass legislation that forces insurance companies to accept of practice. We are trying…

My clients come to me because what I do works. They trust me. I don’t need research to prove anything. I do not believe in research because of the double slit experiment. Perception creates our reality. That is the error or Western research… the expectation of failure/inconsistency. Private insurance/indoctrination is a barrier to healthcare between practitioner and client.

Good morning Dr. Wang, your research is very comprehensive and impressive, thank you for the work you did, I will reference it when needed.

Thank you so much to spread this information. I totally agree with you. I will read this paper and spread it to my group.

Hi, Dr. Wang, thank you for your text. I did look at you website and I appreciate you forwarding article. I will pass it along to fellow colleagues. Regards.

Why would it matter if I read this? How do you plan to change the discussion around acupuncture research? You have put a lot of effort into getting this links out but I am not sure why it is so important to you that everyone reads this. Most research is not disseminated in this way.

Thank you for contacting me, however I am confused since a massive meta-analysis conducted by researchers from all over the globe and checked for six years concluded that acupuncture was 52% more effective than Western medicine standard of care in five major arears of pain. See the New York Times article on this: http://mobile.nytimes.com/blogs/well/2012/09/11/acupuncture-provides-true-pain-relief-in-study/?refere=

Does this not suffice or do people not know of this study?? Also, this is his wife Caroline Burdulis also a licensed acupuncturist and diplomate of Oriental medicine. If you follow the link to the actual study that was done, you will find that an international community of 28 researchers actually checked all of the information over a six-years period from the highest quality acupuncture studies ever done. The meta-analysis covered a total of 30 years. As far as I know this is the most significant study done today because of these very factors.

Dear Dr. Wang, thank you for sending me your article. If Acupuncture is a placebo, it is a very very effective one!

I do not think there will ever be an adequate Western medical explanation for why acupuncture is so effective. It does not bother me if they try to explain it.

I appreciate your contact. I finished your opening summary on placebo and think you make good points. I get very good results and I treat more regularly than most. I will try to finish your paper soon. Is there an imminent cause or concern that has motivated your outreach?

I always think fact can not be beaten by words. Fist of all, I am not a doctor, an acupuncturist only. Second of all, I never heard anyone says acupuncture is not useful. Third of all, insurance company definitely do not like to refer payment to acupuncture service because there is no standardized practice guideline yet. Shall we continue working to reach that goal?

Hello, and greetings from Alexandria, VA! I've not read the article yet, but NIH studies, etc seem to have gone beyond the issue of placebo, etc. The issue here is that Doctors, chiros, physiotherapists are practicing acupuncture (I imagine that means it is not placebo also) without proper training. I know this is true in Canada, correct? Well, I'll read the article... Have a beautiful, Qi-flowing day.

Hi, Dr. Wang, thank you for what you have done for our profession. I will pass this information to my colleagues and related others. We do need to do things together for acupuncture!

My clients come to me because what I do works. They trust me. I don't need research to prove anything. I don't believe in research because of The Double Slit Experiment. Perception creates our reality. That's the error or Western research...the expectation of failure/inconsistency. Private insurance/indoctrination is a barrier to healthcare between practitioner and client.

The joint commission in the United States just explicitly recommended acupuncture instead of opiates for pain relief. I don’t think we are at a crucial juncture here.

I also hope that my article is completely useless and never being needed in future in any way and in any aspect.

I wish that the decision of government will never change from government to government.

I wish that my paper will never be used as supportive evidence for acupuncture, in a court against the sue from big pharmacy company or western medicine associations (as they have sued chiropractic several times ago). I wish them do not sue acupuncture any time in future, even if acupuncture becomes bigger and bigger.

I wish that the research society comes into agreement that acupuncture indeed works though it is still hard to understand how it works. No positive and negative data published again and again to waste time and the efforts for so many researchers in this area. I also wish that without my article, someone already told the researchers who published negative paper the reasons they got the negative data.

I wish the public will just laugh at the negative articles in websites that are against acupuncture. I wish that the public are not affected by the overwhelming negative articles online (check key words acupuncture and placebo in google).

Hello Martin, I think one reason results of acupuncture treatment may not be so good in the US is because many doctors take an 8 week course, learn the meridian system. They then apply western thought to come up with treatment plans and call that acupuncture. I went to a five element school, masters degree. We were steeped in eastern philosophy and daoist philosophy for the first 1-1/2 years before we even saw patients. In order to be an effective acupuncturist one must understand eastern philosophy. It is a completely different way of looking at health and illness than that in the west. Western treatments don't "work" because most are not practicing acupuncture as it was intended. A very sad situation. Personally, I am not treating patients but am still very interested in studying eastern philosophy and how they view life. I wish we in the west understood these concepts, we would be healthier and happier. Not to mention we probably wouldn't be bombing every place we can on earth!!! I'm not sure what it is that you want me to do? Thank you, Rose

Dr. Wang, I totally agree with you. I am trying to do the same thing just like you! Your article is great but not enough to convince the western medical doctors. But there are a group of doctors in US who believe and use alternative medicine in their practice. We need support from them. Do you have Linkin? If you do, please connect with me. Lets work together for this! Thanks for reaching out!

Very well. I will certainly refer to your article. Thank you. There was a lot of effort in this article. Sometimes I use the example of treating animals with success doing acupuncture. Animals do not have a belief system like humans have and it still works on them. The best to you.

Since acupuncture is a restricted activity, it should also be done by a restricted profession.- eg Acupuncturists only.

Since the legislation of the "Health Profession Act", a few years ago, any discipline can use acupuncture in the scope of their practice: Physiotherapists, Dentists, Occupational Therapists, Chiropractors. It is no longer used with the respect that we, Acupuncturists use. i.e. a closed room, for each patient, balancing the body, looking at the tongue & taking pulse. It is used to treat the patient quickly & see as many pateints in 1 given day.

When I was injured in a MVA, in 2000, I saw a number of Health Professionals, including Physiotherapists. The Physio would do acupuncture on me, although I told them I already received acupuncture through my acupuncturist. The way the Physio practice, in Private Clinic, is that they can only use 2 modalities per patient - what ever takes the least time to perform as they see 5-8 patients per hour. So, the modalities they use greatly are hot pack - ice - acupuncture, as they can leave the patients by themselves, and move on to next patient. They never wash their hands in between & therefore can "contaminate a person's Qi" with another. I always do a ritual between my patients so that I don't contaminate my patients spiritually nor karmically. I learnt that in China.

I think the liberal use of acupuncture by several Health Professions is hurting the Acupuncture Profession and subsequently our patients.

SOLUTION? each of us ..or.. CAAA should lobby to the Government to remove acupuncture as a modality to make "money" by the physiotherapists. Each profession should do what they were trained to do at University. There is no "physiotherapy modality" performed, anymore. Most pf then do Acupuncture! or... Physios now do what the Chiros used to do: neck manipulation etc... What has gone wrong?

Anyway I think that if all the acupuncturists would get together and request a "re-visitation" of the Health Profession Act, it may help re-boost the profession, without having people like you, write a letter to the patients.

When I started doing acupuncture, I was soooo busy, but now, I can barely make a living, because all the physios do acupuncture.

Sorry that my email today disturbed you a lot. I will try to discuss with you later. (I am busy today).

To pretest our profession, I agree that only acupuncturists can perform the acupuncture treatment. To ask to restrict the acupuncture therapy to acupuncturists, and to negotiate with the Government, we need our reasons. If we say that the acupuncture does not work well in the hands of physiotherapists, the Government may answer that even the acupuncture should be deleted and wash out of the medical service: because the "acupuncture is a placebo effect" by a lot of medical studies."

I feel that, if the acupuncture used by physiotherapy does not work well, it is our chance, not only a challenge. I have a lot of clients come to me after they visited physiotherapist who indeed did acupuncture to them but failed. The clients still search for "professional" acupuncturist for help. If we want to complete with those other profession, we have to work in a different way, otherever, to show that the overall acupuncture treatment in our hands works much better in their hands. By how? by typical acupuncture procedures and technique, by proper treatment plan, such as I mentioned in my articles, that to do acupuncture everyday for three days, then once every other day for some days. And also using more modalities in TCM scope, such as herbal therapy.

I use acupuncture (100% of clients) and herbal therapy (more than 90% of clients) together. I let them to drink the herbal tea before lie down on the table for acupuncture. My way of herbal therapy is not the text book style of herbal therapy, but the Jing Fang herbal therapy. I have an idea to start a webinar for the herbal therapy.

By this way, our healing effect should be much higher than that in physio therapy. Once client come to us, they will tend to stick to us.

This year, the client flow is slower than before. One of the major reasons is that many people loss job and they have no benefit. This affected not only us as acupuncture, but also physio, the chiro, the dentist. We know this because we are in the same building, and none of us are busy this year. So, no worry but we need to update our skill and stand out in front of physio therapy, so to survive.