Acupuncture Within The Western Research Model

Acupuncture Within The Western Research Model

Acupuncture, a traditional Chinese medical practice, has been used for thousands of years to promote health and alleviate various ailments. It involves the insertion of very fine needles into specific points on the body with the aim of restoring the flow of Qi and blood. While acupuncture has gained popularity and recognition worldwide, it still often encounters scepticism within the framework of Western medicine (WM) research models. This disparity arises due to several factors that challenge the conventional scientific approach.

1. One of the primary reasons acupuncture doesn’t fit neatly into the WM research model is due to its holistic nature. Chinese medicine (CM) views the body as an interconnected system, where imbalances in one area can affect multiple aspects of health. In contrast, WM primarily focuses on isolating and studying individual components of the body or disease processes. This reductionist approach allows for controlled experiments and measurable outcomes. However, WM struggles to measure and quantify how these components interact as a whole. CM and acupuncture, however, while aiming to address the body as a whole, focusses on the interaction of each of these systems, thus making it potentially difficult to isolate specific variables for scientific study.
2. Another issue lies in the complexity of acupuncture treatments. In CM, each patient is considered unique, and treatments are tailored accordingly. Acupuncture points and treatments are chosen based on an individual’s symptoms, constitution, underlying imbalances and other factors. This personalised approach contrasts with the standardised protocols and large sample sizes often employed in WM research. It becomes challenging to design double-blind, placebo-controlled studies that adequately capture the intricacies of acupuncture treatments. In short, results are not repeatable between patients using fixed protocols, and this doesn’t sit well within the current WM research model.
3. The mechanism of action behind acupuncture within a WM context remains a constant subject of debate. CM explains it in terms of managing the flow of Qi through channels or meridians, and balancing Yin and Yang energies within the body. These concepts differ significantly from the Western understanding of physiology and pathophysiology. which are based on anatomical structures, biochemical pathways, and neural signalling. Within CM, while it may seem strange to be talking about medicine in the context of yin, yang and qi, one must remember that this terminology represents the cultural values and forms a working template for this ancient and powerful medicine—a template that is deeply rooted in a classical language and philosophy that is over two thousand years old. This is no different from how modern WM navigates within its own template and in line with its own cultural values. Neither is wrong; they’re just different. With this in mind, it’s perhaps not surprising that the subjective nature of Qi and the lack of corresponding terminology in WM make it challenging to establish a common ground for research collaboration. But to give us some context, whether we look through the lens of CM or WM, we don’t have all the answers. We can’t define or quantify Qi anymore than we can define consciousness. They are both elusive concepts but inherently undeniable in reality.

Bridging The Gap Between Western Research and Chinese Medicine:

One must remember that CM and acupuncture have proven themselves over two thousand years of clinical observation and practice. In recent years, efforts have been made to bridge the gap between acupuncture and WM research. Some studies have focused on identifying physiological responses associated with acupuncture, such as changes in blood flow, neural activity, and the release of endorphins. While these findings offer valuable insights, they often fail to completely understand how acupuncture works. Additionally, the placebo effect, lack of proper controls and the role of the therapeutic relationship between the practitioner and patient can further complicate the interpretation of or invalidate results.

Sham Acupuncture & The Problems with Current Research:

Sham acupuncture (SA), also known as placebo acupuncture, is a technique used in clinical trials and research studies to create a control group that mimics the act of acupuncture without penetrating the skin or stimulating specific acupuncture points. While SA serves a valuable purpose in determining the efficacy of acupuncture treatments, it is not without its problems. Until recently, there has been a general assumption that it is inert. However, research has shown that SA may produce physiological and psychological responses, which can complicate the interpretation of study results and may prove unreliable.

Additionally, SA procedures vary across studies, making comparing results and establishing consistent standards challenging. It is often unclear how SA or other placebo interventions have been administered and what measures and controls are in place to reduce bias. In some cases, SA may not effectively blind participants or researchers, potentially introducing bias into the study. These challenges highlight the importance of carefully designing and implementing SA protocols to ensure reliable and unbiased research outcomes in acupuncture and related therapies.

Is Sham Acupuncture Still Acupuncture?

SA is often performed on or near acupuncture points to create a control group closely resembling the acupuncture treatment. It aims to create a placebo effect by providing a similar experience to the participants without the specific therapeutic stimulation associated with acupuncture. The SA technique may involve the following:

• Superficially touching the skin with the acupuncture needle.
• Using a blunt needle that does not penetrate the skin.
• Using non-penetrating devices that simulate the sensation of needle insertion.

By targeting acupuncture points or using similar procedures, researchers aim to assess the specific effects of acupuncture beyond the placebo response. However, it is essential to note that the approach to SA can vary greatly across studies. As above, there has been a general assumption that sham interventions are inert. However, research has shown that SA interventions may produce physiological and psychological responses. Therefore, researchers must strive to develop rigorous control methods to ensure an accurate evaluation of acupuncture’s efficacy moving forward.

Double-Blinding And The Elimination of Bias:

Double-blinding is a crucial methodological approach in clinical research that aims to minimise bias and increase the validity of the study findings. Within the context of acupuncture, double-blinding participants and acupuncturists is often challenging, leading to the potential for bias in both groups. Patients may have preconceived notions and expectations about the effectiveness of acupuncture, which can influence their perception of treatment outcomes. Similarly, acupuncturists may have beliefs and preferences that can impact their treatment approach and evaluation of outcomes. This can potentially introduce bias in the assessment of acupuncture’s efficacy. As above, one of the main problems with double-blinding in acupuncture research is the difficulty in creating a genuinely inert placebo intervention. With the potential for participants to experience the placebo effect in any context, even though treatment may lack therapeutic value. this has the potential to lead to inflated treatment effects and difficulty distinguishing actual treatment effects from placebo effects.

The Significant Difference: Acupuncture vs Sham Acupuncture vs No Treatment: 

In various clinical studies and research trials, acupuncture has frequently demonstrated a significant difference compared to no treatment or being placed on a waitlist. This suggests that acupuncture interventions have the potential to offer therapeutic benefits beyond mere placebo effects. However, compared to SA, which mimics the experience of acupuncture but does not provide the specific therapeutic stimulation associated with traditional acupuncture, the results often show no significant difference. On the surface, this observation indicates that the clinical effects of acupuncture may, to some extent, be attributed to non-specific factors such as the placebo effect, expectancy, and the therapeutic context. However, while the lack of significant difference between acupuncture and SA raises questions about the specific physiological mechanisms underlying acupuncture’s effectiveness, it does not necessarily discount its potential clinical value. It does. however, raise more questions about SA interventions and the continuing assumption that they are inert. Further research is necessary to better understand the complexities of acupuncture’s mechanisms and refine study designs to enhance our understanding of its therapeutic effects.

The Balance: It’s All About What Works:

It is crucial to acknowledge that the limitations of the WM research model do not necessarily invalidate acupuncture’s efficacy. Many patients report positive outcomes and find relief through acupuncture treatments. The challenge lies in translating these individual experiences into scientifically acceptable evidence that meets the standards of WM research.

There’s No Research To Prove That Acupuncture Works. Or Is There?

Finally, and perhaps most importantly, it is inaccurate to state that acupuncture is not supported by an extensive and robust evidence base. Medical evidence users, including clinicians, patients, and policymakers, generally regard Cochrane systematic reviews as the gold standard. As of June 2023, there are 18,436 clinical trials of acupuncture and 141 systematic reviews in the Cochrane database. This number continues to grow exponentially every year.

Compared to CM, does WM fare any better within its own research model? A systematic review and meta-analysis of 1,567 Cochrane systematic reviews by Howick et al. (2020) found that only 12% of all healthcare interventions were supported by high-quality evidence—only 5.6% of which reported a statistical and clinical significance. In short, even if the bar for “acceptable evidence” included only moderate quality evidence, only 42% of all current health interventions studied would meet this criterion—this includes within Western medicine. In other words, the evidence base for acupuncture is comparable or superior to the evidence supporting most “standard of care” treatments. One could argue that these facts suggest a systemic and unconscious bias towards acupuncture—the very problem that all research is designed to eliminate.

Conclusion:

In conclusion, acupuncture’s misalignment with the WM research model stems from its holistic approach, personalised treatments, and differing conceptual frameworks. While this creates challenges for conducting controlled studies and explaining the underlying mechanisms, it does not dismiss the potential benefits of acupuncture. While acupuncture may not work for everyone, like any medical intervention, integrative approaches that combine both Eastern and Western perspectives may offer a promising path forward, fostering a better understanding and utilisation of acupuncture within the broader healthcare system.

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