Placebo Acupuncture?

Apparently,  fake acupuncture works nearly as well as real acupuncture, suggesting that much of the benefit of acupuncture is in the placebo effect.

For me, the idea that poking a bunch of small needles in someone’s back can reduce lower back pain is ridiculous. I dislike even getting a shot at a doctor’s office, so personally I’d rather take a double dose of pain killer than become a human pincushion.  

However, I find the placebo effect of acupuncture fascinating. Clearly, there are many people who think they feel better after acupuncture.  However, in the study mentioned in the CNN article, almost as many people who receive the “fake” acupuncture think they feel better after procedure as people who think they feel better after “real” acupuncture. After reading about this study, I am not impressed with acupuncture. I am impressed with the complexity of the human brain. There are many people who feel better just by thinking that they are going to feel better because of acupuncture, not because of any medical merit of acupuncture itself. There has to be some incredibly biochemistry going on in the brain to explain that. Makes me wish I knew more about how the brain works and that science, in general, knew more about the brain.


Evelyn is a geologist, writer, traveler, and skeptic residing in Cape Town, South Africa with frequent trips back to the US for work. She has two adorable cats; enjoys hiking, rock climbing, and kayaking; and has a very large rock collection. You can follow her on twitter @GeoEvelyn. She also writes a geology blog called Georneys.

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  1. I've often wondered if the real effect of acupuncture is simply a distraction from the pain. The sensation alerts the brain to pay attention to wherever the needles are, which pulls some attention away from the pain.

  2. Since I am a skeptic and an atheist myself, I get where the incredulity about eastern medicine is coming from, but in the case of both acupuncture and ayurveda, I think the skeptics are wrong, the studies are biased and the reporting is highly one-sided.

    Let me acknowledge up-front that the purported basis for both systems of medicine that I have mentioned are probably completely bogus. Neither the chakra theory nor the chi theory makes any sense, and both have in fact been properly debunked by proper science (I have read up on this).

    But there is no doubt that both acupuncture and ayurveda DO deliver on their promises in real, measurable ways. My father had a slipped spinal disc – a real, physical, visible-in-scans slippage – which would have required expensive treatment that probably wouldn't even have cured it for sure. He went in for acupuncture instead (we lived in Singapore at the time, and there were several specialists around), and I was flabbergasted, furious, and incredulous at what he'd done.

    Three months later, he was walking around without help or pain for the first time in a year. Scans showed the disc was back in place, and the only problem was that the abraded muscle fibres (from the original injury) had not healed, and he had trouble bending over backwards. This was a HUGE improvement from how he'd been feeling from the day of his injury: he could not stand up without help, he could not walk without a cane, he could not sit for long and he could not sleep on anything softer than a bare floor without making the pain worse.

    I have known many people who successfully treated their heart disease with ayurveda, without the sort of medication, diet or exercise western medicine recommends. (They followed a different diet, and a different set of exercises, but no medication.) An array of other diseases treated as chronic and incurable by western medicine have seen cures in ayurveda – high blood pressure, certain types of kidney disease, diabetes, hypo and hyper-thyroidism.

    What keeps western medicine from acknowleding these cures is that they don't work for everyone. Most of these treatments are customised for a person's particular body chemistry (though again, there's a lot of mumbo-jumbo here), and that actually makes a lot of sense to me. Reproducability is all well and good for physics experiments, but everyone reacts differently to foods, exercise and medication – to say a cure doesn't work simply because it works only for SOME people does a great disservice to the cause of medicine itself.

    I think what's really necessary is much, much greater research into systems of eastern medicine with a view to really understanding it and demystifying it rather than to discredit it.

  3. BTW: my dad's acupuncture treatment was eleven years ago. He had to go back once three years later for retreatment, but his back is still doing fine. His regular physician is entirely unsurprised, as it was she who recommended acupuncture in the first place.

  4. Why so convinced the benefit is entirely "placebo effect"? From what I've heard about this this study it could also be that the poking does have a benefit, but the acupuncture locations/methods are unnecessary. The faults in the study were discussed in the Skeptic's Guide (including the suspiciously low success rate of the drugs). It sounds almost like you're immediately dismissing the poking as possibly being beneficial just because you don't believe in acupuncture.

    We'd need a real double-blind test. Hard to do with acupuncture. I'm sure being sedated is against the acupuncture rules. Also hard to fake-administer the acu blindly…

  5. nandini,

    "Most of these treatments are customised. . .Reproducability is all well and good for physics experiments, but everyone reacts differently to foods, exercise and medication – to say a cure doesn’t work simply because it works only for SOME people does a great disservice to the cause of medicine itself."

    If there's any real phenomena here, it should show up statistically in a double-blind study, plain and simple. If it only works for SOME people, it should still be enough to be better than the control, right? If the SOME is so small that you can't distinguish from control, then it's unethical to sell the service as beneficial. If you can't manage to make an impression over a a statistically significant sample, then the chances of you helping a random person coming into your shop off the street are pretty slim. It's reduced to near-snake-oil.

  6. Nandini,

    Thank you for that 100% efficacy study on acupuncture — of exactly ONE data point, with no controls, no blinding, no nothing. In other words, a worthless anecdote.

    If nothing else, it is entirely possible that your dad's injury might very well have been healing itself over time just by his favoring it so much instead of aggravating it. To attribute the improvement solely to acupuncture when there has been no specific attempt to rule out other possibilities, including simple self-correction, is specious and of no scientific use whatsoever.

    I'm glad that your dad feels better, truly I do. But your assignation of credit to acupuncture makes just as much sense as that of a dog being absolutely certain that his barking every day is what makes the postal carrier leave.

    ~David D.G.

  7. Nandini: all the other illnesses you mention are the very ones that a change in lifestyle and/or diet can have a profound impact on progression or lack thereof.

  8. Also, I'm pretty sure there have in fact been double-blind studies of acupuncture, though those focused on placement of the needles (traditional vs. random). I'd say it's at least worth some research targeted at finding out just what endorphin rushes are actually good for…..

  9. Well, here's the thing with acupuncture:

    First of all, it's being used to treat various things that simply don't sound like they could be cured by poking people with needles (like smoking addiction, etc…)

    Secondly, most "ancient oriental medicine" only remains popular because it's oriental and supposedly has been used successfully for thousands of years by those "highly advanced ancient Chinese" for example. It makes me wonder, if you asked an accupunture-believer who they'd rather have administer the treatment, a licensed physician or an old Chinese mystic with a long white goatee who works while having the appropriate oriental sounding music in the background, who would they pick? And why?

    And of course, as has already been said by others, many quack treatments experience a bit of lingering respect when the original, official mode of operation has been discredited as physically nonexistent or physiologically impossible. Usually, in the form of the few people who were miraculously cured by it. Sadly, scientific research seems to be unable to find anything to support a possible breakthrough new addition to our medical toolbox, and the anecdotal stories remain just that. Unreplicated in follow-up research.

    I'm openminded enough to give acupuncture the benefit of the doubt for now. But not to the point that I feel it's justified to already refund it as a valid medical practice (which, sadly, it is in many countries). It is, after all, still very firmly in the alternative corner of the market. And until it's been vindicated, I think it should be treated as such.

    i.e. Quackery until proven otherwise.

  10. The article doesn't express the same intention as the blogger

    who posted it.After careful review , you'll find that, "Acupuncture —

    real or sham — helps back pain", meant to reflect the number of

    test subjects who reported relief of acupuncture treatment, compared

    to others who received conventional therapy.

    "In the real acupuncture group, 47 percent of patients improved. In the sham acupuncture group, 44 percent did. In the usual care group, 27 percent got relief."

    So the article never suggested that the shame group was as efficient as

    the acupuncture group,however it's apparent by the numbers reported,

    that both groups were more efficient than the 27% who received conventional care, why hasn't that blog been posted?

    As for the 47 vs 44 percent, I submit that perhaps with over a thousand acupuncture points one could puncture,the placebo group might have easily been unintentionally struck or stimulated, a few valid acupuncture points.

    because with such a big net to cast, how could you not expect

    to catch even a few fish?

    Just some thoughts.

    Lady Mercury

  11. Not that this applies to anyone here, necessarily, but yeah, people do throw around the term "placebo effect" like it's a well-understood phenomenon.

    Incidentally, I tend to agree with ydant. I suspect that acupuncture, if there really is something to it, probably works on a principle similar to TENS. (Disclaimer: It's not clear whether or not TENS really works, either, but at least TENS has a plausible scientific motivation behind it.)

    The problem is that it's so difficult to test acupuncture in a controlled double-blind manner that nobody has done it yet. As a result, it's currently impossible to tell if it's placebo or the mere act of applying needles (regardless of where they are applied) that results in pain relief.

  12. I'm reading Lady Mercury's response, and I just don't see what the hell she's talking about. Do the numbers not say that accupunture, whether real or sham needleplacement, has about the same pain relief effect? And does this then not mean that accupunture is effective only insofar as people are being stuck with needles, but apparently it really doesn't matter where you stick 'em?

    So the whole premise of accupuncture and the "art" of accupuncturists knowing where to stick the needles is basically a load of hogwash. Even *I* could relieve someone's backpain just as effectively, simply by sticking them with a bunch of needles. That is essentially the message I take away from the article.

    The only reason I can think of why someone is not noticing the glaringly obvious placebo effect at work, or making excuses to explain away the results of the placebo group, is if they have a need to believe that accupuncture is something more than it really is.

    Maybe someone should do some research to determine the optimum number of needles that receives the best placebo-effect. Obviously, three needles are going to result in more perceived pain relief than one needle. And 50 needles might seem like a bit of overkill. So how many does it take for someone to believe they've really been helped? I bet you'd find more correlation between the number of needles used than between different schemes of needle placement.

  13. FYI, everyone, "Lady Mercury" is that guy Mimick, the same troll from ages ago who reappears occasionally under different names. His comments require my approval. Right now there are a few comments being held. I don't mind approving them for now, if you're all interested in batting him around a bit, but I will stop approving once he gets nasty (as he usually does). Let me know.

  14. If you approve them, they will appear out of order, won't they? (as in, older comments will suddenly appear inbetween responses we've already made).

  15. ydant, Wordplayer, John Philips:


    That is exactly what I am advocating, actually. Some real, double-blind studies based on what acupuncture/ayurveda ACTUALLY CLAIM rather than what western medicine expects of them. Let researchers present a large set of potential patients, let the acupunpurists pick a subset from among these that they claim they can cure, and let the games begin. Honestly, it's not hard. But every single acupuncture research study I've seen is about proving the hypothesis that "it doesn't work the way we want it to" or "its basis and/or explanation is bogus". Take this study, for example. Their conclusion is it doesn't matter where you stick your needles, the pain relief is the same – i.e. the whole "pressure point" theory is bogus. Good. But one step forward now – WHY is there pain relief at all from sticking needles into yourself? Isn't that worth looking into?


    1. Anecdotal evidence is evidence; you don't get to throw out data that doesn't fit into your preconceieved, untested, unresearched and baseless theory that "Acupuncture is bogus".

    2. My conclusion is not that acupuncture works. My conclusion is that furthur study is needed; and said further study should try taking acupuncture's claims seriously, for once.

    3. Slipped discs do not mend themselves – if you did a bit of research into the condition you'd find that it's thought to be incurable without major surgery… which is what hospitals repeatedly told my dad.

    John Philips:

    Check your facts. Renal diseases, diabetes and high blood pressure are considered incurable by western medicine. Treatments for these conditions focus on controlling the illness rather than curing. OTOH, ayurvedic treatments for the same are CURES. Similarly, slipped discs do not cure themselves either.

  16. exarch: "So the whole premise of accupuncture and the “art” of accupuncturists knowing where to stick the needles is basically a load of hogwash. Even *I* could relieve someone’s backpain just as effectively, simply by sticking them with a bunch of needles. That is essentially the message I take away from the article."

    Well… maybe, maybe not. Where you stick needles is certainly unimportant; that's the primary take-home message from this study. I think we all agree on that much.

    Now I don't know much about acupuncture, but aren't needles supposed to be jiggled rhythmically? Couldn't that kind of low-level rhythmic stimulation cause the release of natural painkillers, much like the theory behind TENS? And if so, and such a thing is considered to be theraputically desirable, might it not be a good idea to try to replicate this, whether using needles, electricity or something else?

    Don't get me wrong here. I'm not putting money on it. However, it sounds sufficiently plausible to my inexpert ears that more research wouldn't be a complete waste of time.

    The other take-home message, for me, is that acupuncture still hasn't been adequately tested using controlled double-blind trials, and until it is, we won't be able to definitively say that it's all placebo. And conversely, we also won't be able to say that it's of any clinical value.

  17. Nandini, no, anecdotes are not evidence. Anecdotes are (duh!) anecdotes. They are unverifiable stories and/or claims, often told as third or fourth hand accounts, from your dad's doctor, to your dad, to you, that's at least three steps prone to errors in translation/interpretation.

    Anecdote is the only way alternative medicine ever cures cancer for example. Fact is, usually nobody really bothered to check whether it was actually cancer that plagued the patient, everybody just assumed it was. The real scientists don't get in until whatever it was has been miraculously cured, and the scientist can only observe that, indeed, there is no cancer to be found. Voilà, instant scientific validation that cancer ha

  18. s been cured.


    If your anecdote could be verified, it would be a fact.

    So what I'm wondering is: does your dads case show up in a medical journal somewhere, or is it at least officially reported somewhere as a miracle self-healing injury, or did everyone somehow just say "Gee, whaddya know, the uncurable except for surgery affliction cured itself without surgery. that's funny. Okay, next patient!".

    That's sounds even more unbelievable than the idea that little pinpricks somehow moved a slipped disk back into place.

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