How Much of Acupuncture is the Placebo Effect?

I’d like to discuss two major concerns that people have regarding acupuncture as a form of medical care. These are two concerns that I constantly hear about from skeptics (usually friends and family members of patients, but sometimes patients themselves) and you may be surprised at my answers towards these concerns.

1. Acupuncture is not scientific, therefore it is not valid as a form of healthcare.

2. Whenever a patient feels better after receiving acupuncture, it must be due to the placebo effect since acupuncture has no scientific basis.

Regarding the first issue, whether or not acupuncture is scientific, you may be surprised by my answer:
The skeptics are correct on this one, acupuncture is NOT scientific. It is, however, empirical.
Here’s the definition of “scientific” from dictionary.com:

Scientific: based on or characterized by the methods and principles of science.

Using the above definition, acupuncture cannot be considered scientific since its theories cannot be explained by the three traditional branches of science (biology, chemistry, and physics). Acupuncture was created over 5,000 years ago by people who had no understanding or education in modern science. Additionally, most universities and scientific institutions have not accepted the validity of acupuncture as being scientifically sound. And while you may read an article in the newspaper once in a while talking about acupuncture working for a specific health issue, the vast majority of medical doctors still feel that acupuncture is no better than voodoo.

But although acupuncture is not scientific, meaning that its theories are not based on principles found in modern science, it IS empirical.

Here’s the definition of “empirical” from dictionary.com:

Empirical: based on, concerned with, or verifiable by observation or experience rather than pure theory or logic.

Easy explanation: “empirical” means that it works, “scientific” means you can explain it using scientific terms. Acupuncture is empirical because it works a reliable percentage of the time, it cannot currently be explained using scientific language so it is NOT scientific.

A competent acupuncturist can perform acupuncture on a certain number of patients with a certain health disorder…and get a predictable success rate. Most studies done on acupuncture show a success rate of at least 60%, thus showing that while acupuncture may not be explained by scientific principles, it is a reliable form of healthcare in that a predictable result will be obtained when performing the treatment on certain patient populations.
Please remember, “scientific” and “empirical” is not the same thing.

Here’s a quick story to illustrate this point:

A few years ago an elderly gentleman came to me for emphysema. He was having trouble breathing even with medication and his lung function was steadily declining. His pulmonologist thought he was crazy for considering acupuncture because it was not scientific and could not possibly work. This gentleman’s daughter had previously been a patient of mine for some hormonal issues that I helped her with, so he thought that I might be able to help him.

Long story short…four months later this man was breathing very well, and was even able to reduce his medication. The only thing different was that he was receiving acupuncture.

I received a phone call from this man’s pulmonologist, who was curious about what I did for this patient and how he was able to find relief with acupuncture. He wanted me to explain the theory behind my treatment for emphysema so I began by telling him about meridian theory and the flow of energy (Qi) in the acupuncture meridians. The pulmonologist then interrupted my explanation and said this:

“I don’t want to hear about acupuncture theories and meridian lines because they have not been proven to exist. I want you to explain the effect of acupuncture using western science terms from biology and chemistry. If you can’t explain what you do using scientific terms, then in my mind what you are doing is nothing but a mere placebo, and that is why this patient is feeling better…simply a placebo.”

I tried explaining to the pulmonologist that acupuncture is thousands of years old, and the culture that created acupuncture did not have biology and chemistry, thus I was not able to explain what I did using “his” language. Needless to say the conversation did not end well and although his patient was very happy with me, this pulmonologist did not refer any patients to me .

So here’s the issue: if you receive acupuncture and your health is improved, how important is it for you to have an explanation of your healing that is based on western science terminology? A good acupuncturist can help increase your health and wellbeing, but will not be able to explain it using the same language that your regular doctor uses. If this is important to you, then you will be very disappointed and should probably try something else. But if you just want to get better and have your health back, then definitely go for acupuncture.

This is not to say that a scientific explanation for how acupuncture works does not exist, the scientific community may “discover” an explanation for how acupuncture works in the future, at which point acupuncture will be deemed “scientific” and the skeptics will then feel comfortable trying it. While the skeptics will have to wait until they get permission from academia before they try acupuncture, in the meantime people who are more open-minded will continue to benefit from this form of healthcare just like so many have over so many thousands of years.

“How much of the effect of acupuncture is due to placebo?”

This is the second critique of acupuncture that I’d like to address. When a patient receives good results from acupuncture, especially from a health issue that they’ve had for many years and was not cured through western medicine, they don’t understand how it worked and then they ask if the effect was due to placebo.

In talking to patients about this, I have found that many people believe that the concept of placebo, or “mind over matter” is something unique to the modern era, and that people in ancient times were not aware of the placebo effect. This is not true; the ancient acupuncturists were well aware of the placebo effect and discussed it in depth.

To illustrate this point, I would like to quote to you a passage from the oldest known book on acupuncture, the Huang Di Nei Jing (Yellow Emperor’s Inner Classic) written in 200 B.C.:

“The superior doctor will treat 10 patients…and 9 will be cured.

The average doctor will treat 10 patients…and 7 will be cured.

The inferior doctor will treat 10 patients…and 6 will be cured.”

Keep in mind that this was written well over two thousand years ago in 200 B.C. According to this passage an inferior doctor will have a 60% success rate with his patients.

Well what if a doctor has less than a 60% success rate with his patients? What is he then considered?
According to the standards set by the most ancient acupuncturists in 200 B.C., anything less than a 60% success rate and you were not even considered to be a real doctor practicing medicine! They considered anything less than a 60% success rate to be due to placebo!

You see, even in ancient history there were intelligent, rational people who knew of the placebo effect and that the power of the mind could be exploited to heal disease.

In ancient China you had faith healers, sorcerers, shamans, and all sorts of people who could claim to heal disease by doing very bizarre things. And guess what, sometimes these things would work and a patient would be healed by saying a certain prayer or wearing a “magical” necklace. But even in ancient China the legitimate acupuncturists of that time dismissed such treatments as being nothing more than placebo because they never worked more than 60% of the time.

That was how they determined if a treatment, or a particular doctor, was legitimate or fake. Did they have at least a 60% success rate?

In modern society you have people who buy “miracle cancer cures” over the internet…and yes sometimes this person becomes cured of cancer so they think that they have now found a legitimate cure that would work for everyone. The problem is that when you look at ALL of the people who bought and took that “miracle cancer cure”, then look at the percentage that were actually cured, you will find that a very small percentage were cured of their cancer, not enough to be anything but placebo.

If your friend buys a lottery ticket and wins a million dollars, does that mean you will too? Of course not, because you are not considering the percentage of people who win the lottery relative to how many people play it. This same reasoning applies to the various diet and weight loss gimmicks that you see on TV. Sure they work for some people, but not for the majority.

So if the ancient Chinese considered the placebo effect to work up to 60% of the time, what does modern western science consider to be the success rate of a placebo?

Modern scientists widely consider 30% of the population to be susceptible to placebo…not much more. You can reference this 30% number by reading the “placebo” entry on wikepedia.com. Modern science considers anything with less than a 30% success rate to be most likely a placebo, whereas the ancient acupuncturists from 200 B.C. considered anything less than 60% successful to be placebo. Back then you were not even considered to be a legitimate doctor (and a bad one at that!) if you had less than a 60% success rate.

The ancient Chinese were not only just as aware of the placebo effect as we are today…they had much stricter standards for considering a treatment to be legitimate and not placebo (60% compared to the modern figure of 30%).
So if you go to an acupuncturist and are healed from whatever ailment you came in for, how can you tell if it was the treatment that healed you vs. the placebo effect?

The honest answer is that you can’t.

You can’t tell if your individual healing was a placebo or not, however you can tell if the form of treatment used falls within the criteria of being a placebo by assessing it’s overall success rate. If the overall success rate is above 30% it is not placebo by modern western standards. It needs to be above 60% to meet the standards of ancient China.

This doesn’t just apply to acupuncture, by the way. This can apply to western pharmaceuticals and even knee surgery (you can Google “placebo knee surgery” to find studies that show placebo knee surgeries to be almost as effective as actual knee surgeries).

As an additional point, on average our clinic is the 8th place that a patient comes to regarding their particular health issue. We found this out by conducting a survey of our patient files in the year 2010. This means that by the time someone comes to us with their back pain, panic disorder, auto-immune disease, etc. they have already been to SEVEN different regular doctors and clinics with little to no success.

Assuming that this patient is healed at our clinic, they will then ask if the treatment was due to the placebo effect or power of suggestion. My response is usually “If you are that susceptible to placebo and the power of belief, why didn’t it work with the last SEVEN doctors you went to?”

Furthermore, the majority of patients who come to Natural Chinese Medicine are not people who necessarily believe in acupuncture. They come with an open mind, yet a dose of healthy skepticism (which I think is a good thing). They come to our clinic because we are the last resort after traditional medicine did not work. These are hardly the type that would be prone to believing so much in acupuncture that it could cause them to mentally will away their illness.

So in summary, although acupuncture cannot be explained by scientific rationale (at least not yet), it does offer empirical results and does not meet the criteria of a placebo as defined by modern science.

“If the superior doctor has a 90% success rate, the average doctor a 70% success rate, and the inferior doctor a 60% success rate, what is the success rate of the clinicians at Natural Chinese Medicine?”

Since I brought up this topic by using that quote from the Huang Di Nei Jing, it is a fair question to ask. Yet I’m not sure how to say it without coming across as arrogant or boastful.

So I’ll just say it flat out…yes, we at Natural Chinese Medicine do in fact have an overall success rate of 90%. I say this not as a boast, but as a statement of fact based upon the success of our clinic and the trust that we have established with our patients and the local community.

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