Acupuncture infiltrates the University of Maryland and NEJM

This is embarrassing. In a recent article in the New England Journal of Medicine, Brian Berman from the University of Maryland argues why acupuncture should be recommended for patients with lower back pain. In the very same article he and his colleagues explain that the evidence shows that there is no difference between real acupuncture and sham acupuncture. That’s right: it doesn’t matter where you place the needles, or even if you puncture the skin. Even toothpicks will give the same effect. Any good scientist would conclude, obviously, that acupuncture doesn’t work.

But not Dr. Berman. Or (to give proper credit) his co-authors, Drs. Langevin, Witt, and Dubner.

Without a hint of irony, Berman and colleagues describe how

“Internal disharmony is believed to cause blockage of the body’s vital energy, known as qi, which flows along 12 primary and 8 secondary meridians. Blockage of qi is thought to be manifested as tenderness on palpation. The insertion of acupuncture needles at specific points along the meridians is supposed to restore the proper flow of qi.”

Note the careful wording: they write “is believed to cause” and “is supposed to restore.” Perhaps they don’t believe it themselves? Maybe they’ll explain later that this pre-scientific magical thinking has no place in modern medicine, and no basis in biology, physiology, physics, or any other science.

Nope! Instead, they say

“Efforts have been made to characterize the effects of acupuncture in terms of the established principles of medical physiology on which Western medicine is based. These efforts remain inconclusive, for several reasons.”

How about this reason: there’s no effect, therefore nothing to explain. Perhaps Berman missed that first-year course in logic.

Let’s be clear: acupuncture is pseudoscience. It’s based on magical thinking about a non-existent “life force” that has never had one whit of evidence to support it. The only benefits are placebo effects, as the sham acupuncture experiments demonstrate. The notion of “meridians” that can be somehow fixed by sticking needles into the skin is laughable. (A 2000 review article concluded that meridians and acupuncture points simply don’t exist.) Berman’s article attempts to give acupuncture credibility by pointing to studies that show, for example,

“Acupuncture has been shown to induce the release of endogenous opioids in brain-stem, subcortical, and limbic structures.”

Without getting into the details (most of these studies are poorly done), it’s no surprise that sticking needles into the skin causes a physiological effect. Duh!

Berman has gone to great lengths to try to show that acupuncture works. One of the studies he cites is his own NIH-funded study of “electroacupuncture”, a treatment that involves sticking in needles and then applying an electrical current. (One wonders how the “ancient” Chinese acupuncturists managed to plug in their needles.) To demonstrate that electroacupuncture releases hormones, they tortured some rats – nearly electrocuted them, in fact. To quote from the study:

“EA [electroacupuncture] intensity was adjusted slowly over the period of approximately 2 min to the designated level of 3 mA, which is the maximum EA current intensity that a conscious animal can tolerate. Mild muscle twitching was observed.”

But hey, what’s wrong with a bit of rat torture in the name of pseudoscience?

Why do I say this is embarrassing? Well, I’m a professor at the University of Maryland. I’m not at the the School of Medicine (where Berman is), which is an independent campus in Baltimore, quite distinct from the much larger main campus in College Park, where I work. But when the headline says “University of Maryland”, it reflects on all of us. And while I can’t prevent Dr. Berman from promoting pseudoscience, at least I can make it clear that he’s not speaking for me.

Dr. Berman is the recipient of millions of dollars in grants from NIH’s National Center for Complementary and Alternative Medicine (NCCAM) (here's one). It’s no surprise, then, that Berman concludes his NEJM article by calling for more research into acupuncture:

“It may also be important to try to identify the optimal candidate for acupuncture on the basis of individual beliefs, expectations, and psychological profile.”

In other words, let’s see if particularly gullible people might be more willing to tell us that acupuncture works. He recommends other studies too, presumably to be funded by NCCAM. Berman’s work is an example of why I have repeatedly called on Congress and the President to eliminate NCCAM. NCCAM’s annual budget of $129 million is an appalling waste, and after >15 years and >$2 billion in funding, it has yet to prove the efficacy of a single “alternative” treatment.

After reviewing the research and acknowledging out that sham acupuncture is just as effective as “real” acupuncture, Berman and colleagues recommend how to treat a hypothetical patient with chronic lower back pain:

“We would suggest a course of 10 to 12 treatments over a period of 8 weeks from a licensed acupuncturist or a physician trained in medical acupuncture.”

This is astonishing: they just finished explaining that acupuncture doesn’t work any better than sham treatment. So why go to a “licensed” acupuncturist, since you can use toothpicks that don’t puncture the skin and get the same effect? Toothpick acupuncture won’t cost $125 per session (that’s $1000 for Berman’s recommended treatment), and it doesn’t carry the very real risk of infection. Based on the evidence reviewed in their own article, Berman et al. are recommending a treatment that seems to border on malpractice.

I hasten to add that the University of Maryland at Baltimore (not my campus!) has many outstanding scientists and excellent research programs. But UMB seems happy to support this rotten apple in its midst (as does NEJM, I should add). It issued a press release about Berman’s article in which Albert Reece, Dean of the medical school, says

“Dr. Berman and his team at the University of Maryland Center for Integrative Medicine are international leaders in the field of integrative medicine; they are among the many innovative, world-class researchers at the University of Maryland School of Medicine.”

I’m afraid I’ll have to disagree with the Dean on that. Berman's Center for Integrative Medicine is an embarrassment to the University, and its presence undermines the efforts of other scientist to understand and treat disease.

But hey, maybe I’m missing something. Perhaps I just have a blockage in my qi.

(For further reading, I highly recommend the excellent blog posts on the Berman et al. study by Mark Crislip, David Gorski, and Steven Novella, all at Science-Based Medicine.)