Sadly, the Washington Post once again falls for acupuncture pseudoscience

It’s like playing whac-a-mole. No matter how many times I write a column showing that some wildly implausible practice is nonsense, new articles pop up claiming “Hey, look at this! It really works!”

So I’m going to try to whack another mole, because people can be harmed by bad information, especially when it comes in the form of medical advice.

Recently the Washington Post ran a column under the headline, “Does acupuncture work for chronic pain? Here’s what the science says.” (The column first appeared back in July, but the Post’s website promoted it again just last week.)

Before giving you the Post’s answer, let me give you the correct answer. No! Not “maybe” or “sometimes” or “we’re not sure.” Acupuncture doesn’t treat anything, and it carries a real risk of harm, particularly from infections. I’ll get to that below.

I’ve written on this topic many times before (in 2013, in 2012, in 2010, and more), and I’ve even called out the Washington Post for their pro-acupuncture pseudoscience (see this column, which I wrote in 2016). The physicians over at Science-Based Medicine have debunked more acupuncture studies than I can count; they’ve even created a special webpage (which I highly recommend) dedicated to explaining the bogus claims that acupuncture proponents make.

Acupuncture, in case you don’t know this, is a practice where people who call themselves acupuncturists (they are not doctors) stick needles into your body to “treat” various conditions. The claim is that these needles can manipulate your vital life force, or “qi”, which runs along supposed acupuncture lines throughout your body.

That’s just wrong. Modern biology has taught us a whole lot about human physiology, and there just aren’t any lines with mystical forces flowing through them. There are nerve fibers, true, but acupuncturists don’t use those. (And if their needles were piercing nerves, it would hurt like heck.)

Acupuncture and qi are part of Traditional Chinese Medicine, or TCM, a collection of largely ineffective and sometimes very harmful folk beliefs. TCM’s popularity started to grow in the mid-20th century when Chairman Mao launched a propaganda campaign pushing it. Mao himself never used TCM, but his government couldn’t afford real medicine, so they convinced people that inexpensive folk medicine was just as good. It wasn’t.

But I digress.

Acupuncturists claim to treat many conditions, but they especially like to claim that they can treat chronic pain, for at least a couple of reasons. First, pain is inherently subjective, so the only way to measure if a treatment is working is to ask the patient. This makes it hard to study objectively. And second, pain symptoms usually wax and wane, even without any treatment. Patients usually want treatment when the pain is at its worst, which means once the pain subsides, the patients will give credit to whatever they were doing at that time. So pain is fertile ground for people selling quack treatments.

Now let’s get to that column in the Washington Post. The column promises to tell you “what the science says,” and it quickly gets to the point, saying yes, it does! First it puts forward the logically flawed (and non-scientific) claim that hey, the U.S. Medicare system now covers acupuncture for back pain, so it must be effective.

Ugh, where do I start? Well, like it or not, Medicare approval of a treatment doesn’t mean the treatment works. (And conversely, some treatments that work are approved for coverage by Medicare.) So that’s just a logical fallacy. I wish it were true that Medicare was purely science-driven, but both the federal and state government have been lobbied for years by acupuncturists (and other purveyors of dubious therapies) to provide public tax dollars to cover their practices. For a deeper dive into these lobbying efforts, I recommend the lengthy takedown by Jann Bellamy explaining that acupuncture is “legalized quackery.”

The Post article then goes on to discuss the science, for which it relies primarily on a single study, a meta-analysis published in 2019 by Andrew Vickers. (The column was written by Dr. Trisha Pasricha, who has sterling credentials, including training at Johns Hopkins Medicine where I also work. Alas, good credentials don’t always mean that you can trust the holder of those credentials, and this is one of those instances.)

Vickers has published multiple meta-analyses, and if he’s shown anything, it’s how easy it is to cherry-pick from the (extensive) acupuncture literature and find studies that prove whatever point you want to make. The Post column asserts that Vickers used 39 “high-quality” studies, but that is debatable. Many of the studies were done in China, which (as Science-Based Medicine physicians David Gorksi and Steven Novella have pointed out) virtually never publishes a negative study of acupuncture.

I’ve done a deep dive into one of Vickers meta-analyses of acupuncture–an earlier one–for one of my medical school classes, where I use it to illustrate how bad studies can be mis-reported by scientists themselves and by the media. I don’t have time to go through it here, but among other problems, Vickers doesn’t seem to understand how placebo controls work.

Here’s what I mean by cherry-picking. Vickers went through 100’s of studies to pick the 39 that he included. One of those supposedly high-quality studies looked at acupuncture for knee arthritis. That study found that both acupuncture and sham acupuncture (the placebo arm) and the same small effect on knee pain, and that patients who received no treatment at all reported more pain than patients. The authors of the study (and Vickers) concluded–wrongly–that because acupuncture was better than nothing, it must be working. Wrong! If you don’t beat the placebo, then your treatment fails.

For a drug trial, failing to beat the placebo means the game is over. But with acupuncture, it means “more studies are needed,” and the whac-a-mole game continues.

Oh, and I should add that as far as knee arthritis goes, the reduction in pain in both the acupuncture and placebo group was much less than has been reported in studies that use ibuprofen.

That’s right, ibuprofen is far better than acupuncture. Not to mention cheaper and more convenient.

If this weren’t enough, a more recent study has already contradicted the Vickers study as physician-blogger Steven Novella pointed out in a recent column. Novella wrote that “the evidence is too low quality to conclude that acupuncture works, as desperate as proponents are to say we can reach that conclusion.” So no, Dr. Pasricha, the latest science does not say that acupuncture works. Quite the opposite.

I’m still understating how badly acupuncture has failed every well-designed study to test its effectiveness. Studies have shown that placing the needles in random locations works just as well as using so-called acupuncture points. Other studies showed that sham acupuncture, where the needles don’t pierce the skin but where subjects believe they did, also works just as well. And “expert” acupuncturists can’t agree on the locations of acupuncture points.

And don’t get me started on acupuncture and the risk of infection. Acupuncturists aren’t trained in real medicine, and they don’t use proper sterile procedures. This means that they don’t necessarily sterilize their hands, or your skin at all of those points where they’re plunging needles into you. There have been thousands reports of infections due to acupuncture (dating back decades), some of them fatal. And because acupuncturists aren’t part of the medical system, we can be virtually certain that infections are under-reported.

Acupuncture isn’t going away any time soon, because people are making money from it, and no matter how many studies show that it’s nothing more than a fiction, those people will keep insisting on more studies. Plus they can point to hundreds of poorly-done studies that claim to show benefits, and argue–as the Post column does too–that “more research is needed.” I’m not making this up: that precise phrase appears in Dr. Pasricha’s article.

There are even scientific journals entirely devoted to acupuncture (here and here, for example), and they make money too, for the for-profit publishers that produce them. So you can be sure that more studies are coming, and some of them will be positive, even though acupuncture is utterly ineffective.

Even so, the Washington Post can and should do better. Here’s my (free) advice for those considering acupuncture: save your money, and just take some ibuprofen.

Washington Post's Science section descends into pseudoscience

The Washington Post has some bad news about migraines.

Every Tuesday, the Washington Post has a special section devoted to Health and Science. It’s usually my favorite section, with features such as “medical mysteries” and highlights of the latest news from the world of science.

Not this week. Instead, the front page of the section featured a lengthy article that was a long anecdote by a woman who firmly believes that acupuncture cured her migraines. The title gave me a feeling of dread: “Acupuncture needles stung, but they cured my migraines” (the online version linked here has a different title). As I feared, there wasn't a whit of science in it.

Let’s get one thing out of the way first: acupuncture is rank pseudoscience. It’s based on a primitive, pre-scientific notion of a “vital force” (for which no evidence exists), usually called qi, that runs through the body along meridians (no evidence for these either). Plunging needles into the meridians is supposed to manipulate this vital force and cure all sorts of things, ranging from pain to infections to cancer. All of this is nonsense. If you want to know more, I recommend Acupuncture Watch; or see Ben Kavoussi’s article explaining how postmodernism, with its notion that all truth is relative, has allowed acupuncture and other mystical, archaic beliefs to gain traction in medical practice; or check out Jann Bellamy’s discussion of acupuncture as “legalized quackery”.

I’ve written about the nonsense that is called acupuncture before (in 2013, and in 2012, and in 2010), so I won’t rehash that here. But it’s really disheartening to see a great (or once-great?) newspaper devote a large chunk of its weekly science section to pseudoscience.

Back to this week’s nonsense article. In this lengthy piece, author Margarita Gokun Silver describes how she began to experience debilitating migraines after the age of 40, which grew worse over time. She tried pain relievers, which worked at first but then stopped working. One expensive pill worked for the migrations but gave her severe nausea. Eventually, she writes, “exhausted by these side effects, I turned again to the Internet.”

Great. Now, there’s nothing wrong with looking for solutions in the Internet–we all do it. But this is an article in the Washington Post Science section! Nowhere does the author describe anything resembling actual science. Instead, she describes how she discovered a “breakthrough” in her yoga class, when another yoga student suggested acupuncture. She decided to give it a try.

(You might be wondering, who is Margarita Gokun Silver? She describes herself as a writer, novelist, and painter–not a scientist or a doctor.)

After several acupuncture sessions, the author tells us, her migraines seemed less frequent, and eventually she decided she was cured. She still gets migraines, but when they get bad she uses acupuncture again. This, she tells us, is her cure.

The entire story is a classic example of how we can fool ourselves into thinking that whatever we tried last is what worked. Migraines come and go, and this woman’s story is not unusual. She had a long series of bad migraines that eventually subsided, and she still gets them. When they were at their worst, she tried everything she could find, and when the episodes became less frequent, she gave full credit to acupuncture. She might just as well have tried chocolate milk, and then written an article claiming “chocolate milk cured my migraines!”

I don’t blame the author (well, not much) for wrongly believing that correlation equals causation. But we have scientific methods that are really, really good at figuring out if a treatment works. Scientists have already looked at this particularly claim, and the bottom line is that acupuncture doesn’t cure migraines. If you don’t believe me, then read the article about treating migraines by Dr. Steven Novella, a Yale neurologist who specializes in headaches, and look at his summary of how not to treat migraines, which points out that

“acupuncture proponents have been able to change the rules of clinical research so that essentially negative or worthless studies of acupuncture are presented as positive.”

Last week's Washington Post Science section was a major fail. I can't imagine why they gave a lengthy forum to a non-scientist to write about pseudoscience. If they wanted to feature a story about migraines, there's plenty of good science out there, even if there's no magical cure. What's next, Washington Post? Will you invite Jenny McCarthy to write about vaccines and autism, or Gwyneth Paltrow to discuss detox treatments? I sure hope not.