Trick or Treatment (8 page)

Acupuncture’s reputation in the West had risen and fallen in less than a decade. It had been praised unreservedly following President Nixon’s visit to China, only later to be treated with suspicion by the medical establishment. This did not mean, however, that Western physicians were necessarily close-minded to the whole notion of acupuncture. The more extraordinary claims might have been unjustified, but perhaps many of the other supposed benefits were genuine. The only way to find out would be for acupuncture to pass through the same protocols that would be required of any new treatment. The situation was best summarized by the American Society of Anesthesiologists, who issued a statement in 1973 that highlighted the need for caution, while also offering a way forward:

The American Society of Anesthesiologists, therefore, was neither accepting nor rejecting the use of acupuncture, but instead it was simply arguing for rigorous testing. These level-headed experts were not interested in anecdotes, but rather they wanted ‘objective evaluation’ with large numbers of patients. In other words, they wanted to see acupuncture submitted to the sort of clinical trials discussed in Chapter 1, which had decided the effectiveness of treatments such as bloodletting and lemon juice for scurvy. Perhaps acupuncture would turn out to be as useless as bloodletting, or perhaps it would be as effective as lemons. There was only one way to find out: do proper research.

During the 1970s universities and hospitals across America began submitting acupuncture to clinical trials, all part of a massive effort to test its impact on a variety of ailments. Some of the trials involved just a handful of patients, whereas others involved dozens. Some tracked the impact of acupuncture in the hours immediately following a one-off treatment, while others looked at long-term treatments and monitored the progress of patients over several weeks or even months. The diseases studied ranged from lower back pain to angina, from migraine to arthritis. Despite the wide variety of clinical trials, they broadly followed the principles that had been laid down by James Lind: take patients with a particular condition, randomly assign them either to an acupuncture group or to a control group, and see if those receiving acupuncture improve more than the control group.

A huge number of trials had been conducted by the end of the decade, so in 1979 the World Health Organization Inter-regional Seminar asked R. H. Bannerman to summarize the evidence for and against acupuncture. His conclusions shocked sceptics and vindicated the Chinese. In
Acupuncture: the WHO view
, Bannerman stated that there were more than twenty conditions which ‘lend themselves to acupuncture treatment’, including sinusitis, common cold, tonsillitis, bronchitis, asthma, duodenal ulcers, dysentery, constipation, diarrhoea, headache and migraine, frozen shoulder, tennis elbow, sciatica, low back pain and osteoarthritis.

This WHO document, and other similarly positive commentaries, marked a watershed in terms of acupuncture’s credibility in the West. Budding practitioners could now sign up to courses with confidence, safe in the knowledge that this was a therapy that genuinely worked. Similarly, the number of patients waiting for treatment began to rise rapidly, as they became increasingly convinced of the power of acupuncture. For example, by 1990 in Europe alone there were 88,000 acupuncturists and over 20 million patients had received treatment. Many acupuncturists were independent practitioners, but slowly the therapy was also becoming part of mainstream medicine. This was highlighted by a British Medical Association survey in 2002, which revealed that roughly half of all practising doctors had arranged acupuncture sessions for their patients.

The only remaining mystery seemed to be the mechanism that was making acupuncture so effective. Although Western doctors were now becoming sympathetic to the notion that needling specific points on the body could lead to apparently dramatic changes in a person’s health, they were highly sceptical about the existence of meridians or the flow of Ch’i. These concepts have no meaning in terms of biology, chemistry or physics, but rather they are based on ancient tradition. The contrast between Western incredulity and Eastern confidence in Ch’i and meridians can be traced back to the evolution of the two medical traditions, particularly the way in which the subject of anatomy was treated in the two hemispheres.

Chinese medicine emerged from a society that rejected human dissection. Unable to look inside the body, the Chinese developed a largely imaginary model of human anatomy that was based on the world around them. For example, the human body was supposed to have 365 distinct components, but only because there are 365 days in the year. Similarly, it seems likely that the belief in twelve meridians emerged as a parallel to the twelve great rivers of China. In short, the human body was interpreted as a microcosm of the universe, as opposed to understanding it in terms of its own reality.

The Ancient Greeks also had reservations about using corpses for medical research, but many notable physicians were prepared to break with tradition in order to study the human body. For instance, in the third century
BC
, Herophilus of Alexandria explored the brain and its connection to the nervous system. He also identified the ovaries and the fallopian tubes, and was credited with disproving the bizarre and widely held view that the womb wandered around the female body. In contrast to the Chinese, European scientists gradually developed an acceptance that dissecting the human body was a necessary part of medical research, so there was steady progress towards establishing an accurate picture of our anatomy.

Autopsies were becoming common by the thirteenth century, and public dissections for the purpose of teaching anatomy were taking place across Europe by the end of the fourteenth century. By the mid-sixteenth century, the practice of dissection for teaching anatomy to medical students had become standard, largely thanks to the influence of such leading figures as Vesalius, who is acknowledged to be the founder of modern anatomy. He argued that a doctor could not treat the human body unless he understood its construction, but un fortunately obtaining bodies was still a problem. This forced Vesalius, in 1536, to steal the body of an executed criminal still chained to the gibbet. His aim was to obtain a skeleton for research. Luckily much of the flesh had already rotted away or had been eaten by animals, so much so that the bones were ‘held together by the ligaments alone’. In 1543 he published his masterpiece,
De Corporis Fabrica
or
The Construction of the Human Body
.

Early European anatomists realized that even the most elementary discoveries about the human body could lead to profound revelations about how it functions. For instance, in the sixteenth century an anatomist named Hieronymus Fabricus discovered that veins contain one-way valves along their length, which implies that blood flows in only one direction. William Harvey used this information to argue in favour of blood circulating around the body, which in turn ultimately led to a clear understanding of how oxygen, nutrients and disease spread through the human body. Today, modern medicine continues to develop by ever-closer examination of human anatomy, with increasingly powerful microscopes for seeing and with ever finer instruments for dissecting. Moreover, today we can gain insights into a living dynamic body, thanks to endoscopes, X-rays, MRI scans, CAT scans and ultrasound – and yet scientists are still unable to find a shred of evidence to support the existence of meridians or Ch’i.

So, if meridians and Ch’i are fictional, then what is the mechanism behind the apparent healing power of acupuncture? Two decades after Nixon’s visit to China had re-introduced acupuncture to the West, scientists had to admit that they were baffled over how acupuncture could supposedly treat so many ailments, ranging from sinusitis to gingivitis, from impotence to dysentery. However, when it came to pain relief, there were tentative theories that seemed credible.

The first theory, known as the
gate control theory of pain
, was developed in the early 1960s, a decade before scientists were thinking about acupuncture. A Canadian named Ronald Melzack and an Englishman named Patrick Wall jointly suggested that certain nerve fibres, which conduct impulses from the skin to more central junctions, also have the ability to close a so-called ‘gate’. If the gate is closed, then other impulses, perhaps associated with pain, struggle to reach the brain and are less likely to be recognized as pain. Thus relatively minor stimuli might suppress major pain from other sources by shutting the gate before the troubling pain impulse can reach the brain. The gate control theory of pain has become widely accepted as an explanation of why, for example, rubbing a painful limb is soothing. Could gate control, however, explain the effects of acupuncture? Many acupuncturists in the West argued that the sensation caused by an acupuncture needle was capable of shutting gates and blocking major pain, but sceptics pointed out that there was no solid evidence to show that this was the case. The gate control theory of pain was valid in other situations, but acupuncture’s ability to exploit it was unproven.

The second theory for explaining the power of acupuncture is based on the existence of chemicals called
opioids
, which act as powerful, natural painkillers. The most important opioids are known as endorphins. Some studies have indeed shown that acupuncture somehow stimulates the release of these chemicals in the brain. Not surprisingly, acupuncturists have welcomed these studies, but again there have been sceptics. They question whether acupuncture can release enough opioids to create any significant pain relief, and they cite other studies that fail to confirm any connection between endorphins and acupuncture.

In short, here were two theories that could potentially explain the powers of acupuncture, but as yet they were both too tentative to convince the medical establishment. So instead of accepting either theory, scientists urged further research. Meanwhile, they also began to propose a separate explanation to account for the pain relief provided by acupuncture. In fact, if correct, this third theory could potentially explain all its supposed benefits, not just pain relief. Unfortunately for acupuncturists, this third theory attributed the impacts of acupuncture to the
placebo effect
, a medical phenomenon with a long and controversial history.

In one sense, any form of treatment that relies heavily on the placebo effect is fraudulent. Indeed, many bogus therapies from the nineteenth century had turned out to be nothing more than placebo-based treatments. In the next section we will explore the placebo effect in detail and see how it might relate to acupuncture. If the placebo effect can successfully explain the apparent benefits of acupuncture, then 2,000 years of Chinese medical expertise would evaporate. If not, then the medical establishment would be forced to take acupuncture seriously.

The power of placebo

The first medical patent issued under the Constitution of the United States was awarded in 1796 to a physician named Elisha Perkins, who had invented a pair of metal rods which he claimed could extract pains from patients. These
tractors
, as he dubbed them, were not inserted into the patient, but were merely brushed over the painful area for several minutes, during which time they would ‘draw off the noxious electrical fluid that lay at the root of suffering’. Luigi Galvani had recently shown that the nerves of living organisms responded to ‘animal electricity’, so Perkins’ tractors were part of a growing fad for healthcare based on the principles of electricity.

As well as providing electrotherapeutic cures for all sorts of pains, Perkins claimed that his tractors could also deal with rheumatism, gout, numbness and muscle weakness. He soon boasted of 5,000 satisfied patients and his reputation was buoyed by the support of several medical schools and high-profile figures such as George Washington, who had himself invested in a pair of tractors. The idea was then exported to Europe when Perkins’ son, Benjamin, emigrated to London, where he published
The Influence of Metallic Tractors on the Human Body
. Both father and son made fortunes from their devices – as well as charging their own patients high fees for tractor therapy sessions, they also sold tractors to other physicians for the cost of 5 guineas each. They claimed that the tractors were so expensive because they were made of an exotic metal alloy, and this alloy was supposedly crucial to their healing ability.

However, John Haygarth, a retired British physician, became suspicious about the miraculous powers of the tractors. He lived in Bath, then a popular health resort for the aristocracy, and he was continually hearing about cures attributed to Perkins’ tractors, which were all the rage. He accepted that patients treated with Perkins’ tractors were indeed feeling better, but he speculated that the devices were essentially fake and that their impact was on the mind, not the body. In other words, credulous patients might be merely convincing themselves that they felt better, because they had faith in the much-hyped and expensive Perkins’ tractors. In order to test his theory he made a suggestion in a letter to a colleague: