When good journals print nonsense. (And good doctors too).

It is hard to believe the drivel some people are prepared to countenance just because it is supposed to be very old drivel. Chen KL, et al. Acupuncture in the neonatal intensive care unit-using ancient medicine to help today’s babies: a review. J Perinatol. 2017;37(7):749-56.

Starting with the questionable premise that acupuncture has been in use for ‘thousands’ of years (a brief summary of the recent history of Acupuncture can be found here)., the authors of this article promote its investigation for pain control in the newborn’. Even if the earliest known possible references to acupuncture (which date from about 100 BCE) do really refer to what we now know as acupuncture, the fact that it is an old system is not necessarily in its favour. For it is based on pre-scientific theories of how bodies work, and the manipulation of non-existent energies (Xi) that flow through non-existent meridians, we would be better to remain extremely sceptical that sticking needles anywhere in the body would have distant effects on specific illnesses, or indeed any reproducible effect at all.

Fortunately we have ditched just about all of “traditional western medicine”, which was also based on a similarly profound lack of understanding of anatomy and of physiology.

What is clear from published research is that there are sometimes small effects of acupuncture, which are reproduced regardless of the site that the needles are stuck into, and that you can get the same effects without sticking the needle in at all. The better a study is designed, the lesser the effects of acupuncture. In studies with complete blinding, using sham acupuncture at random sites in control groups, the small effects of acupuncture are usually identical to the small effects of sham controls. (See here for a review of systematic reviews of acupuncture for pain control which concludes “Numerous reviews have produced little convincing evidence that acupuncture is effective in reducing pain. Serious adverse events, including deaths, continue to be reported”).

Some people have promoted these small effects as evidence that acupuncture harnesses the “placebo effect” (as if that was a good thing) what it really is, is evidence that it does not have a real effect.

Using acupuncture, of any variety, including shining lights on “acupuncture points”, is a totally unethical thing to do in an investigation of pain control in the newborn. To perform a painful procedure and test acupuncture against a known effective analgesic is an idea that should horrify anyone who cares about pain in babies.

The articles quoted in this review include ridiculous nonsense such as the “demonstration of active acupuncture points” in the ears of babies with neonatal abstinence syndrome. The demonstration of these non-existent points is often made with a “machine that goes ping”,

which is what was done in the study they refer to. These are galvanometers of various designs, which are used as  supposed identifiers of acupuncture points, they have never been shown to do anything except go “ping”. It is hard to believe that anyone could swallow the idea that there is a specific point in the ear that can be needled to create specific effects elsewhere in the body, based on totally imaginary “homunculi” like this one.

Far from being thousands of years old, auricular acupuncture was made up in France in the 1950’s. The “machines that go ping” measure electrical conductivity of the skin, which varies according to the angle of the implement, the pressure applied, and how much the skin is stretched: such machines have never been demonstrated to detect any real structure or phenomenon.

Despite its total lack of scientific justification there are unfortunately a couple of studies in newborn infants that have been performed. They, not surprisingly, showed no effect of laser acupuncture or of acupuncture accompanied by electrical stimulation. One of the studies, examining the analgesic effect of laser acupuncture, compared laser acupuncture alone to sucrose alone before heel lancing in newborns, the infants in the sucrose group had less pain; that is a truly unethical trial.

We must not start exposing newborn infants to painful procedures in order to investigate the impact of this nonsense. Acupuncture is nothing more than a theatrical placebo, which is unlikely to impress a newborn infant. As Colquhoun and Novella note “A small excess of positive results after thousands of trials is most consistent with an inactive intervention. The small excess is predicted by poor study design and publication bias…The best controlled studies show a clear pattern, with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work.”

If you can get this nonsense published in a normally high quality journal, maybe I should write a review article about ear candling, or the benefits of homeopathy: or maybe I should set up an “alternative medicine NICU”, it would probably be as effective as Mitchell and Webb’s emergency room.

About keithbarrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged . Bookmark the permalink.

One Response to When good journals print nonsense. (And good doctors too).

  1. Arun Nair says:

    Well said !!
    So should one condemn other complimentary therapies like osteopathy in neonatal population until we have concrete evidence. The problem however is that good journals would continue to publish rubbish. We have to learn to rein in and protect vulnerable babies and their families.
    Arun Nair

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s