Australasian Science: Australia's authority on science since 1938

Why Acupuncture Misses the Point

By Marcello Costa

History reveals the sociopolitical factors behind the rise and fall of acupuncture.

Acupuncture, an integral part of traditional Chinese medicine (TCM), has become popular as a stand-alone intervention in a number of countries. However, after extensive investigation it is becoming clear that there’s no evidence-based support for its use.

As part of TCM, acupuncture is a pre-scientific modality. As such, it’s unlikely to be accepted by modern medical scientists.

Acupuncture is based on imaginary structures and undemonstrable “vitalistic” forces. An undetectable immaterial life force, qi, is said to flow through “meridians” in the body. Supposedly circulating within these channels, qi regulates bodily function.

Qi is modulated by 12 bilaterally distributed channels (six Yin and six Yang) supplemented by two midline channels: one in front and one at the back of the body. Disease is said to occur when the flow of qi becomes blocked. TCM advocates unblocking through acupuncture, moxibustion and multiple herbal and animal extracts.

In the 19th century, China started accepting the emerging scientific basis of medicine. The teaching of acupuncture was banned by the Imperial Medical Academy in 1882, and its general use banned in 1929. Meanwhile, modern medicine developed rapidly.

Acupuncture continued as a minor activity until the Chinese Civil War ended in 1950. Not surprisingly, the Communist Party, based on materialist Marxism, rejected TCM, including acupuncture, as superstition.

However, Chairman Mao Zedong revived TCM as part of the Great Proletarian Cultural Revolution of 1966, recognising peasant doctors still using TCM and establishing “barefoot doctors” using a comprehensive manual. The revival increased Mao’s authority among the peasants and has since become part of Chinese nationalism. TCM now plays an important cultural and political role in modern geopolitics.

Despite the overwhelming importance of scientific medicine in China today, supported by the vast majority of health workers, China’s emergence as a political and economic giant has given the traditionalists a further impetus, by supporting TCM with cultural pride, to expand China’s influence worldwide.

The Chinese government promotes TCM heavily. In 2008, the World Health Organisation endorsed an international agreement drawn up in Beijing to support the safe and effective use of traditional medicine within the healthcare systems of member states. In 2011, China signed TCM partnership agreements, promoting greater recognition of TCM with more than 70 countries. A trade agreement with China in 2015 enabled TCM professionals to practise, and TCM methods to be fostered, in Australia.

Globalising aspects of TCM are finding their way into important scientific journals such as Nature, which sponsored an entire section on “traditional Asian medicine”. Interestingly, however, China confers a Bachelor of Medicine degree only on students of modern scientific medicine. Western medicine is highly regarded, while TCM (including acupuncture and herbs) is used mainly by those of lower socio-economic status. Since the early 20th century, the number of TCM practitioners has dropped from 800,000 to 270,000, while western-trained physicians have increased from 87,000 to about 1,750,000. In China, “medicine” implies modern medicine, not TCM.

As acupunctures loses support in medicine, it features increasingly in constellations of alternative interventions within private enterprises that mix, almost randomly, many pseudoscientific interventions under the vaguely attractive umbrella of “wellness”. This hides acupuncture from public scrutiny.

The evidence from decades of study of acupuncture’s effectiveness continues to be weak and inconsistent. There is now more than enough evidence to confidently conclude that it doesn’t work. There is no justification for further studies. It is merely a theatrical placebo based on pre-scientific myths.

All health-care providers who base their treatments on scientific evidence whenever credible evidence is available, but who still include acupuncture as part of their armamentarium, should revise their practice. There is no place for acupuncture in medicine.

Marcello Costa is Matthew Flinders Distinguished Professor and Professor of Neurophysiology at Flinders University.