EDITOR’S NOTE: Because, for the first time in a year and a half, both professional and personal responsibilities precluded my producing a post for Science-Based Medicine, today is the perfect time to present a guest post by Ben Kavoussi. Ben is a medical informatician with an interest in the scientific evaluation of CAM, as well as a Captain in the Army Medical Service Corps. He also studied to become an acupuncturist himself, and his article is a fascinating look at some little known history behind acupuncture that strongly suggests that it is more akin to astrology than you may be aware of. Certainly I had been unaware of it, and I bet most of our readers are unaware of it, too.

Enjoy!

I’ll be back with a post here next week at the latest.

Astrology with Needles

by Ben Kavoussi, MS, MSOM, LAc

The following is an excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytical and impartial manner. It argues that if the effects of “real” and “sham” acupuncture do not significantly differ in well-conducted trials, it is because traditional theories for selecting points and means of stimulation are not based on an empirical rationale, but on ancient cosmology, astrology and mythology. These theories significantly resemble those that underlined European and Islamic astrological medicine and bloodletting in the Middle-Ages. In addition, the alleged predominance of acupuncture amongst the scholarly medical traditions of China is not supported by evidence, given that for most of China’s long medical history, needling, bloodletting and cautery were largely practiced by itinerant and illiterate folk-healers, and frowned upon by the learned physicians who favored the use of pharmacopoeia.

Heaven is covered with constellations, Earth with waterways, and man with channels.

Acupuncture is presumed to have its origins in blood ritual, magic tattooing and body piercing associated with Neolithic healing practices.^2,3 The Neolithic origin hypothesis is supported by the presence of nonfigurative tattoos on the Tyrolean Ice Man–an inhabitant of the Oetztal Alps in Europe–whose naturally preserved 5,200-year-old body displays a set of small cross-shaped tattoos that are located significantly proximal to classical acupuncture points. Medical imaging shows that the middle-aged man suffered from lumbar arthrosis and the cross-shaped tattoos are located at points traditionally indicated for this condition.^4,5 Similar nonfigurative tattoos and evidence of therapeutic tattooing, lancing and blood ritual have been found throughout the Ancient world, including the Americas.^6,7,8 Health-related tattoos are still prevalent in Tibet, where specific points on the body are needled with a blend of medicinal herbs in the dyes. These practices appear to be largely intended to maintain balance with the natural and spiritual worlds, and also to protect against demonic infestation and malevolence. Seemingly, this Neolithic and Bronze Age lancing heritage, which was intertwined with magic and animism has evolved in various cultures into codified systems of lancing and venesection for assuring good health and longevity. In addition to treating the impurity or superabundance of blood, in various cultures lancing was also believed to affect the flow of a numinous life-force that is, for instance, called qi (or chi, 氣, pronounced “chee”) in Chinese, prāna (प्राण) in Sanskrit, pneuma (πνεύμα) in Greek, etc.⁹ In many instances, elements of metaphysics, mythology, mysticism, magic, shamanism, exorcism, astrology and empirical medicine intimately intertwined, making it difficult for modern scholars to interpret them as mutually exclusive categories.

In China, for instance, the numinous force was believed to mirror the Sun’s annual journey through the Ecliptic–meaning its apparent path on the celestial sphere–and to circulate in a network of 12 primary jing luo (經络) known in English as the chinglo channels or simply channels or meridians (a term coined in 1939 by George Soulié de Morant, a French diplomat). These imaginary pathways run from head to toes and interconnect around 360 primary points on the skin.¹⁰ There is a strong possibility that the web of these channels was a rudimentary model of the vascular system that was conceptualized according to an episteme­–meaning a set of fundamental beliefs–that was based on astrological principles and mythology. This episteme­ also indicated that a person’s health and destiny are determined by the position of the Sun, the Moon, the 5 Planets and the apparition of comets, along with the person’s time of birth.¹¹ In this worldview, each body segment corresponds to one of the 12 Houses of the Chinese zodiac system di zhi (地支) known in English as the Earthly Branches, and which consists of 12 two-hour (30°) divisions of the Ecliptic. The channels are therefore named according to their degree of yin (阴) and yang (阳), from tai yang (太阳) to jue yin (厥阴), which are terms that describe the phases and the positions of the Sun and the Moon.¹² Each has five special points designated by the characters 水 (Water), 木 (Wood), 火 (Fire), 土 (Earth) and 金 (Metal) which are also the Chinese terms for Mercury, Jupiter, Mars, Saturn and Venus,¹³ and seem to correspond to the transit positions of these Planets in the matching House. Each point is also associated with a color, which comes from the visual appearance of the matching Planet in the night sky. Venus is white, Jupiter blue-green, Saturn golden-yellow, Mars red, and Mercury “black,” for it appears to be the dimmest of the five. Each of these points has also an occult connection with a direction, a segment of time, a season, a number set, a taste, a musical note, an internal organ, a body region, etc, in an ancient Chinese metaphysical cosmology often referred to as “correlative cosmology”¹⁴ and reminiscent of the esoteric and mystical beliefs held by Pythagoras of Samos (c. 580-c. 490 BC) and his followers, the Pythagoreans.¹⁵ In his occult and magico-mystical worldview, the nature of the life-force qi is often described in such terms:¹⁶

The major premise of Chinese medical theory is that all the forms of life in the universe are animated by an essential life-force or vital energy called qi. Qi also means “breath” and air and is similar to the Hindu concept of prāna. Invisible, tasteless, odorless, and formless, qi nevertheless permeates the entire cosmos. Qi is transferable and transmutable; digestion extracts qi from food and drink and transfers it to the body, breathing extracts qi from air and transfers it to the lungs. When these two forms of qi meet in the blood-stream, they transmute to form human-qi, which then circulates throughout the body as vital energy. It is the quality and balance of your qi that determines your state of health and span of life.

Other texts refer to qi as a “cosmic spirit that pervades and enlivens all things”¹⁷ and “from which the world was created.”¹⁸ For instance, the alchemist Ko Hung (葛洪, 2nd – 3rd Century AD) writes that “Man is in qi and qi is in each human being. Heaven and Earth and the ten thousand things all require qi to stay alive. A person that knows how to allow qi to circulate will preserve himself and banish illness that might cause him harm.”^{19, 20} The belief in a “cosmological correlation” between its pathways in the body and the Houses of the Chinese zodiac seems to be based on health and safety beliefs in geocentric cosmology and the related doctrine of “as above, so below” which stipulated that everything in the Heavens has its counterpart on Earth and also in man.

The episteme of “as above, so below” and correlative cosmology were prevalent throughout the ancient world, from the Eastern Mediterranean cultures to Northern Europe. It is notably found in the relics of a collection of occult writings called the Corpus Hermetica which are believed to be compiled in Hellenistic Egypt during the 1st or 3rd century AD and are attributed to Hermes Trismegistus (“Thrice-great Hermes”), the Greek equivalent of the Egyptian god of wisdom, Thoth. The original text was presumably lost or destroyed during the systematic annihilation of non-Christian literature between the 4th and 6th centuries AD. Nonetheless, a section of it known as the Emerald Tablet survived and was translated into Arabic by the Muslim conquerors and later into Latin by John of Seville c. 1140 AD and by Philip of Tripoli c. 1243 AD. An Arabic version of the Tablet by the Muslim polymath and alchemist Abu Musa Jābir ibn Hayyān (أبو موسى جابر بن حيان , c. 721-c. 815 AD) states “That which is above is from that which is below, and that which is below is from that which is above, working the miracles of One.”²¹ Given the prevalence of this set of fundamental beliefs throughout the ancient world, it seems that the natural philosophy that has given rise to the underlying theories of acupuncture in China stems from the same set of beliefs in that were also prevalent along the Silk Road in Persia, Mesopotamia, Egypt and in Greece and that have influenced the health and safety beliefs of pre-Christian Europe, such as the Eastern Mediterranean mystery cults,²² such as Mithraic Mysteries.²³ This hypothesis is supported by a statement by Gregor (Gregorius) Reisch (c. 1467-1525) in Margarita Philosophica (Pearl of Wisdom), first published in 1503:²⁴

The pagans believed that the zodiac formed the body of the Grand Man of the Universe. This body, which they called the Macrocosm (the Great World), was divided into twelve major parts, one of which was under the control of the celestial powers reposing in each of the zodiacal constellations. Believing that the entire universal system was epitomized in man’s body, which they called the Microcosm (the Little World), they evolved that now familiar figure of “the cut-up man in the almanac” by allotting a sign of the zodiac to each of twelve major parts of the human body.

Figure 1: European medieval Zodiac Man form John de Foxton’s Liber Cosmographiae, published in 1408. It indicated the repartition of astrological influences on the body which physicians used to determine the auspicious time to let blood. Images courtesy of The Master and Fellows of Trinity College, Cambridge, UK.

Given this fundamental belief, European physicians until the 17^th Century based the practice of medicine on celestial computations, also known as Iatromathematics, astrological medicine or astromedicine. They therefore utilized planetary transition tables called ephemerides or Alfonsine tables to cast a prognostication–meaning a disease outcome prediction based on astrological conjunctions, alignments and the angle between Planets (Aspects)–prior to perform venesection, cupping, cautery, surgery or to prescribe medicines with specific astral powers.²⁵ Disease was then believed to result from interruptions to the flow of the numinous life-force pneuma and an imbalance in the four humors--blood, yellow bile, black bile and phlegm–which were each associated to an Element, a Planet, a color, etc, according to European correlative cosmology. Therapy consisted of purging the offending humor and its noxious pressures during favorable Aspects. Most bloodletters would open a vein in the arm, leg or neck with a fine knife called a “lancet.” They would tie off the area with a tourniquet and hold the lancet delicately between thumb and forefinger and strike diagonally or lengthwise into the vein to avoid severing it. They would then collect the blood in a measuring bowl.²⁶ Initially, according to the classical Greek procedure, blood was let from a site near the location of the illness but later physicians drew a smaller amount of blood from a distant site. This procedure not only required the knowledge of the distal cutting points and the precise amount of blood to draw, but also the knowledge of ephemerides to establish the suitable Aspects and timing. Medieval medical manuscripts therefore contained ephemeris charts (volvelles) and the schematic of a body covered with astrological signs, generally known as “Zodiac Man,” which illustrated the specific influences of astrological signs on body parts and organs (Figure 1) and the location of the associated bloodletting points (Figure 2).

Figure 2: European Bloodletting Man from Hans von Gersdorff’s Feldtbüch der Wundartzney, published in 1528. Bloodletting was done by venesection or the application of leeches. Most of these points correspond to key acupuncture points, such as LV3, UB40, SI3, LI4, LI11, SJ3, LU5, etc. Image courtesy of the National Library of Medicine, US.

The allotment of the zodiacs to each of the major parts of the body started at the head with Ares and ran down to the feet, which belonged to Pisces. Cancer was believed to be responsible for diseases of the lungs and the eyes and Scorpio the genital afflictions, for instance.²⁷ The practice of lancing, bloodletting and cupping (الحجامة, hijama) to affect specific organs or to mitigate specific diseases based on a postulated relationship between the internal organs and points on the surface of the skin is still prevalent amongst the Muslims worldwide and nowadays video instructions for it are available, even on YouTube. It is plausible that the same principle is at the origin of acupuncture channels in China²⁸ because the distribution of the regions of astrological influences and the related venesection points portrayed in medieval Islamic and European manuscripts significantly resembles the allocation of master, command, influential, and other key points (Table 1). It is important to note that Greco-Arabic bloodletting was known in China and fragments of Avicenna’s (c. 980 – 1037) Cannon of Medicine (الطب في القانون) were translated during the time of the Yuan dynasty (1271-1368) and published along with other Persian and Arabic texts in the Hui Hui Yao Fang (回回藥方)–meaning the Prescriptions of the Hui Nation–with much of the text in Arabic.²⁹ The correlation between Chinese acupuncture and bloodletting is further supported by the fact that the Chinese character zhēn (針) etymologically refers to lancing with coarse needles or any sharp object used for scarification, bloodletting and minor surgery.³⁰ In addition, As Paul Unschuld points out, the opening of superficial or deep-lying vessels for bloodletting seems to predate the manipulation of qi with needles.³¹ However, Linda Barnes, in her fascinating book on how China, the Chinese, and their healing practices were imagined in the West from the late Middle Ages through to the mid-19th Century, also argues that there were “sufficient apparent similarities that an early observer might have been excused for imagining that the Chinese and European practices grew from the same conceptual framework.”³² Although she seems to agree with Paul Unschuld’s assessment that acupuncture emerged as an offshoot of bloodletting, she also notes that the early European observers seem to have misunderstood the ways in which the body itself was conceptualized by the Chinese, and assumed that they were simply using a version inferior of the Greek humoral system, and routinely failed to recognize or value an alternate conceptual universe which, in the long run, made it easier for them to dismiss Chinese understandings of the human body.

Table 1: Similarities between Muslim and medieval astromedicine and traditional acupuncture theory. For instance, LU7, a point on the Lung meridian is the command point of the head and the neck; LI4, an important point on the Large Intestine meridian controls the face and the throat; SP4 on the Spleen meridian is used for the diseases of the chest, breast and the stomach. The Kidney meridian controls the genitals; an important point related to San Jiao (UB39) is found on the knee; one related to Gallbladder (GB40) on the ankle; and the most important points of the Liver meridian, LV2-3 are on the feet, etc.³³ Be noted that a two-hour segment is the same time measure than 30°, for the celestial sphere moves by 15° every hour.

Paradoxically, for most of China’s long medical history, lancing, bloodletting, acupuncture and surgery were practiced by itinerant folk-healers and considered a lower class of therapy compared to the use of pharmacopoeia. As the historian Bridie Andrews Minehan describes:³⁴

The lowly acupuncturists engaged in a great deal of minor surgery, and the two specialties of acupuncture (zhenjiu) and external medicine or surgery (waike) overlapped considerably. Illustrations of the nine needles of acupuncture, featured in many handbooks from the late imperial period, depicted scalpel-like knives, cautery irons, and three-edged bodkins for bloodletting and lancing boils, as well as the fine needles we currently associate with acupuncture.

Andrews Minehan also notes that although needling is often cited in the Yellow Emperor’s Canon of Medicine, throughout the history of China relatively little has been written on it elsewhere. Reportedly, by the middle of the second millennium its practice was mostly abandoned, and eventually the Chinese and other Eastern societies took steps to eliminate it altogether.^{34, 35} In 1822 an edict banned its teaching and practice from the Imperial Medical Academy, the institution that provided physicians to the Court. The Japanese government equally prohibited the practice in 1876.³⁶ The final step in China took place in 1929 when it was literally outlawed.³⁷ However, in the early 1930s a Chinese pediatrician by the name of Cheng Dan’an (承淡安, 1899-1957) proposed that needling therapy should be resurrected because its actions could potentially be explained by neurology. He therefore repositioned the points towards nerve pathways and away from blood vessels-where they were previously used for bloodletting. His reform also included replacing coarse needles with the filiform ones in use today.³⁸ Reformed acupuncture gained further interest through the revolutionary committees in the People’s Republic of China in the 1950s and 1960s along with a careful selection of other traditional, folkloric and empirical modalities that were added to scientific medicine to create a makeshift medical system that could meet the dire public health and political needs of Maoist China while fitting the principles of Marxist dialectics. In deconstructing the events of that period, Kim Taylor in her remarkable book on Chinese medicine in early communist China, explains that this makeshift system has achieved the scale of promotion it did because it fitted in, sometimes in an almost accidental fashion, with the ideals of the Communist Revolution. As a result, by the 1960s acupuncture had passed from a marginal practice to an essential and high-profile part of the national health-care system under the Chinese Communist Party, who, as Kim Taylor argues, had laid the foundation for the institutionalized and standardized format of modern Chinese medicine and acupuncture found in China and abroad today.³⁹ This modern construct was also a part of the training of the “barefoot doctors,” meaning peasants with an intensive three- to six-month medical and paramedical training, who worked in rural areas during the nationwide healthcare disarray of the Cultural Revolution era.⁴⁰ They provided basic health care, immunizations, birth control and health education, and organized sanitation campaigns. Chairman Mao believed, however, that ancient natural philosophies that underlined these therapies represented a spontaneous and naive dialectical worldview based on social and historical conditions of their time and should be replaced by modern science.⁴¹ It is also reported that he did not use acupuncture and Chinese medicine for his own ailments.⁴²

It is the reformed and “sanitized” acupuncture and the makeshift theoretical framework of Maoist China that have flourished in the West as “Traditional,” “Chinese,” “Oriental,” and most recently as “Asian” medicine. Nowadays, in every major metropolitan area in the US and in Europe, one can find acupuncture boutiques where practitioners inaccurately claim that gently puncturing the skin with silicon-coated stainless-steel filiform needles is a scholarly medical tradition of ancient China that has been used for over 2,000 years to relieve pain and to treat a variety of diseases. Meanwhile and despite what is reported by the advocates, this gentle insertion of fine needles at specific points on the skin has consistently failed in well-conducted trials to show compelling evidence of efficacy for conditions that are amenable to specific treatments.^{43, 44} And whatever the clinical efficacy of any type of needling therapy, there is still no convincing evidence that meridians exist as discrete entities distinct from blood vessels.⁴⁵

ADDENDUM:

My sincerest apologies to Linda Barnes for citing her work as simply arguing that there are sufficient similarities between needling in China and bloodletting in Europe to warrant the belief that both practices grew from the same conceptual framework. Indeed, the full citation is substantially more nuanced and complex, and corrections were made to reflect her full argument. I appreciate her bringing this to my attention.

 REFERENCES:

1. Veith I (Translator). The Yellow Emperor’s Classic of Internal Medicine. University of California Press, 1st edition. 2002.
2. Ernst E. Acupuncture – a critical analysis. J Intern Med. 2006; 259(2):125-137.
3. Ramey D, Buell PD. A true history of acupuncture. Focus Altern Complement Ther. 2004;9:269-273.
4. Dorfer L, Moser M, Spindler K, Bahr F, Egarter-Vigl E, Dohr G. 5200-year-old acupuncture in central Europe? Science. 1998;282(5387):242-243.
5. Dorfer L, Moser M, Bahr F, et al. A medical report from the Stone Age? Lancet. 1999;354:1023-1025.
6. Smith, GS, Zimmerman R. Tattooing Found on a 1600 Year Old Frozen, Mummified Body from St. Lawrence Island, Alaska. American Antiquity 40(4): 433-437. 1975.
7. Garcia, Hernan and Antonio, Sierra. Wind in the Blood – Mayan Healing & Chinese Medicine. Redwing Books, 1999.
8. Villoldo A. Shaman, Healer, Sage. Hamony Books, 2000.
9. Lao Tzu (Author), Mair VH (Translator). Tao Te Ching: The Classic Book of Integrity and the Way. New York. Bantam Books. 1990.
10. Whorton JC. Nature Cures: The History of Alternative Medicine in America. Oxford University Press, 2004.
11. Wu AS. Chinese Astrology. The Career Press, Inc. 2005.
12. Lo V. The territory between life and death. Essay review. Med Hist. 2003 Apr;47(2):250-8.
13. Walters D. Chinese Astrology. Aquarian Press. 1987.
14. Pregadio F. Great Clarity: Daoism and Alchemy in Early Medieval China. Stanford University Press, 1st edition. 2006.
15. Burkert W. Lore and Science in Ancient Pythagoreanism. Harvard University Press, Cambridge, MA. 1972.
16. Reid D. Chinese Herbal Medicine. Shambhala. 1987.
17. Pas JF. Historical Dictionary of Taoism. The Scarecrow Press, Inc. 1998.
18. Religion of Tao. Center of Traditional Taoist Studies. www.tao.org. Accessed September 2008.
19. Fischer-Schreiber I. The Shambhala Dictionary of Taoism. Shambhala. 1st edition. 1996.
20. Ware J. Alchemy, Medicine and Religion in the China of A.D. 320. The Nei P’ien of Ko Hung (Pao-p’u tzu). Cambridge (Mass.): M.I.T. Press, 1966. Reprint. New York: Dover Publications, 1981.
21. Holmyard EJ (editor) The Arabic Works of Jabir ibn Hayyan. New York, E. P. Dutton. 1928.
22. Kingsley P. Ancient Philosophy, Mystery, and Magic: Empedocles and Pythagorean Tradition. Oxford University Press. 1997.
23. Copenhaver, BP (Editor). Hermetica: The Greek Corpus Hermeticum and the Latin Asclepius in a New English Translation, with Notes and Introduction. Cambridge. 1992.
24. Reisch G. Margarita Philosophica, Hoc Est Habituum Sev Disciplinarum Omnium. Basileæ 1583.
25. Jackson WA. A Short Guide to Humoral Medicine. Trends Pharmacol Sci. 2001 Sep;22(9):487-9.
26. Starr D. Blood: An Epic History of Medicine and Commerce. Knopf. 1st edition. 1998.
27. Manilius M (author), Goold GP (Translator). Manilius: Astronomica. Harvard University Press. 1977.
28. Epler DC Jr. Bloodletting in early Chinese medicine and its relation to the origin of acupuncture. Bull Hist Med. 1980 Fall;54(3):337-67.
29. Alpher JV (Editor) Oriental Medicine: An Illustrated Guide to the Asian Arts of Healing. Serindia. United Kingdom, 1st Edition 1995.
30. Hall H. Puncturing the Acupuncture Myth. Science-Based Medicine. Posted on October 21, 2008. Accessed November 2008. http://www.sciencebasedmedicine.org/?p=252.
31. Unschuld PU. Medicine in China: A History of Ideas. University of California Press. 1988.
32. Barnes LL. Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press. 2005.
33. Kim HB. Handbook of Oriental Medicine. Harmony & Balance Press; 3rd Edition. 2007.
34. Andrews BJ. History of Pain: Acupuncture and the Reinvention of Chinese Medicine. APS Bulletin. May/June 1999;9(3). 5.
35. Unschuld PU: The past 1000 years of Chinese medicine. Lancet Suppl SIV9:354, 1999.
36. Skrbanek P: Acupuncture: Past, present and future, in Stalker D, Glymour C (editors): Examining Holistic Medicine. Buffalo, NY, Prometheus Books. 1985.
37. Ma KW. The roots and development of Chinese acupuncture: from prehistory to early 20th century. Acupunct Med 1992;10(Suppl):92-9.
38. Andrews B. Tailoring Tradition: The Impact of Modern Medicine on Traditional Chinese Medicine, 1887-1937. In Alleton V and Volkov A (editors). Notions et Percpetions du Changement et Chine. Paris: Collège de France, Institut des Hautes Études Chinoises. 1994
39. Taylor K. Chinese Medicine in Early Communist China, 1945-63; A Medicine of Revolution, RoutledgeCurzon, 2005.
40. Scheid V. Chinese Medicine in Contemporary China: Plurality and Synthesis. Duke University Press, 2002.
41. Schram SR. The Political Thought of Mao Tse-Tung. New York: Praeger Publishers. 1969.
42. Basser S. Acupuncture: a history. Sci Rev Altern Med 1999;3:34-41.
43. Ernst E, White A, eds. Acupuncture: A Scientific Appraisal. Oxford, UK: Butterworth-Heinemann. 1999.
44. Ernst E. The recent history of acupuncture. Am J Med. 2008 Dec;121(12):1027-8.
45. Ernst E. Complementary medicine: the facts. Phys Ther Rev 1997;2:49-57.

One of the fathers of critical thinking and skeptical inquiry, the French philosopher Bernard le Bovier de Fontenelle (1657–1757) recounts in 1687 in his Histoire des oracles–a debunking book on popular beliefs, myths and superstitions that caused tremendous stir in theological and philosophical circles of his time–a colorful story that could very well illustrate the flurry of interest and research in acupuncture that followed a 1971 anecdotal account of its use in China, and the plethora of verbiage and publications that ensued. If the story of the Tooth of Gold is comical, colorful and amusing, its applicability to acupuncture is not.

In 1593, the rumor ran that a seven year old in Silesia grew a tooth of gold in place of one of the cheek tooth he lost. Horatius, professor of medicine at the University of Helmstad, wrote a history of this tooth in 1595 and alleged that it was partially natural, partially miraculous, and that it was sent by God to this child to console the Christians that were oppressed by the Turks. Just imagine what consolation and what concern this tooth might bring to the Christians or to the Turks. For this tooth not to lack historians, Rullandus rewrote its history in the same year. Two years later, Ingolsteterus, another learned man, wrote against the views of Rullandus on the tooth of gold; to which Rullandus immediately wrote a fine and wise reply. Another great man named Libavius gathered all that had been written on this tooth and added his own views. Nothing lacked to these many fine books, other than the tooth were truly of gold. When the goldsmith examined it, he found that it was made of a leaf of gold skillfully applied to the tooth; but they began by writing books and then they consulted the goldsmith.¹

Translated from French by the author

Besides the glut of popular publications on Chinese acupuncture and medicine by wishful authors without any training in biomedical sciences and healthcare, the NIH, the NCCAM, and some of our most prodigious medical universities also have official and academic publications on the subject that too well resemble the fine and wise publications of Horatius and his contemporaries. They also began by writing books and articles on the theories that could explain the purported indications of acupuncture, and then they assessed the veracity these indications in clinical trials and according to the principles of evidence-based medicine.

The rumor ran this time in 1971, when James Reston, a journalist in President Nixon’s press corps, reported in an article in The New York Times to have experienced relief by acupuncture for his postoperative abdominal distension. Within the following months, journalists, scientists and physicians made pilgrimages to China, most reporting in the popular press, and a few in scientific journals, that thousands of successful operations were being carried out in PRC using acupuncture anesthesia; some described its use for a host of conditions; other went as far as claiming its miraculous efficacy for treating paralysis and deafness!²

For acupuncture not to lack authors and historians, many holistic health gurus who did not have any knowledge of the history of medicine in China or in the West; who lacked familiarity with the Chinese language and cultural linguistics; and who have never–or, at best, for short periods–been to China,³ also turned their Countercultural fantasies about the “Mythical Orient” into a series of introductory books on the “Foundation of Chinese Medicine,” or on “Understanding Chinese Medicine” and portrayed a set of astrology-based beliefs that throughout the history of China have been associated with astral magic, amulets and talismans, and frowned upon by the leaned physicians,⁴ as gentle, humane, natural, organic, holistic and patient-centered therapies that are free from the constraints of the so-called repressive rationality of industrialized medicine. Certain went as far as associating the health and safety mythologie of Bronze-Age China with emergentism and naturalism, and metaphorically described them as a “Web That Has No Weaver.”

Meanwhile, numerous clinical trials were also initiated, often poorly-conducted and biased, and their results too often suggested that acupuncture is effective for a surprisingly wide range of conditions.⁵ Finally in 1997, the NIH resorted to a panel of scientists and experts, “to provide health care providers, patients, and the general public with a responsible assessment of the use and effectiveness of acupuncture for a variety of conditions.” In the published Consensus Statement that gathered their views, the NIH claimed that there is “clear evidence” that needle acupuncture is effective for a long list of conditions and perhaps beneficial for many others.⁶

In the sobering decade that followed, systematic reviews of literature, notably one by Howard H. Moffet of Kaiser Permanente Division of Research, indicated that although acupuncture can affect outcomes and is distinguishable from a placebo, trials that compare distinct needling regimens often do not indicate statistically significant differences in outcomes. Indeed, the dominant scientific rationale for acupuncture involves the release of neurochemicals (such as endorphins) by the irritation and injury it causes, but there is little evidence that this release depends on any specific points or means of stimulation. Therefore, traditional theories for selecting points and stimulation methods appear to be unreliable for creating distinct regimens in clinical trials. Furthermore, since the difference between “real’’ and “sham” (control) treatments has not been clearly demonstrated, Moffet’s review concluded that most acupuncture clinical trials lack any scientific rationale to justify any specific regimens, and  that the theoretical basis and logic for acupuncture practice and research need to be re-evaluated.⁷

A most recent, as-yet-unpublished NIH-sponsored three-arm trial on chronic back pain also seems to confirm these conclusions. The subjects received either an individualized regimen according to the traditional acupuncture theories, or a standardized regimen, or sham (control) needling. Results demonstrate that acupuncture added to usual care was superior to usual care alone, but different regimens were not more effective than control needling.⁸ These results indicate that the observed actions of acupuncture are either due to the placebo effect, or to the irritation and injury caused by the insertion of a needle, and they in fact are independant of the traditional theories for selecting points and stimulation methods.

Deplorably, these results also indicate that in an era when pharmacogenomics and therapeutic cloning appear to be not-too-distant possibilities, medical inquiry and publication can still be based on rumor and hearsay in the press and in the popular culture, and lead to much illusory verbiage before scientific rigor and skeptical inquiry could assess their veracity, just as it happened about 500 years go, in 1593!

REFERENCES:

1. Fontenelle BLB (Author), Bergier J (Editor). Fontenelle: Entretiens sur la Pluralité des Mondes suivi de Histoire des Oracles. Marabout Université. 1973. 
2. Reisser PC, Reisser TK, Weldon J. New Age Medicine: A Christian Perspective on Holistic Health. Intervarsity Press. 1988.
3. Bauer M. An Interview With Dr. Paul Unschuld, Acupuncture Today. July, 2004, Vol. 05, Issue 07.
4. Barnes LL. Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press. 2005
5. Ernst E. The recent history of acupuncture. Am J Med. 2008 Dec;121(12):1027-8.
6. National Institutes of Health. Acupuncture. NIH Consensus Statement. 1997;15(5):1-34.
7. Moffet HH. Traditional acupuncture theories yield null outcomes: a systematic review of clinical trials. J Clin Epidemiol. 2008 Aug;61(8):741-7. Epub 2008 Jun 6.
8. Low-back pain: NACCAM Symposium features two researchers. Focus Complement Alt Ther. 2007;XIV(4):4-6.

The following is the second adapted excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytical and impartial manner. This section argues that the current flurry of interest in acupuncture and Oriental Medicine stems predominantly out of postmodern opposition to Enlightenment rationalism, and bears witness to Orientalism and consumerism in contemporary medicine.

In five years, from 1971 to 1975, l directly experienced Est [Erhard Seminars Training], gestalt therapy, bioenergetics, rolfing, massage, jogging, health foods, tai chi, Esalen, hypnotism, modern dance, meditation, Silva Mind Control, Arica, acupuncture, sex therapy, Reichian therapy and More House — a smorgasbord course in New Consciousness.¹

 Jerry Rubin (1938 – 1994)

Although acupuncture has been known in the US since the 19^th Century, its therapeutic claims were dismissed or judged to be “much overrated” by the medical community.^2,3 Nonetheless, the publication of a report in the New York Times by James Reston, a reporter in President Nixon’s press corps who had received acupuncture for postoperative cramps in Beijing in 1971 changed this perception, and triggered a flurry of interest amongst the American public and some in the medical community.⁴ Within the following months, journalists, scientists and physicians rushed to China to withness this peculiar phenomenon, which the popular press and a few scientific journals sensationalized by reporting that thousands of successful operations of all sorts were being carried out in PRC using acupuncture anesthesia; some elaborated on its widespread use for a myriad of conditions, to include paralysis and deafness!⁵

These unconfirmed claims in the heady social and intellectual climate of the 1970s–meaning the American Counterculture; the rejection of mainstream values, beliefs and ideals; the youth movement, nonconformism and the hippie subculture, the belief in a “New” and  “Cosmic” consciousness and the cult phenomenon; revolutionary ideas mixed with environmentalism; organic farming and the avoidance of pollution, agrochemicals and pharmaceuticals; nonconformism and alternative lifestyles; a syncretistic mix of psychedelic drugs, Eastern religions and Native American spiritualities; the resurgence of the taste for mystic, occult, and magical phenomena;^6,7 and the belief in the existence of a separate and non-ordinary reality, as upheld by one of the fathers of the New Age movement, Carlos Castaneda⁸–gave the justification to view acupuncture as a “heal all” therapy based on alternate perceptions of health and disease.  This amalgamation happened precisely when a whole generation of disenchanted Westerners were eager to find novel solutions for their existential predicaments; one that would be free from the constraints of the so-called “repressive rationality” of modern science in “overdeveloped” societies.^9,10. Most Western publications on acupuncture therefore fostered the belief that Eastern healing arts have crucial characteristics directly and unequivocally opposite to the repressive rationalism of the West.

This unfounded belief seems to stem out of our collective amnesia about lancing and bloodletting, and the belief in the existence of pneuma, or other vitalist notions that have been part of European natural philosophy and medicine since the Greek Antiquity. Indeed, as a result of successive epistemological ruptures¹¹ during the last five centuries, medicine in the West has gradually evolved from late medieval astromedicine and humoral pathology to the molecular medicine and cellular pathology of today. Therefore, fundamental notions that once underlined European medicine have gradually become so foreign to us that their Eastern counterparts now seem to be based on worldviews fundamentally different than ours. But in the eyes of many historians and epistemologists, they have always appeared as similar to ideas that prevailed in Pre-Enlightenment Europe, and based on which the Fasciculus Medicinae¹² and other late medieval medical treatises were written.

These ideas continue to find an audience in todays’s post-Counterculture era due to the continued postmodern opposition to Enlightenment rationalism and the claim that modern science does not provide more access to the truth than any other fields of knowledge–that scientific discourse is mainly just another coherent “narrative” or “language-game” governed by a set of protocols and a special terminology.^13,14 In this climate of incredulity toward “metanarratives” and universal knowledge, many nonscientific forms of knowledge have gained legitimacy and popularity as a result of the prevalence of postmodern culture, politics and economics. Many ancient, folkloric and traditional systems of medicine have thus appeared as compelling narratives, perceived by patients as legitimate and equivalent but opposite to the logical empiricism of modern science.

The persistence of such ideas is also due to what the late Edward Saïd (1935–2003) has called Orientalism. In a 1978 publication by the same name, Saïd convincingly argued that the idea that Eastern cultures have crucial characteristics directly and unequivocally opposite to the West is a Western construct that “exotices” the East while neglecting considerations of power. Saïd argued that the alleged distinction between Oriental and Occidental thought primarily derives from a set of scholarly and popular fantasies about Eastern civilizations, Classical Eras, Golden Ages, scriptures, works of art, philosophies and religions where mysticism is set against the rationalism and detachment of the West.¹⁵ Saïd also argued that this mythical Orient is a mere fiction that serves to represent the hidden desires of Western cultures, a mysterious “Other” onto which we project our fantasies.¹⁶ The pervasiveness of such projected fantasies about Eastern reactions to health and disease onto acupuncture and Chinese medicine, certainly confirms Saïd’s argument. The fictional character of this “Other” medicine can be further perceived in the indecisiveness of the professional associations and the regulatory agencies to refer to acupuncture and related modalities as “Chinese,” “Oriental,” “Asian” or “Eastern,” for these utterly broad “umbrella” categorizations are based on political correctness, and do not correspond to any geopolitical and historical reality other than a geographical and philosophical “orient”-ation.

Paradoxically, while the theme of “evidence of effectiveness” was gradually becoming a central part of international, national, and regional public health dialogue in the 1980s and 1990s,¹⁷ medical Orientalism became an important commercial phenomenon by becoming synonymous with the fashionable and eclectic New Age notions of “natural,” “alternative,” “holistic” or “integrative,” and has since catered to health-consumers who aspire towards traditionalism and spirituality,¹⁸ and who believe in a vast spectrum of ideas and practices sourced by Eastern religions, paganism, alternative science, astrology, and a range of other beliefs emanating out of a general interest in the paranormal.^19,20 In a fascinating article on cults in American, Camille Paglia explains how the New Age movement gradually became an international commercial success in the 1990 with specialty shops and mail-order catalogs supplying the “ritual paraphernalia of amulets and talismans, healing crystals, angel icons, incense, candles, aromatherapy bath salts, massage rollers, table fountains, wind chimes, and recordings of trance music in Asian or Celtic moods.”²¹ To this, she could have added herbal products, various types of yoga, chakra and energy healing, tai chi, qi gong, reflexology, reiki, shiatsu and also acupuncture, where, as Robert Frank and Gunnar Stollberg have argued, “physicians tailor their practice to the individual patient’s (perceived) demands.”²² This international commercial success has undeniably benefited China’s export of medicinal herbs and acupuncture related products, especially when their domestic use is in sharp decline due to the broader availability of modern medicine in a country that strives to reach the top in science and technology. 

At last, considering how the popular press in the 1970s created an enormous interest for acupuncture in the West; how many books by authors who often did not have any familiarity with Chinese history, culture and language popularized a set of unexamined assumptions about the mythical Oriental and its medicine; and how they persists merely due to a set of social, intellectual and economical factors; it is pertinent to evoke Bernard le Bovier de Fontenelle’s (1657–1757) words of wisdom, who in 1687 in Histoire des oracles wrote what should be the “mantra” of all serious endeavor and publication in alternative medicine: “if the truth of a fact were always ascertained before its cause inquired into, or its nature disputed, much ridicule might be avoided by the learned.”²³

REFERENCES:

1. Cross G. An All-Consuming Century: Why Commercialism Won in Modern America. Columbia University Press. 2000.
2. Cassedy J. Early uses of acupuncture in the United States, with an addendum (1826) by Bache F, MD. Bull N Y Acad Med 1974; 50: 892–906.
3. Gross S. A System of Surgery. Philadelphia: Blanchard & Lea, 1: 1859.
4. Reston J. Now, about my operation in Peking; Now, let me tell you about my appendectomy in Peking. New York Times. July 26, 1971:1.
5. Reisser PC, Reisser TK, Weldon J. New Age Medicine: A Christian Perspective on Holistic Health. Intervarsity Press. 1988.
6. Turner F. From Counterculture to Cyberculture: Stewart Brand, the Whole Earth Network, and the Rise of Digital Utopianism, University of Chicago Press. 2006.
7. Roszak T. The Making of a Counter Culture: Reflections on the Technocratic Society and Its Youthful Opposition. University of California Press; New Ed edition. 1995.
8. Castaneda C. The Teachings of Don Juan: A Yaqui Way of Knowledge. University of California Pres. 1968.
9. Unschuld PU The reception of Oriental medicine in the West. Lecture given in Kobe, Japan, May 1995. www.paradigm-pubs.com/sites/www.paradigm-pubs.com/files/u1/reorme.pdf. Accessed March 2009.
10. Marcuse H. One-Dimensional Man: Studies in the Ideology of Advanced Industrial Society. Beacon Press. Boston. 1964.
11. Bachelard G. Formation of the Scientific Mind. Clinamen Press, Manchester. 2002.
12. Ketham, J de. The Fasciculus Medicinae of Johannes de Ketham, Alemanus : facsimile of the first edition of 1491. With English translation by Luke Demaitre ; commentary by Karl Sudhoff ; trans. and adapted by Charles Singer. Birmingham: Classics of Medicine Library, 1988.
13. Lyotard JF, Thébaud JL, Godzich W (translator). Just Gaming. University of Minnesota Press, Minneapolis, 1985.
14. Powell J. Postmodernism For Beginners. New York: Writers and Readers. 1998.
15. Powell J. Easter Philosophy For Beginners. New York: Writers and Readers. 2000.
16. Sim S. Introducing Critical Theory. Totem Books. 2002.
17. Anderson LM, Brownson RC, Fullilove MT, Teutsch SM, Novick LF, Fielding J, Land GH. Evidence-based public health policy and practice: promises and limits. Am J Prev Med. 2005 Jun;28(5 Suppl):226-30.
18. Sedgwick M. Against the Modern World: Traditionalism and the Secret Intellectual History of the Twentieth Century. Oxford University Press, 2004.
19. Siapush M. Post-modern values, dissatisfaction with conventional medicine and popularity of alternative therapies. J Sociol 1998; 34: 58-70.
20. Partridge CH. The Re-enchantment Of The West: Alternative Spiritualities, Sacralization, Popular Culture, and Occulture. T. & T. Clark Publishers. 2005.
21. Paglia C. Cults and Cosmic Consciousness: Religious Vision in the American 1960s, Arion, Winter 2003.
22. Frank R, Stollberg G. Medical acupuncture in Germany: patterns of consumerism among physicians and patients. Sociol Health Illn. 2004 Apr;26(3):351-72.
23. Fontenelle BLB (Author), Bergier J (Editor). Fontenelle: Entretiens sur la Pluralité des Mondes suivi de Histoire des Oracles. Marabout Université. 1973. 

The state of California (CA) which is home to the most advanced education and research in biomedical sciences, computational biology, genomics and proteomics, etc, is also home to 19 institutions that have state-approved training programs in Traditional Chinese Medicine (TCM), a pseudo-medicine that is based on ideas and practices sourced by ancient cosmology, mythology, astrology, and a range of other pre-scientific beliefs that have been partially “sanitized” during the Maoist era.

Emerging out of the recent hype about complementary and alternative medicine (CAM), the educational curricula of these institutions include the study of acupuncture’s point-and-meridian system, the health and safety beliefs of ancient and medieval China, humoral pathology, herbalism, Asian massage, and a limited amount of modern biomedical sciences at a level below what is required from vocational nurses. These curricula are supposed to provide the necessary knowledge and skills for the graduates to pass a comprehensive state licensing exam and provide “primary” healthcare in CA. However, pursuant to CA Code of Regulations, Title 16, Section 1399.451(b) it is improper for these “primary” healthcare providers, “to disseminate any advertising which represents in any manner that they can cure any type of disease, condition or symptom!” Nonetheless, both the internet and the local press abound with ads by CA licensed practitioners who claim that acupuncture can cure or mitigate many diseases, ranging from allergies and infertility to stroke and paralysis.

Under the banner of CAM, a handful of these practitioners also advertise that they can communicate with spirits and heal with crystals, colors or sounds; they practice healing touch (reiki) and distance healing (via PayPal!); provide spiritual counseling and ministerial services, and make implausible medical claims such as healing a chronic condition with just one needle!

All 19 programs are approved by the CA Department Affairs’ (DCA) Board of Acupuncture, since CA law requires that the content of an acupuncture training program be assessed and approved by the State.

Baffled by the absurdity of some of the content of these programs and the outrageous claims of some of the graduates, I addressed the DCA’s Board of Acupuncture on June 20, 2008, to request the repeal of state-approved healthcare programs that endorse the teaching of vitalism, metaphysics and snake-oil-science. To clarify the matter, I reminded the Board that vitalism is a doctrine that stipulates that the functions of a living organism are due to a transcendental vital faculty distinct from physicochemical forces, which distinguishes living organisms from non-living matter. Vitalism was the fundamental dogma of natural sciences and medicine in the West until the 19th Century where disease was believed to derive from interruptions to the flow of a vital principle, called pneuma, and imbalances in four humors. Eastern traditions have similar notions such as qi in China, ki in Japan and doshas in India. I also reminded the Board that vitalism was disproved in the 19th Century by Friedrich Wohler who showed that it is possible to synthesize an organic substance in the laboratory. Louis Pasteur disproved a related concept called “spontaneous generation.” More recently, Stanley Miller, during a landmark experiment in 1953, demonstrated that organic substances could be created by very simple physical processes from inorganic substances.

The counterargument presented by the former Chair of DCA’s Acupuncture Board, Dr. Adam Burke, is instrumental in understanding the thought process behind the official legitimization of voodoo science and New Age nonsense in the Golden State. Dr. Burke, who is also a Senior Research Advisor to the American Association of Oriental Medicine and the Co-Director of the Institute for Holistic Healing Studies at San Francisco State University (SFSU), stated that:

If you biomedicalize it all… if we strip the history and the philosophy and the understanding of that, we have shut out millennia of understanding of human illness that could enrich our understanding of healing people. That would be such a historic loss… I don’t think we’ll completely understand these things. The Journal of Alternative and Complementary Medicine, also Mary Ann Liebert, hardcore, very big science journal editor – Distant Healing. They don’t know how but some of the people at the Institute of Noetic Sciences, which was founded by an astronaut, up in Marin, they are doing research on distant healing. They principle investigator is a physicist. They are getting their research published in the best physics journals in the United States. They’re trying to show the physical nature of these phenomena. We don’t understand them but it’s not metaphysics. I mean I wish there had been more metaphysics when I was in school and I don’t imagine schools have gone backwards. I imagine they are going more towards integrative medicine.

Now, does not this sound like the ultimate in anti-rationalism and anti-science coming from the Chair (former) of a State Board with the mandate of protecting the public health, safety and welfare? The entire text is available at the following link:

www.acupuncture.ca.gov/about_us/minutes/20080620.pdf

A few weeks later, I got an official letter from the DCA, stating that after careful review, the Board had not found anything objectionable in the curricula of state-approved TCM schools.

I gather that the dreadful mixture of anti-intellectualism, anti-rationalism and low expectations at the New Age of Unreason is doomed to remain the basis for many public health policies in the Golden State. And as long as Chinese metaphysics and vitalism are perceived as anything but pre-scientific and disproved worldviews, pseudo-doctors and purveyors of TCM woo-woo will continue to provide the community of believers with medical astrology, alchemy, humoral pathology and even dialogue with the dead, heal with incantations, crystals, colors or sounds, remotely or via touch, and make implausible medical claims–all with the full blessing and endorsement of the CA Department of Consumer Affairs.

Editor’s Note: Please be aware that Ben is deployed in Iraq right now. What that means is that his Internet access is somewhat sporadic. He will show up from time to time to answer comments, however.

ERRARE HUMANUM EST, SED PERSEVERARE DIABOLICUM
- To err is human, but to persist diabolical -

Lucius Annaeus Seneca (c. 4 BC – 65 AD)

The California (CA) Department of Consumer Affairs (DCA) has an informational booklet on Acupuncture and Asian Medicine that besides depicting many New Age fantasies about prescientific medicine, also makes the unfounded claim that based on a 1997 consensus panel, the NIH formally “endorses” the use of acupuncture for a set of specific conditions, and that there is “clear evidence” that it is effective for some of them. This booklet is available at:

http://www.acupuncture.ca.gov/pubs_forms/consumer_guide.pdf

Wondering about this “clear evidence,”  I wrote a letter a few months ago to the National Center for Complementary and Alternative Medicine (NCCAM) and asked for a clarification.

Their candid response explicitly stated that the CA booklet “misstates the purpose of the 1997 consensus panel on acupuncture.” The NCCAM also added that as a “Federal research agency, the NIH does not endorse any product, service or treatment, nor are NIH consensus documents statements of policy.”

I also found out that the NIH Consensus Development Program’s website has now a disclaimer concerning the 1997 consensus statement on acupuncture:

This statement is more than five years old and is provided solely for historical purposes. Due to the cumulative nature of medical research, new knowledge has inevitably accumulated in this subject area in the time since the statement was initially prepared. Thus some of the material is likely to be out of date, and at worst simply wrong.¹

I therefore wrote to the CA Acupuncture Board to inform them of their misstatements. Not receiving an answer, I took the matter to Secretary Fred Aguiar, the Director of CA State and Consumer Services Agency, which oversees the DCA and the Acupuncture Board.

Here is where things went from error and misstatement to persistence in ignorance.

The response letter I finally received from the DCA indeed stated that:

The Board and its legal counsel, LaVonne Powell, concur that the consumer’s guide does not contain erroneous statements on the efficacy of acupuncture.  The Board states that the 1997 consensus statement released by the NIH, a part of the U. S. Department of Health and Human Services, clearly states that “there is clear evidence that needle acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting and probably for the nausea of pregnancy.”  In addition to other supporting statements, the report stated that continued access to qualified acupuncture professionals for appropriate conditions should be ensured.  The report concluded that there was sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.

While the Board acknowledges that the 1997 NIH consensus statement does not specifically state that they “formally endorse” the use of acupuncture, supporting statements in the report could be defined as an endorsement.  However, prior to reprinting the consumer’s guide, the Board will contact the NIH for their input concerning this issue.  If warranted, appropriate changes will be made to the consumer’s guide prior to printing.

In other words, while the NCCAM (one of the institutes that make up the NIH) maintains that the NIH does not endorse any product, service or treatment, and that it is a misstatement to say that the 1997 NIH consensus panel of scientists has found clear evidence of efficacy, CA bureaucrats and their attorney insist it is otherwise!

Also, it seems safe to presume the Board and DCA have remained willfully blind to the well-conducted research since 1997 that has found very little evidence of efficacy, if any, for the purported indications that are listed in the above-mentioned Consumer’s Guide.

Obviously, while science- and evidence-based medicine has gradually became the basis for international, national, and regional public health policies, here in CA the world of healthcare is going backwards, and pseudo-science combined with sectarian politics seem to play an increasingly important role in public health policies on CAM. Any scientific evidence against the efficacy of a dubious modality, such as traditional acupuncture, is therefore deliberately shed or replaced with the biased views of individuals who are part of a “consumer protection” agency, but do not have any knowledge of biomedical sciences and evidence-based medicine; and who persistently place special interest politics–e.g., CA acupuncture training programs’–before the public’s health, safety and welfare. The CA DCA and its Acupuncture Board thus remain woefully inept in assisting the consumer in distinguishing between scientifically proven therapies and unproven modalities that are based on a combination of voodoo-science and a set of New Age fantasies about Eastern civilizations, and their mythical science and medicine.

1. http://consensus.nih.gov/1997/1997Acupuncture107html.htm

EDITOR’S NOTE: Dr. Gorski is currently in Chicago attending the American College of Surgeons Clinical Congress. As a result, he has not prepared a post for this week (although he doesn’t feel too guilty about missing this week, given that he did write two rather hefty posts last week, one on the cancer quackery known as the German New Medicine and the other on a rather dubious monkey study being promoted by the anti-vaccine movement). Fortunately, we have Ben Kavoussi to fill in with a post on some of the more exaggerated claims of advocates of nutritional interventions for various diseases and conditions. Enjoy!

A centipede was happy quite,

Until a frog in fun

Said, “Pray, which leg comes after which?”

This raised her mind to such a pitch,

She lay distracted in the ditch

Considering how to run.

Anonymous

Just like complementary and alternative medicine (CAM), nutritionism — meaning the unexamined assumption that food is only a conveyor of the substances it contains ^1,2 — has evolved independently of science and medicine since the 1970s, and has caused so much wondering and confusion about food and diet that many Americans have become unable to eat properly. Today, there isn’t a popular magazine that doesn’t have a “health and nutrition” section that — often with the backing of very little science — promises many health benefits of a nutrient or warns against the harms of another; and then provides a list of foods that contain it. The same publication might time and again write the exact opposite, further adding to the already-prevalent nutritional confusion. Nutritionism is thus an ideology sourced by popular beliefs, academic reveries, and the food and dietary supplements industry, where food is simply seen as a mean to achieve a specific health goal. In its latest form, however, coupled with genomics and biomedical informatics, and called “nutrigenomics” or “nutritional genomics,” nutritionism takes academic reveries to such an extent that it could be accurately described as “science fiction.” The Center of Excellence for Nutritional Genomics at UC Davis writes indeed (in bold) on its website that:

“The promise of nutritional genomics is personalized medicine and health based upon an understanding of our nutritional needs, nutritional and health status, and our genotype. Nutrigenomics will also have impacts on society — from medicine to agricultural and dietary practices to social and public policies — and its applications are likely to exceed that of even the human genome project. Chronic diseases (and some types of cancer) may be preventable, or at least delayed, by balanced, sensible diets. Knowledge gained from comparing diet/gene interactions in different populations may provide information needed to address the larger problem of global malnutrition and disease.”

Nutritional genomics is one of the “omics” that have come out of the human genome project — meaning the mapping of the 3 billion base pairs that make up the 20,000-25,000 genes in the human genome — and claims that it can develop means to optimize nutrition by exploring “personalized” or “genome-based” nutrition, in which foods are optimized for each individual’s unique genetic makeup. This goal is presumably achieved by correlating gene expression or single-nucleotide polymorphisms in health and disease with the consumption of a food or a combination of foods. The website of the UC Davis Center also states that its goal is to “devise genome-based nutritional interventions to prevent, delay, and treat diseases such asthma, obesity, Type 2 diabetes, cardiovascular disease, and prostate cancer.” The Center also adds (again in bold) that its goal is also to “reduce and ultimately eliminate racial and ethnic health disparities resulting from environment and gene interactions, particularly those involving dietary, economic, and cultural factors.”

The fundamental clinical medicine and public health assumptions that underlie this narrative are (1) the supposition that our lack of understanding of the precise mechanisms of environment/gene interactions is at the origin of our failure to prevent or to delay these diseases; and (2) that the futuristic cognitive tools of nutrigenomics can convert the large, complex, high-dimensional and nonlinear data on the complex interactions between the genetic makeup of a susceptible population and multiple environmental variables into useful knowledge. Identifying the positive and negative connections between the common constituents of their diet with genetic determinants of health and disease, will presumably uncover the insufficient intake or overconsumption of certain nutrients, and a population’s inability to absorb, metabolize or excrete them. To encounter that, nutritional genomics claims to be able to recommend specific, “personalized” and “genome-based” nutritional adjustments. According to the Center of Excellence’s Director, Raymond Rodriguez, nutritional genomics has been identified “as an emerging research focus of critical importance to global health and a vital link between agriculture, food and human health.”

To illustrate the nutritionism in these assumptions, and the “sciencefictional” nature of the promised solutions to the current epidemic of obesity, Type 2 diabetes and cardiovascular disease in the US, let us first consider the last time nutritionists undertook such grandiose public health and clinical ambitions. I am referring to the fat-free diet craze of the late 1980s, which Gary Taubes and Michael Pollan independently deconstruct as politically-motivated nutritionism. As Taubes writes in The Soft Science of Dietary Fat:

Since the early 1970s, for instance, Americans’ average fat intake has dropped from over 40% of total calories to 34%; average serum cholesterol levels have dropped as well. But no compelling evidence suggests that these decreases have improved health. Although heart disease death rates have dropped–and public health officials insist low-fat diets are partly responsible–the incidence of heart disease does not seem to be declining, as would be expected if lower fat diets made a difference. Meanwhile, obesity in America, which remained constant from the early 1960s through 1980, has surged upward since then–from 14% of the population to over 22%. Diabetes has increased apace. Both obesity and diabetes increase heart disease risk, which could explain why heart disease incidence is not decreasing. That this obesity epidemic occurred just as the government began bombarding Americans with the low-fat message suggests the possibility, however distant, that low-fat diets might have unintended consequences–among them, weight gain.³

To that Michael Pollan, the author of The Omnivore’s Dilemma, adds in a New York Times article called Unhappy Meals:

Last winter came the news that a low-fat diet, long believed to protect against breast cancer, may do no such thing — this from the monumental, federally financed Women’s Health Initiative, which has also found no link between a low-fat diet and rates of coronary disease. The year before we learned that dietary fiber might not, as we had been confidently told, help prevent colon cancer.²

In other words, it appears that nutrition-based clinical medicine and public health in the last decades not only have been unable to prevent, delay, and treat diseases, but have actually contributed to the current rise of metabolic syndrome, obesity, Type 2 diabetes, cardiovascular disease, and a host of other conditions arising from glucose intolerance and metabolic syndrome. According to Gary Taubes, the rampaging epidemic of obesity in America is partially due to the disastrous ambitions of Senator George McGovern’s Select Committee on Nutrition and Human Needs that changed the nutritional and public health policy in this country in the late 1970s. McGovern’s Committee had a mandate to eradicate malnutrition and disease, but in the mid-1970s the original mandate was replaced by an overzealous fight against “overnutrition,” and the health concerns associated with the dietary excesses of Americans. The Committee held hearings in July 1976, at the end of which McGovern — who was heavily influence by the diet-guru Nathan Pritikin’s very low fat diet and exercise program — with the aid of a handful of his staff members created the basis for the disastrous fat-fear-mongering of the next three decades.

In the wake of the panel’s recommendations, to which a 1982 National Academy report added the association of dietary fat with cancer,⁴ Americans did change their diets; and their average fat intake dropped significantly. But instead of fruits, vegetables and legumes, the average person replaced the missing fat with refined carbohydrates and high-fructose corn syrup, ostensibly as a way to avoid the evils of fat. Gary Taubes adds that the food industry which had little incentive in advertising non-proprietary items such as vegetables has been a major contributor to this public health blunder, for it spends the great bulk of the $30-billion-plus spent yearly on food advertising on selling carbohydrates in the guise of fast food, sodas, snacks, and candy bars. Michael Pollan writes that paradoxically Americans got really fat on this new low-fat, high-carbohydrates diet.

Now that two of the top leading causes of death in the US, meaning heart disease (1^st) and diabetes (6^th),⁵ are predominantly arising from decades of nutritional confusion and fear-mongering, nutritional genomics, armed with Artificial Intelligence, data mining and pattern-recognition technology is poised to “sniff” through the 3 billion-byte-long code of the human genome, and uncover genetic patterns that would explain why and how the low-fat and high-carbohydrates diet recommendations of George McGovern’s Select Committee are causing glucose intolerance, obesity, Type 2 diabetes, and cardiovascular disease in susceptible individuals and populations! But all we need for this purpose is some common sense, a little knowledge of American public health history, and the initiative to look through the grocery bills, the refrigerators, the restaurant menus or the trash cans of susceptible individuals and populations, and we can easily find out how super-sized refined carbohydrates and high-fructose corn syrup have made their way to their diet. For this, there is no need to analyze their genome with the aid of computational biology and pattern recognition technology, unless we have a taste for science fiction and Digital Age divination — none of which merits to promise medicine and health!

Nutritionism about prostate cancer has a connection to the dietary supplement industry that deserves to be mentioned here. A diet rich on animal fats and poor in grains, fruits and vegetables has been blamed for not providing enough of the presumably needed lycopenes, selenium, vitamins C and E, green tea, sulforaphane (found in broccoli, cabbage and cauliflower) and soy, and thus supplements, as David Heber, the Founding Director of UCLA Center for Human Nutrition, and coincidentally the Chairman of Herbalife’s Nutrition Advisory Board claims, could be used to prevent the occurrence of prostate cancer.⁶ According to a 2004 Forbes article, Heber joined the Board at roughly the same time the multilevel marketer of supplements and weight-loss products made a $3 million donation to establish the Mark Hughes Cellular & Molecular Nutrition Laboratory at the Center for Human Nutrition, leading to the criticism of Heber’s nutrition-based preventive claims as unfounded and pro-supplements, for obvious reasons.⁷ As for the value of any type of nutritional intervention to prevent, delay, and treat prostate cancer, Bill Nelson, a pioneer in the study of diet as preventive medicine at Johns Hopkins Brady Urological Institute tells us:

I’d have almost no reservations about advising someone to make sure his selenium levels are not too low, says Nelson. Beyond that, eat plenty of fruits and vegetables, and less red meat. And beyond that, take every story about a new dietary “wonder drug” with — pardon the food imagery — the proverbial grain of salt.⁸

The nutritional management of asthma is even less in need of avant-garde nutritionism. Merck Manual briefly mentions that “diets low in vitamins C and E and in ω–3 fatty acids have been linked to asthma, as has obesity,” and nothing beyond that.⁹ But if the deficiency of these nutrients and obesity are truly linked do asthma, then all we need is to “eat food, not too much, mostly plants,” as Michael Pollan recommends, and get them local, organic, seasonal and diverse, as others have suggested. And if you think that the link between obesity and asthma is a new discovery; and that the knowledge of how dietary chemicals alter gene expression or structure is required to address the problem, then read Galen of Pergamum’s (ca. 130-ca. 200) humbling treatise on the Thinning Diet:

The thinning diet is indicated for the majority of chronic diseases, which can, indeed, frequently be treated by such means alone, and without recourse to drugs. It is therefore important to form a clear idea of this diet; for wherever a result can be achieved purely by regimen, it is preferable to refrain from pharmaceutical prescriptions. Even with complaints of the kidneys and joints (provided the patient is not yet presenting joints full of ‘stones’), I have known many cases where the thinning diet lead either to complete remission or at least to a lessening of the pain. I have also known quite a few sufferers from chronic breathing difficulties derive such benefits from it that they returned completely to normal, or else suffered very few attacks over a long period.¹⁰

REFERENCES:

1. Scrinis G. Functional foods or functionally marketed foods? A critique of, and alternatives to, the category of ‘functional foods’. Public Health Nutr. 2008
2. Pollan M. Unhappy Meals, The New York Times, January 28, 2007
3. Taubes G The Soft Science of Dietary Fat. Science. 30 March 2001. Vol. 291. no. 5513, pp. 2536 – 2545.
4. Campbell TC, Campbell TM. The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-Term Health. Benbella Books; 1 edition. 2004.
5. Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B. Deaths: Final data for 2006. National vital statistics reports; vol 57 no 14. Hyattsville, MD: National Center for Health Statistics. 2009.
6. Yip I, Heber D, Aronson W. Nutrition and prostate cancer. Urol Clin N America 1999;26:403-11.
7. Pomerantz D. Supplemental Income. Forbes. November 04, 2004
8. Nelson B. Prostate Cancer and Diet. Prostate Cancer Update. Volume V, Winter 2000.
9. Beers MH, Porter RS, Jones TV. The Merck Manual. Merck. 18th Editions. 2006.
10. Galen C, Singer PN. Selected Works, Oxford University Press. 1997.

Bloodletting, of course, was a major aim of early vessel therapy and is frequently described in the Su wen.¹

Paul U Unschuld

“Cargo cult” is a metaphor that describes the act of imitating an activity or a practice without any insight into the underlying principles. In the literal sense, it refers to a magico-religious practice observed in tribal societies, where the members ritually imitate the activities of a technologically-advanced society they had contact with, so that they can magically draw their material wealth. For instance, after WWII, indigenous tribes in New Guinea who had come in close contact with cargo planes, started to build landing strips and populated them with plane-like effigies that were made of straw, bamboo, and coconuts, so that they can magically lure the passing planes.² The term “cargo cult science” was introduced by Richard Feynman in a speech at Caltech in 1974 to describe pseudoscientific studies in which all the superficial aspects of a scientific inquiry are adhered to, but the underlying principles are not scientific. He classified many educational and psychological studies as such, for having the appearance of academic research but lacking the principles of a scientific inquiry.³

Another example of cargo cult science is the plethora of two-arm acupuncture studies that compare a needling regimen using the traditional concepts, and compare it with a non-interventional placebo. These studies might have the appearance of clinical research, but they are inherently flawed and inconclusive, because they do not rule out the possibility that the observed results are mainly due to the painful stimulus and injury caused by a needle, which can occur regardless of the insertion point. Indeed, an acute noxious stimulus from a prickle, heat, or any other painful stimulus – almost anywhere on the skin – can attenuate the perception of pain in another area of the body through a reflex called “counter-irritation,” also called the “pain-inhibiting-pain effect” or “diffuse noxious inhibitory control” (DNIC).⁴ DNIC was extensively studied by Fauve et al. in the 1980s, who showed in mice that it has an effect equivalent or superior to that of glucocorticoids.^5,6

Counter-irritation has been known since antiquity, and is at the base of many noxious folk remedies, such as the application of cautery, blistering and moxibustion (the burning of dried Artemisia annua on the skin) to name but a few, whereby “one pain masks another.”⁷ These modalities were once widely used, generally in an attempt to reduce inflammation.⁹ It is therefore plausible that the nonspecific effects observed in some types of acupuncture are also linked to DNIC, since some authors have reported that acupuncture is only effective in producing analgesia when the stimulation itself is of a sufficient intensity to cause an unpleasant sensation. The DNIC induced by needles is believed to be mediated by the release of endogenous opioid neuropeptides and/or monoaminergic neurotransmitters, mainly because naloxone, a central and peripheral opioid receptor antagonist, is reported to reverse its effects.^10,11 A true interpretation of this finding invalidates the traditional lore of the meridian-and-points system, and indicates that any needling regimen can lead to outcomes associated with DNIC. This finding echoes the position of Felix Mann, MD, the founder of the British Medical Acupuncture Society, who after decades of practice reached the conclusion that putting needles in “wrong” places was as effective as a “correct” treatment. He therefore wrote that “traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes.”¹²

There is also credible evidence that the stimulation of a myofascial trigger point (TrP), meaning a localized, hyperirritable nodule nested within a palpable taut band of skeletal muscle or fascia,¹³ can evoke short-term anti-nociceptive effects on the same segmental dermatome.¹⁴ This local hypoalgesic effect is reported to be greater than stimulation at remote dermatomes.¹⁵ It is based on this finding, that Janet Travell, MD, (1901-1997) began needling hyperirritable points with syringes in in the 1940s, injecting them first with procaine.¹⁶ Procaine was later replaced by saline solution,¹⁷ which was later replaced by “dry needling” (TrP-DN ) — without any fluid in the syringe.^18,19 Although the dermatomal distributiosn of anti-nociceptive effects do not correspond to the distribution of the Chinese meridians, they do affect the outcome of two-arm studies because any needling regimen in the same dermatome should lead to similar results. Therefore, two-arm studies cannot rule out the possibility that the observed results are due to anti-nociceptive effects on the same segmental dermatome, which can occur regardless of the classical theories for point selection and means of stimulation.²⁰

In addition, both laboratory and clinical evidence have recently shown the existence of two-way interactions between the nervous system and the innate immunity. There is experimental evidence showing that percutaneous and transcutaneous neurostimulation can inhibit macrophage activation and the production of pro-inflammatory cytokines.²¹ Kevin J Tracey, MD and his collogues at Feinstein Institute for Medical Research have shown that an increase in the production of Acetylcholine (ACh) can inhibit the synthesis of TNF and other pro-inflammatory cytokines in organs rich in cells of the monocyte-macrophage system.²² Tracey argues that Ach interacts with members of the nicotinic ACh receptor (nAchr) family, in particular with the alpha-7 subunit (α7nAchr), which is expressed not only by neurons, but also macrophages and other cells involved in the inflammatory response.²³ It is therefore conceivable that the anti-inflammatory actions that have been associated with needling – and have been used to justify the traditional concepts of acupuncture – are directly or indirectly mediated by neurostimulation and inflammatory macrophage deactivation, and can occur with transcutaneous or percutaneous neuromodulation anywhere proximal to nerves.²⁴ This is consistent with the hypothesis of George A. Ulett and Songping Han, who argued that certain effects of needling, especially in the ear, might be explained by a “broad parasympathetic effects” due to the stimulation of vagus nerve, which also innervates the ear.²⁵ Again, two-arm studies cannot rule out the possibility that the observed results are due to the broad neurostimulatory effects of needling, and regardless of the needling regimen.

In sum, for the reasons stated above, two-arm acupuncture studies that compare a traditional regimen with a non-interventional placebo are inherently inconclusive. I would further argue that the regimen used in these studies is not even reflective of the traditional methods, because the loci of cautery, blistering, cupping, moxibustion and acupuncture might have been selected simply because they were particularly sensitive and painful, and the alleged analgesic and anti-inflammatory effects of traditional regimens are not achievable by the “soft needling” technique used in clinical studies today. These studies unequivocally use quasi-unperceivable, painless, filiform, silicon-coated needles for ethical reasons and to prevent dropouts. This type of “acupuncture without tears” amounts to what Arthur Taub has suitably called “nonsense with needles.”²⁶

Finally, the most compelling argument to qualify acupuncture of a cargo cult, is the fact that its apostles remain obstinately faithful that someday, someone will prove that “astrology with needles” is a panacea that can naturally restore health and longevity. This is despite the fact that well-conducted three-arm clinical trials that used sham controls with needle insertion at “wrong” points (points not indicated for the condition) or non-points (locations that are not known acupuncture points) along with a non-interventional control group, have failed to demonstrate that there is a reliable difference between sham and “true” needling. Three well-designed three-armed randomized controlled clinical trials with 302, 270, and 1007 patients, respectively, have demonstrated that acupuncture and sham acupuncture treatments were more effective than no treatment at all, but there was no statistically significant difference between true and sham acupuncture,^27,28,29 suggesting that it does not have unique effects on the central nervous system, or on pain and pain modulation.³⁰ These studies indicate that the “meridional theory” is of low importance, and does not lead to specific therapeutic effects.^31,32 The most recent challenge came from a review article in the New England Journal of Medicine which concluded that acupuncture’s specific therapeutic effects – if any – are small, and its benefits are mostly attributable to “contextual and psychosocial factors, such as patients’ beliefs and expectations, attention from the acupuncturist, and highly focused, spatially directed attention on the part of the patient.”³³

I see the pointless studies that aim to validate notions that date of Galen’s era, and hear the irrational narrative of the apostles of this cargo cult at the twilight of a dying hope, and I think of Baudelaire’s morose elegy to “The Swan:”

A swan which from its cage had made escape
Patting the torrid blocks with webby feet,
Trailing great plumes of snow, while beak agape
Tumbled for water in the parching street;

Wildly it plunged its wings in dust again,
Mourning its native lake, and seemed to shrill:
“Lightning, when comest thou? and when, the rain?”
Strange symbol! wretched bird, I see it still.³⁴

Charles Baudelaire (1821 – 1867), Flowers of Evil

In November 2010, the California Department of Consumer Affairs (DCA) finally decided to act responsibly and forbid the prevalent practice of Chinese bloodletting by licensed acupuncturists.

The practice became a concern for the DCA when allegations of unsanitary bloodletting at a California (CA) acupuncture school surfaced.

The incident allegedly occurred during a “doctoral” course for licensed practitioners. The instructor was reportedly demonstrating advanced needling and bloodletting techniques. During the process, he took an arrow-like lancing instrument that is called a “three-edged needle” (三棱针), sharpened it with sandpaper, cleaned it with alcohol, and then asked a student-volunteer to roll a towel around his neck (similar to what is depicted in Image 1). The instructor then cleaned the student’s temporal region with alcohol, and punctured a superficial blood vessel with the arrow-like instrument. The student then held his head over the garbage can, gushing blood for a while.

Images 1 & 2. Chinese bloodletting. Image 1 shows a technique used to bleed the head or the face, where a towel is rolled around the neck to control the arterial pressure. Image 2 shows the practice of “wet cupping.”

The ancient practice of bloodletting, with or without cupping, is still widely used in Chinese medicine to remove “stagnant blood, expel heat, treat high fever, loss of consciousness, convulsion, and pain.”¹ The amount of blood let depends on the condition, and the location of the incision. A contemporary book recommends letting a tiny amount from a point adjacent to the thumbnail for a condition described as “wind-heat invasion” of the lung. The symptoms associated with this unscientific nomenclature include chills and fever, sore throat, stuffy or runny nose, and a yellow discharge,² which could correspond to many respiratory conditions, including the common cold, influenza, pneumonia, etc.

Bloodletting with cupping, also known as “wet cupping,” consists of placing suction cups on top of an incision to expurge “bad,” “excessive,” or “stagnant” blood. This is the dirty version of “dry cupping” where cups are placed over an area of intact skin to draw underlying blood and fluids to the surface.³

As several posts on the Science-Based Medicine website have indicated, bloodletting is not uniquely Far-Eastern, and has been practiced throughout the world since antiquity. Muslims still practice a version of it (known as Al-hijamah, الحجامة) for indications similar to those of the Chinese (Images 3 & 4).

Images 3 & 4. A practitioner of al-hijamah bleeds a patient at his clinic in the West Bank. Image source: Reuters/Nayef Hashlamoun (West Bank Health). August 2009.

The Acupuncture Board of CA, which falls under the DCA, has come under criticism for being made up of trade insiders and affiliates of acupuncture schools, and–most importantly–for failing to protect the public from quacks and charlatans. In the past, members have even been investigated for taking bribes and selling licensing exam answers. The Board was replaced recently in an attempt to clean up the quasi-anarchic and corrupt licensing and practice of Chinese medicine in CA. It appears that now the DCA is taking public health seriously, and is cleaning up the profession, one calamity at a time. This time it reined in the practice of Chinese bloodletting.

Hopefully we will not need another gruesome or dreadful event for a “consumer protection agency,” such as the DCA, to also realize that beneath the absurdity of these medieval treatments, resides the immanent danger of un- and misdiagnosis of conditions that need real medical attention.

With many thanks to Kristin Koster for her valuable comments.

REFERENCES:

1. State Administration of Traditional Chinese Medicine and Pharmacy. Advanced Textbook on Traditional Chinese Medicine and Pharmacology. Volume IV. New World Press, Beijing. 1997.
2. Maciocia G. The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. Churchill Livingstone; 1 edition. 1994.
3. Seigworth GR. Bloodletting over the centuries. NY State J Med. 1980 Dec;80(13):2022-8.

Let us be certain of a fact before being concerned with its cause. It is true that this method is too lengthy for most people who naturally run to the cause and overlook the certitude about facts; but at last we will avoid the ridicule of finding the cause of what does not exist.¹

Bernard le Bovier de Fontenelle (1657-1757)

Amidst the plethora of flawed, implausible, and wasteful research on acupuncture and Chinese medicine, a 2002 study on the “Relationship of Acupuncture Points and Meridians to Connective Tissue Planes” stands out as the height of factual neglect. In it, Helene Langevin and Jason Yandow of the University of Vermont’s College of Medicine claim to have matched real anatomical structures with the elusive acupuncture “meridians.” It should be noted that the widely accepted term “meridian” is a metaphor coined by George Soulié de Morant (1878 – 1955), a French delegate to China, and has no semantic relationship with the original Chinese word.² The original designation is the composite word jing luo (經絡), which literally means “channel-network.” The term has been translated to English as chinglo channels, channels, vessels or more commonly, meridians. Debunking this study is of particular relevance because it is often used by acupuncturists and a wide range of other CAM providers to legitimize the meridian lore. The principle author, Helene Langevin, is a CAM celebrity and a member of the “Scientific Committee” of the International Fascia Research Congress, an organization dedicated to the “emerging field of Fascia Studies.” She is an Associate Professor of Neurology and the Director of the Program in Integrative Health at the University of Vermont; and has conducted multiple NCCAM-funded studies on the role of connective tissue in chronic pain, acupuncture and manual therapies.

This is what Langevin and Yandow wrote in their 2002 paper’s abstract:

Acupuncture meridians traditionally are believed to constitute channels connecting the surface of the body to internal organs. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue. This hypothesis is supported by ultrasound images showing connective tissue cleavage planes at acupuncture points in normal human subjects. To test this hypothesis, we mapped acupuncture points in serial gross anatomical sections through the human arm. We found an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections.³

What makes this study fundamentally flawed, despite its scientific appearance, is the fact that it is the embodiment of what I have elsewhere called “medical Orientalism.” By this term I mean a depiction of Eastern healing arts by Western authors, academics and researchers that is not generated from historical facts or reality, but from stereotypes that envision approaches to health and disease in the East as fundamentally dissimilar to the West. The historical facts do not support the fascial-planes hypothesis, and rather indicate that the Chinese concept of jing luo is quasi identical to the Greek notions of phlebes (blood vessels in general) and neura (ligaments, nerves, etc.). Indeed, as the classics scholar Elizabeth Craik has convincingly argued:

Chinese medicine resembles Hippocratic theory in that anatomical structures and orifices (perhaps better described as systems and processes) are seen in terms of the channels which link them to one another and to other areas of the body. Greek phlebes and Chinese mo are significant in physiology (normal–carrying blood and pneuma or qi) and pathology (abnormal–carrying noxious matter, inducing disease). Their supposed paths do not exactly coincide, but several are broadly similar (and more similar to each other than either is to the observed paths of arteries and veins). In particular, the route of the Chinese du channel (“governor vessel”) from spine to back of head carrying life force is similar to that of the Greek vessel carrying vital myelos. And the vessel centrally placed in the forehead in some Greek accounts is similar to the anterior continuation of the Chinese du channel. Furthermore, the parallel pairs of vessels symmetrically placed on either side of the du channel correspond with the parallel pairs of vessels postulated in many Greek accounts… Originally in China there was no elaborate system of acupuncture points (for example, twenty-eight points on the du channel) with measurements, any more than in Hippocratic practice. In sum, we see similar channels, with similar paths and similar contents, the focus of similar treatment for similar medical conditions.⁴

The elusive and mysterious meridian system seems therefore to be nothing more than a rudimentary and prescientific model of blood vessels and nerves. Langevin and Yandow’s conceptual model can thus be seen as historically unfounded. It is also implausible because postulating an anatomically precise “medical gaze” for ancient and medieval physicians is anachronistic. As one reader (Dr. Le Petomaneon) pertinently commented on my previous post, The Cargo Cult of Acupuncture, this postulation “begs the question of how preindustrial Chinese researchers could have created an accurate map of meridians without the advanced technology it has taken for anyone to have a remotely credible claim to have detected them.” In fact, as Michel Foucault (1926-1984) has pointed out, it is only in 18th-century Europe that the body became something that could be mapped with precision.⁵ For millennia prior to that, anatomical structures that lay below the threshold of the visible were conceptualized according to mythology, astrology, and other figments of the imagination. Consider, for instance, the 17th-century medical manuscript by Yang Jizhou (杨继洲) called the Zhenjiu Dacheng (针灸大成), where the medical and astrological narratives are inseparable. This work, which is incorrectly translated as the Great Compendium of Acupuncture and Moxibustion, describes a medical gaze that is not directed towards the body and its anatomy, but towards the Heavens and astrology.⁶ The Zhenjiu Dacheng and other prescientific manuals of medicine in China are not exploratory guides about the fascial planes or other anatomical structures; they are manuals of medical astrology. This is why the original designations of the principal meridians (e.g., tae yang, jue yin) represent the angular position (hour angle) of the Sun (Table 1), and not the “physiological functions thought to be specifically related to each,” as Langevin and Yandow inacuretly state. The historian Paul Buell has argued that even the Yellow Emperor’s Inner Canon (黄帝内经, Huangdi Neijing, 400-200 BC), the formative book of Chinese medicine, is as much an astrological compendium as a medical text.

Image 1. The Chinese zodiac system called Stem-Branch (干支 gānzhī). The closed loop formed by the meridian network mimics the circular nature of the zodiac system. Image source: Facts and Details about China and Japan.

Table 1. Chart depicting an astrological relationship between the 12 main meridians, the 12 main organs, and the constellations of the Chinese zodiac system.⁷ Each meridians is named after a solar hour-angle (meaning the position of the Sun on the Ecliptic), and corresponds to a 2-hour time division of the Celestial Equator.

Also, historical facts do not supports Langevin and Yandow’s assertion that “during acupuncture treatments, fine needles traditionally are inserted at specific locations of the body known as acupuncture points.” The instruments described in the Inner Canon are mostly pins, lancets, fleams and bodkins; not fine needles. Besides, the ideogram zhēn (针), which has been mistranslated as “needle,” actually means any instrument of puncture, incision or penetration, such as a pin, lancet, needle or any other sharp device. In the Inner Canon, the term mostly refers to lancing and bloodletting, not acupuncture (as we define it today), particularly in a section called Simple Questions (素問, Su wen).⁸ Of the nine sharp instruments described in the the Inner Canon (Images 2-4), only three resemble coarse needles and pins.⁹ Some of these instruments significantly resemble the instruments of bloodletting and surgery found in medieval Europe (Image 5). In fact, most of the traditional reference material that is currently associated with acupuncture and meridians is actually about a variety of methods and instruments to incise structures that share their paths, contents, and focus of treatment with the Greek notion of phlebes (blood vessels in general). If the current map of acupuncture points and meridians is distinct from the vasculature, it is because in the early 1930s the pediatrician Cheng Dan’an (承淡安, 1899-1957) resurrected and rehabilitated the vanishing street trade of therapeutic piercing by moving the treatment loci away from the blood vessels. He illustrated his revisions by painting the new pathways onto the skin of individuals and then photographing them. He also replaced the coarse medieval tools with the fine needles we associate with acupuncture today.¹⁰ It is the reproduction of these new pathways in modern acupuncture textbooks, and the new use of fine needles that Langevin and Yandow have unknowingly taken for historical facts.

Image 2. The nine tools described in the Inner Cannon are fund in medical manuscripts throughout the history of China. Image source unknown.

Image 3. Dimensions of the nine tool: the measurement unit is the cun (寸, pronounced “ts’un”), which is roughly equal to 3.3 cm (1.3 inches). Image source: Essentials of Chinese Acupuncture.¹¹

Image 4. Reproduction of the nine tools. They do not look like “fine needles” to penetrate the fascial planes. Image source unknown.

Image 5. Reproduction of European medieval bloodletting and cautery tools based on archaeological finds at the abbey of Saint Eutizio, Italy. Legend: A. Cautery irons, 35 cm; B. Fleam & bowl, 28 cm; C. Medical spoon, 14 cm; D. Bodkin to remove arrows, 20 cm. Image source: Medieval Design.

In my previous posts I have argued that since the Chinese classics, such as the Zhenjiu Dacheng, base their meridian and point selection on astrology, and not on experimentation, it is not surprising that needling “nonacupuncture” (sham) control points is just as effective as “true” acupuncture.¹² In a recent article in The New England Journal of Medicine, Helene Langevin, Brian Berman, and their colleagues finally acknowledge that:

The simplest explanation of such findings is that the specific therapeutic effects of acupuncture, if present, are small, whereas its clinically relevant benefits are mostly attributable to contextual and psychosocial factors, such as patients’ beliefs and expectations, attention from the acupuncturist, and highly focused, spatially directed attention on the part of the patient.¹³

In view of this admission, it seems that the further use of public funding to explore a hypothetical link between acupuncture and the fascial planes (or other structures) would amount to waste and misuse. The editors and contributors of Science-Based Medicine have consistently expressed their objection to the public funding of CAM research in general, especially for acupuncture. The Center for Inquiry’s Office of Public Policy has also voiced its opposition through their Position Paper on Acupuncture:

The Center for Inquiry is deeply concerned that the new found prominence of unproven and unscientific therapies like acupuncture diminishes the primacy of science in our health policy discourse and degrades our healthcare system. We believe the uncritical adoption of acupuncture will ultimately add incalculable costs to our already overburdened healthcare system and will lower standards of medical training and treatment. More fundamentally, the expansion of alternative medical institutions–increasingly funded by the federal government–lends dangerous and undue authority to pseudoscience, degrading respect for science in the public realm.¹⁴

According to the Center for Inquiry, the 2010 budget fo the National Center for Complementary and Alternative Medicine (NCCAM) is $128.8 million – more than 60 times greater than its $2 million budget in 1992.  The budget of the Office of Cancer Complementary and Alternative Medicine (OCCAM) was $121 million in 2008, and is presumably higher in 2010. Together, these funds amount to $240 million of taxpayer dollars, without counting the money these institutions have received from the government’s stimulus packages. Yet, not a single publicly funded research project has shown that a CAM modality is significantly beneficial for anything. Some of these projects are scientifically flawed, others (like the one discussed here) are based on inaccurate assumptions and factual neglect.

The laissez-faire attitude at NCCAM and OCCAM, and their leadership’s ignorance of historical and epistemological facts about the projects they fund, are certainly responsible for this deplorable situation. As a result, not only millions of taxpayer dollars are being spent on seemingly ridiculous research projects, but also the very fact that they are supporting these projects is often used to lend an appearance of legitimacy to treatments and ideas that are not legitimate. Furthermore, as Kimball Atwood has argued, this research grant money has resulted in the establishment of a cadre of academics who have come to rely on the federal government with little regard for the scientific issues associated with CAM research.¹⁵ Helene Langevin is certainly one of these academics.

With special thanks to Kristin Koster, PhD, Paul Buell, PhD, and Paul Ingraham for their valuable comments.

REFERENCES:
1. Fontenelle BB (Author), Bergier J (Editor). Fontenelle: Entretiens sur la Pluralité des Mondes suivi de Histoire des Oracles. Marabout Université. 1973.
2. Kendall DE. Dao of Chinese Medicine: Understanding an Ancient Healing Art. Oxford University Press, USA; 1 edition. 2002.
3. Langevin HM, Yandow JA. Relationship of Acupuncture Points and Meridians to Connective Tissue Planes. Anat Rec. 2002 Dec 15;269(6):257-65.
4. Craik EM. Hippocratic Bodily “Channels” and Oriental Parallels. Med Hist. 2009 January; 53(1): 105–116.
5. Foucault M. The Birth of the Clinic: An Archaeology of Medical Perception. Vintage. 1994.
6. Wilcox L (Translator). The Great Compendium of Acupuncture and Moxibustion. vol. V. The Chinese Medicine Database. 2010.
7. Maciocia G. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Second Edition. Churchill Livingstone. 2005.
8. Unschuld PU. Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. University of California Press. 2003.
9. Dharmananda S. Bleeding Peripheral Points: An Acupuncture Technique. [Accessed 24 August 2010].
10. Andrews BJ. History of Pain: Acupuncture and the Reinvention of Chinese Medicine. APS Bulletin. May/June 1999;9(3).
11. Anonymous. Essentials of Chinese Acupuncture. Foreign Language Press, Beijing, China.1979.
12. Moffet HH. Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials. J Altern Complement Med. 2009 Mar;15(3):213-6.
13. Berman BM, Langevin HM, Witt CM, Dubner R. Acupuncture for chronic low back pain. N Engl J Med 2010 Jul 29; 363(5):454-61.
14. Slack R, Mielczarek EV. Acupuncture: A Science-Based Assessment. Special Report. A Position Paper from the Center for Inquiry’s Office of Public Policy. 10 June 2010. [Accessed 05 October 2010].
15. Atwood K. The Ongoing Problem with the National Center for Complementary and Alternative Medicine. Skeptical Inquirer. 2003, 27(5). [Accessed 8 October 2010].

All the world sees us
In grand style wherever we are;
The big and the small
Are infatuated with us:
They run to our remedies
And regard us as gods
And to our prescriptions
Principles and regimens, they submit themselves.

Molière, The Imaginary Invalid (1673)¹

The passage above is part of a burlesque doctoral conferment ceremony, where the French playwright Molière (1622-1673) mocks the unscrupulous physicians of his time. “All the excellency of their art consists in pompous gibberish, in a specious babbling, which gives you words instead of reasons, and promises instead of results,” he writes. In Moliere’s plays doctors never cure anyone; they are put on stage just to display their own vanity and ignorance.² The Spanish painter Francisco de Goya (1746-1828) also took on the same issue by painting in 1799 a well attired jackass taking the pulse of a dying man, in a pose that accentuates the large gem on his hoof.

Image 1. De qué mal morirá (Of what illness will he die?) by Francisco de Goya is held at the Biblioteca Nacional, Madrid, and The Metropolitan Museum of Art, New York.

But if the asinine doctors of Molière and de Goya’s time never cured anyone, it is because they held prescientific views, and believed that disease was caused by imbalances in “humors,” and by malefic influences of the Heavens. Even the most educated among them treated illnesses in good faith by purging, bloodletting and enema at astrologically auspicious times. In contrast, current physicians who for the sake of funding embrace and endorse unscientific views and practices under the guise of CAM or integrative medicine, do so knowing that they often contradict the established principles of physics, chemistry, and biology. Therefore, in addition to promoting “snake oil science”³ (as R. Barker Bausell calls it), these physicians are also guilty of bad faith. Most of this takes place at large academic centers, where funding seems to outweigh the concern for science. As Val Jones, MD, writes in 2009′s Top 5 Threats To Science In Medicine:

Often referred to by David Gorski as “Quackademic” Medical Centers – there is a growing trend among these centers to accept endowments for “integrative” approaches to medical care. Because of the economic realities of decreasing healthcare reimbursements – these once proud defenders of science are now accepting money to “study” implausible and often disproven medical treatments because they’re trendy. Scientists at these centers are forced to look the other way while patients (who trust the center’s reputation that took tens of decades to build) are exposed to placebo medicine under the guise of “holistic” healthcare.

A list of these centers, available at the Academic Woo Aggregator website, reveals the prestigious University of California (UC) as the most represented, with 3 centers: the UCSF Osher Center for Integrative Medicine; the Susan Samueli Center for Integrative Medicine at UC Irvine; and the Collaborative Centers for Integrative Medicine at UCLA, which includes the Center for East-West Medicine. The William R. Pritchard Veterinary Medical Teaching Hospital at UC Davis, with its Acupuncture and Traditional Chinese Veterinary Medicine (TCVM) clinic, should perhaps be added to the list.

Among them, UCSF’s Osher Center for Integrative Medicine has the largest funding, with a cumulative sum of over $28 million. Established in 1997 by the Dean Emeritus of the School of Medicine, Haile T. Debas, MD, and the very generous support of the Bernard Osher Foundation, the UCSF Center collaborates with Harvard University, and the Karolinska Institute in Stockholm.

Some of the “integrative” medicine research involves acupuncture, even if it might end up being a source of scientific embarrassment. Consider, for instance, the dubious research during the 1990s at UC Irvine by the physicist Zang-Hee Cho, who claimed to have in vivo evidence by fMRI for acupuncture’s putative effects. Cho and his colleagues published a series of papers, notably one in the Proceedings of the National Academy of Sciences (PNAS), where they claimed to have observed a correlation between the visual cortex and an acupuncture point on the toe. Based on this unconfirmed observation, they became persuaded that acupuncture involves the activation of the cortical region associated with the targeted organ.⁴ Cho went as far as claiming that the cortical activation depends on the subject’s personality type, which could be yin or yang! Fortunately, the PNAS article, which is often referenced by acupuncture apologists, was retracted in June 2006 by Cho himself and a number of its coauthors:

Accumulating evidence suggests that the central nervous system is essential for processing these effects, via its modulation of the autonomic nervous system, neuro-immune system, and hormonal regulation. We, therefore, carried out a series of studies questioning whether there really is point specificity in acupuncture, especially vis-à-vis pain and acupuncture analgesic effects as we originally reported in our PNAS article, that had not yet been confirmed by other studies… Having concluded that there is no point specificity, at least for pain and analgesic effects, and that we no longer agree with the results in our PNAS article, the undersigned authors are retracting the article.

Z. H. Cho

S. C. Chung

H. J. Lee

E. K. Wong

B. I. Min⁵

Cho has since left the University of California, and is now the Director of the Neuroscience Research Institute at Gachon University of Medicine and Science in Korea. However, his research lead to a $5.7 million gift to UC Irvine in 2000 by Henry and Susan Samueli to research acupuncture, herbal therapy, and the “Indian science of life,” Ayurveda. This funding was used to create the Susan Samueli Center for Integrative Medicine.

UCLA’s “integrative” medicine also involves acupuncture. Although several separate groups and individuals provide acupuncture at UCLA, most of it is now centralized at the Center for East-West Medicine, which was founded in 1993 by its current Director, Ka-Kit Hui, MD. The Center’s website states that in March 2005, the Annenberg Foundation awarded $2 million to UCLA to establish the Wallis Annenberg Endowed Chair in Integrative East-West Medicine. An additional $115,790 grant allowed for the creation of a “healing environment.” Meanwhile, the Center is using UCLA’s international fame to lend legitimacy to Chinese folk medicine. Take a peek at UCLA Today of Jun 17, 2010:

Representing a 5,000-year history of traditional Chinese medicine, Chinese Vice Minister of Health Dr. Wang Guoqiang and a six-person delegation came to campus June 11 to see what they could learn from UCLA, which has long been at the forefront of research in integrative medicine and education in the western world… The Chinese delegation, which had a four-day stay in the U.S., chose UCLA as the only academic medical center to visit to learn how traditional Chinese medicine (TCM) and integrative medicine are practiced as a new health care model… Wang is the highest-ranking official in China overseeing the development of Chinese medicine and integrated medicine.

Image 2. UCLA Vice Chancellor for Health Sciences, Dr. Eugene Washington (left); Chinese Vice Minister of Health, Dr. Wang Guoqiang; and Dr. Ka-Kit Hui, Director of the UCLA Center for East-West Medicine (right). Image Source: UCLA Today.

Now read the following grim news about UCLA’s budget, announced just three months before, which might put the arrival of the Chinese delegation in a whole new perspective. UCLA Today wrote on Feb 18, 2010 that:

In planning for next year’s budget, campus leaders believe that UCLA will face a permanent loss of $117 million in state funding for 2010-11, the same as in 2009-10, but with one difference. The $55 million cut that was made on a one-time basis in 2009-10 will become permanent… And although Gov. Arnold Schwarzenegger seeks to restore the one-time $305 million reduction made to UC’s budget this fiscal year — $55 million of which was cut from UCLA’s budget — campus leaders said they are assuming that the State Legislature is going to reject his proposal.

With UCLA experiencing an unprecedented drop in state support, even snake oil science is welcomed, as long as it leads to further funding prospects. After all, as the Roman Emperor Vespasian once said: Pecunia non olet (money does not smell).

In my 2009 post Astrology with Needles, I presented images from European manuals of bloodletting, which clearly indicate that the acclaimed 5,000-year history of traditional Chinese medicine does not include acupuncture as we know it today. What the Chinese practiced is lancing and bloodletting with bodkins and lancets, which significantly resembled what Europeans and Muslims also practiced. This is why the venipuncture points portrayed in European medieval manuscripts significantly overlap with key points described in the Chinese classics. In addition, the evidence presented in my recent post, The Acupuncture and Fasciae Fallacy, shows that the tools described in the Chinese classics resemble fleams and other venipuncture instruments of medieval Europe, and have little resemblance to what is currently considered an acupuncture needle. This is because acupuncture with fine needles is a modern invention; one that was transformed from a side-lined practice of the early 20th-century to an essential and high-profile part of the national health-care system under the Chinese Communist Party.⁶

Finally, the visit of the Chinese delegation to UCLA reminds me of a 1998 French film called The Dinner Game (Le dîner de cons). In it, Pierre and his Parisian friends organize a dinner party each week, where everyone invites the most ridiculous character he can find, so they can all have a good time mocking him. But when Pierre invites François, who he thinks will steal the show, his clueless guest inadvertently exposes hidden and embarrassing aspects of Pierre’s life. The visitors that have come to UCLA to represent 5,000 years of hocus-pocus, and are eager to learn about an integrative medicine that is mainly a showcase to obtain funding, might have–like François–unknowingly exposed a mockery, and with it, a great charade.

REFERENCES:

1. Poqulin JB (Author), Frame DM (Translator, Introduction). The Misanthrope and Other Plays. Signet Classics. 1968. The quoted section was translated by Barbara J. Becker, PhD.
2. Livingston PN. Comic Treatment: Molière and the Farce of Medicine. Vol. 94, No. 4, French Issue: Perspectives in Mimesis (May, 1979), pp. 676-687.
3. Barker Bausell R. Snake Oil Science: The Truth about Complementary and Alternative Medicine. Oxford University Press. 1st edition. 2007.
4. Cho ZH, Chung SC, Jones JP, Park JB, Park HJ, Lee HJ, Wong EK, Min BI. New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci U S A. 1998 Mar 3;95(5):2670-3.
5. Retraction in Cho ZH, Chung SC, Lee HJ, Wong EK, Min BI. Proc Natl Acad Sci U S A. 2006 Jul 5;103(27):1052.
6. Taylor K. Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution. Routledge. 2005.

… animals are divided into (a) those that belong to the emperor; (b) embalmed ones; (c) those that are trained; (d) suckling pigs; (e) mermaids; (f) fabulous ones; (g) stray dogs; (h) those that are included in this classification; (i) those that tremble as if they were mad; (j) innumerable ones; (k) those drawn with a very fine camel’s-hair brush; (l) etcetera; (m) those that have just broken the flower vase; (n) those that at a distance resemble flies.

– Jorge Luis Borges (1899–1986)¹

Not too long ago, I came across a disease taxonomy proposed by a certain East-West Medical Research Institute (EWMRI), that includes the kind of fantastic afflictions — such as “running piglet” disorder — fit for the best Borgesian list.

This obscure institute, located at Kyung Hee University in Seoul, Korea, is one of the 800 WHO Collaborating Centres designated to carry out various activities in support of the Organization’s programs. With the collaboration of China, Japan, Vietnam, Australia, and the US, this center is working to incorporate medieval Asian disease nomenclature to the 11^th version of the International Classification of Disease (ICD-11).

The proposed taxonomy that has resulted from the collaboration is called the International Classification of Traditional Medicine (ICTM). It resembles a shopping list made by randomly mixing a medical dictionary with Harry Potter, and reads like a Surrealist poem penned in a marathon Automatic Writing session. Right after influenza, dysentery, and cholera, one can find miasmatic malaria (瘴瘧)… pestilence (瘟疫)… plum-pit qi (梅核氣)… running piglet (奔豚)… wasting-thirst (消渴)… T-shaped malnutrition (丁奚疳)… umbilical wind (臍風)… syndrome of liver fire blazing the ear (肝火燔耳證) (ouch!)… and many other astonishing entries, which I invite you to browse for your own amusement — or dismay.

The 2007 version of the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region lists the proposed disease categories on pages 162 to 203.

The proposal suggests that “a future ICTM could comprise not only East Asian Traditional Medicine but traditional medicine practices from other WHO regions… such as India, Sri Lanka and Africa.” This leaves us to wonder whether “pacing zombie swagger” may figure as a possible entry if the ICTM decides to include the Caribbean one day?!

I recognize that the Korean research institute, the Kyung Hee University, and the health care community in Asian countries are free to believe in the existence of pestilence or miasmatic malaria, and can treat their populations with incantations, amulets, talismans, lancing, or even bloodletting, if they so choose. But what really concerns me is the possibility that these medieval views on disease might someday become legitimized in the US, not only because they fit New Age ideas and ideals, but also because they bear WHO’s seal of approval.

Traditional acupuncturists in many US states already practice medicine based on medieval views similar to those expressed by Avicenna (c. 980–1037) in the 1025 Canon of Medicine, which — although ingenious for its time — was already obsolete in the 17^th century. This “medical primitivism” (the rejection of science-based and industrialized medicine) is the result of the counterculture of the 1960s, postmodern ideology, and the New Age movement. Trough political pressure, primitivism has increasingly become an acceptable form of healthcare in the US under the guise of “alternative” or “Oriental” medicine. An ICD that includes the “running piglet” might reinforce this political momentum, and might further the resurrection and re-legitimation of notions that are closer to fantasy than reality.

Indeed, as Jeannie Kang, an acupuncturist in Los Angeles, CA, and the head of the American Association of Acupuncture and Oriental Medicine (AAAOM) Korean Advisory Council, writes in Qi-Unity Report:

Incorporating traditional medicine into the ICD coding system for medical records and billing is an essential prerequisite for advancement of traditional medicine into the mainstream medical system. The WHO has agreed to work with a standardized terminology on the basic terms it has identified.

The last WHO meeting to discuss the ICTM was held in the Philippines, February 7–11, 2011.

I find that this “standardized terminology” bears a significant — and instructive — resemblance to the outlandish bestiary that Borges recounts in The Analytical Language of John Wilkins. Borges, whose Magical Realism blends facts and fiction liberally, attributes the passage he cites to an elusive Chinese encyclopedia called The Celestial Emporium of Benevolent Knowledge.

The naive oddity of the underlying logic of association that yields the Celestial Emporium‘s taxonomy has inspired considerable commentary, notably by the philosopher Michel Foucault, who writes in The Order of Things that it shatters “all the familiar landmarks of thought — our thought, the thought that bears the stamp of our age and our geography.”² But more pertinently, the clinical psychologist, Louis A Sass, writes in Madness and Modernism that such oddity of thinking shows the signs of a typical schizophrenic thought pattern.³

Different cultures at different stages of their development have used different logics of association to categorize illnesses. Prior the advent of modern science, disease taxonomies (nosologies) were predominantly based on symptoms, and identified by means of vernacular naming systems. “Running piglet” is, for instance, a Chinese agrarian metaphor that indicates a panic attack. However, scientific nosology is predominantly based on etiology (causative agent) or pathogenesis (causative mechanism), except for idiopathic conditions. As a result, most ancient categories have disappeared: they are obsolete. “Melancholia” (meaning “excess of black bile”) is an example. Other categories are archaic: that is, when the name is used in modern nosology, it refers to a significantly different category. Malaria (originally meaning “bad air”) is a good example. The proposed addition to the ICD11 ignores this important paradigm shift.

Therefore, tossing modern and obsolete categories together into a single system of categorization, like the proposed ICTM, departs from common-sense, loses coherence, fragments into contradictory points of view, and ultimately turns into a “word salad”: a mixture of words and expressions that, while seemingly meaningful, actually carries no significance.

Lastly, I think the illogical nosology for which the AAAOM is “very excited” is the product of a style of thought that is, at best, idiosyncratic and odd. At worst, it is the hallmark of the cognitive slippage and technophobic delusions that characterize the modern apologists of unscientific medicine(s). In all, it is a significant leap away from reason, in the direction of the Dark Ages.

With special thanks to Kristin Koster, PhD, for her valuable contribution.

REFERENCES

1. Borges, Jorge Luis (Author), Weinberger, Eliot (Editor). ‘The Analytical Language of John Wilkins’ in Selected Nonfictions. Penguin Books. 1999. Return to text
2. Foucault, Michel. The Order of Things: An Archaeology of Human Sciences. Tavistock. 1985. Return to text
3. Sass, Louis A. Madness and Modernism: Insanity in the Light of Modern Art, Literature and Thought. Harvard University Press. 1998. Return to text

Imagine living 20 years spending 24 hours a day in a cage that tightly fits your body, not giving you room to stand up, stretch out, turn around, or move at all.

Imagine that twice a day during these years you would have a metal catheter inserted into a hole which has been cut into your abdomen, allowing the catheter to easily puncture your gall bladder, or maybe a long syringe inserted into your gall bladder, piercing through your skin again and again, by people who are not doctors.

Imagine becoming infected and cancerous because of this twice-daily physical invasion, and becoming neurotic due to your claustrophobic imprisonment.

Imagine having one or both of your hands cut off so someone can sell them for a lot of money.

Imagine you begin to chew at your hands, if you are lucky enough to have one or both left, due to your developing neuroticism, and to distract yourself from the pain you experience twice a day, every day, for your entire life.

This is reality for an estimated minimum of 12,000 bears across Asia.

– Sara Pegarella, JD

Currently, animal activists across China are up in arms because Gui Zhen Tang Pharmaceutical Corporation, a Fujian-based company that sells bear bile for use in Traditional Chinese Medicine (TCM), has tried to increase production through an initial public offering (IPO). The company is being accused of cruelty towards animals in the process of extracting their bile at an industrial scale. Bear bile, or Xiong Dan (熊胆), is an important ingredient in TCM.

The issue is not new: since the early 2000s, animal activists have circulated hundreds of shocking articles, images, and videos that recount unimaginable cruelty towards caged bears in Asia. The practice has even outraged celebrities, such as Jackie Chan, who have pleaded with consumers to stop buying products made from bears and other endangered species. But now it’s all over the news. Gui Zhen Tang’s IPO has met with fierce public opposition, and has once again led environmentalists to appeal against the cruelty of live bear bile extraction.

As this documentary shows, bear bile is sold throughout Asia for a variety of conditions. The Chinese Herbal Medicine: Materia Medica (1986) by Dan Bensky, Andrew Gamble, and Ted Kaptchuk lists bear bile as a remedy for trauma, sprains, fractures, hemorrhoids, conjunctivitis, severe hepatitis, high fever, convulsions, and delirium. The Materia Medica also states that “because of the high price of bear bile (Xiong Dan), often cow bile, Fei Bovus (Niu Dan), is substituted at a higher dose.”¹ There is no mention, however, of the horrific means by which the animal bile is obtained. The guide also lists other animal products (rhinoceros horn, tiger bones, deer musk, and bat and squirrel feces [sic]) used as medicine.

Image 1. The bear bile entry in the 1986 version of Materia Medica by Bensky et al. The entry in the latest edition (3rd ed. 2004) has been moved to “Obsolete Substances.” Image used with the explicit permission of Eastland Press.

The globalization of TCM has lead to a dramatic increase in the demand for bear bile along with other traditional remedies. Bear bile is sold in Asian apothecaries throughout the world in the form of powder, solution or pills. It is likewise the key ingredient in many Asian “patent medicines” used for tapeworm, childhood nutritional impairment, hangovers, colds, and even cancer. Bear bile is even found in Chinese throat lozenges, shampoo, wine, and tea.

Image 2. Raw bear bile in both liquid and powder forms. Photo: Kathleen E. McLaughlin, the Chronicle Foreign Service correspondent in Beijing

Overall, the worldwide trade in bear parts, including bile, is estimated to be a $2 billion industry. Research in August 2007 by the animal rights group Animals Asia shows its staggering profitability: while the wholesale price of bile powder is around US$410 per kg in China, the retail price increases exponentially to 25 to 50 fold in South Korea, and to 80 fold in Japan (US$33,000 per kg)!

While the trade in bear products is prohibited under the Convention on International Trade in Endangered Species (CITES), and the importation and trade of bear bile products to North America is illegal under both US and Canadian law, many products are still openly offered for sale in Chinese stores. Back in 2001, when the World Society for the Protection of Animals conducted a probe of Asian shops in Canada and four US cities — Chicago, New York, Washington, and San Francisco — it found that 91% of the shops surveyed sold some form of bear part, including farmed bile powder, bile medicines, and whole gallbladders, which the merchants claimed originated from wild bears in China. When WildAid, an animal rights group based in San Francisco, sent an undercover investigator into Chinatown in 2004, two shopkeepers readily produced vials in velvet-lined boxes with pictures of a bears on the lid.

Bear bile is obtained through surgically implanting a tube in the animal, in a process called “milking,” that produces an average 15 ml (.5 oz) of bile each time. The Humane Society of the United States reports that the process of milking is so painful for the bears that they moan and often chew their paws during the procedure. In order to make access to the animals easier, the farmers often break the bears’ teeth and pull out their claws, sometimes brutally removing whole digits. If the bears stop producing bile, they are left to die, or are killed for their gallbladder and paws (considered a delicacy in China).

According to Jeanette McDermott, the founder of Ursa Freedom Project, bear farming in Asia increased during the 1980s in response to the dwindling supply of bear parts obtained from bears hunted in the wild. Tragically, the situation grew out of control, and by the early 1990s, there were over 400 bear farms in operation, containing more that 10,000 bears. Plans were in place to increase the number of bears in farms to 40,000 by the year 2000.

Today, China produces 7,000 kilos of bear bile annually, much of which is illegally exported to Japan, Korea, Australia, Canada, and the US. Whole bear gallbladders are also exported: the Humane Society of the United States says smugglers have been caught with gallbladders packed in coffee to conceal their smell, or dipped in chocolate to disguise them as chocolate-covered figs.

Most of the bears used in bile farming are Himalayan black bears (Ursus thibetanus), also known as “Asiatic black bears” or “Moon bears,” due to the cream-colored crescent moon shape on their chests. As their population has decreased by almost 40 percent over the past few decades, they have been listed (since 2000) as among the most critically endangered species on the International Union on Conservation of Nature’s Red List of Threatened Species.

A number of the bears in bile farms are captured illegally in the wild as cubs. Poachers either wait to capture new-born cubs until the mother leaves the den in search of food , or sometimes they simply kill her to get to the babies. Some of the cubs are born in captivity — but in either case, bear cubs rarely survive to adulthood — and those who do often grow into the bars of their cages as their bodies mature.

Image 3. Is this traditional medicine or savagery and barbarism? Photo: Cornelius Maarselar/Animals Asia

Animal activists posing as potential clients report that the caged bears moan, writhe in pain, and clutch their stomachs as the bile drains from their bodies. Sometimes the bears try to pull out the catheters. Those that succeed are immobilized in an iron corset. Under-nourished and highly stressed from horrific pain and unnatural confinement, the bears lie in agony, in their own filth.

According to Jeanette McDermott, bile is not the farmers’ only source of profit from the bears. Some farmers amputate one or two paws from live bears to sell to restaurants. When bears are no longer able to secrete bile, they are left to die from sickness or starvation. Bears might endure this torture for up to 25 years, making their lifetime a reality of suffering and pain in the name of “natural” and “traditional” medicine.

Image 4. This metal clamp is placed around bears who might struggle or move around excessively in order to ensure they remain still through the painful bile extraction. Photo: Animals Asia

There are a number of extremely painful techniques used for milking bear bile. Image 4, above, illustrates the common extraction technique that relies on plastic or metal catheters, and often necessitates a metal jacket in order to restrain the bears (the chilling details can be found at the Animals Asia website). Some farms rely on an ultrasound machine to guide a catheter connected to a medicinal pump. In this method, the bears are sedated — usually with ketamine — restrained with ropes, and have their abdomens jabbed repeatedly with four-inch needles until the gallbladder is located. Animals Asia suspects that this process leads to dangerous leakages of bile into the body, and to a slow and agonizing death from peritonitis.

In recent years, China has introduced a new, “humane,” free-dripping extraction method, which does away with the need for catheters. Free-dripping involves carving a permanent hole, or fistula, into the bear’s abdomen and gall bladder, from which bile drips out freely. The damage caused by the bile’s leaking back into the abdomen, together with infection from the permanently open puncture, is even worse than the catheters method, and results in a high mortality rate. Often, the bears’ livers and gallbladders become severely diseased through this process, and the collected bile is contaminated with pus, blood, urine and feces.

Image 5. Sometimes a hollow steel stick is pushed through the bear’s abdomen, and the bile runs into a basin under the cage. In this case, about half of the bears die from infections or other complications. Photo: Animals Asia

Image 6. Ultrasound bile extraction from a bear in Vietnam. Photo: Asia Wild Life

A healthy bear’s bile is as fluid as water, and ranges in color from bright yellow-orange to green. However, Animals Asia’s vets have described bile leaking from the gallbladders of farmed bears as “black sludge.” Eminent Chinese and Vietnamese pathologists have warned the public not to use bile taken from sick bears.

The active substance in bile (of bear and all other mammals) is ursodeoxycholic acid (UDCA), also known as Ursodiol, which is easily synthesized, and has been available for several decades. It is estimated that 100,000 kilos of synthetic UDCA are already being used each year in China, Japan, and South Korea, and that the total world consumption may double this figure.

Despite the availability and affordability of synthetic UDCA and suitable herbal alternatives, some practitioners obstinately continue to prescribe bear bile, which in turn drives up the market demand, and pressures the Chinese government to continue to allow the practice of bear farming.

The world’s appetite for bear bile and other parts has also led to the hunting and killing of wild bears in the North America. The media reports that the poaching of bear gallbladder for its use in TCM is on the rise in the US. The Los Angles Times, of August 22, 2008, writes that Fish and Game Wardens in California (CA) often report finding dead black bear carcasses that have been skinned and dismembered. The gallbladder is by far the most often stolen part (see the Los Angeles Times of November 29, 2010). The CA animal safety group, BEAR League, reports that since the beginning of 2007, as many as 87 dead bears have been found near state roadsides. On occasion, they report the bears’ heads or paws are cut off, but they also report finding bear carcasses with the gallbladder missing.

Image 7. This California black bear was struck and killed on State Highway 89 near Lake Tahoe in August 2008. State wildlife officials say the gallbladder was removed. Photo: BEAR League

The appalling impact of TCM on endangered species goes well beyond bears though. It affects the world’s most precious and protected animals, such as Bengal tigers, American bears and African rhinos. A worldwide interest in alternative medicine and the ease of international commerce now put dozens of species worldwide at risk. And while most of traditional Chinese medicines rely on herbs, the demand for products made at the expense of threatened animals continues to grow. In reality, many of the current claims associated with the medicinal value of animal products are spurious; but reality hasn’t stopped the rising demand for these illegal substances, and the profits to be made by poachers and smugglers rise.²

While the use of some animal products was perhaps justifiable in the past  — when there were no alternatives available, the extent of demand was limited, and the particular species were plentiful in their natural habitat — it is no longer sustainable, or justifiable, given our modern, globalized, and technically-advanced world. Today, with other approved therapeutic alternatives available, there is little justification for the use of endangered species such as the black bear.³

The belief advanced by the Counterculture of the 1960s and the New Age movement — that “natural” curatives are better than their synthetic equivalents — contributes enormously to TCM’s popularity in North America today. These groups originally objected to the growing over-consumption and over-reliance on synthetically-produced medicines, over natural alternatives. And while these concerns should be considered serious, the apologists of TCM and other types of traditional medicines fail to recognize that at present, their massive demand for “natural” products has made crime against animals commonplace. TCM has behind it a powerful, moneyed group of consumers whose “needs” now drive a whole black market economy — one that supports poachers, bear bile farmers, and all types of heinous torture.

As I wrote his article, I was overwhelmed with rage, and repulsed not only by the horrific images of the animal holocaust in Asia, but also by the enormous hypocrisy of the proponents of TCM, who effectively claim that pus-infested bear bile, and the by-products of animals tortured, disfigured, and dismembered in the name of the“natural” are better, safer, and “gentler” than synthetic pharmaceuticals.

With many thanks to Sara Pegarella, JD, and Kristin Koster, PhD, for their valuable comments.

The above mentioned animal rights advocacy groups (Animals Asia, Asia Wild Life, etc.) were not interviewed for this piece and any information attributable to them was taken from their websites. I encourage you to visit these sites to become more informed and involved.

REFERENCES

1. Bensky D, Gamble A, Kaptchuck T. Chinese Herbal Medicine: Materia Medica. Revised Edition. Eastland Press. 1986. Return to text
2. Ellis R. Tiger Bone & Rhino Horn: The Destruction of Wildlife for Traditional Chinese Medicine. Island Press; 1 edition. 2005. Return to text
3. Still J. Use of animal products in traditional Chinese medicine: environmental impact and health hazards. Complement Ther Med. 2003 Jun;11(2):118-22. Return to text

Not only his name and his titles of nobility were forged, but parts of the teachings of the man who introduced acupuncture to Europe were also invented. Even today, treatments are provided based on his fantasies.

– Hanjo Lehmann¹

Decades before President Nixon’s visit to communist China, and before the articles in the Western popular press on the use of acupuncture in surgery, a Frenchman by the name of George Soulié de Morant (1878-1955), published a series of colorful accounts of the use of acupuncture in early 20th-century China. His work led to the creation of a school of thought known as “French energetics,” which has become the theoretical foundation for many proponents of acupuncture in the West, including Joseph Helms, MD, the founder and former director of the American Academy of Medical Acupuncture (AAMA), and the founder of the acupuncture certification course for physicians.

But just as the medical community gradually learned that the reports of the use of acupuncture in surgery in communist China were inaccurate, exaggerated, or even fraudulent, we are now learning that the reports on the use and efficacy of acupuncture by Soulié de Morant were also fabricated.

According to a 2010 article published in Germany by Hanjo Lehmann in the Deutsches Ärzteblatt (a short version was published in Süddeutsche Zeitung), there is no real evidence that the Frenchman who is considered the father of Western acupuncture ever stuck a needle in anyone in China, and he probably never witnessed a needling.

A century prior to Soulié de Moran’s publications, the therapeutic use of needles enjoyed immense (though short-lived) popularity in Western Europe — mainly in France, Germany, Austria. This use of needles consisted mostly of the so-called locus dolendi treatment, where needles are placed solely in the vicinity of the affected area(s).² But due to its lack of significant efficacy, this treatment vanished just as rapidly and completely as it had appeared.

During that time, paradoxically, acupuncture was excluded from the Imperial Medical Institute of China by decree of the Emperor in 1822. The knowledge and skills were retained, however, either as an interest among academics or through everyday use by rural folk healers. With China’s increasing acceptance of scientific medicine at the start of the 20th-century, final ignominy for acupuncture arrived, when in 1929, it was outlawed, along with other forms of traditional medicine.³

The practice of acupuncture, however, reappeared in France a few years after it was outlawed in China, and from there it gradually spread to Western Europe and the US. This time, its theories were based on the laws of meridians (where points distant from the affected areas are needled according to intricate algorithms). This renaissance was largely due to Soulie de Morant’s legacy.

Soulié de Morant was born in Paris in 1878, and attended a Jesuit school. The prevailing story is that he was a child prodigy, and in addition to speaking fluent English and Spanish, he also learned Mandarin from a Chinese man who lived in Paris, and who (according to family friend Judith Gautier, a French writer) spent an afternoon with the young George writing Chinese characters (or ideograms) in the sand.

Soulié de Morant went to China at the turn of the 20th-century at the age of 21 to work for a French bank. The legend goes that he was fluent in Mandarin before going to China, and that once there, he also learned Mongolian. Reportedly, his language skills and his knowledge of Chinese culture brought him to the attention of the French Ministry of Foreign Affairs, who appointed him judge of the Joint French Court of Shanghai, and later the Vice-Consul of Foreign Affairs in Yunnan. Presumably, he then became the French Consul in several Chinese cities.

The legend also includes the story of how, while in office, Soulié de Morant witnessed a Chinese physician help the victims of a “terrible cholera epidemic that raged in Beijing at that time,” without recourse to modern medicine. His curiosity aroused, he began to read ancient medical texts, and studied acupuncture under several renowned physicians. Purportedly, he later practiced acupuncture himself, and it is reported that his knowledge and skills were such that he became respected by the Chinese — an incredible accomplishment for a foreigner, then or now.⁴

He returned to France in 1910, was married in Paris in 1911, and had two children. He then tried to return to China, but only succeeded to go back for a few months in 1917. After this final trip to China, he wrote several books on Chinese art and literature. Curiously, he didn’t mention acupuncture in any of his writings until 1929 — the same year it was outlawed in China.

Initially confronted with skepticism and derision, Soulié de Morant’s writings on acupuncture eventually managed to attract the support of several French physicians. His major work, L’acuponcture chinoise, outlines his “theory of energy” and its therapeutic manipulation by acupuncture. He is also known for coining the widespread term “meridian,” as a translation for the Chinese expression jingluo (經絡), which literally means “channel-network.” He translated the term qi (氣), the Chinese equivalent of the Greek notion of pneuma (πνεύμα), into the modern term “energy.”

The 1994 translation of L’Acuponcture Chinoise. Image source: Paradigm Publications

One of the main people who challenge the authenticity of Soulié de Morant’s understanding of acupuncture and his interpretations of the Chinese classics is the American scholar, Donald (Deke) Kendall, PhD, who writes in the Dao of Chinese Medicine that by jingluo, the Chinese were simply referring to blood vessels. Kendall argues that Soulié de Morant’s theories are actually the result of profound misunderstandings and misinterpretations of the classics, which have resulted in the portrayal in the West of the rudimentary description of the vascular system by the Chinese as an elusive network of intangible “energy” channels.⁵

There is ample evidence in support of Kendall’s claims, including the work of the classics scholar Elizabeth Craik, who has convincingly argued that the Chinese notion of jingluo is quasi-identical to the Greek notions of phlebes (blood vessels in general) and neura (ligaments, nerves, etc.).⁶

But Hanjo Lehmann, the author of the recent article in Deutsches Ärzteblatt, goes a step further. Lehmann lists a set of contradictions and inconsistencies in Soulié de Morant’s account of his journey in the Far-East, which shed doubt on his overall character, the integrity of his narrative, and the credibility of his exposure to, and practice of, acupuncture in China. Lehmann calls him a scharlatan.

Lehmann first points out that it would be unlikely for a 21-year-old without any formal education in Chinese (and who had never lived in China) to master a complex language with several thousands of characters, even if he took courses regularly for several years. We recall that the only testimony of Soulié de Morant’s formal “studies” in Paris came from Judith Gautier (1845-1917), who affirmed that on one occasion, a Chinese friend of the family in Paris drew characters in the sand with him.

According to Lehmann, Soulié de Morant likely started his foreign service in 1903, as a low-level interpreter at the Shanghai Consulate, and not as a “judge” in Shanghai. The belief that he was actually nominated as a judge might come from the fact that in his book Exterritorialité et intérêts étrangers en chine, Soulié de Morant states that the French delegate in the Joint Court was “usually the first interpreter” of the consulate.

As for his consular nominations when he was only in his mid-twenties, Lehmann argues that they are certainly false. It is only after he left the French Foreign Office, (probably in 1924), that he received the title of “honorary consul.” In fact, it is only in his writings after 1925, that he calls himself Consul de France.

Lehmann also believes that his aristocratic name “Soulié de Morant” was a forgery, and that he was born simply Georges Soulié.

As for acupuncture, Soulié de Morant claims that he first saw and practiced the technique himself during a cholera outbreak in Bejing in 1908 — but no records of such an outbreak at that time exist. According to the History of Chinese Medicine by Wong and Wu, an epidemic of plague and typhus occurred roughly around that time, but in Hong Kong and Fuzhou in Jiangxi.⁷ There is no record of a cholera epidemic in Beijing or anywhere else.

Moreover, although Soulie de Morant recounts his studies with two renowned acupuncturists of academic rank, other Western writers remind us that during that time, only street practitioners and rural folk healers, worked with needles therapeutically; the use of needles was actually often associated with amulets and talismans, and thus frowned upon by the Chinese academia.⁸

These and dozens more inconsistencies that discredit Soulié de Morant, suggest that the his claims about acupuncture, and the lore of energy meridians and qi, are founded on sloppy translations, misconceptions, or even pure forgery. But the accuracy of these notions are never disputed by the Chinese, because — as Lehmann points out — the public image of acupuncture in China today is based mainly on its reputation in the West. The Chinese consider that any criticism or fundamental discussion would jeopardize that reputation.

Over the last half-century since his death, Soulié de Morant’s interpretation of the traditional tenets of acupuncture, known as “French energetics,” have inspired the creation of over a dozen methods, organizations, and schools abroad,⁹ each with different levels of orthodoxy, critical thinking, or even rationality.

Consider, for instance, a theoretical construct known as the “Energetics of Living Systems” that was developed by the French physician Maurice Mussat. He is one of the leaders of the French school of medical acupuncture, and has taught in the US under the auspices of Joseph Helms, MD. Mussast takes the fabulations of Soulié de Morant to the next level of absurdity by projecting cybernetics, complexity theory, and quantum mechanics onto meridian-based acupuncture.

Mussat indeed believes there is a parallelism between the energetics of the meridians and the “mathematical order inherent in the trigrams and hexagrams” of the I-Ching, a Chinese classic of geomancy (a type of divination based on patterns formed by tossed rocks, sticks, sand, etc.). Mussat, who believes he has connected the symbolism of the I-Ching with modern quantum physics, has devised “algebraic derivations” to measure meridian energetics, and has created a diagram that “incorporates nearly all of the fundamental energy relationships of acupuncture.”¹⁰ Mussat’s forced conflation of acupuncture and quantum physics is outlined in his 3-volume Energetics of the Living Systems Applied to Acupuncture, as well as in other creations of his overinclusive thinking.

A German book on Mussat’s “quantum-medicine” (1983). Image source: VGM Verlag GmbH for Integrative Medicine.

The cognitive derailments of Maurice Mussat have, in turn, greatly influenced Joseph Helms, the founder and former Director of the AAMA.¹¹ Helms, who combines family medicine, acupuncture, and homeopathy, served on the advisory panel of the Office of Alternative Medicine, NIH, and presented to the White House Commission on Complementary and Alternative Medicine Policy. In his book, Acupuncture Energetics, Helms writes:

Mussat inspired me with the strength of his conviction and his creative merging of two disparate traditions of thought and medicine. He guided me to perfect my clinical skills and to start teaching. My early clinical time with him, combined with the years we lectured together, created an indelible matrix of clear expression that I hope is manifested throughout this work.¹²

Since the 1980s, the AAMA has taught the fantasies of Soulié de Morant and Mussat on meridians and energy under the label of “medical acupuncture” to thousands of physicians in the US , many of whom were members of the military. In fact, in 2009, the office of the Surgeon General of the Air Force instituted a pilot program for active duty physicians to be trained by Helms Medical Institute, and gave out 32 scholarships on a competitive basis. According to Stars and Stripes, the US military’s independent news source, the program is now expanded to all service branches, and will certify 60 active duty physicians in 2011 as “medical acupuncturists.”

Meanwhile, well-conducted clinical trials have indicated over and over that needling location has little differential effect on outcomes, and that acupuncture is largely devoid of specific therapeutic effects.¹³ The support for this argument comes from a series of 8 large randomized controlled trials (RCTs) initiated by German health insurers. These RCTs were related to chronic back pain, migraine, tension headache, and knee osteoarthritis (2 trials for each indication). Their total sample size was in excess of 5000. Even though not entirely uniform, the results of these studies tend to demonstrate no or only small differences in terms of analgesic effects between real and placebo needling.¹⁴

This evidence indicates that the use of specific meridians, points, and particular types of stimulation are not critical factors independent of conditioning, expectancy or other neuropsychological factors. Needling seems to have a broad anti-inflammatory and antihyperalgesic effect, which could be attributed to the pain and tissue injury, or the neurostimualtion caused by the needle, regardless of the insertion point. In view of this, the meridian and point lore, and the premisses of “Acupuncture Energetics,” are all devoid of any scientific rationality.

Considering that acupuncture was reintroduced to the West based on a narrative that was apparently fraudulent; that its cultural assimilation has conflated it with New Age crackpottery; and that reliable RCTs contradict its medical claims, it’s time once-and-for-all to cease wasting taxpayer dollars on its dissemination.

NOTE: The opinions expressed here are those of the author, and do not reflect the positions of Hanjo Lehmann and Donald (Deke) Kendall.

REFERENCES

1. Lehmann H. Akupunktur im Westen: Am Anfang war ein Scharlatan. Dtsch Arztebl. 2010; 107(30): A-1454 / B-1288 / C-1268. Return to text
2. Feucht G. Streifzug Durch die Geschichte der Akupunktur in Deutschland, Deutsche Zeitschrift fur Akupunktur, 10. 1961. Return to text
3. Ma KW. The roots and development of Chinese acupuncture: from prehistory to early 20th century. Acupunct Med 1992;10(Suppl):92–9. Return to text
4. Soulié de Morant G. L’acuponcture chinoise. 2 vols. Paris: Mercure de France, 1939-1941. Published in English as Chinese Acupuncture, edited by Paul Zmiewski. Brookline, MA: Paradigm Publications. 1994. Return to text
5. Kendall DE. Dao of Chinese Medicine: Understanding an Ancient Healing Art. Oxford University Press, USA; 1 edition. 2002. Return to text
6. Craik EM. Hippocratic Bodily “Channels” and Oriental Parallels. Med Hist. 2009 January; 53(1): 105–116. Return to text
7. Wong KC, Wu TH. History of Chinese Medicine. Oriental Book Store. 1977. Return to text
8. Hillier SM, Jewell T. Health Care and Traditional Medicine in China 1800-1982. Routledge; 1 edition. 2005. Return to text
9. Hsu E. Outline of the History of Acupuncture in Europe, The Journal of Chinese Medicine, 29. 1989. Return to text
10. Mussat M. Energetique Physioloque de l’Acupuncture. Paris, France: Librairie le Francois. 1979. Return to text
11. Birch SJ, Felt RL. Understanding Acupuncture. Churchill Livingstone; 1 edition. 1999. Return to text
12. Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Medical Acupuncture Publishers; 1st edition. 1995. Return to text
13. Ernst E. The American journal of medicine, Vol. 121, No. 12. December 2008. Return to text
14. Baecker M, Tao I, Dobos GJ. Acupuncture Quo Vadis? On the current discussion around its effectiveness and “point specificity.” In: McCarthy M, Birch S, Cohen I, et al, eds. Thieme Almanac 2007: Acupuncture and Chinese Medicine. Stuttgart, Germany: Thieme; 2007:29-36. Return to text

Luis Fernando Verissimo, a Brazilian writer, once proposed “voodoopuncture”. Instead of going to the acupuncturist, you would be treated without leaving home. The voodoopuncturist would stick acupuncture needles in the voodoo dolls of you! I add that voodoopuncture could be outsourced to Haiti and/or China. It is a win-win-win situation!

– Leonardo Monasteri, Brazilian economist

As unbelievable as this might sound, “voodoopuncture” is no fiction at all.

The practice is called “Tong Ren healing,” and involves needling or hammering an acupuncture mannequin, as if it were a voodoo doll. The main Tong Ren “Master” in the US is an acupuncturist in the Boston area by the name of Tom Tam. He treats groups of terminally ill and debilitated patients in a deliverance ceremony that is noting but a revamped Taoist exorcism — only the clay or straw doll is replaced by a plastic mannequin:

Unfortunately, Tom Tam is not the only licensed healthcare provider who is treating patients with hocus pocus and crackpottery. There are over 30,000 other adepts of Traditional Chinese Medicine (TCM) in the US who practice medicine based on notions of health and disease that are rooted in paranormal and magical beliefs. Some of these practitioners take their delusions to the outer limits of absurdity: consider, for instance, “acutonics” and “colorpuncture” as described in these videos:

In anthropology of religion, the principles that underline the above practices are called “imitation” (e.g. using a doll to affect a person), and “correspondence” (e.g. using a sound to affect an object). They are the hallmarks of what is called “sympathetic magic,” meaning the belief that a person, or a thing, can be affected through something that represents it, or that has similar attributes.¹ The principle of magical correspondence in TCM is called wu xing (五行) in Chinese, and is known as the Five Phases/Elements Theory in English. It can be summarized as follows:

1. Everything (including our organs) is ruled by one of 5 entities: Water (水), Wood (木), Fire (火), Earth (土), and Metal (金) — which are also the Chinese names for the planets Mercury, Jupiter, Mars, Saturn, and Venus.² For instance, the heart is ruled by Fire (Mars), the liver by Wood (Jupiter), etc.

2. There is a sympathetic connection (or resonance) between things that are ruled by the same entity (or planet). For example, the heart is connected with the color red, the direction south, the summer season, a bitter taste, and the feeling of joy — because all of these are ruled by Fire (Mars).

3. All 5 entities are interconnected and act on each other. Disease is understood as a result of either the over-, or under-influence of one entity on another. For example, digestive disruptions can be attributed to “Wood overacting on Earth.”³

The concept map (pictogram) of wu xing is often drawn by placing the 5 entities in a circle, and then connecting them according to the lines of influence. The connecting lines create a “pentacle,” or a pentagram within a circle (Image 1).

Image 1. The pictogram of wu xing. Image Source: acupuncture.com

This pictogram, unbeknownst to most TCM practitioners, is nearly identical to a sigil (magical or religious symbol) found in the Old Religion of Northern Europe, also known as “Wicca” (from the Old English word wicca, meaning a male sorcerer). The only difference between the Chinese and the Wiccan pictograms is that Wicca uses Air instead of Wood, and Spirit instead of Metal. The assignment of attributes (color, sound, taste, etc.) to each entity also varies slightly (Image 2).

Image 2. The Five Elements of Wicca.

According to the historian Cornelia J. de Vogel, this sigil was commonly used by the druids in the context of spell casting, and protection against evil and malevolence.⁴ It was likewise used in ancient Greece among Pythagoreans in the context of the cult of Hygieia (Ὑγεία, Salus in Latin), the Greek patron of well-being, sanitation, and the prevention of disease (Image 3). Notably, their brotherhood (an esoteric cult based on numerology) also believed in resonance between numbers, tastes, colors, sounds, and the classical elements.⁵

Image 3. Pythagorean pentagram in Three Books of Occult Philosophy (Libri Tres de Occulta Philosophia) by Heinrich Cornelius Agrippa (1486 – 1535). The word Ὑγεία (Hygieia) is inscribed on the outer circle.

In Christian Europe, some of these pagan beliefs and symbols were culturally assimilated. For instance, the pentacle became the symbol of the five wounds of Jesus Christ.⁶ But with the advent of science and modernity, magical thinking, its symbolism, and all the rituals that accompanied it were discredited as superstition and ignorance.

Paganism and magic, however, weren’t so easily done away with — and they experienced a renaissance with the American Counterculture of the 1960s. Vietnam-era demonstrations with large hippie contingents famously mixed politics with occultism, magic, and witchcraft. For example, at the mammoth antiwar protest near Washington DC, in October 1967, demonstrators performed a mock-exorcism to levitate the Pentagon and cast out its demons.⁷

The magical notions of occult resonance and interconnectedness now find their zealots in the growing Neo-pagan and New Age movements. These revamped notions provide the conceptual basis for energy or vibrational medicine, which includes not only colorpuncture and acutonics, but also herbalism, reiki, reflexology, crystal therapy, magnet therapy, aromatherapy, acupuncture, and many other methods to channel putative “energy fields.”

A 2006 publication reported that in 2004, the annual spending on various channeling methods and alternative healthcare in the US was about $10 to $14 billion. It also estimated the number of Americans involved with New Age activities to be around 12 million.⁸

The popularity of these unscientific ideas and practices in the last decades has had a terrible impact on the public health policy in the US. One consequence is the licensing of non-physician acupuncturists in over 40 states. As George Ulett wrote in 2003, “is a travesty that in this time of scientific evidence-based medicine, acupuncture treatments are given to unsuspecting US patients by some 20,000 acupuncturists, posing as primary care doctors.”⁹ Be noted that their number has now increased to over 30,000.

Another consequence is the attempt to mainstream TCM and energy medicine by means of lobbying and political pressure. This leads to national and regional healthcare policies that are not based on science and evidence, but on consumerism and financial interest. As Steven Novella writes in Politics and Science at the HHS, this tends to “contaminate” science, and change the rules so that a popular modality can get a free pass. Novella adds that “modalities that require political pressure to force them into our health care system are those that are not backed by good science.”

An example of politically-motivated healthcare policy is the Federal Acupuncture Coverage Act of 2011 (H.R.1328), which is sponsored by House Representatives Maurice Hinchey (D-NY), Judy Chu (D-CA). It intends to “… provide for coverage of qualified acupuncturist services under part B of the Medicare Program, and to amend title 5, United States Code, to provide for coverage of such services under the Federal Employees Health Benefits Program.”

Yet another example is the current pressure put on the US Department of Health and Human Services by Judy Chu (a Representative for a district with a heavy concentration of acupuncturists and apothecaries) to make TCM and acupuncture part of the “Essential Health Benefits.” These benefits are a set of federally-mandated services under the Patient Protection and Affordable Care Act (PPACA).

This comes at a time when California State Senator Leeland Yee is trying to expand the scope of acupuncturists’ practice in his state to include the performance of “Chinese traumatology” — whatever that means.

If Maurice Hinchey, Judy Chu, Leeland Yee, and the TCM syndicate get their way, then revamped exorcism and sorcery will further infest the American healthcare system.

And if they don’t, I can already imagine voodoopuncturists in their cubicals in China, just like Leonardo Monasteri predicted: “…tap, tap, tap, can you feel me now?”

REFERENCES:

1. Frazer JG (Author), Fraser R (Editor). The Golden Bough: A Study in Magic and Religion: A New Abridgement from the Second and Third Editions. Oxford University Press, USA; Abridged edition. 1998.
2. Walters D. Chinese Astrology. Aquarian Press. 1987.
3. Maciocia G. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Churchill Livingstone. 1989.
4. de Vogel CJ. Pythagoras and Early Pythagoreanism. Assen: Van Gorcum; 1966.
5. Burkert W. Lore and Science in Ancient Pythagoreanism. Cambridge, MA: Harvard University Press; 1972.
6. Ferguson G. Signs and Symbols in Christian Art. New York: Oxford University Press, 1959.
7. Paglia C. Cults and Cosmic Consciousness: Religious Vision in the American 1960s, Arion, Winter 2003.
8. Pike SM. New Age and Neopagan Religions in America. Columbia University Press. 2006.
9. Ulett GA. Acupuncture: archaic or biologic? Am J Public Health. 2003;93(7):1037; author reply 1037-1038.

Voodoo science is a sort of background noise, annoying but rarely rising to a level that seriously interferes with genuine scientific discourse… The more serious threat is to the public, which is not often in a position to judge which claims are real and which are voodoo. Those who are fortunate enough to have chosen science as a career have an obligation to inform the public about voodoo science.

– Robert L. Park, PhD, 2000¹

Imagine you are an ordinary person with limited knowledge of science and medicine, and you see this 2010 video on tai chi and qi gong by the National Center for Complementary and Alternative Medicine (NCCAM) — one of the agencies that make up the National Institutes of Health (NIH). I am certain that the solemn voice of the Director of NCCAM, Dr. Josephine Briggs, talking about “rigorous scientific research” and “accurate, authoritative information on complementary and alternative medicine,” will leave you with a strong sense of confidence in her message.

In addition, despite the fine-print and the disclaimer, the appearance of Dr. Briggs in the video could be broadly viewed as a sign of tacit endorsement. Often, the very fact that a treatment is associated with the government is already a de facto stamp of approval and a warranty of efficacy. For instance, the publication below by the California Department of Consumer Affairs states that the NIH formally “endorses” acupuncture, simply because in 1997, a panel of scientists assessed its use and effectiveness for a variety of conditions. Since 1997 the scientific review of acupuncture by NIH has become synonymous with its endorsement, despite the fact that as a federal research agency, the NIH does not endorse any product, service, or treatment.

In October 26, 2011, a few weeks after Steve Jobs’ death, Josephine Briggs decided to do something she has never done before: she put an explicit disclaimer on her blog:

When making treatment decisions, unproven “alternative medicine” approaches should not replace conventional medical care approaches known to be useful or helpful. Simply put, the evidence is not there (emphasis added).²

Three paragraphs down the page, she goes on — with a candor rarely seen from her — that given the recent news about Steve Jobs’ choices for cancer treatment, all health decisions “should be guided by the best available evidence.”

If you recall, Jobs put off surgery in favor of juice fasts, cleansing, acupuncture, herbal medicine and other remedies he found online. Job’s biographer, Walter Isaacson, writes that he also followed a doctor who ran an alternative medicine clinic.³ Obviously, Dr. Briggs’ new-found skepticism did not get to him on-time.

Josephine Briggs’ sudden confession actually raises more questions than answers: did she have an enlightenment, an “Aha moment” in October 2011, and she suddenly realized that the evidence was not there? Or perhaps she knew all along, and while her institute was spending over $2 billion of US taxpayers’ money, she conveniently looked the other way? The question is pertinent because — despite the overwhelming criticism from the scientific community — Briggs and her staff have refused to admit that most research in alternative medicine is a reprehensible waste of public funds. If she has willingly looked the other way, then we are dealing here with bad faith and the betrayal of the public’s trust.

And waste and betrayal, there is. Skeptics Eugenie Mielczarek and Brian Engler write in the January/February 2012 issue of the Skeptical Inquirer that since 1992, there have been over 1000 monetary awards by NCCAM to fund hundreds of clinical trials. None of them has revealed anything new that would justify the current annual expenditure of $134 million. Some of these funded studies are beyond absurd: $250,000 was wasted to determine whether waving hands over fatty rabbits will decrease their cholesterol. Did it? Almost ten years later, we still don’t know! Public funds were also wasted to study the efficacy of prayer to cure AIDS or to hasten recovery from breast-reconstruction surgery. Other funded studies involved the use of ancient Indian remedies for type 2 diabetes, magnets for arthritis, carpal tunnel syndrome or migraine headaches, and coffee enemas for pancreatic cancer. It is not surprising that none of these studies showed any efficacy beyond the placebo effect.⁴

After examining hundreds of grants, dozens of scientific papers, 12 years of documents and advisory council meeting minutes, the Chicago Tribune also reports that NCCAM has spent millions of taxpayer dollars on studies with “questionable grounding in science.” The Tribune cites a grant for $374,000 to find out if inhaling lemon and lavender scents would improve wound healing. NCCAM has also wasted funds in studies of various forms of energy healing, including one based on the ideas of a self-described “healer, clairvoyant and medicine woman” who says her children inspired her to learn to read auras. The cost to the taxpayer was $104,000.⁵

All that is proven by these studies is that that most alternative “cures” work no better than placebo. It is also the case for acupuncture: a 3-arm randomized clinical trial on chronic back pain with 638 subjects showed that both acupuncture and sham control were better than usual care in managing low-back pain. However, the acupuncture regimen was not found to be more effective than a sham procedure that did not penetrate the skin. In other words, there is no difference between any type of acupuncture, and a placebo control procedure that does not involve real needles. This study was published in 2009 in the Archives of Internal Medicine.⁶

Well, here’s Josephine Briggs’ reaction to this acupuncture study:

This adds to the growing body of evidence that there is something meaningful taking place during acupuncture treatments outside of actual needling.

In other words, Briggs states that a treatment is useful because something meaningful is taking place outside of the treatment itself! But, isn’t this the very definition of the placebo effect? Based on her outlandish argument, needling voodoo dolls should also be considered as treatment — and perhaps qualify for funding — because something meaningful is taking place outside of actual needling!

But now that acupuncture, herbal remedies and a vegan diet did not help an American icon, Josephine Briggs is having an Aha moment, and is suddenly realizing that the evidence is not there! Why didn’t she admit to it earlier? Why did her agency omit credible evidence against the efficacy of these remedies for over a decade? Is her forced admission — or rather confession — some kind of proactive measure? These questions remain unanswered. But what is now certain, is the fact that NCCAM’s claim of being “dedicated to exploring complementary and alternative healing in the context of rigorous science,” is in flagrant conflict with its actual practices-on-the-ground.

Besides, let’s also not forget that this conflict is first and foremost politically motivated.⁷ It is the work of “alternative-medicine purveyors” and their powerful allies who seek to legitimize their anti-science agenda through a federal agency, and to maintain government funding for the promotion of “willful ignorance.”

Willful ignorance is certainly the hallmark of some of NCCAM’s Advisory Board members. Take a good look at their credentials and you will notice one element universally lacking: rigorous scientific training. Even worse, some have been entirely dishonest about their credentials or have a record of disregard for science- and evidence-based medicine, altogether.

Since 2009, Kimball Atwood, has written several posts on this site about the former member of NCCAM’s Advisory Council, the “AltMed Superstar,” Ted J Kaptchuk. According to Atwood’s investigation and also documents obtained from the California Acupuncture Board, Kaptchuk not only does not have real academic training, but he also has grossly misrepresented his credentials. Atwood suggests that Kaptchuk may have violated federal law by lying about his credentials when applying for federal grants.

Atwood adds in his November 11, 2011, comments that:

The revelation that this degree never existed now undermines all of those things, with ramifications that go way beyond Kaptchuk himself. The lie is so fundamental that it casts suspicion on all of his trial reports, for example. That affects all of his co-authors.

Be noted that even real credentials are not necessarily indicative of aptitude for scientific inquiry. Consider another former member of the Advisory Council, Adam Burke, PhD, MPH, MS, LAc. Despite what reads like a string of illustrious credentials, Burke doesn’t have any biomedical training: his graduate degrees are from UC Santa Cruz and UCLA in Social Psychology and Health Education. His healthcare “degree” doesn’t even come from an academic institution: it’s from the American College of Traditional Chinese Medicine in San Francisco (a private vocational school, where he is presently on faculty).

Here’s testimony to Adam Burke’s contempt for science:

If you biomedicalize it all, my big fear and this is why I’m in the university and one of the reasons why I went back to the university is if we strip the history and the philosophy and the understanding of that, we have shut out millennia of understanding of human illness that could enrich our understanding of healing people.

What follows is just crazy talk:

Distant healing — They don’t know how, but some of the people at the Institute of Noetic Sciences, which was founded by an Astronaut up in Marin, they are doing research on distant healing. Their principle investigator is a physicist — they are getting their research published in the best physics journals in the United States.

– Adam Burke, California Acupuncture Board Meeting Minutes, June 20, 2008

Burke also boasts the rather awkward honor of serving as Editor-in-Chief of The American Acupuncturist, the official publication of the American Association of Acupuncture and Oriental Medicine (AAAOM). Here below is a photo of AAAOM representatives meeting with Director Josephine Briggs in 2008:

Image 1. Front Row (L-R): Will Morris, Josephine Briggs, Martin Herbkersman, and in the back Row (L-R) Partap Khalsa, Misha Cohen, Adam Burke, Rebekah Christensen. Image Source: The American Acupuncturist, Fall 2008.

It is certainly not due to their concern for “rigorous science” that the above met with Josephine Briggs. It is because in this New Age of ignorance, hocus-pocus is big business, and getting the government involved can create the false perception of endorsement for any nonsense. This is a common charade that has been played by alternative-medicine purveyors for decades, with the public’s safety at stake.

But no matter — what we see recorded here is a 2008 meeting between an advocacy group and NCCAM. They were assembled to present Briggs a wish-list that included an increase in herbal research; grants to support AAAOM conferences; and the placement of acupuncturists on university research, grant review teams, and research advisory panels. The wish-list also requested “the expansion of the NCCAM Advisory Board to include individuals versed in mixed research methods, including qualitative, population-based research, quality and other approaches.”⁸

Now fast forward to 2010, about two years after the photo, and AAAOM’s candidate, Adam Burke, is appointed to NCCAM’s Advisory Board. Immediately after, the AltMed wizards from the above picture write in the January 2010 issue of Qi-Unity Report:

We look forward to the in-depth professional and research acumen Dr. Burke will bring to the NCCAM Advisory Council and to the benefits that will accrue to the AOM profession as our medicine transitions into the mainstream of U.S. health care delivery.

“In-depth professional and research acumen” and “our” medicine?! I just cannot refrain from laughing out loud.

But this is no laughing matter. The NCCAM budget for 2011 was $127.7 million.⁹ They requested a $3.4 million increase in funding for 2012.¹⁰ This is over $131.1 million taken away from serious medical research. Fortunately, Adam Burke was not re-nominated in 2012, and cannot influence the channeling of funds for “herbal research” or “grants to support AAAOM conferences” — especially now that we know the evidence is not there.

But despite Dr. Brigg’s disclaimer, many key questions still remain unanswered. How much more money is NCCAM going to waste for studying remedies where something meaningful is taking place outside of the actual treatment? How many more self-proclaimed experts with fabricated or unfit credentials are going to feed off the taxpayer? How many more Steve Jobs need to die before we realize that alternative medicine is in essence foolishness?

In my opinion, none, absolutely none. Once we become aware that the evidence is not there, a transgression takes place; this is when a legal line is finally crossed, and — as Robert Park has argued — foolishness becomes fraud.

With many thanks to Daniel Bederian-Gardner, Kristen Koster, Dawn Martin, Eugenie Mielczarek and Robert Slack for their valuable comments. The opinions expressed here are the author’s.

REFERENCES:

1. Park RL. Voodoo Science: The Road from Foolishness to Fraud. Oxford University Press. 2001. Return to text
2. Briggs JP. A Role for Complementary Medicine? NCCAM. 26 October, 2011. Retrieved 8 April 2012. Return to text
3. Isaacson W. Steve Jobs. Simon & Schuster; First Edition edition. 2011. Return to text
4. Mielczarek EV, Engler BD. Measuring mythology: startling concepts in NCCAM grants. Skeptical Inquirer. Volume 36.1, January/February 2012. Return to text
5. Tsouderos T, Federal center pays good money for suspect medicine. Chicago Tribune. December 11, 2011. Return to text
6. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009 May 11;169(9):858-66. Return to text
7. Mielczarek EV, Araujo DC. Power Lines and Cancer, Distant Healing and Health Care. Skeptical Inquirer. Volume 35.3, May/June 2011. Return to text
8. AAAOM Meets with the National Center for Complementary and Alternative Medicine (NCCAM). American Acupuncturist. Volume 45 FALL 2008. Return to text
9. NCCAM Funding: Appropriations History. NIH. 12 September 2011. Retrieved 8 April 2012. Return to text
10. Fiscal Year 2012 Budget Request. NIH. 12 September 2011. Retrieved 8 April 2012. Return to text

Many of the specific issues that the Governor and the Legislature asked the Commission to review have festered because the [California] Acupuncture Board has often acted as a venue for promoting the profession rather than regulating the profession.

– Little Hoover Commission, Regulation of Acupuncture: A Complementary Therapy Framework: September 2004, page 63.

On March 12, 2012, during a brief Sunset Review hearing, the California Senate Committee on Business, Professions and Economic Development asked the California Acupuncture Board (the Board) to respond to a set of harsh criticisms.

It is not the first time that the dysfunctional Board — which falls under the Department of Consumer Affairs — is being scrutinized by the legislator. The Board has a long history of operating in an inefficient manner, misreading its governing statutes, and potentially endangering the public by refusing to promulgate regulations concerning the sterilization of acupuncture needles or the wear of medical gloves by practitioners.

In the past, members and affiliates have even been investigated for taking bribes and selling licensing exam answers. The Board was replaced several times in order to clean up the quasi-anarchic and corrupt practice of acupuncture and Oriental medicine in California.

This time, the Senate Committee listed 10 major issues in a Background Paper, which is a worthwhile read for those interested in the regulation of acupuncture. The Senate expressed serious concerns about many administrative, educational, licensing, enforcement, consumer protection and budgetary matters. In response, the Board Chair and Executive Director offered little explanation. The Board now must respond to the Background Paper in specifics.

Trouble at the state acupuncture regulating authority goes back to 1982. The longtime chairman of the former acupuncture regulating agency (the Acupuncture Committee), Chae Woo Lew, was selling the answers to the California Acupuncture Licensing Examination for $10,000 to $20,000. He made $500,000 to $800,000 from an estimated 80 test takers. He was caught in 1988, but only a few dozen individuals who bought answers from him were ever caught. Lew was sentenced in 1990 to five years in prison.

In 1999 Acupuncture Committee became the Acupuncture Board. The Board was sunrisen until June of 2002.

During the 2002 sunset review of the Board, an independent state oversight agency called the Little Hoover Commission (LHC) was charged to assess longstanding and contentious issues regarding the State’s regulation of acupuncture — including a review of the scope of practice and educational requirements for acupuncturists, the process for accrediting acupuncture schools and for examining licensees.

LHC provided its assessment to the Legislature in September 2004 in a report called Regulation of Acupuncture: A Complementary Therapy Framework, (Report #175). LHC blamed the Board for many of the problems the profession faced. The report stated that the Board had “too frequently acted as a venue for promoting rather than regulating the profession.” It added that as a result, the Board had “missed opportunities to protect the public by providing accurate and complete information about the therapies that licensees can provide.” The report also stated that the Board had not “adequately incorporated emerging scientific evidence into board policies, regulations and public communications.”

The following Board review in 2005 found little improvements. Among the main concerns was the fact that the Board had misread its governing statutes concerning the scope of practice of acupuncturists. It also pointed out that the Board had potentially endangered the public by refusing to promulgate regulations concerning the sterilization of needles or even to discuss this issue as an agenda item in any public meeting.

During the most recent Board review, the Senate committee pointed out that most of the current issues are the same as those the former sunset review committees had struggled with. The persistence of these issues appears to indicate a general lack of accountability and follow-through on the part of the Board, making one wonder if there is a real willingness to take direction from the Legislature and to implement its recommendations.

The March 12, 2012, hearing ended with the Senate Committee letting the Board’s Chair and Executive Director know that it was very concerned about how the Board operates.

One of the persisting issue is the Board’s insufficient oversight of continuing education units (CEUs) . The Board has consistently approved material that is “grossly out of compliance” with it own regulations. The Senate Committee gave examples of courses in numerology, vitalism, astrology, “the Capacity and Function of Love,” cosmology, magic, sound healing with tuning forks; Reiki and “Four Energy Healing Theories,” whatever that means.

A 2003 CEU certificate in “Alchemical Acupuncture” taught by Jeffrey C. Yuen. A workshop in such outrageous nonsense is sufficient to renew an active acupuncture license in California.

The Board has indeed a long history of approving CEUs in hocus pocus. Examples are courses in mysticism, Taoism, alchemy, astrology, iridology, magic, geomancy (I-Ching), numerology, etc. The latest list is available here. What is most disturbing is the Board’s continuing denial that there is something wrong with approving a course in subjects such as astrology…

This flyer states in a different section that “This workshop is approved for 21 CEUs in Category 1 by the California State Board.”

After a complaint letter to the Board, its Executive Officer, Janelle Wedge, writes to me that: “Based on the comments received, there is no reason to alter the approval of the course.” Wedge resigned right after the Senate hearing.

Another Senate criticism was the disciplinary case management time-frame. The Board, which is responsible for regulating the practice of approximately 10,000 acupuncturists, takes at least 2½ years to investigate and take action. Since 2008, there has been an average of 223 enforcement cases per year; the majority involve unprofessional conduct, ethical issues, practice management issues and sexual misconduct. A list of disciplinary actions is available at the Board Actions webpage. The Board has received an average of 145 direct complaints complaints per year since 2008. It has also received 78 arrest/conviction reports from law enforcement since 2008.

And arrest and conviction there is — even for major crimes, such as trafficking in persons and sexual slavery. The media reports that since 2006, 17 people from 10 massage and acupuncture parlors in Redondo Beach, CA, have been arrested for alleged acts of prostitution (The Daily Breeze, Dec 8, 2010). In June 2009, 22 women – most of them Chinese nationals – were arrested in Vista, CA, in connection with 9 day spas and acupuncture clinics (FOX 5 San Diego, June 4, 2009). Prior to that, in March 2007, in one of the largest prostitution investigations ever in Orange County, CA, five individuals were arrested in business that advertised acupuncture and massage but sex was the only service provided.

According to District Attorney Tony Rackauckas, plastic food wraps were used instead of condoms in an acupuncture brothel in Orange County, CA. Photo source: Orange County Register.

Crime at acupuncture and massage parlors is such a concern that some local governments in Southern California have taken their own preventative measures by withholding business licensing. For example, the neighboring cities of Redondo Beach and Torrance have recently passed Urgency Ordinances that impose a moratorium on the issuance of any new permit, license, approval or entitlement pertaining to new massage/bodywork and acupuncture businesses, services and practitioners.

The picture that emerges here based on the Senate review and reports in the media, is that acupuncture in California is a poorly-regulated and corrupt profession with an ill-defined scope of practice. Many practitioners are deluded purveyors of New Age mumbo-jumbo, and a few are criminals involved in human trafficking and prostitution. The dysfunctional Acupuncture Board not only does not protect the public from quacks and criminals, but quite to the contrary, has a long legacy of acting in their favor. None of this serves the best interest of the public.

By looking at this picture, the world “Kafkaesque” comes to my mind. It is the only term that can accurately describe the senseless, disorienting and often menacing complexity of acupuncture regulation in California. The Board’s failure to follow a clear course of action, its unwillingness to implement its mission, the incomprehensible delays in disciplinary actions, and the bizarre and illogical rationale for some of its decisions, all point to the cynical dereliction of public safety by a group of defiant insiders.

Editor’s Note: Dr. Gorski was on a rare vacation last week, recharging his batteries. As a result, there is no new material by him this week. Fortunately, Ben Kavoussi was ready with another in his series of posts on traditional Chinese medicine. Dr. Gorski will return next week; that is, if he doesn’t return even sooner because he can’t stand to be away from SBM for two whole weeks.

The established laws of nature do not support Oriental Medicine’s claim of Yin and Yang and Five-Phases Theory. Oriental Medicine’s main theory was constructed when our civilization had limited methods to understand our surroundings, and as such, it is only an ancient illusion.¹

— Yong-Sang Yoo, MD, PhD, Chairman of the Committee for Medical Unification, Korean Medical Association, 2010

Yong-Sang Yoo is one of the strong and growing voices in Korea that is calling for an end to the national insurance coverage for Oriental Medicine.

Similarly, Professor Zhang Gongyao of the Central South China University petitioned the central government of China in 2006 to abolish support for Oriental Medicine because it has “no clear understanding of the human body, of the functions of medicines and their links to disease. It is more like a boat without a compass: it may reach the shore finally but it’s all up to luck.”² Zhang Gongyao and fellow critics have consequently blasted China’s traditional medicine as an often ineffective, even dangerous derivative of witchcraft that relies on untested concoctions and obscure ingredients to trick patients, and employs a host of excuses if the treatments do not work.³

Bloodletting is used in Oriental Medicine to relieve excess “heat,” meaning fever, sore throat, joint pain, muscle sprain, as well as inflammation. It is often practiced in unsanitary conditions.

A Product of Archaic Thinking

The arguments of Yong-Sang Yoo and Zhang Gongyao are reminiscent of those of William R. Morse, Dean of Medical School at West China Union University, who wrote in 1934 that China’s traditional medicine was a “weird medley of philosophy, religion, superstition, magic, alchemy, astrology, feng shui, divination, sorcery, demonology and quackery.” Morse added that Chinese diagnostic methods “border on the ridiculous and possibly cross the line into absurdity.” Harvey J. Howard — a Dean at the Peking Union Medical College — also wrote in 1934 that “the great majority of these Chinese medicines reminds one of the list of remedies suggested by the third witch in Shakespeare’s Hamlet.”⁴

Despite its antiquated underpinnings, Oriental Medicine has survived in East Asia due to an unfortunate interplay of socioeconomic and political forces. For instance, after being outlawed during the Japanese occupation (1910-1945), the profession was resurrected in South Korea and was able to join the National Medical Insurance program in 1987. This revival is due to the Korean government’s laissez-faire policy, combined with the unified efforts and the activism of the advocates.⁵ In China, Oriental Medicine has a protected status that — at least in theory — guarantees it equal footing with scientific medicine.

But since the 1970s, Oriental Medicine has almost experienced some popularity in the West, although for different reasons. Once considered archaic and obsolete, Oriental Medicine has greatly benefited from the postmodern attitudes towards science and knowledge. This is because postmodernists consider the “truth” as being relative to one’s viewpoint or stance. They do not see science as a superior process of acquiring knowledge, but as a “belief system,” a “language game,” which does not give more access to truth than other conceptual constructs.⁶

This attitude towards science has even achieved the status of academic orthodoxy in Liberal Arts and Humanities in the last decades.⁷ Many proponents of “alternative” medicine use this academic attitude to reject science as a method of determining the truth about health and treatments.⁸ Anti-science advocates believe that these notions offer a viewpoint that is “placed in stark contrast to the naive materialism that informs some scientific points of view.”⁹

The proponents of unscientific medicines, however, do not realize that prior to the scientific revolution, medicine was some kind of “mass professional delusion,” as David Wootton has pointed out. Prescientific remedies, in general, did more harm than good. Wootton argues that patients sought help from physicians, not because of the efficacy of the ancient remedies, but out of desperation; because doing something was perceived as better than doing nothing.¹⁰

They also tend to forget that, as Paul Unschuld has argued, a sharp contrast between “Western” (meaning scientific) medicine and Oriental Medicine is entirely fictitious. The concepts and practices of scientific medicine have their roots not only in traditional European medicine but also in Chinese medicine, writes Unschuld. This is because modern medicine has emerged from a set of conceptual roots that once existed in Europe and continue to exist today in the Far-East. Unschuld therefore argues that by looking at Eastern medicine, modern medicine is actually looking at its own past.¹¹

Prevalent Along the Silk Road

The conceptual similarities mentioned by Unschuld are not coincidental. Historical evidence clearly indicates that the medicine of medieval China and Europe were once intimately linked through the contribution of Middle-Easterners. Due to the importance of this rich cross-pollination along the Silk Road, the historian Paul Buell also disputes the validity of “any claims of isolation between east and west, west and east, with the individual worlds turned in on themselves.” Rather, he recognizes an ongoing “medical and other globalization of the cultures of Eurasia in the 13th and 14th centuries.”¹²

Indeed, the spice trade by Middle-Easterners along the Silk Road brought many herbal, animal and mineral products to Europe from the Far-East. These products were used for seasoning food, dying fabrics, making perfumes, love potions and tonics, and also for treating diseases. Often spice traders would create a sense of mystery by withholding the origins of their wares, and would ensure high prices by spinning fantastic tales about how they obtained them.¹³ This trade was so vital to Europeans that when it was curtailed by wars in the Near East and the conquest of Constantinople by Ottoman Turks in 1453, they decided to explore a maritime route to the spice sources westwards. In 1492, Christopher Columbus set out sail to find this route.¹⁴

As a result of the commerce between Europe and the Far-East during the Middle-Ages, it would be accurate to state that although the medieval medicine of Europe owes its origin to Greeks and Romans, a significant portion of it actually came from concepts that were commonly shared along the Silk Road. These concepts are commonly known as humorism or humoralism. It is a belief that the body is made up of several fluids (humors), and an excess or deficiency of any of them directly influences health and disposition. Diseases were not seen as forces or entities separate from the body, but as states of humoral imbalances.¹⁵

In humorism, each body fluid (humor) was associated with an organ, a quality, a temperament, etc. (Table 1). The prevalent belief was that if humors became imbalanced (dyscrasia) or unhealthy (cacochymia) illness resulted. Deficiencies and excesses or humors were diagnosed by examining the pulse, body discharges and complexion. Bloodletting, purging, enemas, nutrition, and herbal remedies were routinely used as ways to bring the humors back into balance.¹⁶

Blood was thought to be made in the liver and distributed throughout the body in the veins. Air and “vital spirits” went from lungs to the heart, where they were distributed to the tissue via arteries. The fact that a cut artery squirted blood rather than air was explained by unseen links between arteries and veins that opened upon injury. The belief was that the tissues consumed all blood delivered to them, and the liver had to make new blood continuously.¹⁷

The four humors in Greco-Arabic medicine. The Chinese have a five humor system, with different but comparable relationships. Source: Jackson WA, 2001

It is important to realize that humorism was a first step towards scientific thinking and materialism. Prior to that, disease was believed to be caused by malignant supernatural forces, such as angry divinities, demons, spirits, or by witchcraft and malediction. It was the punishment for impiety and sin, or for the failure to observe religious rites and precepts. Paul Unschuld also views the advent of humorism as a shift from the “ontological” (single-factorial) view to a “functional-individualistic” (multi-factorial) view of disease.

A late medieval publication, the Fasciculus Medicinae (first printed in 1491) illustrates the most important figures of the humoral theory in medieval times.¹⁸. If you look at the books on the top shelf in this woodcut from the Fasciculus, next to Aristotle, Hippocrates, and Galen, stand Avicenna, Haly Abbas, Rhazes, Mesue, and Averroes. Pliny the Elder’s Historia Naturalis, and the books of Isaac Judaeus and Avenzoar are either open on the stand or on the table.

In this first printed medical text to contain illustrations, the author outlines the breadth of medical lore in 15th century Italy. This woodcut represents a scholar at the University of Padua surrounded by medical classics. Image Source: Title page from Johannes de Ketham’s Fasciculus Medicinae. Venice: J. and G. de Gregoriis, de Forlivio (Venice, 1495). Library of Congress, US.

The birthplace of the majority of these authors traces the Silk Road. Avicenna was a Central Asian, born near Bukhara in present-day Uzbekistan. Haly Abbas was from Ahvaz, in contemporary Iran. Rhazes was born in Ray, and Mesue in Gundeshapur — both in Iran. Isaac Judaeus Israeli was born in Egypt, and Averroes and Avenzoar were from Andalusia, in present-day Spain. The period of this remarkable Judeo-Islamic contribution to European medicine is from 8th to 12th century.

The most important figure during this period was Avicenna (ابن سينا, Ibn Sīnā, 980–1037), the author of the Canon of Medicine (القانون في الطب, Al-Qanun fi al-Tibb). Originally written in Arabic, the Canon was a summary of all the medical knowledge of its time. The complete compendium, or portions of it, were eventually translated into Persian, Latin, Chinese, Hebrew, German, French, and English.¹⁹

The illustrated opening page of the second book of the Canon of Medicine. Undated; probably from Iran at the beginning of 15th century. Source: The National Library of Medicine, US.

The earliest and most enduring translation of the Canon into Latin is attributed to Gerard of Cremona (c.1114–1187), who completed it in Toledo, Spain.²⁰ Soon afterward, the influence of the Canon was permeating the writings of 13th century physicians in Europe.²¹ In the 14th century, medical universities made extensive use of it for teaching.²² It remained a standard reference for every medical practitioner throughout the rest of the Middle Ages.²³ An improved translation was published in Venice in 1527 and was reprinted several times. In total, some sixty partial or complete editions of the Canon were published in Europe between 1500 and 1674.

A Latin copy of the Canon of Medicine, dated 1484, at the P.I. Nixon Medical Historical Library. Image source: The University of Texas Health Science Center at San Antonio, TX, US.

Zhu Ming of Beijing University of Chinese Medicine, and Felix Klein-Franke of the Hebrew University of Jerusalem have argued that on reading the Canon, they were struck by the similarity of some of Avicenna’s writings to Chinese medical theories. Among them, is Avicenna’s theory of humors, his pathology, his remarks about how to distinguish the primary disease from the secondary, and his pulse diagnosis (sphygmology). Avicenna distinguishes 19 types of pulse, each with a quality that indicate a specific functional disorder. According to Klein-Franke and Ming, Avicenna’s sphygmology does not have much in common with Galen’s; instead, it significantly resembles Chinese pulse theory.²⁴

In addition, the Canon makes several references to medicines of Chinese origin. Klein-Franke and Ming name 17 plants on which Avicenna wrote “imported from China” or “the Chinese type is preferable,” etc. It is therefore indisputable that Avicenna had access to, and made great use of, the medical lore of China.

Other scholars have looked at the ways in which Greco-Arabic medicine has influenced Chinese medicine. The Canon was translated into Chinese during the Yuan dynasty (1271–1368), and published along with other Persian and Arabic texts in the hui hui yao fang (回回藥方), with much of the text in Arabic.²⁵

A late 15th century version of hui hui yao fang exhibited in the Chinese Hui Cultural Relics Museum. Image source: SINA Corporation, China.

The hui hui yao fang was probably the official formulary of the Mongolian administration during the Yuan dynasty. Paul Buell sees this document as a “smoking gun” of cultural influences, most of which are now untraceable, because nearly all the other relevant works have been lost. This is why the impact of Chinese medicine on Greco-Arabic medicine, and vice-versa, is widely unknown.

Avicenna is not the only medieval figure whose work shows the exchange of medical ideas and manuscripts between Middle-Easterners and the Chinese. The bibliographer Ibn al-Nadim (ابن النديم, dec. 995 or 998) writes that while a Chinese scholar was visiting Rhazes (رازی, Rāzī) in Baghdad, he translated the so-called “Sixteen Books of Galen,” i.e. the Arabic summary of the most influential books written by Galen. The fate of this translation remains unknown.²⁶

Cultural exchanges along the Silk Road are the reason why Y. C. Kong and D. S. Chen of the Chinese University of Hong Kong write that there is an “inherent affinity between Islamic and Chinese medicines.”²⁷ Paul Buell adds that the medical syncretism that came out of this exchange became in the Middle Ages the base of most European and Middle-Eastern practices, with influences felt as far afield as India and Africa. As seen earlier, this syncretism is apparent in the illustrations of the Fasciculus Medicinae.

Discarded After the Renaissance

Beginning in the 16th century, humorism became increasingly criticized by Renaissance scholars. Andreas Vesalius (1514–1564) was the first to publish a treatise that challenged the anatomy of Galen and Avicenna (the same year that Copernicus published, 1543 — a remarkable year). Others followed suit, including William Harvey (1578–1657), who refuted many humoral assumptions about blood in his treatise on cardiovascular circulation. Harvey measured the amount of blood pumped by the heart in one hour, and showed that it exceeds the weight of the entire body. He also showed that the valves in the heart and the veins allowed the blood to flow in one-way only, and that veins carried blood towards the heart, not towards the limbs.

In the 17th century, humorism was already synonymous with obscurantism and ignorance. The French playwright Molière (1622–1673) made great use of humoral language in writing comedies:

Now, when the vapors of which I speak pass from the left side, where the liver is located, to the right side where the heart is, it happens that the lung… having communication with the brain… by means of the vena cava… meets on its way the vapors which fill the ventricles of the scapula… and because the aforementioned vapors have a certain malignity… which is caused by the acridity of the humors engendered in the concavity of the diaphragm…²⁸

Now compare this laughable anatomy and physiology with a paragraph on “Internal Diseases” in a prevalent textbook of acupuncture and Oriental Medicine, published in 1999.

Wind stirred up by upsurge of liver yang sends qi and blood upwards , which together with the accumulated phlegm Fire disturb the mind , leading to sudden loss of consciousness…²⁹

The inventions and discoveries of the 18th century allowed medicine to undergo a paradigm shift. Disease became subject to new rules of classification and medical knowledge took on an unprecedented precision. Physicians began to describe phenomena that for centuries had remained below the threshold of the visible and expressible.³⁰

Medieval notions such as Humoral pathology, vitalism and spontaneous generation were entirely discredited in the 19th century, when Louis Pasteur, Robert Koch, and others bacteriologists were able to establish indisputable links between germs and disease trough observation and experimentation. The discovery of the cellular basis of disease, and the role of microorganisms in pathogenesis made modern and scientific medicine possible.

Interestingly, as Paul Unschuld points out, when in 19th century Ferdinand von Hebra identified the mite as causing scabies, or when Agostino Bassi identified a fungus as causing silkworm disease, their ideas were initially rejected, not because they were new and revolutionary, but because they were based on a single-factorial view of disease, which then was considered to be old and outdated!

The 20th century witnessed the advent of the molecular basis of disease which addresses the chemistry of disease and recovery processes. Science has identified specific molecules that are involved in disease susceptibility, progression and prognosis, and has allowed the development diagnostic and therapeutic methods based on biochemistry. This has led to an exponential success in disease prevention and treatment, increasing the life expectancy and the quality of life of modern humans.

However, the postmodern fallacy that the science behind these spectacular achievements is merely a “language game” and a “belief system” has allowed the return of mass professional delusions under the label of Chinese, Oriental or Asian Medicine. As an unfortunate byproduct, dangerous and outdated therapies have been legitimized, and quacks and charlatans can overtly defraud those who cannot distinguish scientific medicine from lore and fantasy.

Modern purveyors of obscurantism and ignorance have also created alternative training programs, have funded biased research and publications, have accused the scientific community of corruption and conspiracy, and have spurred legislative efforts to subvert evidence-based medicine and peer-reviewed science.³¹

This is why responsible physicians, scientists, and public health officials in the West should follow the momentum created by Yong Sang Yoo and Zhang Gongyao in Asia, and call for an end to the licensing of Oriental Medicine practitioners. The modalities and the rationale used by these practitioners are almost identical to the ones we abandoned centuries ago. As George Ulett, MD, PhD, wrote in 2003, it is a “travesty that in this time of scientific evidence-based medicine,” treatments based on archaic thinking are given to unsuspecting patients.³²

With many thanks to Daniel Bederian-Gardner, Ui-Won Hwang, Paul Ingraham, Hyunwoo Kim, Chul Koo and Robert Slack for their valuable comments or contributions. The opinions expressed here are those of the author.

References

1. Yoo YS. Traditional Oriental Medicine and Integrative Medicine. Hanyang Medical Reviews 2010, Vol. 30, No. 2. Return to text
2. Zhou SF. The Future of Traditional Chinese Medicine. Aust J Acupunct Chin Med 2009;4(1):23–24. Return to text
3. Magnier M. Scalpel vs. Herb in China. Los Angeles Times. January 08, 2007. Return to text
4. Morse WR. Clio Medica—Chinese Medicine. Paul B. Hoeber, Inc. 1934. Return to text
5. Lee HJ, Jun W; Hong SP. Alternative Modernity: The Revival of Korean Oriental Medicine in Modern South Korea. American Acupuncturist; Winter2008, Vol. 46, p18. Return to text
6. Lyotard JF. The Postmodern Condition: A Report On Knowledge. University of Minnesota Press. 1984. Return to text
7. Boghossian P. Fear of Knowledge: Against Relativism and Constructivism. Oxford University Press. 2006. Return to text
8. Stenger VJ. “Postmodern” Attacks on Science and Reality. Quackwatch. Posted 30 May 98. [Accessed 15 April 2012] Return to text
9. Morris W. Medical Epistemology: A Bias of Culture?. Acupuncture Today. March, 2011, Vol. 12, Issue 03 Return to text
10. Wootton D. Bad Medicine: Doctors Doing Harm since Hippocrates. Oxford University Press, USA; 1st edition. 2006. Return to text
11. Unschuld PU. Traditional Chinese medicine: Some historical and epistemological reflections. Social Science & Medicine, 1987, vol. 24, issue 12, pages 1023-1029. Return to text
12. Buell PD. Medical Globalization in the Mongol Era’, in T.S. Ishdorj (ed.), Mongol Sudlalyn Ogulluud, Essays on Mongol Studies, Ulaanbaatar: ‘Bembi San’ Khevleliyn Gazar (Mongolian Academy of Sciences, International Congress of Mongolists), 138–47. 2007. Return to text
13. Dalby A. Dangerous Tastes: The Story of Spices. University of California Press; 1st edition. 2002. Return to text
14. Turn J. Spice: The History of a Temptation. Alfred A. Knopf. New York. 2004 Return to text
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16. Jackson WA. A Short Guide to Humoral Medicine. TRENDS in Pharmacological Sciences. Vol.22 No.9 September 2001 Return to text
17. Unglaub Silverthorn D. Human Physiology: An Integrated Approach. Benjamin Cummings; 4 edition. 2006. Return to text
18. de Ketham, J. The Fasciculus Medicinae of Johannes de Ketham, Alemanus : facsimile of the first (Venetian) edition of 1491. With English translation by Luke Demaitre ; commentary by Karl Sudhoff ; trans. and adapted by Charles Singer. (Birmingham, Ala.: The Classics of Medicine Library, 1988). Return to text
19. Elgood C. A Medical History of Persia and the Eastern Caliphate. Cambridge. Cambridge University Press, 1951. Return to text
20. Savage-Smith E. Europe and Islam. In: Western Medicine: An Illustrated History. London I (ed). Oxford University Press: New York. 1997. Return to text
21. Siraisi NG. The Canon in the Medieval Universities. In: Avicenna in Renaissance Italy: The Canon and Medical Teaching in Italian Universities after 1500. Princeton University Press: Princeton. 1987; 44-46. Return to text
22. Khan KJ. The Canon: Essential Artillery of the Medieval Medical Student. University of Toronto Medical Journal, Volume 89, Number 1, December 2011. Return to text
23. McVaugh MR. Europe and Islam. In: Medicine in the Latin Middle Ages. In: Western Medicine: An Illustrated History. London I. (ed). Oxford University Press: New York. 1997; 58-59. Return to text
24. Klein-Franke F, Ming Z. Avicenna’s Links with Chinese Medicine. A Chapter of the History of Sino-Arabic Relation During the Middle Ages. Asian Medicine. December 1998. Return to text
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32. Ulett GA. Acupuncture: archaic or biologic? Am J Public Health. 2003;93:1037. author reply 1037-8. Return to text

The [California Department of Consumer Affairs'] use of the term “endorsement” is inaccurate, may confuse the public, and may lead the public to falsely conclude that NIH has made certain efficacy and/or safety conclusions regarding acupuncture. Further, consensus conference reports are not a policy statement of NIH or the Federal Government… NIH asks that you correct these two points of information in your booklet and on your website.

— Jack Killen, MD, Deputy Director, NCCAM, NIH

I have to praise the Deputy Director of the National Center for Complementary and Alternative Medicine (NCCAM), Jack Killen, for asking the State of California to remove a couple of false claims in a “Consumer’s Guide” on acupuncture.

Indeed, on June 12, 2012, Dr. Killen wrote a letter to the California Department of Consumer Affairs (DCA) expressing concerns about an informational booklet which makes the unfounded claim that the NIH “formally” endorses acupuncture. The booklet also incorrectly states that NIH has “found clear evidence that needle acupuncture is effective” for a list of conditions. Here’s a snapshot of this publication:

Albeit the long letter, the message is clear and simple: “As a U.S. Federal research agency, NIH does not endorse any product, service, or treatment.”

Soon after receiving the letter, the DCA removed the booklet from circulation, deleted the online version from its website, and stopped sending out copies to new licensees.

This official booklet has been published for over a decade. There have been 3 editions since 2002, and all claim that NIH “formally” supports acupuncture and that there is “clear evidence” of its efficacy.

As a result, thousands of unsuspecting patients have since 2002 chosen acupuncture as a treatment.

I first came across the booklet in 2009. Shocked by its preposterous claims, I wrote a letter to NCCAM the same year and asked for clarifications. Their response contained the same essential message found in Killen’s recent letter:

The booklet misstates the purpose of the 1997 consensus panel on acupuncture. As a Federal research agency, the NIH does not endorse any product, service or treatment, nor are NIH consensus documents statements of policy.

— Terry Evans, NCCAM, March 3, 2009

Since 2008, I have sent Terry Evans’ letter to the California DCA and its Acupuncture Board on several occasions. In response, I was told each time that although the NIH does not explicitly state that they “formally endorse” acupuncture, “supporting statements in the 1997 report could be interpreted as an endorsement”!

In other words, according to State of California, the NIH formally endorses acupuncture, even if it the NCCAM – one of the institutes and centers that make up the NIH – explicitly says that it does not!

The latest version of this asinine statement was sent to me in May 2012 by Reichel Everhart, the DCA Deputy Director for Board and Bureau Relations:

Just 3 months prior to Everhart’s letter, DCA’s Acupuncture Board was put in the hot-seat by the State Senate, mainly for failing to protect the public. The Senate explicitly told the Board that its mission was to regulate the profession, not to promote or to protect it. But so far, the Senate criticism have fallen on deaf ears: a senior member and former Chair of the California Acupuncture Board made this baffling statement in a public meeting just around the same time Everhart wrote to me:

I think given what is in front of this Board, and the work that we are continuing to do to try to create legitimacy around the entire subject and to maintain legitimacy and to promote the profession, we should oppose anything that is so nebulous that should possibly detract from the standardized work that is being done nationally…

— Robert Brewer, former Chair and current member of the California Acupuncture Board, May 17, 2012

Brewer’s statement provides an insight on why it has taken so long to remove the booklet in California: there is an obvious resistance to any evidence that is not in favor of acupuncture or disputes its very purpose. California is not the only state with a protectionist acupuncture board: many regulatory agencies across the US have long operated as lobbies, with the sole intent of legitimizing and promoting the profession. As co-blogger Jann Bellamy recently wrote in a an article about acupuncture practice acts in the US, some even allow the practitioners to act as primary healthcare providers:

Licensing acupuncturists and oriental medicine practitioners and giving them the right to “diagnose,” “prevent” and “cure” disease and to employ other nonsensical “CAM” practices and products is most certainly not in the best interest of the public’s health, safety and welfare.

Fortunately, the Californian Senate seems to be fully aware of the absurdity of regulating acupuncturists as primary care providers. They also know that the Board has a long history of acting as a shield for acupuncture training programs and professional organizations. In March 2012, the Senate Business, Professions and Economic Development Committee made the following comment that supports my argument:

Both the [Little Hoover Commission] and Legislative Counsel did not believe that the law creating the Acupuncture Act intended for an acupuncturist to be the primary care professional responsible for coordinating (or being the “gatekeeper”) for the ultimate care of a patient.

The Senate Committee was referring to the 2004 findings of the Little Hoover Commission, an independent state oversight agency that investigates the government and makes recommendations to promote efficiency and to improve service. The commission’s report (Report #175, September 2004) to the Governor and the Legislature had observed:

The policy choice to give patients direct access to acupuncturists was clear, but the statutory intent to regulate acupuncturists as a “primary care health care profession” is not. The term has many potential meanings. While some people may turn to acupuncturists first for everything that ails them (one potential meaning), it is difficult to see how practitioners of an alternative healing paradigm can be responsible for coordinating care with biomedical specialists (another potential meaning).”

— (Regulation of Acupuncture: A Complementary Therapy Framework, page 25.)

After the 2012 sunset review, the Senate gave the Acupuncture Board two years to address a long list of problems and concerns. My hopes are that at the end of this deadline (or even before) the Senate realizes the futility of having a separate board for acupuncture.

Meanwhile, what should be done with the 10,000 or more active licensees in California? Even if they use “a smorgasbord of implausible and unproven diagnostic methods and treatments” — as Jann Bellamy puts it — I do not foresee an immediate end to their licensing, especially during an economic downturn. However, the state also has the obligation to place the protection the public at the highest priority.

In my opinion, the best way out of this quagmire is to disallow acupuncturists to work as primary care providers, and to require prior consulting and screening by a physician, a nurse practitioner or a physician assistant. This is in the best interest of the public, for it leaves the responsibility of coordinating the ultimate care of a patient in the hands of a competent primary care provider.

But at least for now, witchdoctors in California can no longer bluff out that the NIH formally endorses their craft, and that there is clear evidence that it is works for anything!

With many thanks to Daniel Bederian-Gardner, Jann Bellamy and Paul Ingraham for their valuable comments. The opinions expressed here are the author’s.

The sun shone down upon that putrescence,
As if to roast it to a turn,
And to give back a hundredfold to great Nature
The elements she had combined…
— Charles Baudelaire, The Carcase¹

Trouble for the struggling California Acupuncture Board (Board) is far from being over.

After being taken to task by the California Senate less than a year ago for acting “as a venue for promoting the profession” rather than regulating it, now the Board is being petitioned for reform by license applicants after a major compromise in the California Acupuncture Licensing Examination (CALI). This is the exam that allows the graduates of state-approved training programs to practice acupuncture, herbalism and Asian massage in California. Physicians who use these modalities are regulated by the Medical Board.

Bear in mind that California is the only state in the nation that has its own acupuncture licensing examination. In other states where the profession is regulated, candidates have to take a battery of computer-based tests developed by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). The California test is designed by the Department of Consumer Affairs, and could be taken in English, Chinese or Korean. This means that an individual can get licensed and practice healthcare in California, without understanding a word of English!

The recent test compromise is so significant that the Office of Professional Examination Services (OPES)—an entity within the Department of Consumer Affairs which develops licensing examinations—was called to testify during the November 2012 Board meeting.

Bob Holmgren of OPES told the Board that following a tip, investigators discovered that test preparation seminars in the Los Angeles area were selling study guides that contained actual questions from former exams. How did this happen? Holmgren believes that a number of test takers have been memorizing questions, so that seminar organizers can reconstruct the whole examination—something that is in clear violation of Section 123 of Business and Professions Code. Holmgren called the level of accuracy of these study guides “shocking,” and added that the questions went back for years.

Bob Holmgren of OPES testified in Sacramento during the November 2012 Board meeting. The room was filled with students, school representatives and trade representatives.

Based on this finding, OPES disregarded the answers to the compromised questions in the August 2012 examination. As a result, there was a 30% drop in the passing rate of an exam that already had a low passing rate. A total of 439 candidates took the exam: 270 (61.5%) failed; 169 (38.49%) passed. A pass/ fail history of the exam shows these percentages to be at a record low.

It is not the first time that the State is dealing with cheating and corruption in its acupuncture licensing system. Back in 1980s, the chairman of the former acupuncture regulating agency (the Acupuncture Committee), Chae Woo Lew, was caught selling test questions for $10,000 to $20,000. Lew was sentenced to five years in prison. According to the Los Angeles County district attorney’s office, there may be over 100 acupuncturists involved in the licensing payoff scheme. Only a fraction of all the unqualified practitioners who may have become licensed with Lew’s alleged assistance were caught and prosecuted (Los Angeles Times, March 04, 1989).

Cheating and criminal behavior was a particular area of concern for the “Little Hoover Commission” (an independent oversight agency that investigates State government operations to improve efficiency, economy and service) in 2004. The Commission recommended that to prevent fraud, the responsibility of creating and administrating the licensing exam should be placed in the hands of an outside agency, preferably a national organization, such as NCCAOM.

The Hoover Commission’s policy recommendations and legislative proposals about acupuncture met stiff political opposition from the Board and professional organizations, and were never implemented.

However, on March 12, 2012, during the Sunset Review hearing, the California Senate Committee on Business, Professions and Economic Development brought up the Little Hoover Commission’s findings and expressed serious concerns about the ongoing administrative, educational, licensing and consumer protection issues that the Board has not been able to resolve for over a decade.

Added to this discontent and disconnect, is the political (and possibly legal) action by aggrieved license applicants who failed the last exam because of the removal of the comprised questions. A group of them operating under the name of CALE United Test Front (CTUF) has called upon the Board and the Dept. of Consumer Affairs to justify its recent 30% drop in the passing rate. They have also requested the institution of an exam that is “created, and administered utilizing professional methods, standards and industry input specifically from educators and acupuncturists to avoid less disconnect from exam content and what is being actually taught in the schools.”

Another group of applicants has hired an attorney who recently sent a letter to the Board, detailing the group’s concerns, in addition to charges of negligence if the Board does not respond to the test takers’ demands for the re-scoring of the August 2012 exam to a “customary 70% cut score.” He is also asking for greater transparency with respect to all processes associated with the creation, administration, and assessment of the exam.

Their attorney, Robert Sulnick, argues that the Board has a “fiduciary duty to ensure fair examinations,” and added that throughout its history, “independent oversight committees have identified breaches of fiduciary duty, identifying difficulties with the acupuncture examination (i.e. fraud and criminal charges).”

Notice that the referenced breaches of fiduciary duty that were discussed by several oversight committees were towards the people of California. Nowhere this failure to adequately protect the public is more evident than in the content of the licensing exam.

Indeed, since the Business and Professions Code Section 4926 defines the practice of acupuncture as being “subject to regulation and control as a primary health care profession,” the Board is therefore licensing traditional and folk healers so they can work as first-contact health care providers! And the licensing examination is a reflection of this regulatory lunacy.

In its current form, the exam does not assess the level of medical knowledge that provides the future practitioner with the knowledge, skills and abilities necessary to perform “primary health care.” To the contrary, the exam’s primary focus, and what is being taught in schools, is the practice of acupuncture and Asian Medicine, not “primary care,” as it is defined by the Institute of Medicine in Primary Care: America’s Health in a New Era (1996).

This immediately begs the following questions: how can individuals who do not have adequate competencies in the scientific basis of disease and evidence-based medicine, act as primary care providers? Don’t we have here an obvious disconnect between the regulation of acupuncture, and the reality of its teaching, licensing and practice? Isn’t this a legislative blunder that can negatively impact the public’s health and safety?

These are issues that the State oversight entities have actually brought to the Board’s attention in 2001, but have never been addressed–mostly due to political pressure by acupuncture organizations and training programs.

These influential training programs are by and large post-secondary vocational institutions existing as standalone schools. Some of them were actually founded as religious institutions, which exempted them from the usual post-secondary regulations. With student loan money pouring in, little oversight from the State, lax accreditation standards, and an easy pathway for international student visas, an acupuncture school is an easy start-up with big profit potentials. The key has been the sympathetic Board. Any regular attendee will tell you that at most Board meetings, the majority of attendees are school representatives or lobbyists looking after their interests by encouraging the status quo in the content of the exam and the regulation of acupuncture.

Regardless; the next exam is scheduled for February 14, 2013. According to the Board’s attorney, Spencer L. Walker, only after the completion of the cheating investigation and a review and evaluation by an independent expert, the Board will schedule this matter for discussion at a future Board meeting. A timeline for the investigation and discussion has not been set.

Meanwhile, countless Californians will continue to seek “primary care” from providers who do not have adequate training in scientific and evidence-based medicine. A few of these providers might even have obtained their license fraudulently. As for the wronged test-takers, their concerns seem unlikely to be addressed before the February 2013 exam. And it is almost a certainty that none of this convoluted mess will be cleaned up anytime soon, given that the Board has a long history of—as Robert Sulnick puts it–“kicking the can down the road.”

The opinions expressed here are those of the author and do not reflect the positions of the above mentioned individuals, agencies or organizations.

References:

1. Richard Herne Shepherd, Translations from Charles Baudelaire with a few original poems. (London: John Camden Hotten, 1869)

English proficiency is not a necessary precursor to becoming a contributing citizen in California’s economy and should not be used by the Board to discriminate against talented and skilled individuals who seek to provide high-quality acupuncture services in California.

— State Senators Curren D. Price Jr. and Darrell Steinberg, letter to the California Acupuncture Board, March 22, 2013.

To appreciate the recklessness of this statement, and to illustrate the Senators’ disconnect with the reality of Oriental medicine, let’s take a look at a consummate example of services provided by acupuncturists. The following video features the “Master” Kim Nam-soo demonstrating his moxibustion technique. He conducted a similar workshop for future acupuncturists in 2010 at Emperor’s College of Traditional Oriental Medicine in Santa Monica, CA. Make sure you do not miss the part where the Master is skillfully adding his own spit to the treatment!

Kim Nam-Soo (also known as “Gudang”) is a 97-year-old acupuncturist from South Korea. In this video, he is teaching a form of moxibustion (burning of a mugwort cone on or near the skin). He is first preparing a wad of mugwort (Artemisia vulgaris), he is then placing it on an acupuncture point and burning it with an incense stick. Note that he is using his own saliva to make the mugwort more malleable before sticking it to the patient’s skin!

Besides acupuncture and moxibustion, the other services these “talented and skilled” individuals provide consist of massage, cupping, breathing techniques, and the use of herbal, animal and mineral products. In most states, bloodletting is not part of their scope of practice — except for Arkansas.

Forty years after the legalization of the profession in California, one can complete a 4-year vocational degree in acupuncture and Oriental medicine here in the Golden State — all in Chinese or Korean — and then pass a state licensing exam in the same language. The license allows the graduates to lawfully act as a “primary care provider” without having a working knowledge of English! As a result of this aberration in our healthcare laws, hundreds of unscrupulous fortune-seekers come to California each year to learn and practice unscientific mumbo-jumbo without ever learning English. Most of them could not study acupuncture in their native country because healthcare providers are upheld at a much higher standard than here, and acupuncturists are required to know modern biomedical sciences along with traditional modalities.

The Acupuncture Board of the Department of Consumer Affairs (DCA) was recently working to address this issue by limiting the California Acupuncture Licensure Examination (CALE) to English-only. On March 20, 2013, the CA Acupuncture Board organized a town hall meeting in San Francisco to present the reasons behind the necessity of an English-only licensing exam and then ask for public comments (click on the following image to read the report obtained under the California Public Records Act).

Yet, the initiative came to an abrupt end by a cease-and-desist letter from State Senators Curren D. Price Jr., Chair of the Senate Business, Professions and Economic Development Committee, and Senate President pro Tem Darrell Steinberg. The Senators have asked the Acupuncture Board to immediately abandon its attempts to institute an English-only exam. They are claiming that asking for language proficiency from a healthcare provider is “discrimination!”

Ironically, the cease-and-desist letter came from the same Senate committee that harshly criticized the Board in March 2012 for promoting the profession instead of protecting the public. Exactly a year later, it is the Senators themselves that have come to promote the profession, and to act in overt disregard for the California Business and Professions Code 4928.1:

Protection of the public shall be the highest priority for the Acupuncture Board in exercising its licensing, regulatory, and disciplinary functions. Whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount.

Also, this letter is rather curious in that it does not seem to be stating an official position of the Senate or the Business, Professions and Economic Development Committee. The letter starts “We write . . .” but it does not say that either the Senate or the Committee took a vote on the issue, nor do the Senators claim to be writing on behalf of either body. It rather seems that the letter reflects the Senators’ personal opinion, even if this request is on the official Senate stationary and the authors use their official title.

What is also strange here, is the fact that the licensing of healthcare providers without English fluency is not a real concern for the Senators. A staff member who wished to remain anonymous even confirmed that the Senators wrote this letter without consulting any conventional healthcare providers, public health officials, or anyone else with knowledge of infectious diseases, pharmacology, or drug-herb interactions.

Senators Price and Steinberg (and their advisers in this matter, LeOndra Clark, and Bill Gage) seem to have allowed the popularity of Oriental medicine in the Golden State to cloud their common sense, leading them to ignore the crucial fact that acupuncture is not without adverse effects because it is an invasive procedure. They are ignoring that many complications can arise from acupuncture and threaten the patient after needling or after the use of supplements. An acupuncturist who does not have enough English proficiency to conduct a thorough patient interview may not be able to ensure that the modalities within his or her scope of practice are not contraindicated or otherwise subject to caution.

It is therefore important to remind the Senators and their advisers, LeOndra Clark and Bill Gage, that although acupuncture does not seem very harmful, a 2012 study by Wheway et al. indicated that the total figure of needling adverse incidents is likely under-reported and underestimated. Some of these incidents are medical emergencies involving organ injury. When needles are pushed in too deeply, they can indeed injure nerves or puncture internal organs – particularly the lungs, which causes pneumothorax.

Additional dangers include bleeding or bruising due to needling, especially in cases where the patient has a bleeding disorder or takes anticoagulants. Electro-acupuncture, which involves applying mild electrical pulses to the needles — something akin to Percutaneous Electrical Nerve Stimulation (PENS) — can interfere with a pacemaker. Acupuncture can also lead to pregnancy complications. This is why an acupuncturist has to be able to effectively communicate with patients and to also make sure that emergency services are available.¹

The use of herbal products also requires effective patient-provider communication. Besides the inherent toxicity of some of them, the potential for herb-drug interactions also exists and should always be a real concern. Several of herbal products have been demonstrated to compete with drugs for cellular receptors, and therefore, a mostly unknown and unreported form of “polypharmacy” exists in patients that also take conventional drugs.²

A good example is the commonly used medicinal herb dang gui (Angelica sinensis). Also known as dong quai, tangkuei, or “female ginseng,” Chinese medicine uses dang gui for premenstrual, menopausal, and other gynecological symptoms, as well as for fatigue, anemia, and high blood pressure. Pharmacological properties of this herb have been attributed to constituent coumarins, polysaccharides, fenulate and/or falvonoids.^3,4 In a clinical setting, the concurrent use of dang gui and warfarin reportedly potentiates the anticoagulant effects of the latter, and increases the international normalized ratio (INR) – a measure to monitor the impact of anticoagulants. This can cause widespread bruising.^5,6 Considering these factors, the use of dang gui with anticoagulants, platelet inhibitors and thrombolytic agents is contraindicated.^7,8

Licorice root, known as gan cao in Chinese, is another commonly used example that can cause drug-herb interactions. Licorice which contains compounds that mimic aldosterone can interfere with the renin-angiotensin-aldosterone axis and lead to hypokalaemia.⁹ Licorice has been demonstrated to decrease the clearance of prednisolone and to increase prednisolone bioavailability. Licorice has also been reported to potentiate the cutaneous vasoconstrictor response of hydrocortisone. In total, more than 100 drugs are known to interact with licorice, including corticosteroids, antihypertensives, diuretics, laxatives, and other potassium-depleting drugs.¹⁰

The California Acupuncture Board, whose mandate is to protect the public, has attempted several times to address the lack of proper patient-provider or provider-provider communication. But every time, groups of practitioners, students, school representatives, and trade insiders vehemently object to any change by claiming discrimination, by calling themselves “contributing citizens,” and by receiving support from politicians who know even less about acupuncture and Oriental medicine than they do about healthcare or patient safety. On March 20, 2013, they came in large numbers for a showdown at a town hall meeting in San Francisco, where the Board was presenting the reasons behind the proposal to limit the licensing exam to English only.

Immediately after, State Senators Price Jr. and Steinberg ran to their rescue with a cease-and-desist letter stating that the US is not necessarily an “English-speaking country,” and that “English proficiency is not a necessary precursor to becoming a contributing citizen in California’s economy.” The Senators also add:

We respectfully request the Board to immediately cease and desist in its efforts to adopt an English-based examination and urge the Board’s consideration of other robust examination options that require a high level of competency for licensure and also preserve the ability for applicants to take the examination in languages other than English.

The Board cancelled other town hall meetings it had scheduled and laid the issue to rest.

In many ways this setback speaks to California’s poor healthcare policies, its politicians, and the place of science in its public health arena. Making healthcare policies based on racial and ethnic politics indicates a profound lack of concern for science and evidence in medicine. Also, claiming that effective patient-provider communication and language proficiency are not necessary to provide an invasive procedure such as acupuncture irresponsibly endangers the public by reducing medicine to the rank of politics.

For those of us who put our faith in science and evidence, these non-English speaking “contributing,” “talented and skilled” citizens, are in reality ignorant voodoo-doctors who have become “primary” healthcare providers because of an enormous absurdity in California law. Since the legalization of acupuncture in the Golden State, these individuals have continuously endangered the public, and each time anyone tries to do anything about patient safety, they run to the first medically-illiterate politician they can find, and cry harassment and discrimination.

Unfortunately, now that California lists acupuncture as a benefit that insurers must include in new plans under the Patient Protection and Affordable Care, New Age hocus-pocus has taken a false sense of legitimacy and efficacy simply because it is listed as a mandatory benefit under the new healthcare law. Acupuncture joins tobacco cessation, vision screening and other benefits that insurers must cover for patients under new plans, beginning in 2014. Appallingly, this turns deluded ignorants into much needed providers; and if they do not speak any English, as long as they are contributing to California’s economy, oh well!

As for the crackpot who came to California in 2010 to teach future acupuncturists how to put spit and filth on patients, according to The Korea Times he was suspended in his native country the year before for practicing his craft without a license.¹¹

With many thanks to Harriet Hall, Ui-Won Hwang, Paul Ingram and JooNyun Kim for their valuable assistance or comments. The opinions expressed here are those of the author.

REFERENCES

1. Wheway J, Agbabiaka TB, Ernst E. Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency. Int J Risk Saf Med 2012;24:163-9. Return to text
2. Chan E, Tan M, Xin J, Sudarsanam S, Johnson DE. Interactions between traditional Chinese medicines and Western therapeutics. Curr Opin Drug Discov Devel. 2010 Jan;13(1):50-65. Review. PubMed PMID: 20047146. Return to text
3. Zhao KJ, Dong TT, Tu PF, Song ZH, Lo CK, Tsim KW: Molecular genetic and chemical assessment of Radix Angelica (Danggui) in China. J Agric Food Chem (2003) (9):2576-2583. Return to text
4. Page RL 2nd, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy. 1999;19:870-876. Return to text
5. Fugh-Berman A: Herb-drug interactions. Lancet (2000) 355 (9198):134-138. Return to text
6. Drug interactions between Abbokinase and dong quai: Drugs. com, Drugsite Trust, North Shore, Auckland, New Zealand (2009). www.drugs.com/drug-interactions/abbokinase-with-dong-quai-2280-3882-2366-0.html [Accessed 11 May 2013]. Return to text
7. Dong quai (Angelica sinensis): US National Library of Medicine, Bethesda, MD, USA (2009). www.nlm.nih.gov/medlineplus/druginfo/natural/936.html [Accessed 11 May 2013]. Return to text
8. Circosta C, Pasquale RD, Palumbo DR, Samperi S, Occhiuto F. Estrogenic activity of standardized extract of Angelica sinensis. Phytother Res. 2006;20(8):665-9. Return to text
9. Epstein MT, Espiner EA, Donald RA, Hughes H. Effect of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects. Br Med J. 1977 Feb 19;1(6059):488-90. Return to text
10. Licorice drug interactions: Drugs.com, Drugsite Trust, North Shore, Auckland, New Zealand (2009). www.drugs.com/drug-interactions/ licorice-index.html [Accessed 11 May 2013]. Return to text
11. Han J. Acupuncturist Causes Controversy. The Korea Times (2009-01-27). www.koreatimes.co.kr/www/news/biz/2009/07/123_38492.html [Accessed 28 May 2013]. Return to text