Acupuncture Is Theatrical Placebo

This 2013 editorial presents a comprehensive critical analysis of the efficacy of acupuncture, arguing that it is a 'theatrical placebo' without clinically meaningful benefits. The authors, David Colquhoun and Steven Novella, base their argument on decades of research and multiple meta-analyses involving more than 3,000 studies.

The editorial outlines the historical context of acupuncture, noting that it has not always been popular, even in China. The authors mention that in 1822, Emperor Daoguang went so far as to ban acupuncture from the Imperial Medical Academy. Its resurgence in the West was due primarily to the anecdotal account of journalist James Reston in 1971, after he received acupuncture in China.

Analysis of large multicenter clinical trials conducted in Germany and the United States consistently revealed that true and sham acupuncture do not differ significantly in pain reduction across multiple conditions: migraine, tension-type headache, low back pain, and knee osteoarthritis. This finding suggests that the concept of meridians is 'purely imaginary.'

The meta-analyses cited, including studies by Madsen et al. with 3,025 patients and Vickers et al. with 17,922 patients, found minimal differences between true and sham acupuncture — only 10 points on a 100-point pain scale. According to scientific consensus, such improvement is classified as 'minimal' or 'little change,' insufficient for patients to perceive tangible benefit.

The editorial highlights the problem of publication bias, which is particularly severe in alternative medicine. Notably, all studies originating in China, Japan, Hong Kong, and Taiwan were positive, suggesting cultural or commercial bias. In addition, 90% of studies had methodological problems that rendered them susceptible to bias.

For specific conditions, the authors conclude that there is no convincing evidence of efficacy of acupuncture for rheumatoid arthritis, smoking cessation, irritable bowel syndrome, weight loss, addictions, asthma, depression, insomnia, neck and shoulder pain, knee osteoarthritis, sciatica, stroke, and tinnitus.

Even for postoperative nausea and vomiting (PONV), a condition for which some evidence exists, the authors question the quality of the studies. The meta-analysis by Lee and Fan included several treatments beyond traditional acupuncture, and only 4 of the 40 studies had adequate allocation concealment.

The results show a clear pattern: in the best-controlled studies, the outcome does not depend on the location of the needles or even on their insertion. Because these are the variables that define acupuncture, the logical conclusion is that acupuncture does not work beyond the placebo effect.

The editorial concludes provocatively that it would be better to follow the example of Emperor Daoguang and ban acupuncture from clinical practice, tolerating it only as a 'voluntary tax on the credulous' in private establishments, provided they make no unfounded claims.