A recent and extremely interesting contribution to the continuing debate about why and how acupuncture works was recorded by the BBC as a part of a three-part programme dealing with different aspects of "alternative" medicine.

The programme on acupuncture (the other two were on faith healing and herbal medicine) was fascinating for a number of reasons.

Firstly, it showed a major heart operation in China, where a female patient underwent the operation without any general anaesthetic. She had been given sedatives to relax her, and a local anaesthetic was administered, but all the rest was done with acupuncture. In other words, the patient was conscious throughout the entire examination!

What was equally remarkable was the fact that neither the patient nor the medical team carrying out the operation regarded this as in any way out of the ordinary!

The programme also included a scientific test whereby people were given brain scans whilst receiving acupuncture treatment.

The results revealed that the insertion (and, more particularly, the manipulation) of the needles actually had a physical effect on the brain's "pain matrix", ie that part of the brain that controls a person's experience of pain.

This was seen as quite a revelation, and highlights the fact that similar tests are desperately needed in order to try to resolve once and for all the vexed issue of the efficacy (or otherwise) of acupuncture treatment.

A Question of Evidence:

As far as Western medical science is concerned, it all comes down to one thing: evidence.

And not just any old evidence either. Evidence based on anecdote or hearsay is normally discounted. What counts as evidence are things that can be scientifically studied, tested, examined, demonstrated and preferably replicated time and time again by different people in different places and in different situations and circumstances.

All sorts of claims are made regarding the effectiveness of acupuncture in the treatment of certain ailments and conditions, but are normally discounted by Western medical science because of lack of proper, compelling and recorded evidence.

In some (rare) cases, the medical and scientific evidence is quite compelling, and most medical practitioners have little option but to accept it, albeit somewhat grudgingly.

In other cases, the evidence is open to interpretation, or the tests themselves are inconclusive, or are based on an unacceptably low statistical basis, and are therefore suspect.

In others, evidence (in the traditional sense of the term) is simply non-existent.

It has to be said that many of the conditions that acupuncturists treat are extremely subjective in nature: headaches, back aches, fatigue, stress, depression, etc. These, not surprisingly, are the areas where the evidence is less than convincing.

Just consider the following scenarios:

A person goes to an acupuncturist with severe back pain. The actual cause of the pain has not been diagnosed. The patient undergoes a course of (probably quite expensive) acupuncture treatment. The pain subsides, and eventually disappears all together.

But why? Miracle cure? Placebo effect? Faith healing? Psychological manipulation? Coincidence?

Similarly, an overweight or obese person goes to an acupuncturist for help. To be fair, most acupuncture practitioners will stress that acupuncture on its own cannot help a person achieve significant weight loss: the treatment has to be combined with a good healthy diet and a requisite amount of exercise. So the patient undergoes a course of acupuncture treatment and at the same time goes on a weight-loss diet and starts to exercise.

After a certain amount of time some significant weight loss is achieved.

But which of the activities caused the weight loss? All of them? Two out of three? Would the diet and exercise alone have achieved the weight loss without the intervention of the acupuncture treatment? To what extent did the acupuncture treatment contribute to the successful weight loss? Did it help in any way other than by just providing emotional and psychological support?

Who knows?

In the absence of any properly supervised and controlled scientific testing, you can take your pick.

Which is exactly what most people do!

In exactly the same way, current evidence (or lack of it) suggests that acupuncture is unlikely to help people to give up smoking, stop using drugs or alcohol, lose weight, regain their sex drive, increase their sperm count or become pregnant.

The fact that thousands of people all over the world are willing to testify that acupuncture has helped them in these areas is neither here nor there as far as most Western medical practitioners and scientists are concerned. They want to see evidence that it has helped them.

However .....Western medical doctors and scientists accept that there is a fair amount of hard, solid and generally rather convincing evidence which indicates that acupuncture can be highly effective for combating post-operative nausea and vomiting, chemotherapy-related nausea, post-operative dental pain, sickness and vomiting in pregnancy, and osteo-arthritic pain (particularly knee pain).

For everything else - rheumatism, sciatica, neck pain, migraine, tinnitus, spondylitis, strokes, urinary infections, incontinence, irritable bowel syndrome, hay fever, etc. - well, the Western medical jury is still out!

In all of these cases, either the evidence is contradictory or the quantity and/or quality of the evidence is unconvincing and therefore (to use a favourite medical term) "no definitive conclusions are possible".

But let's be absolutely clear about this. Just because the evidence available in respect of certain conditions is not acceptable to Western medical science, this does not invalidate or discredit the practice of acupuncture in those instances.

Remember that the practices and traditions of Chinese medicine are quite alien to those of modern medical science. It is hardly surprising that most medical practitioners in the West reject the evidence of the effectiveness of acupuncture techniques in the majority of cases. After all, they are not speaking the same scientific language!

It is useful to understand the process by which Western medical science determines the effectiveness of medical treatments and techniques.

It has often been said that there is no such thing as alternative or complementary medicine: there is simply medicine which works and medicine which doesn't work.

But how do we make that judgment?

"Double-Blind" Testing ....

The whole of traditional Western medical science is based on the process known as "double-blind" testing. This is where a large group of patients is divided into two (or sometimes more) groups. One group is given the medicine or medical process that is being tested. The other group is given a placebo.

The test is "double-blind" because neither the patients nor the people administering the treatment know which patients are getting the real treatment and which are getting the placebo.

The results of the test determine whether the particular medicine or medical treatment is effective and can be made available to the general public.

You will see that the basic principles underpinning traditional Chinese medicine are entirely missing from this process. The patient is not being treated: the sole purpose of the exercise is to treat, and hopefully alleviate, a set of particular symptoms under strictly controlled conditions.

This approach is totally at odds with the traditions of Chinese medicine - which is precisely why many practitioners of traditional Chinese medicine tend to reject the findings of these medical trials.

Which is why the debate continues .....

As I have already mentioned, there is still widespread scepticism amongst Western medical practitioners about the validity and effectiveness of acupuncture as a medical treatment.

In the context of Western medical science, with its emphasis of strictly controlled and verifiable randomized testing, it is not hard to see where this scepticism is coming from.

It has to be admitted that too few scientific tests have been carried out, and that a comprehensive study of acupuncture techniques, preferably involving thousands of patients in randomized double-blind testing, is long overdue.

Lack of hard evidence, of course, can work both ways. There is, indeed, no hard evidence to suggest that acupuncture doesn't work.

As some people maintain, if acupuncture can help some people lose weight, stop smoking, quit drugs and alcohol, become stress-free, reduce high blood pressure, cure depression, asthma, tinnitus, acne, impotence and God knows how many other debilitating illnesses and ailments, what on earth does it matter whether the "cure" is the result of the placebo effect?

The treatment has dramatically improved the quality of the lives of these people. What more can one ask of any form of treatment?

In the meantime, one has to acknowledge that in the overwhelming majority of cases acupuncture is remarkably safe - much safer, indeed, that a large number of Western medical treatments - with limited side-effects and an increasingly broad international support.

So perhaps the best approach is that of an open and enquiring mind - which is probably good advice in most circumstances!

If you want to pursue this topic further, here is a handful of useful US and UK sites providing legitimate and up-to-date information: