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Is acupuncture pseudoscience?

30 Dec, 16 | by Dr Mike Cummings

eyeballing

An eloquent and tenacious colleague has asked me to write about a cause she has taken up. It is certainly a just cause. She is mostly right I think. I have avoided these fights into which she dives headfirst. But if by being a bystander I silently condone the misdeed, then I have no choice but to join in…

Wikipedia has branded acupuncture as pseudoscience and its benefits as placebo. ‘Acupuncture’ is clearly is not pseudoscience; however, the way in which it is used or portrayed by some may on occasion meet that definition. Acupuncture is a technique that predates the development of the scientific method, introduced by Galileo Galilei among others, by well over a millennium, so it is hardly fair to classify this ancient medical technique within that framework. It would be better to use a less pejorative classification within the bracket of history when referring to acupuncture and other ancient East Asian medical techniques. The contemporary use of acupuncture within modern healthcare is another matter entirely, and the fact that it can be associated with pre-scientific medicine does not make it a pseudoscience.

The Wikipedia acupuncture page is extensive and currently runs to 302 references. But how do we judge the quality or reliability of a text or its references? When I was a medical student (well before the dawn of Wikipedia) I trusted in my textbooks, and I unconsciously judged the reliability by the weight and the cover. I am embarrassed to recount an episode at a big publishing event when I took a one such very large and heavy textbook to its senior editor and started pointing out what I thought were major errors. He laughed at me with a kindly wisdom and said “I’m sure there are lots of mistakes in there.” So now, some years later, as an author I have a different perspective on things, and a good deal more empathy with other authors and editors. I have submitted work for peer review and acted as a reviewer and editor, and with all its faults the peer review process may still be the best we have for assuring some degree of quality and veracity. So I would generally look down on blogs, such as this, because they lack the same hurdles prior to publication. Open peer review was introduced relatively recently associated with immediate publication. But all this involves researchers and senior academics publishing and reviewing within their own fields of expertise. Wikipedia has a slightly different model built on five pillars. The second of those pillars reads:


Wikipedia is written from a neutral point of view: We strive for articles that document and explain major points of view, giving due weight with respect to their prominence in an impartial tone. We avoid advocacy and we characterize information and issues rather than debate them. In some areas there may be just one well-recognized point of view; in others, we describe multiple points of view, presenting each accurately and in context rather than as “the truth” or “the best view”. All articles must strive for verifiable accuracy, citing reliable, authoritative sources, especially when the topic is controversial or is on living persons. Editors’ personal experiences, interpretations, or opinions do not belong.


Experts within a field may be seen to have a certain POV (point of view), and are discouraged from editing pages directly because they cannot have the desired NPOV (neutral POV). This is a rather unique publication model in my experience, although the editing and comments are all visible and traceable, so there is no hiding… apart from the fact that editors are allowed to be entirely anonymous. Have a look at the talk page behind the main acupuncture page on Wikipedia. You may be shocked by the tone of much of the commentary. It certainly does not seem to comply with the fourth of the five pillars, which urges respect and civility, and in my opinion results primarily from the security of anonymity. I object to the latter, but there is always a balance to be found between freedom of expression (enhanced for some by the safety of anonymity) and cyber bullying (almost certainly fuelled in part by anonymity). That balance requires good moderation, and whilst there was some evidence of moderation on the talk page, it was inadequate to my mind… I might move to drop anonymity from Wikipedia if moderation is wanting.

Anyway my impression, for what it’s worth, is that the acupuncture page on Wikipedia is not written from an NPOV, but rather it appears to be controlled by semi professional anti-CAM pseudosceptics, some of whom like to refer to acupuncture as “woo woo”. I have come across these characters regularly since I was introduced to the value of needling in military general practice some 25 years ago. I have a stereotypical mental image: plain or scary looking bespectacled geeks and science nuts, the worst are often particle physicists ;-). By the way, my first choice of career was astrophysics, so I may not be so different at my core :-/. Interacting with them is at first intense, but rapidly becomes tedious as they know little of the subject detail, fall back on the same rather simplistic arguments and ultimately appear to be motivated by eristic discourse rather than the truth.

Addendum
This is probably the first thing I have ever written without any references. Hey it is just an opinion piece, and this is a blog… and 3 clicks will get you here. It has been flagged as having no CI statement, my apologies for the oversight. I take conflicts of interest very seriously.


Declaration of interests

I am the salaried medical director of the British Medical Acupuncture Society (BMAS), a membership organisation and charity established to stimulate and promote the use and scientific understanding of acupuncture as part of the practice of medicine for the public benefit. [2 clicks from this blog]

I am an associate editor for Acupuncture in Medicine. [3 & 1 click from this blog respectively]

I have a very modest private income from lecturing outside the UK, royalties from textbooks and a partnership teaching veterinary surgeons in Western veterinary acupuncture. I have no private income from clinical practice in acupuncture. My income is not directly affected by whether or not I recommend the intervention to patients or colleagues, or by whether or not it is recommended in national guidelines.

I have not chaired any NICE guideline development group with undeclared private income directly associated with the interventions under discussion. I have participated in a NICE GDG as an expert advisor discussing acupuncture.

I have used Western medical acupuncture in clinical practice following a chance observation as a medical officer in the Royal Air Force in 1989. My opinions are formed by data that spans the range of quality and reliability, much of which is in the public domain.

My point of view (POV) is clear, and can be read openly here and in other publications. My publications in this field span 20 years.

In Wikipedia editor terms I could be considered a potential ‘POV pusher’. It is hard to strike a neutral balance when you are an opinion leader in a field that faces inappropriate conventional bias driven perhaps ironically through a lack of exposure to a trusted expert POV. We try to provide peer reviewed data and associated POV via this journal, but this blog is not peer reviewed – it’s a blog.

I have a Wikipedia user account (Drmike001) and have made two suggestions for references on the Talk:Endorphins page (scroll to the bottom).

I have made several charitable donations to Wikipedia in recent years.

I have a logical mistrust of the motives of anyone who advertises an interest or hobby in being a ‘Skeptic’, as opposed to using appropriate scepticism within their primary profession, or indeed organisations that claim to promote generic ‘science’ as opposed to actually engaging in it.

 


 

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