How to place acupuncture in a neurophysiological context. What remains to be done?
Klaus Lundsgaard, M.D.
Gl. Kongevej 80, 1850 Frederiksberg C, Denmark.
According to Medline 4.019 articles on acupuncture were published between 1982 and 19%. They cover investigations in which control groups were used in only 236 cases, equal to 6%. Only 91 articles (6 per year) conform to scientific norms.
A few meta analyses show a modest effect of acupuncture compared with placebo, but they are not convincing. With claim rates of 97.8 or 98.6% in some articles and a placebo effect of 0.4% in others, scientific misconduct cannot always be discounted.
Other investigators have searched for the acupuncture points special morphology and the physiological aspects of the meridians. They have employed radioactive tracers and they have dissected bodies. The search has been utterly fruitless, and no new knowledge has been added.
Time has come for a change of concepts:
Acupuncture points and meridians may be regarded as useful as the similarly imaginary latitudes of the globe are, and they could serve well as guidelines for nomenclature and teaching purposes. Besides, experience shows that there are points on the human body that, treated by a needle, alone or in groups may relieve symptoms or cure illness. This experience can be transferred to others, but at the same time we should impress the need of further research. 'Gate theory', viscero- cutaneous reflexes and a possible influence of neurotransmitters may account for some acupuncture action. We have yet to establish that so is the case.
In the remaining part of the speech, the author stresses heavily the need for application of proper scientific methods. The control groups are essential (which is exemplified), the randomisation must be correctly done, the blinding of the patient and of the investigator is difficult but necessary, and patient groups should be large enough for good statistical evaluation of the results. Finally, the publication should preferably be in an international, peer-reviewed English-languished journal.