My Conversation with an Acupuncture Skeptic

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The other night I found myself in an uncomfortable position.  I was on the defensive.  Not my usual mode of operation.  One of my true loves, acupuncture, was being challenged by a very probing acquaintance that stood across from me in a brightly lit kitchen.

This was supposed to be a casual social gathering.  And I was in the mood to do some gentle mingling.  I was off the clock, after all.  Yet suddenly my lower back was grinding into the countertop behind me and I started to break a nervous sweat.

As much as I am confident in my work and know the facts, I’m not one to drop wisdom bombs at a party in response to someone obviously looking to “win” the conversation.  I tend to hang back when it comes to out-and-out conflict. Why bother? Again, I was in the mood to do some light mingling.

But there he was.  ‘That guy.’  In my face.  Giving me the opportunity to flex my evidence-based-practice muscles.  Goddess bless him.

He leaned up next to me. “So you’re the acupuncturist, huh? My friend told me to try acupuncture, but I don’t think it will work.  No offense, but I think it’s a bunch of BS,” he smirked.  I stared at the almost empty glass he was swirling around and around. Hmmmm. This just got a little awkward.

“I like your friend. They sound cool.” I smiled and took a step backwards.

“Yeah, she is into all that woo-woo stuff,” he gesticulated with dancing mystical fingers. “I just don’t buy it, but maybe I’m too chicken.  Ha ha!  I mean, the thought of getting jabbed with all those needles! …Especially when there is no evidence that it even works.”  He took a confident gulp of his Jack ‘n Coke.

Whoa.  Now hold on a minute, Cowboy.  I adjusted my stance and took a breath, trying to untangle all the potential angles I could take in my response, one of which included a vision of me pulling out a giant needle from my purse and jabbing him in his know-it-all face.  Maybe I was the one who needed a drink.

“Wow. That’s quite the statement…” I needed to buy more time. Before I could bring him to the Light Side, I needed to poke a hole in his anti-woo-woo bubble.  I needed to elicit some good ol’ fashion curiosity.  Give it a personalized spin.

“Let me see your tongue.”  I leaned up next to him, flashing my cutest smirk.

“What?” He gave me that ‘are you coming onto me?’ look.

“Let me see your tongue.  Just stick it out like a puppy dog.”  I demonstrated.  “Blaaaaaa.”

He complied, now under my spell.  “Blaaaaaa?”

“Hmmmm.  Very interesting.  You’ve got a lot going on in there,” I aloofly mutter under my breath, leaving my bait to dangle in the brightly lit kitchen.

“What do you mean?  Is it ok? What do you see? Am I going to die tomorrow!?” He pointed dramatically at his red, puffy tongue (with a thick yellow coat and a center crack), dread collecting in beaded droplets between his eyes.  Suddenly I seemed to have some credibility, at least for the moment.  Funny how that works.

“Well, acupuncturists look at tongues as one our primary diagnostic tools.  They tell us a lot about what’s going on inside your body.” His eyes widened as if he had just realized I had on magic x-ray glasses, which I (more or less) did.
“I don’t have time right now to go into it all with you, but I’d be happy to explain more if you ever want to jump off the ledge and let me jab you with all my woo-woo needles.  Ha ha,” I winked at him, “I’ll go easy on you.”  I was just warming up.

He smiled, and then slowly frowned.

I leaned in and softened my voice. “It sounds like you have some doubts about whether acupuncture will work for you?”

“Yeah, I’m just not sold on the idea that needles can heal people. It’s just too weird.” He laughed nervously and slurped down the rest of his drink.

“I get that. It is weird! Trust me, I’m constantly amazed by how my patients get great results.” He nodded as I spoke. “But the research for acupuncture is getting super strong.  Recently, a couple big studies have proven acupuncture does work, and works better than conventional care for several conditions, especially chronic pain conditions.”  I paused, waiting to see if I had lost him.

He jumped on my pause. “My friend is an MD, and he says acupuncture is just the placebo effect.”

Oh brother.  Enter Placebo Effect stage left.

I must have given the world’s biggest eye-roll, “Well, your MD friend needs to refresh his PubMed search criteria, because that assumption is based on outdated and poorly done research.”

I was getting twitchy.  I just wanted to do some gentle mingling!  And there I was talking about PubMed search criteria at a so-called social gathering.

“So like, if it’s not a placebo, how does it work then?” He crunched some ice between his teeth.

Ok, ok.  He’s listening. Chewing.

“Ok well, there is a lot of really interesting research on how acupuncture works physiologically.  It affects all areas of the body, from your biochemistry (including your opiate system and how you regulate your inflammatory processes), to your connective tissue (especially the fascial layer), to your circulatory system, and even your brain!”

His eyes glazed for a moment.  But he kept nodding, still chewing.

I continued, “What I’m saying is- it’s definitely not just a placebo.  And a recent giant meta-analysis by a guy named Vickers just proved that…I’ll email you the reference if you need some bedtime reading.” And I seriously would have, had he asked.

“Hmmm.  It sounds like you know what you’re talking about…I mean, I’m just making conversation here.”  He looked around the room for his next victim.  My threat of research links via email was working!

“Cool.  I’m happy to answer any more questions you have…if you ever want a consultation.”  I looked around the room for my rebound, doubting I had convinced him of anything.

He leaned back in, closer this time. “So if I come in to see you, you won’t hurt me or give me an infection will you?  That’s what I’m most paranoid about…”  Was he serious? I picked my gaping jaw up off the floor.

“Are you kidding? No way! Adverse side effects, including systemic infections, are even less common than getting struck by lightening.  Seriously. You have a less than 1/1,000,000 chance.” Please, please, please if you don’t hear anything else, please understand that acupuncture is very safe!  Deep breath.

“Plus, I love newbies.” I smiled and reached in my purse for my card.

“Ok.  Well, no promises.  But if I do try it, I’m coming to you.  Cool?” He tucked my card into his back pocket.

“Great! Looking forward to it.”  And I was actually looking forward it.  My annoyance was suddenly and effortlessly replaced by inspiration. I was refreshed. Maybe I had poked a little hole in his bubble after all? Maybe a little evidence-based-woo-woo light was getting in?

I poured us both a drink and held my glass up high.  “Cheers!”  We both smiled and took a swig.

On reflection, I believe he ultimately came around on the acupuncture debate because I heard him out. No doubt it was a struggle for me to not feel utterly defensive and critical of his lack of understanding.  But I must remember: I’m in a bubble of my own.  A bubble where I see how safe and effective acupuncture is for my patients.  I forget people still feel fearful towards it.  Fear that often presents as skepticism.  And skepticism is good and necessary.  Acupuncture research would not be as solid as it is today without having been through (and continuing to go through) rigorous review and examination.  Our critics are our biggest allies.  They force us to grow outside our comfort zones.

And the beautifully comforting irony is- it was this battle-worn data that eased my new friend’s worries that night. It wasn’t the typical argument you often hear from acupuncturists, “This medicine has been around for thousands of years, isn’t that proof enough?”  True. True. Yet, I imagine ‘that guy’ would have just rolled his eyes.  Because not all evidence is created equal.  And it helps to know your audience.

I still posit the best evidence is always personal experience.  That said, I’ll offer this bottom line to all you acupuncture junkies, newbies, and skeptics alike: rest assured it is not only a placebo (although placebo is a factor as with any form of medicine, and we could have a whole another conversation around the power of placebo later). Acupuncture has a proven effect beyond placebo.  And it is extremely safe when done by a trained professional.  Please tell your friends!

And if you don’t believe me, just do a PubMed search. In the very least you will have some good conversation material to use at your next casual social gathering.

Here are a few studies to get you started: 

Haake M1, Müller HH, Schade-Brittinger C, Basler HD, Schäfer H, Maier C, Endres HG, Trampisch HJ, Molsberger A. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007 Sep 24;167(17):1892-8.

Vickers AJ, Cronin AM, Mascino AC, Lewith G, MacPherson H,  Foster NE, Sherman KJ, Witt CM
Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. 2012 Oct 22;172(19):1444-53.

Witt CM1, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S, Willich SN. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009 Apr;16(2):91-7.

And some helpful links: 

The Society for Acupuncture Research:http://www.acupunctureresearch.org

Acupuncture in Medicine Journal: http://aim.bmj.com

Journal of Acupuncture and Meridian Studies:http://www.jams-kpi.com/content/aims

The Journal of Chinese Medicine:http://www.jcm.co.uk/research-archive/

National Center for Complementary and Alternative Medicine (NCCAM):http://nccam.nih.gov/health/acupuncture

British Council of Acupuncture: http://www.acupuncture.org.uk