Hello gnathostomes! Quackademia is a portmanteau coined to describe the encroachment of quackery into otherwise respectable and scientific medical institution. Increasingly, academic institutions are wasting money researching nonsense and the medical centres connected to them are offering patients “treatments” based on Stupid™, all usually under the branding of “integrative medicine”. Among the idiocy most often “integrated” is acupuncture. Which makes some sense seeing as it among the more respected kinds of Stupid™ since it’s not too hard come up with idea for how it might work; even for people who are otherwise skeptical of medical Stupid™. Now, today’s “target video” isn’t directly related to the issue of quackademia; it’s part of the promotional material for an acupuncture clinic run by a guy named Barry Greenberg. But it does rather nicely demonstrate the same type of seemingly scientifically grounded arguments used to sneak Stupid™ into academia. How does acupuncture really work? Okay, let’s just get this out of the way: It doesn’t. Studies comparing “true” and sham acupuncture, in which the needles are never inserted but look and feel like they are, have found no significant difference between the two. It’s a theatrical placebo. It doesn’t matter if it’s pain, menopause symptoms, or any of the other entries on the endless list of things Asian needle-play is supposed to alleviate, it never does it any better than placebo. And no, you can’t use placebo effects to treat people. Firstly because they only work on subjective symptoms, such as pain and fatigue, not on objective ones, meaning that you can’t affect hard outcomes. Secondly, their effect on subjective symptoms varies a lot and “unpredictable” isn’t exactly a much-sought-after characteristic of a medical treatment. Thirdly, there’s increasing evidence that a lot of the benefits from placebo effects are due to how clinical trials are done, and so won’t necessarily show up in the real world. And fourthly, because actively lying to patients is unethical as fuck! Especially when actual treatments, with actual effects, are available! But who cares about studies, science, and all that shit? We’re here for the Stupid™! So let’s hear what generic voice-over lady has to say. The mistranslations of Chinese textbooks on acupuncture to the English language have led to a lot of misinformation about acupuncture and what it really is. Indeed it has. My favourite bit of misinformation is the idea that acupuncture is mentioned in those ancient Chinese texts. Because it isn’t. The closest thing they mention needling, which is a form of bloodletting. While the idea of specific points on the body likely has it roots in medieval European and Middle Eastern astrology, acupuncture as we know it, with qi flowing through meridians, wasn’t invented until 1939. That’s right, the “ancient” medical art of acupuncture is less than a 100 years old. And it wasn’t even invented by someone from China, but by [George Soulié de Morant], who was a French diplomat. The reason Barry thinks the texts have been mistranslated, is likely because his version of acupuncture is an odd cross between needling and what most of us think of as acupuncture. A sort of grab bag of vitalism, if you will. Well, Barry wouldn’t. He really wants you to think there’s a scientific basis for his Stupid™. But as we shall see, he also really wants to keep the connection to those vitalistic ideas… for some reason. Acupuncture is not an energy medicine. Except the treatments in those texts are based on a vitalistic belief in blood containing some sort of life energy. Acupuncture is not Voodoo,… Given that Voodoo is a religion from the Caribbean, and not a vitalistic “medical practice”, I would have to agree. Unless of course you are using voodoo in the colloquial sense of mystical mumbo jumbo woo, in which case, yes, acupuncture is voodoo. … religion, or magic,… Religion? No. But, magic? Yeah. It’s based on a form of vitalism; by definition, it cannot not be magic. … and there are no invisible energy meridians. Wait. You’re not supposed to be debunking acupuncture. I think you have gotten it backwards here. That’s- that’s my job. That’s how this format works. Acupuncture is a real physical medicine based on real anatomy, not energy. Really? Then would you mind showing me the anatomy of an acupuncture point? I can’t seem to find it anywhere. And while you’re at it, could I also get you to explain why studies comparing the effects of “real” acupuncture to inserting needles into places which aren’t acupuncture points have consistently found no difference whatsoever? What acupuncture actually does is improve the flow of oxygen, nutrients, and blood… No, what it actually does is give you one or more small puncture wounds. We’ll get to why. Right now I want to go back to that slide: You just spend 3 slides trying to convince us that acupuncture is totally not a vitalistic energy medicine. And yet, on the very next one the first thing you do is to try and connect oxygen, nutrients, and blood, with vitalistic concepts taken directly from traditional Chinese medicine. And I can’t help but wonder: why did you do that? … through the blood vessel system… The words you are looking for are “circulatory system”. … to nourish every cell of our body. Errm, not all cells get their nutrients straight from the blood because not all tissues have blood vessels in them. If they did, you wouldn’t be able to see because the lenses inside your eyes would be full of blood. I mean, yeah, the blood is ultimately responsible for getting oxygen and nutrients around the body, but you’re making it sound like each cell has its own direct pipeline. Acupuncture treats the #1 cause of disease: blood stagnation, or impared blood flow in the body. No. On both accounts. Blood stagnation is not the #1 cause of disease, and acupuncture can’t treat it: a) because acupuncture can’t treat anything, and b) because blood stagnation is not a thing. Sure, there are conditions where the flow of blood is impaired, we call that ischemia, not blood stagnation, because that term is something Barry and Mrs Voice-over got directly from traditional Chinese “medicine”. In other words, it’s woo. When there is a problem with blood flow to any area of the body, that area cannot function properly. Yes, ischemia is bad for you. The body will not heal without proper blood flow. Only if the flow of blood is restricted below a certain point. Above that point the healing is just going to take longer. By the way, what’s up with your graphics? Why do you keep showing images that look like they’re from an ad for an over-the-counter topical painkiller when you’re talking about improper blood flow? It’s not just me, right? These are clearly supposed to represent things like a headache and joint and muscle injuries, with the weird video game weak spots being the swelling and redness associated with the latter. Both of which are caused by an *increase* in the flow of blood to the area. I don’t have problem with you using images you grabbed of off Google – I do that too sometimes – but could you at least try to use some that don’t contradict what you are saying? Acupuncture causes your blood vessels to dilate and increases blood flow to specific areas of the body… Initially, it’s actually going to do the opposite. Injuring a blood vessel makes it constrict as part of hemostasis; that is, the process of stopping bleeding. But you’re right, once that’s done, they will dilate and become more permeable, which does indeed increase the flow of blood to a specific area. It’s just that the area is the one right around where the needle was inserted, and that it’s a normal part of the healing process. If you haven’t already guessed it, this isn’t what he’s referring to. You see, at some point someone somewhere, got the “idea” to mix: a hypothesis on what muscle knots are, acupuncture, and their poor understanding of anatomy, and then sprinkle it with their belief in Chinese blood magic. At a later point in time, Barry, mostly likely in a different location, heard this “idea”, and bought into it. Muscle knots, or to give them their medical name, myofascial trigger points, are highly irritable patches of muscle, which can sometimes be felt as hard nodes. Using the muscle or putting pressure on the point, can cause severe pain radiating from it, hence the “trigger point” part of name. They’re actually a bit of mystery. It’s not entirely clear what they are, or what’s gone wrong. A prevalent hypothesis is that they’re essentially a local, long-lasting spasm or cramp; that, for whatever reason, a small part of the muscle is permanently contracted to the point that it cuts off its own blood supply. Acupuncture peddlers heard that last part, thought it sounded like blood stagnation, and went off to la la land. The “idea” they came back with, and that Barry is flogging, is that acupuncture points are actually trigger points and that sticking a needle in them not only treats the knot, but also restores the blood supply to other parts of body, which they say are also cut off by the knot. There are few minor problems with that idea. It’s not at all clear if the cramping hypothesis holds up, that’s why it’s a hypothesis. It’s also not clear if sticking needles into trigger points actually does anything. What is very clear, however, is that your knowledge of anatomy is pretty crap. That you think muscle knots are actual knots is bad enough by itself, but you seemingly have next to no idea of a hint of the anatomy of the circulatory system. So let me help you out: This is a simplified diagram of the blood vessels in a muscle. The exchange of gasses, waste, and nutrients happens in the smallest vessels, called capillaries. So in order for the spasming muscle fibres to cut off their own blood supply, they have be “choking” the capillaries supplying them. Now you go ahead and tell the rest of the class how doing this blocks circulation to any other part of the body. Right. It doesn’t. … to relieve pain, improve organ function, and prevent ageing. The first two are sorta true, in the sense that, yes, pain can be a symptom of ischemia, and so fixing it will relieve it, and that, yes, organs need blood to work. However you may want to look up reperfusion damage. These are injuries, which occur due to the damaged oxygen-starved cells not being able to deal with the reintroduction of said oxygen. I know that might seem a bit counterintuitive, but oxygen is actually a pretty nasty chemical. As for reversing ageing, I have no fucking idea what you’re on about. How would that work? Do you even know what ageing is? And if proper blood supply prevents ageing, then why the do people with it still get old? Also, you do realize that you just turned it acupuncture into nothing more than a treatment for single ailment, right? Really, all you really did was add more symptoms to it. Acupuncture points as a concept just lost all meaning. By the way, how do you treat people with even an average amounts of muscle and fat? Do you have a bunch of 15cm-long needles lying around that you use to get trigger points deep in the body? Acupuncture also works by stimulating the nervous system by activating nociceptors, sensory nerves, and proprioceptor fibres… The thing about using big words to explain Stupid™ is that it only works on people don’t know what those words mean. I’m not one of those people. So let’s start with some terminology and a bit of neuroscience! The nervous system is divided into two main parts: the central nervous system, or CNS, which is made of the spinal cord and brain, and the peripheral nervous system, which is everything else. All the information about what’s happening inside and outside of you, comes from specialized nerve cells, called sensory neurons. Somewhat oversimplified, they typically have 3 parts to them: a nerve ending at one end; a long nerve fibre, or axon, which get the nerve signals to the central nervous system; and along the way, usually near the CNS, a cell body which keeps the cell working and alive. Depending on the sense, the actual sensing is done either by the nerve ending, or by a separate sensory cell connected to it. Just to make things confusing, and because scientist aren’t always great at naming things, sensory nerves and sensory neurons aren’t the same thing. As nerve fibres run to or from the central nervous system, they bundle together inside protective connective tissue, a bit like the wires in a cable. These “cables” are the nerves, and the ones with nerve fibres of sensory neurons are sensory nerves. The last two words we need to know to unpack your PowerPoint slide are nociceptor and proprioceptor fibres. Nociceptors are a class of sensory receptors. They respond to things like high temperatures, excess pressure, and chemicals released by damaged cells. In other words, anything your brain, i.e. you, might interpret as painful. Kind of. I say “interpret as painful”, because it’s important to stress that they aren’t pain receptors – you can’t really sense pain; it’s not a physical thing. They’re more like “not good” detectors, letting the CNS know something’s wrong. Whether you end up feeling pain or not, depends on what it does with that information. Basically, pain is super complicated. Proprioceptor fibres, which in real-world anatomy are called proprioceptive fibres, are the nerve fibres of proprioceptive sensory neurons. What the fuck is proprioception you might ask? Well, that would be your sense of body position, and forces acting on it. It’s the reason why you don’t have to look to know where your arms and legs are, and why you know that that almost empty milk carton you thought was full wasn’t as heavy as expected. In practice, what’s being sensed is the angle of your joints, and how stretched your muscles and tendons are. Okay, back to the Stupid™! Acupuncture does activate nociceptors because, to the surprise of no one, it turns out that, yes, getting needles put into you might hurt a bit. What it doesn’t do is activate sensory nerves. At least not in same sense. Obviously, the nerves transmitting the signals from the activated nociceptors get “activated” too, but that’s kind of trivial. It’s what nerves do. I guess you could be referring to some kind of neuropathic pain, that is pain and discomfort caused by damage or pressure to the nerves. Think phantom limb pain, shingles, or simply hitting your funny bone. And sure, there is definitely the potential to induce some form of acute neuropathic pain, but given how tiny the injury is, it seems unlikely, that would actually mean much. It’s also just more stuff that nerves do; none of this is special or unique to acupuncture in any way. Any small injury would do the exact same things. … that travel from the skin to the spine and into the brain. Yeah, I’m going to have to go with “no” on this one. Nociceptors don’t really travel anywhere. They’re at the ends of the axons at the nerve endings. It’s like saying the end of a rope is going somewhere. It’s nonsensical. Sensory nerves do go places. It’s kind of in their job description. But they don’t take the route you describe. In fact, no nerves, of any kind, take that route. There’s a very clear line between the central and peripheral nervous systems and nerves don’t cross that line. Sensory nerves either go directly to the brain, or in some cases are technically part of it, or they go to the spine where the signal is transmitted to neurons in the spinal cord, which then carries it to the brain. The closest real thing to your drivel is the route nerve signals from sensory neurons below the neck take. In other words, at best, you have somehow confused sensory nerves and the signals they carry which, I gotta give to you, is a pretty impressive fuck up. So you’ve got that going for you. As for the proprioceptive fibres, they obviously also don’t take that route either. And I don’t know why you think they’re in the skin. What I do know is that they aren’t. What the swear word would they be doing there, anyway? There aren’t any things there for them to “hook up” to. Those things are in the muscles, tendons, and joints. You know, the parts doing the stuff they are sensing? Oh, and this of course also means that, no, acupuncture won’t activate them. Acupuncture improves the nerve signal to your brain… I’m sorry, could you explain how it does that? Actually no. Scratch that. Could you explain *what* it does? What do you mean by “improves the nerve signals to the brain”? What nerve signals? What about it are you improving? Just saying science words isn’t an explanation no matter how many photosynthetic half-vector force proton verbs you throw in there. … and forces your brain to release opioids, our natural painkillers,… Quick word on terminology here. “Opioids” refers to compounds, synthetic or natural, that bind to opioid receptors, including inhibitors, while “opiates” are the subclass of opioids that can be derived from opium. The human body can and does actually produce small amounts of opiates, including morphine. But I’m going to hazard a guess, that you probably mean endogenous opioid peptides, or quite possibly just the best known family of them, endorphins. It’s a bit hard to tell. In any case, as the name suggests, endogenous opioid peptides are small chains of amino acids that activate opioid receptors. In other words, they are signalling molecules. And yes, they are indeed involved in regulating pain, as well as a bunch of other things. … to shut off the pain signal and eliminate your pain. This is by far the most common answer to the question “How does acupuncture work?”. Bit weird to ask how something works before asking whether it works at all, but whatever. Given that acupuncture doesn’t work, we know that this doesn’t happen. We also know it because people have actually tested it with that science thing I keep bringing up. But let’s pretend it does; that somehow, a tiny injury will cause your nervous system to release enough of its homebrew medicine to treat your lower back pain. Again, why doesn’t this happen every time you get injured? What’s so super special about acupuncture needles that they cause this, but cutting your finger while preparing dinner doesn’t even give you a mild buzz for the rest of the night? Also how often are you expecting me to come by for “treatment”? The effect of the opioid peptides isn’t exactly permanent. Also also, if all we’re after is a shot of endogenous opioids, then simply jogging to and from your acupuncture appointment is going to give you more of them than the acupuncture itself. Acupuncture works by treating the 5 main factors that influence your health: Even without looking ahead in your script, I already know this is going to be “good”. It says loads about you, that you think you can reduce something as complex as human health to just five bullet points and still have it be remotely useful. … the flow of oxygen in your body, the flow of blood in your body… But oxygen is carried by the blood. So unless you think acupuncture works by curing anemia, carbon monoxide poisoning, or something else that would cause lower levels of it in the blood, and it doesn’t seem like you do, those two are the exact same thing. So it’s actually 4 factors. … the health of your blood vessels… The function of blood vessels is facilitate and regulate the flow of blood, so it logically follows that their health is going to affect the flow of blood, which means this is really just a subcategory of number 2. So it’s actually only 3 factors. … the health of your organs, and the health of your nervous system. Okay… dude, what the fuck? You quite clearly want to convince us that acupuncture is totally based on real, actual science, and not at all on prescientific vitalistic ideas about blood and mystical energies. And yet, 3 of the 5 main factors listed are related to blood, while the entire rest of the body only gets 2, and each one is labelled with a woo word from that very form of vitalism. This is the second time you do it! What exactly is your goal here? In short, acupuncture stimulates the body’s natural ability to heal itself! Erm, neither of the mechanisms you’ve mentioned do that. One is essentially a surgical procedure, while the other is a purely symptomatic treatment. Acupuncture treats an endless number of conditions either on its own or in conjunction with Chinese herbal medicine or other therapies. Ignoring that there is a finite number of conditions, that acupuncture isn’t a panacea, and that both it and Chinese herbal medicine are bollocks, then yeah, you’re right; other therapies can indeed treat a number of different conditions. Actually, let’s not ignore those things. I really want to know how you think acupuncture treats cancer, strokes, depression, and the flu. What’s the mechanism? Oh, wait. Looks like you actually have a blog post on the last one. Let’s take a look at it, shall we? “There are certain pressure points that need to be targeted to have the desired effect on the body. A few pressure points are: The area where the nose meets the eye socket – helps reduce congestion and headaches Outer end of the elbow crease – helps improve immunity At the bottom of the cheekbone – relieves stuffy nose, burning eyes etc.” Hmm. Well, that didn’t make it any clearer. I thought you said acupuncture was supposed to primarily work through the muscle knot thing. What’s this nonsense? What does your elbow crease have to do with your immune system? What the fuck did I just read!? So if you are looking for a natural solution to your health problems… Ah yes, because as we all know, having someone stick needles made of stainless steel, a naturally found raw material invented in 1872, into the their skin is something humans do almost instinctively. … without drugs or side-effects… Yeah! Why take drugs when you can just have needles stuck into you? After all, drugs are bad. All of them. Antibiotics, chemotherapeutics, general anesthetics, and antimalarials. None of them have benefited humanity in any way whatsoever. Look you antipharma poopyhead! Sometimes – just sometimes – taking drugs just happens to be the most sensible way to treat a condition. Sometimes it’s the only one. You can stick a needle in someone with type 1 diabetes all you want, but unless it’s at the end of an insulin pen, they will die in what can, at best, be considered a not very pleasant way. Drugs save lives. Do they come with potential side effects? Yes. That’s an unavoidable consequence of the complexity the human body. You can’t expect to affect one part of a heavily interconnected system without affecting others. Which is why all medical treatments have side effects. And so does acupuncture. The difference is that actual doctors and other medical professionals have no problem admitting it. That, and their treatments usually have benefits that outweigh the risks. The most hilarious part is that you have already unintentionally told us some of the potential side effects acupuncture would have if it worked the way you say it does. If it activates nociceptors, then it has the potential to cause pain, and stimulating proprioceptors could mess with the “patient’s” sense of body position. Don’t know about you, but that sounds pretty side-effect-ish. Acupuncture doesn’t even have to work to have side effects; the pain part is definitely still going to be there. Sticking needles into people carries some inherent risks. The skin is the first line of defence against infection, and so any time you make a hole in it there’s is a non-zero chance of getting one. There’s also the risk of hitting one of the many important bits found inside a human. And going by the knowledge displayed in this video, anatomy isn’t one of acupuncturists’ strong suits. There are people who are sadly no longer with us because they had their lungs punctured by acupuncture needles. I mean, for fuck sake, the small injury caused by the insertion is technically a side effect in itself! … look no further. Yes! Stop looking and go talk to an actual medical doctor and ask them what your treatment options are. And then actually listen to them. Get acupuncture today! Or you can ignore science and waste you money on Stupid™. And now, 17 seconds of complete silence. Enjoy! Actually, fuck that! And fuck you too! How dare you peddle quackery to people like this?! I don’t give two qi if you think you’re helping people. The moment you decide to start providing any sort of medical treatment, you have moral responsibility to read up on the evidence for it, and only do it if there is any. You either didn’t do that or, worse, you did it but decided to go ahead anyways. Could be because you don’t know how to evaluate evidence, or it could because you’re a scumbag. I don’t really give a fuck which, so I will just leave it to you to decide yourself!