Hugh MacPherson

                                     4th Oct, 2006

According to Chinese philosophy, the body is made up of “meridians” or pathways
along which energy flows. There are hundreds of acupuncture points of the human
body, although no one in the West has been able to map them physiologically.
However, to even try to do this is to look at acupuncture from the perspective of
Western science and medicine. Chinese medicine looks at the body in a totally
different way: an acupuncturist sees an imbalance and tries to correct it using a series
of needles inserted along these meridians. The question then becomes: which points to
use – and for this one needs to understand the whole philosophy of Eastern medicine.
Not only is this radically different from the way a Western doctor will look at a
patient who presents with a problem, it also doesn’t fit neatly in to a Western
scientific paradigm.

In Chinese medicine, the basic principle is of yin and yang, where yin represents a
cooling, and yang a warming. You can go as far as separating out the two so that you
get yin people who have cold hands and feet, who are lethargic and controlled and
then also yang people who are hyperactive, “hot” and hurried. Acupuncture works on
the principle of correcting the imbalance between their yin and yang. But much more
than that, it’s about understanding why the body has got like this and what you the
patient can do to stop getting too “hot” or “cold” or out of balance. So a lot of it is to
do with giving lifestyle advice to the patient and putting their recovery back into their
own hands.

There are fundamental philosophical differences between acupuncture with its holistic
perspective and Western medical biosciences which take a reductionist approach
relying on evidence and science. The challenge is: how to resolve the two paradigms
– and in fact, is this possible at all?

A big question is, therefore, does acupuncture work? At our clinics in York we
constantly see big improvements in our patients but this isn’t, in itself, real evidence.
There is now good scientific evidence that acupuncture does help conditions such as
migraine, back pain, etc – but what about other problems? The trouble is that most
acupuncturists are working as independent practitioners outside the NHS – and as
such there is no state funding for research and no evidence base to work with. I’m in
the fortunate and very rare position of being funded at the University of York by the
Department of Health, not by the number of patients I can get through the door in a
day. So when I do my research, I’m not financially penalising myself and my family.
That’s why for me it’s a privilege to help build up the evidence base by doing as
much research as I can.

In 1999 we set up a research project using 240 people who were referred by GPs to
receive acupuncture. We divided them into two groups: the first had three months of
acupuncture once a week for a maximum of ten sessions; the other group did not.
Both groups also had some physiotherapy and medication prescribed by their GP.
When we looked at our results, they were surprising – even to us!

We found that both groups got dramatically better overall. At three months a gap
opened up between the two groups: the acupuncture group did a little better than the
group which had just had physio and GP sessions. They had less pain, less worry and
felt better. But more remarkable was what happened as time went on. We continued to
track the two groups at twelve and then twenty-four months and a fascinating picture
emerged: instead of the gap between the two groups staying the same or diminishing,
which one would have expected, it got wider as the months passed! At the end of the
study, the group who had been given acupuncture were significantly improved in
comparison with the control group. The problem is, we just don’t know exactly why
this is.

Many people argue that acupuncture is nothing more than the placebo effect – that
doing any intervention will make a person believe that intervention is having a
positive effect. Now, this isn’t unreasonable – it’s begs the very genuine question:
how do we know it’s the acupuncture itself that causes the effect? After all, there will
be cases of spontaneous recovery; you consult when you are at your worst so the
chances are that you will improve from that level of symptom. There is also the issue
of the contact with a professional who gives you care and attention. You feel better
because someone is listening to you and taking you seriously. There are also the
expectations of the patient themselves, let alone the kudos –“feeling special” going to
an acupuncturist.

So, does the relief in symptoms come from one or more of these factors? Maybe. If
you believe something is going to work, it often will, and medicine is no different.
Yet this position doesn’t fit with the facts we observed in our low back pain study. In
our research we tracked the people who identified themselves as sceptics – and these
people did better in terms of reduction from their symptoms of pain! These kinds of
results are very convincing indeed. It has been noticed generally that sceptics, after a
good experience of acupuncture, then become evangelical and tell everyone they meet
about their conversion!

However, while belief clearly had this unusual effect on a patient’s outcome, you still
tended to get better whatever you believed. More convincing still are the results for
acupuncture on very young children and animals, for whom “belief” is irrelevant.
Even in these groups, acupuncture works – and works well. All I can say is we need
more research so watch this space!

At the start of the year, I took part in the first of three programmes for the BBC on
alternative medicine. The first of these was on acupuncture and the presenter, Kathy
Sykes, confessed at the outset to being a true scepticIn the programme we showed
brain images which we measured with an MRI (magnet resonance imaging) scanner
when inserting an acupuncture needle. We found areas of the brain activated and
deactivated in ways that could not be explained by our current knowledge of neural
pathways. By the end of the programme Kathy had become convinced that

acupuncture really did do something and that there was a plausible mechanism for
how acupuncture might treat chronic pain.

But how accurate do these needles have to be when they are inserted? Does the skill
of the acupuncturist affect the outcome for the patient? When an acupuncturist inserts
a needle, he or she is trying to achieve something called the “qi” (pronounced “chee”)
which can often feel to the patient like a dull ache. We therefore decided to test in the
MRI scanner whether this “qi” sensation gave a different picture than when there was
no sensation of “qi” – and found that yes, there were more deactivations with than
without it. But even here there were surprises: when we looked at the results for men
and women, we found that women tended to experience more of these de-activations
than men. We already know that there are sex differences in the brain’s response to
pain but these were significant differences that were totally unexpected.

There is so much more to do, so many more questions to ask if we are going to be
able to convince health funders, providers and the public that acupuncture really does
work. This week I spoke at the Café Scientifique in Glasgow to a packed audience –
one of the biggest the organisers had ever seen. People are intensely curious about
acupuncture: they want to know more. I did a straw poll at the start and finish of the
evening which consisted of a twenty minute talk followed by two hours of questions
from a mixed audience made up of scientists, vets and the general public. The vet in
particular had been astounded at his own findings from using acupuncture to treat his
animals and had witnessed measurable physiological benefits, including blood
pressure, blood chemistry and joint mobility. Although some in the audience
remained sceptical having heard all the arguments, about a third of those who had
begun as sceptics had changed their mind by the time they went home. The evidence
is building – and the public’s perception of acupuncture is changing.

Hugh MacPherson                                                              060906
Dr Hugh MacPherson
Senior Research Fellow
Department of Health Sciences
Seebolm Rowntree, Area 4
University of York
York YO10 5DD
United Kingdom
Tel: +44 (0)1904 321394
Fax: +44 (0)1904 321388