“The patient is resisting the treatment.”
That’s what it says in my file — or at least what it would say had my acupuncture practitioner kept one.
I don’t like massage, and never have. I most definitely don’t like the pain involved in having somebody clutch my muscles and knead my body like I’m a piece of dough prepared for the oven. Long have needles intimidated me, a fear I’ve only recently overcome by looking at them. The acupuncture needles are smaller and don’t go as deep, but I am repeatedly instructed not to look at them, which makes the entire experience even more agonizing. The distressing feeling of those awful needles sticking out from some elusive acupoints makes me feel like a hedgehog caught in some harrowing trap. It’s a nauseating and seriously unpleasant experience, making my body tingle uncomfortably and freeze in place.
But if it works — maybe it’s worth it?
Yes, but I’ve never really believed that it does — based on nothing but an unsuccessful experience. About five years ago I attended a half-dozen acupuncture sessions before I abruptly stopped: the migraines I hoped they would alleviate seemed only to get worse — often giving me horrible attacks that very same evening.
I’m not the only one: something like one in ten Americans receiving acupuncture treatment have done so for migraine and headache-related issues. Clearly, I’m not in a particularly unique situation.
Scientific Knowledge and the Ways of the World
By nature, I’m skeptical and inquisitive. Claims that seem too-good-to-be-true (or more often too-bad-to-be-true) rarely pass my BS detector. Moreso, the worst kinds of culprits are evidence-poor domains like religion, pseudoscience, and shamanistic rituals (numerology, anyone? Astrology? Nutrition? Recycling?) that seem to offer ironclad solutions for every kind of ills. Faced with whatever problem, my solution fixes it.
The intellectual and emotional spite I hold for them has almost no limits.
But we’re in a difficult world, with many moving parts. Discovering the ways of the world is hard, and I’d be the first to subscribe to a humble creed; a hesitant “I don’t know” is often the right answer. To reference Leonid Rozenblit and Frank Keil’s famous article on the Illusion of Explanatory Depth: I don’t have a clue how zippers, flush toilets, or GPS systems work — then who am I to hold strong opinions on subjects I understand even less?
Well, in those examples, experts do understand how mundane things work, whereas us everyday users don’t. In many parts of our more difficult lives, the obstacles are so much larger: not even highly-trained medical, psychological, or biological experts understand how many paralyzing ills work, what blue whales or great whites do in the deep blue, or why the Pareto Principles or the Golden Ratio show up everywhere.
From perusing some rigorous meta-studies that have investigated acupuncture’s impact on migraines, I get the impression that results are inconclusive. Most seem to suggest that there is a small advantage to pain relief over no-treatment or standard drug treatments. Then again, from personal experience (n=1, I know) that’s a very low bar to clear; for years, doctors have prescribed me this or that substance (beta-blockers, hypertensives, blood-thinning drugs) with less-than-nothing to show for it. On top of my increasingly invasive migraines, I had unpleasurable side effects to contend with. Great job.
For acupuncture, published results seem a little brighter. Disturbingly, there seems to be only a very small difference between effects in patients receiving “true” acupuncture over patients receiving “sham” acupuncture. The placebo, in other words, is strong with this one. In essence, I could achieve about the same results if I convince myself that some random needle pinches are as good as my guy expertly inserting them wherever they ought to go.
It’s easy to become pessimistic and even nihilistic reading results like those. Besides, I’ve recently reviewed both Tim Harford’s How to Make The World Add Up and Stuart Ritchie’s Science Fictions: How Fraud, Bias, Negligence, and Hype Undermine the Search for Truth. The plethora of honest (and plenty of dishonest) flaws found in published scientific result is enough to make anyone doubting our powers to unravel the ways of the world. That’s not so strange: there are remarkably few big effects left in the world— if there were, we would have found them by now, even by chance or everyday inspection. Hyper-sophisticated telescopes are needed to discern minor space-things really far away — but to see the moon you rarely need more than half-decent eyesight and a clear night-sky.
Lots of real-world effects are small, but small effects are still important. A drug that makes most of its patients experience 10% less pain is still tremendously important and definitely worth it. What if acupuncture is that?
Skepticism balanced by humility
It always made very little sense to me. What, there’s a secret connection between my right ear and my liver function? That, if solved, will “balance my bodily forces” and bring my body into balance such that my migraines go away? Really.
What bothers me most is the unfalsifiable, shamanistic nature of it. If the tensions in my neck or the worry-patches in my stomach (ye, I know; just roll with it…) are better now than last week, is that a consequence of the treatment or just due to chance? If real — who knows, anyway? — are we capturing noise or signal?
At least twenty-seven things are different about me today than a week ago — emotionally, physiologically, nutritionally, and digestively. The temperature in the room; my stress levels; how well I slept the night before. Take that physical tension in the area below my ribs. It’s possible that the treatment works and that its improvement is in response to that — but it’s also possible that my body is operating slightly differently since I just fasted for 14 hours. Possibly my body does things a little different in a fasted state vs a non-fasted state. How would we ever know the difference? And maybe I would have gotten better by doing nothing at all…?
It’s not looking great — but here’s the thing: that same epistemic limit faces “regular” science too. My doctors, mindlessly prescribing me this or that drug, are similarly groping in the dark. If my migraines get better, they can easily fool themselves into thinking it was due to their savvy drug-picking skills. If they don’t, maybe we just need to let time pass? If six months later still nothing happened, perhaps the dosage was off because <insert some individual-specific ad hoc reason>?. Or maybe I would have had even more and worse migraines in the absence of medication.
And here’s another thing: those needles do weird things to my body. The nerves they hit somehow radiate through that area — and beyond. They create a moving sensation (“flow”?) up and down my body. At one point my practitioner gently pressed on my shoulders, and the already-burning, shimmering, tingling sensation from the needle in my lower right-arm just exploded into pain. I’m at a loss to explain why.
The treatment sets off many of my BS detectors. It sounds remarkably like other unfalsifiable belief systems: energy “areas”, the body’s “meridian lines”, ephemeral “tensions” undetectable to anyone but the experts, wide and unspecific astrology-like diagnoses about one’s personal life that applies to basically everyone.
But it’s doing something.
Is it all mumbo jumbo? Possibly. Is worth a chance? Probably. Considering the 2-odd attacks per week I’ve averaged during the last two months, it can’t get much worse.
Maybe my skepticism is misplaced and I’m completely wrong here. That’d be nice. But even if I were to improve — how would I tell the difference between noise and signal? Between erudite effect and pretty quackery?
I don’t know.