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  • Writer's pictureYousef Zarbalian, MD

Acupuncture First

Updated: Dec 5, 2019

I agree with the short aphorism put forth by acupuncturists today: "Acupuncture first". Oftentimes, in western medicine we reach for a powerful medication or procedure for a common problem which does not yet warrant aggressive intervention. In these cases, Acupuncture should be considered first.

Skeptics will often point to negative results of randomized double-blind controlled trials and on this basis, will dismiss acupuncture, while ignoring a plethora of research showing non-inferiority or superiority of acupuncture to pharmacologic therapies. I find that the critics are rarely students of Chinese medicine and, tellingly, their critique belies their misunderstanding of the individualized approach of acupuncture treatment in Chinese medicine. Chinese medicine does not approach all people with gastroesophageal reflux or rheumatoid arthritis with the same treatment; the practitioner will take a thorough history to integrate other aspects of the person's disposition to arrive at the best approach, which often will include acupuncture and herbs to restore balance to the patient's body.

Leslie Smith, MD, a physician-acupuncturist like myself, discusses randomized controlled trials in this enlightening article:

The current gold standard in medical research—the randomized controlled trial—doesn’t work very well for studying acupuncture. What are your thoughts on acupuncture research and how it needs to evolve?

The gold standard exists the way it does because of the pharmaceutical industry. With randomized controlled trials, we assume that if we take two people with high blood pressure, both cases of high blood pressure have a common etiology. We can then either put a pharmaceutical band-aid on it and lower their blood pressure, or not if they’re getting a placebo. But acupuncture doesn’t assume that all cases of high blood pressure have a common etiology—and therefore, not everyone gets the same treatment.

This makes it very difficult to prescribe and track outcomes for a particular set of points. There are certainly acupuncture points that are indicated for high blood pressure, or headache, or back pain, but that doesn’t mean that they’re appropriate for each individual person. What we can do is compare acupuncture to no treatment, to pharmaceutical treatment, and to surgical treatment and see where the outcomes are better.

When we do comparison trials, the evidence-based medicine is absolutely clear that acupuncture is superior to placebo and, in many cases, to treatments such as pharmaceuticals and surgery. Acupuncture is not a religion or a belief. I don’t need someone to believe in my ability to help them in order to help them. It always makes me giggle when people say they “believe in acupuncture.” It’s just science.

#AcupunctureFirst #Medicalacupuncture

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