549 ACUPUNCTURE

In March 1996, the Food and Drug Administration (FDA) classified acupuncture needles as medical devices for general use by trained professionals. Until then, acupuncture needles had been classified as Class III medical devices, meaning their safety and usefulness was so uncertain that they could be used only in approved research projects. Because of that "experimental" status, many insurance companies, as well as Medicare and Medicaid, had refused to cover acupuncture. This new designation has meant both more practice of acupuncture and more research being done using needles. It also means that insurance companies may not be able to avoid covering useless or highly questionable acupuncture treatments for a variety of ailments. Nevertheless, Wayne B. Jonas, director of the Office of Alternative Medicine at the National Institutes of Health in Bethesda, MD, has said that the reclassification of acupuncture needles is "a very wise and logical decision." The Office of Alternative Medicine is very supportive (i.e. willing to spend good amounts of tax dollars) on new studies of the effectiveness of acupuncture.

The most frequently offered defense of acupuncture by its defenders commits the pragmatic fallacy. It is argued that acupuncture works! What does this mean? It certainly does not mean that sticking needles into one's body opens up blocked chi. At most, it means that it relieves some medical burden. Most often it simply means that some customer is satisfied, that is, feels better at the moment. The NCAHF issued a position paper on acupuncture that asserts, "Research during the past twenty years has failed to demonstrate that acupuncture is effective against any disease" and that "the perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, operant conditioning, and other psychological mechanisms." In short, most of the perceived beneficial effects of acupuncture are probably due to mood change, the placebo effect, and the regressive fallacy. Just because the pain went away after the acupuncture doesn't mean the treatment was the cause. Much chronic pain comes and goes. An alternative treatment such as acupuncture is sought only when the pain is near its most severe level. Natural regression will lead to the pain becoming less once it has reached its maximum level of severity. Also, much of the support for acupuncture is anecdotal in the form of testimonial evidence from satisfied customers. Unfortunately, for every anecdote of someone whose pain was relieved by acupuncture there may well be another anecdote of someone whose pain was not relieved by acupuncture But nobody is keeping track of the failures (confirmation bias).

Nevertheless, it is possible that sticking needles into the body may have some beneficial effects. The most common claim of success by acupuncture advocates is in the area of pain control. Studies have shown that many acupuncture points are more richly supplied with nerve endings than are the surrounding skin areas. Some research indicates sticking needles into certain points affects the nervous system and stimulates the body's production of natural painkilling chemicals such as endorphins and enkephalins, and triggers the release of certain neural hormones including serotonin. Another theory suggests that acupuncture blocks the transmission of pain impulses from parts of the body to the central nervous system.