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Bias in Acupuncture Research

An unfortunately large amount of acupuncture research is inherently biased as it relies on a physiologically-active placebo. No other form of medicine is required to out-perform a physiologically-active placebo, and some procedures, like surgery and physical therapy, are almost never tested against any form of placebo.

Additionally, acupuncture is only one component and tool within the larger system of Chinese Medicine, which we practice at Abundant Heaven TCM. The 'TCM' stands for Traditional Chinese Medicine, which we hold as our foundation for practicing medicine. It is a comprehensive, holistic, integrative, multi-modal, and complex system of diagnosis and treatment. Such a complex and personalized form of medicine does not test well in highly randomized, extremely limited controlled trials. Forcing acupuncture and Chinese medicine to succeed in limited and unreal circumstances that break the foundations of the approach are not scientific and fail to appreciate the value of personalized medicine with patient-directed outcomes.

In Anderson and Rosenthal's 2013 paper titled "Acupuncture and in vitro fertilization: Critique of the evidence and application to clinical practice" they point out the flaws of acupuncture research, specifically in the arena of fertility research: "Firstly, many studies have consistently shown that placebo acupuncture is not inert and does indeed have a therapeutically beneficial effect. Studies comparing verum (real) and placebo acupuncture often show that both are equally as efficacious, but more efficacious than no treatment or conventional treatment. Secondly, often in acupuncture RCTs the acupuncture intervention is therapeutically suboptimal due to factors such as excluding the use of Chinese medicine diagnosis, lack of individualized treatments for subjects, and inadequate acupuncture dosage. Consequently it becomes very difficult to demonstrate a statistically significant difference between a suboptimal verum intervention and a therapeutically beneficial placebo intervention."

They lay out additional reasoning for why current standards for evidence or lack thereof in acupuncture research are inherently dubious. They specifically point to three major problems:

1) Individualized diagnosis that informs a personalized treatment protocol is foundational to Chinese medicine and is rarely taken into account in acupuncture research.

2) Acupuncture is dose-dependent and most research fails to properly dose treatment to match clinical settings

3) Acupuncture is tested against a biased 'placebo' as 'sham' acupuncture is shown to have physiological effects which confuse results and bias the outcomes

In summary, consider that any time you read an editorialized article pointing to some acupuncture research's conclusion that, "acupuncture wasn't found to be more effective than 'sham' acupuncture", know that it was tested using the biased 'sham' placebo and likely, far and away, outperformed no treatment or a control group.

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