Acupuncture is one of the more popular forms of CAM and is often touted by practitioners as being risk free. The truth is something else. The latest criticism comes from a study published in PLOS One.
The authors describe 30 cases (7 confirmed and 23 suspected ) of primary inoculation tuberculosis all from a single clinic in China over a 3 month period in 2011.
Tuberculosis (TB) has existed in humans for millennia. It is estimated that approximately one third of the world’s population is infected with Mycobacterium tuberculosis which causes 8.8 million new cases of tuberculosis accounting for approximately 1.1 million deaths each year.
Pulmonary tuberculosis is by far the most abundant form: extra-pulmonary tuberculosis accounts for about 20% of cases and tuberculosis of the skeleton-muscular system accounts for 10% of all infections. Interestingly, a low incidence (0.1%) of primary inoculation tuberculosis has also been reported.
In the United States, extra-pulmonary tuberculosis accounts for 18% of all tuberculosis infection, with cutaneous tuberculosis representing 1.8% of cases. Few case reports of primary inoculation tuberculosis are available, with only 33 cases being described between 1935 to 2012. The largest number of cases described in the literature is five.
Given the difference in invasive routes between primary inoculation and pulmonary tuberculosis, no generalization can be made as for incubation period, clinical features, treatment and prognosis of primary inoculation tuberculosis based on lung disease case reports to guide clinical practices. In this study, we described 30 cases with primary inoculation tuberculosis (7 confirmed and 23 suspected) that developed over a short period of time. All subjects were followed up for at least one year to assess the effectiveness of a combination of drug and surgical intervention in treating primary inoculation tuberculosis.
It is important to note that these cases received both acupuncture and electrotherapy, although most of the patients linked the infection sites to the electrotherapy. However, examination of the electro-pads used did not show the presence of the bacteria, and a source could not be determined. During the same time period, 58 patients has been treated similarly, leading to a greater than 50% infection rate.
These results are only from a single clinic, and can not be taken as indicative of the entire practice of acupuncture, but this is not the only example of the risks associated with acupuncture. Edzard Ernst has discussed some of these:
- puncturing the lungs resulting in a pneumothorax,
- puncturing the heart causing a cardiac tamponade,
- puncturing blood vessels causing haemorrhage,
- injuring other vital structures in the body,
- introducing bacteria or viruses resulting in infections.
His article concludes with the following statements.
True, these are almost certainly rare events – but we have no good idea how rare they are. There is no adverse event reporting scheme in acupuncture, and the published cases are surely only the tip of the ice-berg. True, most other medical treatments carry much greater risks! And true, we need to have the right perspective in all of this!
So let’s put this in a reasonable perspective: with most other treatments, we know how effective they are. We can thus estimate whether the risks outweigh the benefit, and if we find that they do, we should (and usually do) stop using them. I am not at all sure that we can perform similar assessments in the case of acupuncture.
We add to that the fact that all credible studies have indicated that acupuncture is no more effective than placebo, and lest you think that the ‘placebo effect’ is a treatment in itself, remember that a placebo is a null treatment. In other words, the same effect can be obtained by giving a patient a sugar pill or a massage and telling them it will help them.
In modern medicine, a risk analysis is performed on the effective of a treatment against the potential for benefit. As time goes by, treatments with a higher risk/benefit ratio are dropped in favour of safer and more effective alternatives.
In acupuncture, we have a treatment that has no proven positive effect and that has an unknown, not not insignificant risk associated with it. Anyone practising Science Based Medicine would not continue to use such a treatment.
via Doubtful News.