From An Acupuncturist to A Placebo Scientist

Why A Pioneer TCM Acupuncturist in America Turned A Leading Placebo Research Scientist

Brook Cheng

September 16, 2022 on linked-in

A Young Communist's Encounter of Chinese Medicine

From there, the ball of the story of a young American communist related to Chinese medicine and placebo effect started rolling.

The name of the young man is Ted Kaptchuk (1947-), the author of the Chinese medicine book The Web That Has No Weaver (1983) which most influentially romanticized so-called Traditional Chinese Medicine (TCM) to the Western audiences.

"I was hanging out with the San Francisco Red Guards and reading Mao, trying to get away from U.S. imperialism," the 64 years-old Kaptchuk recalled (Michael Specter, 2011), "I was militant and crazy...It was a time when the underpinnings of the universe were questioned."

We do not know the details of Kaptchuk's exact political activities at that time. He seemed to have been able to evade the Federal Bureau of Investigation to testify before a grand jury, seeking refuge at a Chinese safe house ("Red House") in California.

He holds a B.A. in East Asian Studies from Columbia University. The fugitive life connected him to Chinese medicine. When as a refuge in California, he came upon a series of books on Chinese medicine. From California, Kaptchuk fled to Macau and studied at the Macau Institute of Chinese Medicine.

From An Acupuncturist to A Placebo Researcher

Kaptchuk stayed in Macau until 1976, when it was safe for him to return to the USA where he started acupuncture practice in Cambridge. After 14 years of practice, in 1990 Kaptchuk quit his acupuncturist career and became a researcher focusing on placebo studies. He is now a professor, a leading scholar in this field at Harvard Medical School.

Image from Wall Street Journal

As historian professor Paul Unschuld from Germany noticed, some of the Western followers of TCM have eventually become suspicious of TCM in more recent years. Kaptchuk is one of them.

Kaptchuk's quitting his career he once romanticized and becoming interested in placebo studies had a reason. Despite the popularity of TCM acupuncture, clinical studies continually fail to demonstrate its effectiveness. Numerous studies worldwide constantly ended up results that indicate TCM acupuncture works no better than placebo. This is a fact that Kaptchuk did not dispute.

In 2001, Kaptchuk together with other American researchers from the Group Health Cooperative in Washington State published the results of their study (Cherkin DC et al, 2001) comparing the effectiveness of acupuncture, therapeutic massage, and self-care education for chronic low back pain.

Treatments were provided in the offices of licensed acupuncturists and massage therapists who were members of a CAM practitioner network used by the HMO. Totally 262 patients with persistent low back pain were randomized into TCM acupuncture group (n=94), therapeutic massage group (n=78), or self-care education group (n=90). Up to 10 massage or acupuncture visits were permitted over 10 weeks.

The study found that although both acupuncture and massage are more effective than self-care at 4 weeks and 10 weeks, therapeutic massage was almost as twice effective (reducing pain by 41.9% from 6.2 to 3.2) as acupuncture (reducing pain by 27.4% from 6.2 to 4.5) when assessed at 1 year of post-treatment. Even more surprisingly, at this 1 year point, even the self-care produced outcome (pain reduced by 37.7 % from 6.1 to 3.8) which was superior to that of TCM acupuncture (pain reduced by 27.4% from 6.5 to 4.5). (The details of this study will be discussed in one of my oncoming posts to unveil the secret why massage or even self-care could beat TCM acupuncture in this case).

"The results of this study suggest that therapeutic massage is effective for chronic or subacute low back pain and raise doubts about the effectiveness of TCM acupuncture", the researchers including Keptchuk concluded.

Keptchuk eventually became skeptical of so-called TCM and started to disdain what he calls the "squishiness" of alternative medicine. He began to consider that "alternative medicine (primarily acupuncture) may generate extremely broad, indeterminate therapeutic effects and therefore, at least from a cultural view, 'in some sense cannot fail'" (Ted J. Kaptchuk, 2002). In other words, alternative medicine in most part, as viewed by him, is a placebo therapy.

A Beauty Portrayed on Misunderstanding

In the West, the first influential book about Chinese medicine was Ted Kaptchuk's The Web That Has No Weaver: Understanding Chinese Medicine (1983). The book romanticized Chinese medicine as "a coherent and independent system of thought and practice that has been developed over two millennia." But the true Chinese Medicine history indicates that such a statement is a misunderstanding (Unschuld P., 2010).

"The fact is, Chinese medicine has been dominated for the past two millennia by the approach Kaptchuk depicts as Western, but this knowledge was simply not available in the late 1970s and early 1980s", Unschuld says.

"Kaptchuk's book became widely read, and created images in the minds of large audiences ... even today when historical research has shown many of these images to be unfounded.

"I do not wish to specifically pick on Kaptchuk. ..At the time he wrote his book, no one in the West knew much about the true nature of Chinese medicine.

"...Westerners created out of hear-say and based on conceptual bits and pieces learned from China an artifact of diagnosis and treatment linked by notions of harmony, wholism, etc., and then attributed to this artifact a Chinese nationality..."

"Falsely attributing TCM a Daoist origin and a history of millennia, a group of Western followers developed the cure of many ills not only of patients, but also of Western medicine. It is this group that was misled, for a long time, by the term TCM...", Unschuld concluded (2010).

In an interview with Acupuncture Today (2004), Unschuld says:

"It is a fact that more than 95 percent of all literature published in Western languages on Chinese medicine reflect Western expectations rather than Chinese historical reality. Bestsellers are usually written by those who know no Chinese, have no access to Chinese medical history, and have never - or at best for short periods - been to China.

"There is, I wish to emphasize, nothing wrong with these books, as they were informed by visions of an ideal health care presumably developed in China. As such, these books tell us something about what is lacking in Western biomedicine, ...

"Nevertheless, while they reflect Western yearnings, they fail to reflect the historical truth of Chinese medicine. Chinese medical history is, indeed, a huge treasure box, and given that TCM has selected only parts of its contents, serious historical research may turn up many more."

The Ancient Acupuncture Is Different

The acupuncture as described in ancient Chinese medical classic Huangdi Neijing is magically effective and reliable, no placebo effect recorded or easily perceivable when you read the Neijing. But with millennia having passed there has "evolved" a TCM acupuncture which has been demonstrated in evidence-based science community again and again as no more effective than placebo.

So what has been wrong with today's acupuncture? Learning the truths in acupuncture history will get the answer to this question.

Epilogue

My writing of this Newsletter – Truth of Acupuncture Science: How A Jewel Ended up A Quackish Stone in Acupuncture History- would not have been possible without the constant inspiration from tons of great works by numerous scientifically-minded people. Among these people, there is professor Ted Jack Kaptchuk, a leading figure in placebo studies, a scholar of East Asian medicine, and an academic authority on medical pluralism. He has been a faculty member at Harvard Medical School since 1998, a professor of medicine since 2013, and professor of global health and social medicine since 2015. The New Yorker listed his work among "The Most Notable Medical Findings of 2015" (Wikipedia).

References

Barnes, Linda, 2005, American Acupuncture and Efficacy.

Bauer, Matthew, 2004, An Interview With Dr. Paul Unschuld, Acupuncture Today – July, 2004, Vol. 05, Issue 07

Cherkin, Daniel C. et al, Randomized Trial Comparing Traditional Chinese Medical Acupuncture, Therapeutic Massage, and Self-care Education for Chronic Low Back Pain, Arch Intern Med. 2001;161:1081-1088

Gordon Melton, J. et al. 1990, New Age Encyclopedia.

Michael Specter, The Power of Nothing, 2011, Annals of Science December 12, 2011 Issue

Ted J. Kaptchuk,The Web That Has No Weaver: Understanding Chinese Medicine, New York: McGraw-Hill, 1983.

Ted J. Kaptchuk, The Placebo Effect in Alternative Medicine, 2002

Paul U. Unschuld, When Chinese Medicine became Chinese: Attributions of Nationality from Inside and Outside, 古今論衡第18 期 2008.10

Wikipedia, https://en.wikipedia.org/wiki/Ted_Kaptchuk (Accessed on Sept 15, 2022)

Mao Zedong, 626 Instruction, Jun 26, 1965. TheFirstNewsToday (今日头条) , 2022-08-05. https://www.toutiao.com/article