Chinese research is apparently getting better. In fact, China is taking first place, ahead of the USA and UK, in publishing scientific papers. With the amount of people China has and the emphasis on being good students, it is hard to see anything stopping China from leading the scientific world other than bad methodology. I suspect most Chinese scientists have recognized the importance of quality in research and are working to repair the poor reputation that Chinese research has developed. Having read plenty of abstracts on Chinese medicine research, I’m well aware of the low quality that has given TCM (Traditional Chinese Medicine) research a bad name. As an American acupuncturist who is determined to provide safe, effective, and responsible treatment in my clinic, I don’t feel the need to hide the fact of research problems in the TCM field. On the contrary, being honest and open about the problems and limitations in my field has won me more respect from intelligent patients, doctors, and scholarly acupuncturists than just parroting the Party line about TCM.
So how bad was Chinese research? In pouring through dozens of abstracts on external Qi Gong energy healing looking for convincing evidence that the ability to project or detect a human energy field has been verified in decent research, the results were stunningly disappointing. Often it’s hard to learn about the actual research methods used from the studies written by the researchers themselves. This is where James Randi’s trip to China with CSICOP (The Committee for Scientific Investigation of Claims of the Paranormal, now just CSI, the Committee for Skeptical Inquiry) takes the cake. I know plenty of psychics and New Agers hiss when they hear these names, but the best way to shame the skeptics would be to rigorously prove psychic abilities in a controlled setting and then take Randi’s million dollar prize (see my recent book review about _Randi’s Prize_) or expose them as closed-minded frauds. Unfortunately for paranormalists, there are far more documented frauds and closed minds on the psychic and religious side of the fence.
As I was reviewing _Randi’s Prize: What sceptics say about the paranormal, why they are wrong and why it matters_, I bought _The Hundredth Monkey and Other Paradigms of the Paranormal: A Skeptical Inquirer Collection_, edited by Kendrick Frazier.
Along with a nice introductory essay by science hero Carl Sagan, there are thought-provoking pieces by Martin Gardner, University of Oregon professor Ray Hyman, and other usual suspects from the skeptical movement. An unexpected gem was the chapter “Testing Psi in China: Visit by a CSICOP Delegation” which details a 1988 trip by a group including James Randi. It really hit home when they visited the Shanghai College of Traditional Chinese Medicine, as that esteemed TCM school is the publisher of several textbooks I used in my acupuncture education. I’ve recently been shaking my head over some of the acupuncture point functions given in _Acupuncture: A Comprehensive Text_ put out by the Shanghai College of TCM and translated by Dan Bensky and John O’Connor, which was a good warmup for the head shaking _The Hundredth Monkey_ produced.
Fitting nicely within the history told in _Qigong Fever_, the CSICOP team reports the following experience from visiting the Xian Paranormal Function Application Association and working with its secretary-general, Mr. Ding Wei Xin:
Professor Fan Yu Lin, president of the group, said in a formal talk that he believed the paranormal phenomena produced by the children were genuine and he tried to explain this as a product of the evolutionary process.
We were in a crowded room with about 80 people. In the rear were several of the “psychic” children, all about 11 years old. Mr. Ding brought forth two young girls for us to test. He first claimed that they could read characters in sealed envelopes. James Randi produced a number of envelopes that had been prepared beforehand, each containing one randomly chosen Chinese character. The children were permitted to hold the envelope in only one hand and for some 20 minutes they were under constant scrutiny by those present. The results were negative and the children became very distressed. Mr. Ding was evidently surprised. The next test, he said, would be of PK [Psychokinesis--moving things with the mind]. He brought up two other young girls and provided two matchboxes. Inside one box was placed a green match, which we insisted be marked on all sides with two red stripes. Mr. Ding said one of the girls would break the match using her psychic power. A second match, similarly identified, was broken into several pieces and inserted into the second box. He asserted it would be restored to its original condition by the other girl. Again our controls were stringent. The boxes were marked on the inside and outside with the initials J.R. They were then sealed with tape. The girls could only tough the box with one hand or lay it on the floor in front of them. They could not remove it from sight. In evident distress at these strict condition, they were not able to perform, and these tests were also negative. Mr. Ding admitted that he had never before marked the matches.
Mr. Ding was himself dismayed at the negative results. He implied that they might be due to the fact that the children were nervous and under the scrutiny of too many people. He agreed that we should continue testing the next day in our hotel under quieter conditions. That evening Mr. Ding held a huge banquet at which we were able to meet and dine informally with six of his prime subjects, including two young boys. We had a wonderful time and ended the night by disco dancing with the youngsters. The atmosphere was friendly and the attitude was positive, something that Mr. Ding had insisted was necessary for proper testing the next day.
[I'm omitting two paragraphs about another strictly controlled test the next morning which similarly showed no psychic powers.]
Mr. Ding again voiced surprise. The children were usually successful. We then told him he could conduct the next experiment as he wished an we would simply observe his method of testing. So we began anew. This time there were four subjects–three girls and a boy. For this experiment Mr. Ding used cellophane tape and matches with green heads. He also wrapped the boxes in paper. The procedure was the same as before, though Mr. Ding told us he would tape the boxes even more tightly. The first box (“A”) contained a broken matchstick; the second box (“B”), a whole match; the third box (“C”), a broken matchstick; and the fourth box (“D”), three matches. He said the children would restore the broken matches or, if whole, break them by the power of their minds. Mr. Ding kept no records of any kind; nor did he mark any of the matches.
Under Mr. Ding’s supervision, bedlam broke out. After a few minutes the children darted from the room with the matchboxes in their possession. They ran up and down the stairs, in and out of the elevator, inside and outside the building. Mr. Ding saw nothing wrong with this. He did not bother to count the remaining matches, nor did he take notes as we had done of all the previous tests. The children went in and out of the room several times. At about noon, after an hour and a half of running around, the children sat quietly in their chairs for 15 minutes in an attitude of concentration. They then said they were tired, and Mr. Ding was not confident that they had been succesful. The children asked if they could leave the hotel grounds with the boxes. Mr. Ding said yes, and proposed that we meet again at eight o’clock that evening. We were shocked at this loose protocol; but it was Mr. Ding’s test, so we agreed.
That evening they all returned. We were told that one of the boxes, box “D,” had been accidentally destroyed; it was not returned. We then proceeded to examine the other three.
The outer wrapping paper and tape on boxes A and B did not appear to have been tampered with or unsealed. When we opened them, the matches were exactly as they had been before. They had not changed. Box “C” was a different matter. Although somewhat the worse for wear, the box at first appeared not to have been tampered with. But on closer inspection it was clear that the tape had been unwrapped and removed; vegetative matter (most likely grass) and a strand of hair were found under the cellophane tape. We opened the box. It had previously contained five broken pieces of a match with a green head. Now we found an entirely intact match, but it had a red head! Moreover, we discovered that the girl in the experiment had given the matchbox to the two boys who returned it, but who had not even been part of the experiment. Mr. Ding apparently saw nothing wrong with this.
We ruled that there was obvious evidence of tampering and that cheating had taken place. Although Mr. Ding now admitted to us that some of his children had cheated in the past, he maintained that many such cases were genuine. Unwilling to admit that a child had cheated in this case, he argued that there may have been vegetative matter on the table when the matchbox was wrapped. This was simply not so. Moreover, he rationalized that the green matchstick had been miraculously changed to a red one. He reached into his brief case and produced a match, carefully wrapped in paper, which appeared to have both a red head and a green heat. This, he said, had been produced by one of the young boys who had returned it; and he affirmed that this indicated an even more surprising power of psychokinesis! Later, when we confronted the two boys individually about what had happened, we got contradictory stories. One even blamed his father, who he said had told him if he could restore a broken green match he could just has easily change it into a red one!
What may we conclude from this fiasco? It was apparent that Mr. Ding was extremely naive and that he was unable to design a simple controlled experiment to detect fraud. Obviously the children were playing games and doing so with impunity. Yet Mr. Ding attributed their feats to a psychokinetic effect. (Frazier, 243-245)
That part wasn’t at the Shanghai College of TCM, but is an amazing story which lines up with other Chinese children’s “psychic abilities” to read with their ears, etc., that duped some of the highest Communist Party officials (as told in _Qigong Fever_). Directly following that passage is a brief summary of their trip to Shanghai:
The last two days of our sojourn in China were spent in Shanghai, a city of faded elegance with very little new construction other than some tourist hotels. Here we met with the faculty and staff of the Shanghai College of Traditional Chinese Medicine. This group seemed most receptive to our suggestion that rigorous tests be made of Qigong. To our surprise, they were completely unaware of the importance of double-blind trials and expressed enthusiasm about doing such tests in the future. They focused primarily on internal Qigong, a form of relaxation that they claimed could reduce hypertension and have a beneficial effect on other illnesses. They were somewhat skeptical of external Qigong, where a master seeks to induce changes in a patient’s health.
We also met at the Dong Hu Guest House with some skeptical scientists and philosophers who said that they had done tests with psychics and Qigong masters with invariably negative results. Unfortunately, they confided, the press was more interested in reporting the fantastic claims of paranormalists than in the more mundane, skeptical critiques. This, we noted, is similar to what occurs in other countries. (Frazier, 245)
At least there were no major scandals at the Shanghai College of TCM! However, I’m not very surprised that in 1988 they were unaware of double-blind study design. My textbook on acupuncture from their school was translated in 1981. My version of _Acupuncture, A Comprehensive Text_ is a 1998 printing but doesn’t note any revisions. Amazon (which that last link leads to) describes this book as:
Compiled by the faculty of one of China’s leading schools of traditional medicine, Acupuncture: A Comprehensive Text is among the most authoritative textbooks and reference sources in its field. Since its translation into English in 1981, it has become a standard text used throughout the world.
There are several comments which show this is still regarded as a key book in acupuncture education:
What does the 1981 copyright have to do with anything? The book has stood the test of time. I’ve had my copy since 1984 and still refer to it regularly. Some don’t like the book because it covers the acupoints by anatomical region… If I had to have only one book on acupuncture, this would be it. Fact is, with all of its 741 pages, this book is the bible, at least in English!
I’ve become used to skipping over absurd claims in TCM books, and hope that other acupuncturists do so as well. What do I mean by absurd? I’ve been writing about the nutritional deficiency Beriberi lately. This serious and fatal deficiency of Vitamin B1 is key in the modern development of nutritional science, and in fact led to the coining of the word “vitamin” just 100 years ago! Beriberi has a cheap, natural cure. It’s called Thiamine, and is in many foods. I don’t recommend you try to treat it with acupuncture. Really.
Unfortunately, _Acupuncture, A Comprehensive Text_ doesn’t agree with me. There are several points, especially on the lower limb, which have “beriberi” as an indication. For example, in page 387, the point “Qi’s Extremity” at the tip of each toe is recommended for:
Apoplectic coma, beriberi, paralysis of toes, red swollen dorsum of foot.
The following page lists three other points with beriberi as an indication. Why are these points on the lower leg? Because beriberi leads to swelling in the feet as the capillary walls weaken and the plasma leaks out into the tissues. Next the lungs fill up, the brain misfires, and the heart fails. Many proponents of TCM state that acupuncture treats the underlying cause of a disease, not just the symptoms. Poking holes in the toes and lower legs to treat foot swelling due to severe malnutrition contradicts that claim. I’m not saying that all of TCM is like this, but it is a real example which is clearly put forth in this influential acupuncture text. Why is it there at all? Who on earth would want to treat beriberi with acupuncture, when brown rice, bean sprouts, or B-Vitamin pills will quickly reverse and cure this condition? Did the authors not know about this in 1981? I understand that the translators’ job was just to translate, but it’s important to note that there is a complete lack of a plausibility filter.
There are no footnotes in this book at all. There are no directly referenced studies (even bad studies). The bibliography is fairly short and mostly references other Chinese textbooks (which in turn probably reference older Chinese textbooks). It is fair to say that there is no supportive research for most of the claims made in this book for acupuncture points. Some might think that the Shanghai College of TCM professors knew what a double-blind test was before CSICOP’s visit, but there is no evidence of that in this text. The only good news about this is that there is still a place for good quality research on acupuncture. Unfortunately, the best research on acupuncture so far shows little benefit, mostly related to pain relief. Definitely no studies have found acupuncture to cure a nutritional deficiency.
What other implausible claims are in _Acupuncture, A Comprehensive Text_? Too many to discuss in just one post, but here’s a smattering from the same couple pages on lower limb acupoints (386-389):
- Infantile convulsions
- Mental illness
- Gingivitis (On the back of the heel! Try brushing and flossing first…)
- Brain disease
- Paraplegia (half of the body paralyzed)
- Puerperal fever (an often fatal bacterial infection of newborns, usually from unclean birthing environment)
Many of the point functions are for local pain (i.e. points around the knee for knee pain). These are more plausible, depending on the cause of the pain. But throughout the book, there are point indications for both specific conditions (like malaria and myopia), and broad categories (psychosis, seizures, paralysis). None of them, from what I’ve been able to find, have been confirmed by decent research. Most of them haven’t even been the subject of bad research. China has notorious “publication bias” meaning they almost exclusively publish positive results (99%). Thus, if a study looks at points on the foot to treat “brain disease” or “mental illness” and fails to find benefit, it will likely be round-filed away instead of printed. This does a disservice to the medical and research communities, as it’s important to know when something has been disproven, too. This would hopefully lead to editing textbooks accordingly and moving on to more productive areas. When cultural pride interferes with honest presentation of scientific findings, it may look good in the short term, but over time everyone suffers.
Most acupuncture patients go for the treatment of pain (I saw the figure 88% somewhere recently, but I can’t find that reference). Most acupuncture research focuses on pain. Unfortunately, pain is very subjective and is the symptom most likely to be influenced by placebo treatments. This increases the need for carefully designed studies with credible placebos.
I suspect very few patients who get a “brain disease” or have a baby with puerperal fever think “I’m going to rely on acupuncture for this!” I also doubt many modern acupuncturists would claim with confidence that they can cure diabetes or gingivitis with acupuncture, though I’m sure many feel like they give “overall support to a healthy system.”
I remember being a beginning student with very hopeful ideas about acupuncture, including the hope that it could cure my nearsightedness. I’ll write more about that in the future (it links in to Aldous Huxley and the Bates Method). But I will say that much of my myopia has been cured by reading Carl Sagan and James Randi.