Placebo Effects in Acupuncture

This article is a summary of a talk presented in February 2019 at a conference on acupuncture sponsored by the National Institutes of Cancer (NCI) and the National Center for Complementary and Integrative Health (NCCIH) at the National of Institutes of Health (NIH). The article touches on the history of placebos in biomedicine and its absence in traditional East Asian Medicine. It then examines some of the predicaments of evaluating acupuncture's efficacy in relationship to placebo controls. Although acupuncture in randomized controlled trials (RCTs) generally demonstrate equivalence or even superiority to medical interventions or other nonpharmacologic therapies, acupuncture's ability to show superiority to placebo controls has been inconclusive, contradictory and, at best, modest. This article highlights the efforts of the German health insurance funds to evaluate acupuncture. Using a large meta-analysis, the article summaries acupuncture's effectiveness and efficacy. Subsequently, RCTs and meta-analyses testing the hypothesis that sham acupuncture, and other device placebos, have augmented placebo responses are described. It seems that acupuncture, and devices in general, have enhanced placebo responses. These findings may be relevant to designing and evaluating placebo-control acupuncture RCTs. Research into placebo acupuncture may also be helpful for other conditions where detection of intervention-placebo differences can be problematic. Further research is warranted.