Is Acupuncture Worth a Punctured Lung? or Does the Risk Out Weigh the Benefit?

Friday’s issue of The New Zealand Medical Journal includes a case report of pneumothrorax in a recipient of acupuncture. For the interested layperson out there a pneumothorax in the collection of air in the space between the lung and chest wall leading in extreme cases to cardiac arrest. Acupuncture can result in pneumothorax when the needle is inserted into the lung tissue while the patient is breathing leading to the laceration of the lung and air being forced out of the lung and into the pleural cavity1. Mmm-mmm, gimmie some of that lung collapsing goodness.

Now lest I give the impression that complications from acupuncture use are common I will hasten to add that they are not. One paper estimates the rate of serious adverse events at approximately 1 per 20,ooo patients2. Though if we look at the rates of acupuncture use in the United States as an example, as of about 2007 approximately 1% of the population reported using acupuncture in the previous 12 months3. This translates to about 155 serious adverse effects per year. Another study found over 2% of patients reported adverse reactions that required treatment4, commonly for bleeding or pain. Multiply these figures by the likely worldwide numbers of people receiving acupuncture.

Lets compare this with the conventional medical field, the drug Terfenadine marketed under the trade name Seldane (Teldane here in NZ) was removed from the market in the US due to increased risk of cardiac arrhythmia when used in conjunction with certain other drugs. This expressed itself as a risk of 0.04 – 0.08 per million “defined daily doses”5. Once a replacement drug came on the market Terfenadine was taken off.

Pneumothorax as a complication from acupuncture isĀ  rare even in this subgroup. More common is infection. As I’ve noted before6, the underlying theory of acupuncture is the manipulation of life energies (Qi or Chi), blockages or imbalances in which are the cause of disease. If such is the case then why should the treating physician7 bother with proper antiseptic technique? I suspect that most modern practitioners are however not so far down the rabbit-hole that they have thrown away germ theory completely, at least the outward practical side involved in cleaning and sterilising implements. Which is why even infections are still relatively infrequent.

I would like to point out however that given the implausibility of the treatment basis, coupled with the fact that most large well designed studies find no benefit beyond placebo does make the existence of any complications ethically troubling. If your treament is no more than an elaborate placebo, are you willing to suffer adverse effects because of it? As reported by Dr Novella of Science Based Medicine8, a recent review of acupuncture admitted that sham (placebo) acupuncture was as good a “real” acupuncture.

Lets delve into the definition of “sham” acupuncture a little more to give the proper context to this revelation. Whereas “real” acupuncture depends on the proper insertion of the needles in specific meridian points on the body sham acupuncture can be considered to be either the placement of needles into non-meridian points, or the use of implements that feel like needles to the patients but do not pierce the skin like toothpicks9. This indicates that it doesn’t matter where you stick the needles and it doesn’t even matter if you stick the needles. How then can we conclude that acupuncture works if you don’t need to perform the two defining characteristics of acupuncture?

Given this background I find it difficult to imagine why acupuncture continues to be recommended despite convincing evidence of efficacy and indisputable evidence of harm. All medical interventions carry some element of risk, this is then weighed against the potential for benefit. However when there is no benefit any amount of risk must make that equation lopsided with regard to harm. With that in mind, if you are attracted to acupuncture as a therapy let me recommend sham acupuncture as the way to go. All the placebo-y goodness of real acupuncture without the potential for the nasty drawbacks of infection, bleeding, pain or even pneumothorax.

Further reading:

Type “Acupuncture” and “Infection” or “Pneumothorax” into Pubmed as key words and you will find a variety of papers, a selection of which are below:

Acupuncture induced pneumothorax:a case report (not the report mentioned in the post)

Editorial:Acupuncture transmitted infections

Cutaneous Mycobacterium haemophilum infection in a kidney transplant recipient after acupuncture treatment.

Acupuncture needle-associated prosthetic knee infection after total knee arthroplasty

Footnotes:

1. Clinical analysis on 38 cases of pneumothorax induced by acupuncture or acupoint injection

2. A cumulative review of the range and incidence of significant adverse events associated with acupuncture

3. http://nccam.nih.gov/health/acupuncture/introduction.htm

4. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form.

5. Detection and reporting of drug-induced proarrhythmias: room for improvement

6. Scepticon: Acupuncture

7. And here I use the term loosely.

8.Acupuncture Pseudoscience in the New England Journal of Medicine

9. I kid you not, here are a couple of the studies:
Description and Validation of a Noninvasive Placebo Acupuncture Procedure
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain

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  1. people are stupid

    • People are poor at judging relative risk but that is not the same as being stupid. Once we start down the track of denigrating the people rather than the unproven treatments that they use then we run the risk of not recognising such failings in ourselves and making the same mistakes.

      Not to mention that these people in some cases are being taken advantage of, should we blame the victim? Finally demonising the other side of a debate is a tactic I would rather not condone in any form.

      But thanks for the comment.

    • Dr Joseph Lodespoto
    • August 28th, 2010

    Experience it for yourself, then judge it. When I was doing my medical rounds in the hospital system .. all i ever came across were CHRONIC illness after chronic illness. My medical colleagues would diagnose the illnesses very proficiently, but when it came time to treatments … the results were little to none, and most patients were even WORSE off from the side effects of the medication. Now i do not think one mode of treatment outweighs the other … but its a COMBINATION of the two fields that works best, depending on the condition, and thats were the future of both fields is heading. Study both, experience both, then you can compare both.

    Dr. Joe

    • It’s surprising how often I hear the refrain “try it yourself” as if my anecdote is of more importance than the medical literature. As this is what most AltMed proponents seem to think I should not be surprised but I do find it odd coming from a medical professional.

      How do you choose treatments? Word of mouth or the documented literature?

      • Tony
      • September 5th, 2010

      What is your feeling on No Fault Fraud?

      • Erm, could you explain how this relates to alt-med or acupuncture injury? Wikipedia tells me this is a auto-insurance issue.

    • JakeP
    • January 21st, 2011

    http://archopht.ama-assn.org/cgi/content/abstract/128/12/1510

    There could be something to acupuncture in small cases (probably from simply stimulating nerves / an immune response), but I sincerely doubt it has anything to do with Qi or any of that. Given how long Acupuncture has survived, I am a bit sceptical that it is completely worthless … even if they are way off base as to why it may work in cases.

    • Interesting study. If I read it correctly though both groups received treatment other than patching or acupuncture (optical correction, and daily near-vision activities). In addition there was no experimental arm that only received the optical correction and near vision activities. Without this all we can say is that the two extra therapies were equivalent (or Acupuncture slightly better), they could be equivalently useless (or acupuncture is slightly better than useless, or rather not using an eye patch is better than useless). Given the extreme implausibility of the treatment we just can’t draw any reasonable conclusions.

      Regarding acupuncture history, while it’s tempting to say there must be something to it just because of extended use that is also tricky. People have also been throwing salt over their should for luck for hundreds of years, does this mean it’s effective or just that people believe it’s effective?

      The preponderance of current medical knowledge indicates that acupuncture provides no more than a placebo effect (itself a contentious topic). It matter not where the needles are inserted nor even if they are inserted, the results are the same. Not exactly a watertight case for efficacy.

      Thanks for the comment.

    • M Kim
    • October 23rd, 2011

    I received an acupuncture treatment from Acupuncturist Chongin David Kwon (a license number A60088111 in Washington State) from the PNC of Bellevue Acupuncture Clinic http://pncofbellevue.com/ (at 5:30 pm of July 29th 2011 for the neck and shoulder pain. He punctured my lung during the acupuncture treatment. This led to a partial lung collapse (“pneumothorax”). Around 7pm on the same day, I started to have sharp chest pain and shortness of breath. I went to an emergency room in the morning of July 30th 2011, and I was diagnosed with a partial lung collapse. I believe that this incident is a result of an unprofessional conduct by Dr. Kwon. He demonstrated incompetence, negligence, and malpractice, which resulted in injury to a patient, and created an unreasonable risk and harm to a patient.

    This incident also resulted in financial damage to myself, incurring a medical expense of over $5000. I called the acupuncturist to reimburse my medical expense. His wife, a receptionist at the PNC of Bellvue clinic said she needs to see all my medical records and bills. I sent all requested information, yet PNC of Bellevue refuses to respond and refuse to reimburse my medical cost. I feel cheated! Dr. Kwon made me to collect all my medical records (which is really time consuming and opinions of medical experts). My husband called the clinic but Dr. Kwon refused to give us a date on when he is ever going to respond. He says, “he is currently seeing a patient and he is busy.” I just hope he does not puncture the lungs of another patient. For those concerned about the safety of acupuncture, be aware of risk, and be aware of Dr. Kwon who punctured my lung and who refuses to reimburse any medical cost for his wrongdoings.

  2. Thanks for sharing your experience here. You bring up a subsequent point to the main thrust of my post and that is the responsibility and culpability of acupuncturists (and alternative practitioners in general).
    From what I have read and observed it can be very difficult to get any disciplinary action against practitioners for giving substandard care even when the effects of potential effects are severe, as in your case. I would hasten to add however that it can be difficult to determine that significant wrong doing is the case, especially if a particular event is a known side effect of a treatment.

    Has to happen to someone, right?

    Even so, the lack of evidence for acupuncture must weigh on the balance when considering these cases. How that might play out in these cases, I don’t know.

  3. I don’t go in for the “mystical powers of Qi” nonsense. As for acupuncture, I found it far more effective in resolving a lower back injury than a sports massage. I’m fortunate to have tons of similar anecdotal evidence from the people in my life who the practice has helped, some quite significantly. Nary a punctured lung between them too.

    Did you know that you can benefit from things you don’t understand instead of griping about them? Give it a shot!

    • I can benefit from things I don’t understand – quite true. What I can’t benefit from is things that have no benefit.

      Not understanding something is not synonymous with it being effective – that’s that point you (and others) apparently missed.

      I point out that complications are rare but – and here’s one of the important bits – LESS rare than complications from other medical interventions which see these interventions taken off the market!

      Why does altmed get a free pass?

      There is no convincing evidence of efficacy (anecdotes don’t count, sorry – I cover this point over and over on the site if you search for “anecdote”) but evidence of harm.

      By any reasonable risk assessment that means people shouldn’t use it.
      This is of course using measures of Objective benefit, if you are fine with subjective benefit (which many people are, and is fine) then by all means go for it.

    • yirenaimes
    • May 26th, 2013

    A few studies don’t mean everything. I could also easily dig out negative studies on conventional medicine.

  1. December 6th, 2011

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