IMH and Acupuncture.

I read with dismay and shock that the Institute of Mental Health is now introducing acupuncture in its hospital. This is what asiaone.com reports:  "The Institute of Mental Health (IMH) has become the first health-care provider here to start using acupuncture to help addicts break their drug, drink or gambling habits."  For more, please read this.

This is a first that no reputable hospital should be proud of.  Medical doctors, if they are to be true to their honourable calling, must always practise only evidence-based medicine.  Anything more than that would not be in line with the clear mandate doctors have to heal their patients.  When I see a doctor, I would be shortchanged if he performs faith-healing on me.  Even if he does not force it down my throat but politely offers faith healing as one of the "methods" of treatment to me when I go to his clinic or hospital, that would be, in my opinion, an outrageous abuse of his position as a legally recognised medical practitioner.

It is not too much for a patient to expect a registered medical practitioner to offer only evidence-based treatment recognised by his peers and validated in proper peer-reviewed journals.  Before IMH embarks on any treatment programme, it is duty bound to satisfy itself and the public that whatever programme it offers is backed by evidence and properly controlled studies and is duly referenced in peer-reviewed journals.

Let us see what evidence IMH has in starting this new acupuncture programme.  How effective is acupuncture?  I have personally gone through a huge amount of data on this question and from what I can gather, there has been not a single study that shows that acupuncture is efficacious.  No, not one.  Any study that seems to suggest even remotely that it has some efficacy is alway immediately shot down by experts in the area who point out that the study is flawed or there is no real control provided.  Almost all studies show there is absolutely zero effect in the use of acupuncture.  Of the rare studies that suggest its mild efficacy, reviews of these studies always indicate some severe flaws in the studies and any perceived efficacy is due wholly and indisputably to placebo effect. In many of the studies that proponents of acupuncture will draw your attention to excitedly, the sample size is too small for any significant conclusion in favour of acupuncture to be made.  It is also significant that the "success" of acupuncture is always in ailments that cannot be properly confirmed such as pain and the placebo effect is usually shown to be at play here.  That it is merely placebo effect is frequently confirmed when a control group is subjected to a needle prick too but they are pricked at the "wrong" point of the body and yet this control group claims to have benefitted from the procedure.

As far as science goes, it is correct to say that acupuncture has no advantage whatsoever apart from being a placebo.  That is a scientific statement of fact and I defy IMH to dispute it with evidence.

Given that acupuncture has zero advantage to the patient, can IMH argue that as long as there is no harm, it's all right to administer the procedure?  Of course not.  A hospital is not a church.  You can show statistics as I have shown in the past (click here) that prayers don't work but churches will continue to pray.  But a hospital is different.  It's obliged to do only that which can be of medical benefit to the patients.  But it's not only that.  Prayers are harmless even if they don't work but the same can't be said of acupuncture.  There are serious risk factors.

The latest study of adverse events related to acupuncture concludes that "although serious AEs associated with acupuncture are rare, acupuncture practice is not risk-free." (See Xu, Shifen, et al. (2013). "Adverse Events of Acupuncture: A Systematic Review of Case Reports"Evidence Based Complementary and Alternative Medicine 2013 Infection was the most common adverse event.  You may click here to read the entire paper.  Bear in mind that the paper is not addressing the question of whether acupuncture works.  The fact that acupuncture does not work is well documented in countless other papers and studies.  This paper only deals with the adverse effect of acupuncture, not its non-existent benefits.

There are many articles that you can find from respectable journals that attest to the fact that acupuncture does not work.  In fact there are at least a few hundred times more articles about the inefficacy of acupuncture than there are of the inefficacy of prayer and so technically, if IMH were to introduce prayer into its list of treatments, it would not be so outrageously wrong as if it were to introduce acupuncture.  If you are interested in reading a sample of the many articles against acupuncture as a treatment for anything at all, please click on this link.  I think I have made my point clear. Acupuncture is inefficacious and not beneficial to the patient except as a placebo. But that's not all. It also exposes the patient to unnecessary risks of adverse effects.

This is what the news report says:  "The Straits Times understands that no major scientific studies have been published on using acupuncture for behavioural addictions but the ancient method has developed in recent years outside of China as part of a combined approach to curb such disorders."  The reader is left wondering why then does IMH introduce acupuncture when no study has been done to show its efficacy on behavioural addictions and there are known adverse events?

If you read on further in the newspaper, we are told this which I quote from asiaone.com:

Acupuncture can enhance the standard mode of treatment, said Associate Professor Wong Kim Eng, clinical director of IMH's National Addictions Management Service, which runs the new acupuncture clinic.
It can help to relieve withdrawal symptoms, pain and cravings, as well as anxiety, he added, noting: "So far, there is no single medication that can cure addiction, or a perfect treatment programme. As an Asian society, we sought to borrow some age-old wisdom to improve treatment for our patients."

Is it right for the clinical director of IMH's National Addictions Management Service to say that acupuncture "can help to relieve withdrawal symptoms, pain and cravings, as well as anxiety"?  What I would like to know is on what basis is he making such a claim?  If a patient were to undergo such a treatment and subsequently takes legal action against IMH for subjecting him to a treatment that is not backed by evidence and proper medical opinion, what defence can IMH rely upon to show that it has acted in the best possible manner as a registered medical hospital that delivers health care services using evidence-based treatments?

The clinical director of IMH's National Addictions Management Service continues to say in that newspaper article that we are an Asian society and so they "sought to borrow some age-old wisdom".  Should we engage tangkees to perform religious rites on the patients? After all, we are an Asian society and if we are at liberty to dish out treatment even when there is no study or evidence for it, what is so wrong with having something that is perfectly consistent with our culture as an Asian society?

What I'm concerned about is the newspaper further reports that this initiative "is backed by the Ministry of Health".  Is it right for the Ministry of Health to back a treatment that is totally unsupported by evidence or any form of study?  Let's not forget that acupuncture has been shown not to have any desirable effect (except as a placebo) on a whole host of ailments that it is traditionally reputed to treat. If acupuncture has been shown not to work in ailments that it is traditionally supposed to treat, what makes IMH think that it will work in something totally new and untested, such as behavioural addiction?

Singapore is a well-known medical hub for responsible and efficient health care services. People in the surrounding countries would fly to Singapore to seek treatment and they do that because they know they can trust the doctors in Singapore to practise responsible evidence-based medicine and they know we have great expertise in the various fields of medicine.  But reputation can be lost very easily and going into treatments that are not backed by evidence is the surest way to ruin our good name.  Acupuncture may be a part of our culture but so are the offering of prayers to the Goddess of Mercy and the rituals of tangkees or temple mediums.  They may be a part of our rich cultural heritage but I sure would not want to see them practised in our hospitals.