This isn't as simple a question as it might seem. I've been working as an acupuncturist for many years, and in my experience I've found it to be tremendously useful for many people, particularly for pain-related conditions and stress/anxiety, and I believe it has an important role to play in the management of other conditions too. 

But I try to constantly remind myself that I am subject to bias just like anyone else, and I have to remain open to changing my opinions in the face of good evidence. There are many types of bias, but confirmation bias is perhaps the one practitioners like myself have to be particularly wary of. For example, let's say someone seeks my services for low back pain. I'd carry out a careful examination, and probably use some tuina massage to begin the treatment and get a sense of what feels tight or tender etc. I might use cupping (demonstrated in this video) to invigorate the circulation of blood and loosen the muscles and connective tissue. Then I would use a selection of acupuncture points based on what I've felt at and around the area of pain, and some further away from the area because of their traditional usage, or their anatomical relationship to the painful area. I would also try to consider and address any underlying factors that may be contributing to the problem.

I might also consult a resource such as A Manual of Acupuncture, remembering that the patient complained that her back and knees were always cold - and find that the point Shangliao (Bladder 31) is specifically mentioned in that context. So I'd be naturally inclined to add that into the mix too.

Two days later, I might get an enthusiastic text message from the patient saying:

'Hi Tom, I can't believe it, the pain's virtually gone, and my knees aren't cold any more!'.

A perfectly natural human reaction would be for me to pat myself on the back for my wonderful treatment. Acupuncture does work, and what's more, it works in mysterious but specific ways - that point (Bladder 31) is great! My prior hopes and beliefs have been confirmed by this experience, and life feels good.

But in reality, how can I be sure which part of my treatment caused the improvement? Was it the massage, the cupping, or perhaps just one of the needles? It's impossible to be sure. In fact, some skeptics would argue that it's more likely to just be a placebo reaction, or that the pain was self-limiting and would have gone away with or without the treatment. There's no way I or my patient can be certain the treatment itself was the cause of the improvement.

And what if I'd had a different text message?

'Hi Tom, thanks for the treatment the other day but to be honest it isn't any better, in fact it's even more sore, so I'm going to try something else'.

Life doesn't feel so great. But because I'm human, my psychological defense mechanisms might kick in and tell me that this wasn't a failure - the patient just didn't give acupuncture a proper chance. I'd be less likely to store away the fact that Bladder 31 didn't seem to make a difference, because that wouldn't help me confirm what I'd like to see happening.

So where does this leave me as a conscientious practitioner, wanting to give honest and realistic advice to people who seek my help? If you ask a skeptic, they'll tell you that any experiences I have as a practitioner are not evidence of any kind - a favourite mantra in these circles is 'the plural of anecdote is anecdotes, not evidence'. I agree that objective evidence is important, and should be continually sought, but I would also argue that clinical experience is valuable, despite problems such as confirmation bias. It may not be completely reliable, but over time, and when practitioners are conscious of their biases, useful information can be gathered and passed on.

However, I do agree that nobody should just take my word for it (or the word of anyone else) - other forms of evidence should also be considered when deciding whether to give acupuncture a try. The scientific study of acupuncture is a thorny subject, and I won't go into detail here about its various inherent problems (Mel Hopper Koppelman discusses these eloquently on her blog if you're interested, for example here. And for the views of someone who has arrived at different conclusions, you could try Prof. Edzard Ernst's blog here). Confirmation bias can be problematic in the scientific community too of course - a skeptic who has already made their mind up that acupuncture is nonsense will naturally focus on negative studies, and a 'believer' will pick out the positive ones!

I run the risk of doing that here, but a recent systematic review seems to offer very good evidence that 'real' acupuncture is significantly more than just a placebo treatment, at least when it comes to certain conditions:

'Our principal finding is that there are statistically significant differences between acupuncture and sham acupuncture, and between acupuncture and non-acupuncture controls for all of the pain types studied' (1).

Naturally, I'm delighted to see this, as it supports what my clinical and personal experience has led me to believe - that acupuncture is a powerful intervention, capable of improving the lives and relieving the suffering of many people. Can I be certain that my opinion is right? No! Can I be certain this review itself was free from all bias? No! But at least the peer review system and the scientific method are designed to minimise that chance. The same can't yet be said for the desperate and relatively disorganised world of acupuncture as a whole, although there are plenty of brilliant people in it, and hopefully the profession will move in that direction, without losing its soul. 

I would encourage anyone to make an informed decision. Read what the skeptics have to say too, consider the scientific evidence, and ask friends who have tried acupuncture about their experiences - then decide whether it might be something you'd like to try. Whoever you talk to and whatever you read, remember that there are likely to biases at play. 

Please feel free to leave a comment below - I'd love to hear opinions of all sorts.


1) Acupuncture for chronic pain and depression in primary care: a programme of research. MacPherson H et al, Southampton (UK): NIHR Journals Library; 2017 Jan. (taken from the Discussion section of Chapter 2).