I think the first thing that I would say is that, my experience is that most people are not skeptics or, you know, this kind of, what I call these official pseudo skeptics. So people who spend a lot of energy trying to debunk things like acupuncture.
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Hello and welcome to another edition of To The Point. Very generously produced by the American Acupuncture Council today. I’m very excited. My guest is the well-known and beloved Mel Hopper, Koppelman, and Mel, for those that don’t know is the executive director of evidence-based acupuncture, an international nonprofit organization dedicated to improving public health through better information about acupuncture’s considerable evidence base. Uh, she completed her masters of science and acupuncture at the Northern college of acupuncture in New York in 2012, and has kind of taken the world of acupuncture by storm since then. Uh, she also has a second master’s of science in nutrition and functional medicine, uh, from the university of Western states in Portland, Oregon, she’s published numerous articles about acupuncture and she practices at her clinic Harbor, integrative health in Bristol, Rhode Island. Uh, so now, you know, so many of us know a little bit about acupuncture research, want to know more and also want to be able to communicate it to both the public and other medical professionals. Um, you know, what do you do when there’s a skeptic that says, oh, well, is the acupuncture just a theatrical, but they, the slave hour or something, you know, how do you retort these, you know, what kind of answer reply, and if you could give us some science to base it on so that we’re, we’re ready when that happens again.
Thank you. Thanks for that question. And thank you so much for having me on, um, I really appreciate it. And to the American Acupuncture Council. Um, yeah, so this is a great question. And one that comes up a lot. Um, I think the first thing that I would say is that, um, my experience is that most people are not skeptics or, you know, this kind of, um, what I call these official pseudo skeptics. Uh, so people who spend a lot of energy trying to debunk things like acupuncture. Um, and so most of the time people, um, that we might come across in different contexts may just be unaware, um, uh, that what of what acupuncture is or how it might help them. Um, and we can talk a little bit about some of the, um, scientific evidence that can help support that. If we’re talking to the public, mostly the public wants to know if we can help them.
Um, and that’s, that’s what I find. So, you know, I have this issue, will you be able to help me? And, and often they’re not going to need a, like a pub med reference bibliography in order to, to convince them, um, although sometimes that can be helpful if a patient or a client needs some support for communicating what they’re doing to other people. Um, that said, if we are speaking to medical professionals, and if we’re speaking in different contexts than having, um, referenced to the, uh, considerable evidence-based can be very useful. Um, and so the first thing that I’ve found, um, is that most, um, you know, depending on the context, most medical practitioners are simply unaware of how much evidence acupuncture has, um, which is a lot. Uh, so I think at last count, um, Cochrane had sequenced something like 14,000 studies, um, of acupuncture, which is more than for chiropractic more than for physiotherapy,
Right? Yeah. And somehow this, this is not out in the public or it hasn’t caught on somehow.
Right? I mean, things are definitely improving since I started, um, since I trained and then started communicating about it. But, you know, one thing that I really would love people to understand, and I was just having a chat about this with, um, Sandra Grassa who’s the, of [inaudible] working really hard at it. Yes. The global acupuncture community, um, really wonderful, um, intelligent guy. Um, and we were talking about how most people don’t realize that once the evidence is there and it’s strong and it’s repeated that doesn’t necessarily mean that it’s a treatment that’s going to be recommended in guidelines. And once the treatment is recommended in guidelines and acupuncture, um, one study found over 1200 recommendations for acupuncture in different guidelines. And, um, this was outside of China and Southeast Asia. So this was in north America, Australia, uh, you know, uh, Australia, New Zealand, Europe, you know, that, um, to my reading that may make acupuncture one of the most recommended treatments. Full-stop so it’s really, yeah.
Oh, I just wanted to interject that. Um, some people might not understand the context of the word guidelines that you’re how you’re using it. Can you explain what you mean by
That really great question. Um, so guidelines, um, will be produced by, it could be a government funded organization frequently, or let’s say a medically medical specialty group. And so there’s a group of experts who come together to review, um, all of the best quality evidence for a treatment for specific conditions to decide what they’re going to recommend. Um, so in the UK, there’s an organization, um, that’s abbreviated as nice. And so for the UK, this organization, nice will produce guidelines. Um, basically saying what doctors in the NHS should be offering, um, in, in other countries that works, it works differently. The United States, um, usually it’s a medical specialty groups will have different guidelines, also. Um, different government organizations will have guidelines. And so what most people don’t realize is that just because official guidelines recommend a treatment such as acupuncture doesn’t mean that, that it automatically gets implemented.
Um, so as an example, um, in the UK, the nice guidelines recommended acupuncture very strongly, um, for the prevention of chronic migraines. It was the second line recommendation, um, after trying a pharmaceutical and I never came across a doctor who was aware of that or who recommended it and patients weren’t aware of it either, even though it was within their constitution to be able to access it. And so, um, but on the, on the other hand, the guidelines had a weak recommendation for Botox, uh, by company called Alligan, which had much less evidence for its effectiveness applied to a lot fewer people, but how their GaN had actually taken the time to put together a hundred page document on how to implement the treatment in the UK. It trained up doctors. And so patients were very easily able to access Botox for migraines, um, on the NHS.
And so the difference there, wasn’t a matter of evidence because acupuncture had more and better evidence. It wasn’t a matter of the recommendations being there because the recommendations were stronger for acupuncture than for Botox. It was a matter that, um, I think many people, including the acupuncture profession, um, in various countries might assume that there’s an automatic, uh, once that recommendation is there, then people will have access and practice in the practitioners will know about it and they’ll be recommending it. And, you know, our doors will be flooded and that’s simply not the case. And so, um, you know, circling back to what you said before is that, you know, people, uh, you know, there is so much evidence for acupuncture and comparatively more evidence for acupuncture than other modalities that may have a stronger branding or people are more aware of, but we just, um, we need to do more perhaps to communicate it. So that’s in the consciousness of the public and the healthcare decision-makers
So public relations campaign.
Yeah. Well, this is it. Um, you know, yeah. Public relations campaign. And I know, um, you know, Matt Bauer at the acupuncture now foundation, he has thought a lot about that and about how to implement that and what the funding would look like for that. Um, the role that the evidence-based acupuncture, um, plays is by summarizing the evidence so that it’s available to be used by, let’s say, um, a public relations campaign, because what different organizations in different countries have found the hard one expensive way is that, um, reading and interpreting and communicating evidence about acupuncture is a really specialist skill. So you can spend, if you’re an organization, you can spend a lot of money on hiring really good PR people that doesn’t necessarily mean that they have the expertise to be able to get across some of the nuances, um, that involve, you know, what we do and how we’re studying.
Hm. So what do you think is the best way to go about this?
Well, yeah, no, I mean, that’s, that’s, that’s a nice question. Um, you know, I think one is first for us to have a better and maybe more accurate understanding of what the challenges are. So when I went to college, uh, for my MSC, um, I guess, you know, over a decade ago now, um, at that time, you know, most of the, the writing and information that was discussing acupuncture in terms of science was written by, by skeptics, by people who basically did not like the look of what we were doing, didn’t understand what we were doing. Um, and just, just thought it was stupid and wanted to tell people not to. And there wasn’t really any other kind of scientific or evidence-based perspective to counter it. So if you were, you know, kind of, uh, an educated, but not medical Joe public, and you wanted to know what the deal was, you really, you, you had either these, um, medical doctor skeptics saying that it’s a theatrical procedure, or you have acupuncture websites that talk about changing and yang, which people might not understand.
And so it might put you off a bit. Um, and so when I went to school, the message that I was getting from my, um, faculty was that there wasn’t much, it wasn’t much evidence for acupuncture because it wasn’t funded and because it was difficult to study, and I believe that they were just believing the skeptics. And when I started to kind of look, you know, look at what the skeptics were saying, and I was really, um, unimpressed with the strength of the arguments. I was like, kind of hoping that it would be like just some really good criticisms of what we did. And I found it was really weak and really not well thought out. Um, and then when I started doing a really basic literature review, I found like loads of studies and systematic reviews and tons of evidence. And so the first problem, um, to, to overcome was to help acupunctures know that what we do actually has a strong evidence base.
So that was, I understand the first problem. And then the second problem I would say is that, you know, research in all fields, especially in medicine is produced far faster than anyone can read it. And so, you know, within the profession, there is often still this kind of idea. Like we need more research that may be partially true. I’m not saying, I’m not saying we should stop doing research on acupuncture, but we, I think even more need people to, uh, to find, read, summarize, and communicate the research has already been done. So that’s the second problem is, is like kind of becoming aware of what’s there and getting out to the practitioners and to people who are working on policy and who were working with legislators at the state and national level. Um, and then the third thing, you know, is doing that. So you can get it into the guidelines and that is happening, right?
So, um, in the UK, the most recent, nice guidelines, um, for chronic pain that would publish in April, 2021, recommend acupuncture for any kind of chronic pain. It’s a very high recommendation. It’s incredible, it’s unprecedented. Um, it’s a really strong recommendation. It’s a really big deal because not only does that affect, uh, the, the population of the UK, if we can help the implementation. Um, but also other countries look to the nice guidelines to inform their policy. So, you know, getting into the guidelines. And then, um, I think the next that next piece is like us realizing that we need to do the implementation is not automatic at all at all. So in fact, you know, having, um, acupuncture rec recommended, uh, in Medicare guidelines here or in, um, the, uh, like joint commission, which is the organization in the United States that regulates all hospitals like over 20,000 hospitals, um, they have guidelines saying that non-pharmaceutical treatments must be offered as a first line of care to kind of prevent unnecessary opioid problems. Um, and they include acupuncture at the top of that list, but that does not then translate into automatically having an acupuncturist in every hospital at all. So we need, um, so, so my first thing is we need to do, uh, I think a good job of testing our assumptions of what the real problems are and making sure that we’re identifying the problems and then kind of solving them in a way that makes, um, the most, the most sense. Um, so that’s, that’s, uh, that’s how I would solve that.
Would it make sense instead of just trying to promote it to the public, these kinds of things, uh, to try to educate the doctors because through them, they w you know, they’ll be referring and then patients will become educated.
Yeah, that’s a, that’s a great question. Um, you know, I, I don’t know how much of the people who watch this are an international audience versus a US-based audience. Um, okay. Cause there’s, um, there are, you know, quite a few geographical considerations in terms of who’s paying for it. Um, so, you know, when, when, uh, the patients or clients themselves are able to make their own decisions, then you, um, you know, then you’re educating them and letting them know that you can help them solve their problems. Um, if we’re working through insurance, you know, and acupuncture is increasingly included on insurance plans, um, in the United States in different places. Um, but certainly I think the big thing, you know, I’ve had conversations with colleagues and one of their, you know, what questions they have about communicating with doctors about acupuncture, what a lot of them said was eating, getting them to care, uh, that it exists, like getting, getting them to show up to a meeting.
And so what that brings up to me is that we want to be really savvy about, like, thinking about what are the problems of the person or organization that we’re talking with that we can help solve. So, like, you know, doctors shouldn’t care that we’re, acupunctures just because we’re acupuncturists. Like what, why should they care? Well, let’s understand what their problems are and what they can. So, and what’s really beautiful about how acupuncture works and evidence-based for acupuncture. And I don’t think this is coincidental is that the evidence for acupuncture’s effectiveness is wrongest the conditions, the wishes, there are the least effective and safe options in conventional medicine.
Hmm. So we know that acupuncture works and there seems to be a resistance to the Western medicine based from adopting it. And it is often marginalized as alternative medicine. Can you speak about that?
Um, sure. I mean, that, that’s, uh, a, well, I mean, a couple of things like that, there’s different ways that we can look at what that means. Um, sometimes skeptics or critics will say something like there’s no like real medicine and alternative medicine, there’s just medicine that works and medicine that doesn’t work. And so, uh, from that perspective, I would say, well, you know, acupuncture is clearly medicine that works by the standards that are set forth for studying an intervention for a variety of conditions. And I do want to step back and say that if we’re talking about a treatment for a condition, it’s not, nothing is really, uh, ever framed in science that it either works or it doesn’t work. It’s really a question of, uh, what is the condition and what is the population and what is the intervention and compared to what oh, okay. So, uh, and there’s like a really, um, uh, big, uh, compared to what, um, thing that we need to bring to this discussion. On the other hand, um, in certain
Those kinds of comparative studies are, are, are important for validating acupuncture, uh, or to, uh, a prescription drug or another modality.
Yeah. So there’s, um, that’s a really good question. So for folks who are watching, you might not come across this before. Um, there’s a number of common ways that interventions are studied. And so most commonly, especially for pharmaceuticals, they’re studied, um, in a double-blind placebo controlled trial, where we’re trying to really control the environment in a very artificial way and remove all these different, um, variables. So we can study the medication and that’s standard for, um, for any treatment that doesn’t involve the practitioner doing anything and just handing over something to be taken. Uh, but it doesn’t, it’s not an appropriate design for any sort of, um, like kind of treatment that involves the practitioners. So for sample like surgery, you know, you can’t do a double blind placebo controlled trial and surgery. You can do sham controlled, which we can talk about, but, um, you can’t blind the surgeon, you can’t do sham controlled therapy, you can’t do sham control.
So anytime the practitioner is guiding the treatment, the practitioner, um, will, will know about it. So it’s just not the appropriate design for that type of Mo of modality. And then, um, on the other hand, you can compare a treatment such as acupuncture to what else is on offer. And really, you know, neither of those designs, I just mentioned, uh, placebo controlled versus kind of a real world, uh, effectiveness study. Neither one of these is right or wrong, good or bad. They just answered different questions. And the questions that patients have, and that clinicians have is I have a patient in front of me who has this problem, what are the options? And what’s the best option for this patient. So they’re comparing it to what else is on the table. So the study design that answers that question is what’s called a pragmatic study that measures acupuncture against, uh, the other things available. So that’s what that does sort of makes it makes sense.
So I first became aware of you on social media with your, um, work with Wikipedia. Can, you know, you had such brilliant responses to the pseudo skeptics, and I know it wasn’t just with Wikipedia. Can you tell people a little bit about that and you know, what you’ve done and where that situation is now?
Sure. Um, that’s a really good question. And it’s, it’s one, I know I’m glad that we’re bringing it up because this is one of the most common things that gets mentioned, uh, by acupuncturists and practitioners in any form is like, okay, well, Wikipedia is the, uh, encyclopedia that anyone can edit. And if you go look at the article on acupuncture, to be honest, I haven’t checked for a little while. Cause it, uh, it doesn’t change too much. Um, they don’t, they don’t have nice things to say about acupuncture at all. Um, and they don’t include, you know, the various Cochrane systematic reviews that show that acupuncture is more effective than sham or effective than usual care. They don’t include the guideline studies. They don’t include all these things. Um, and so, you know, what’s the deal. Why don’t, you know, why don’t we just end it?
Why don’t we do something with it to deal with their bias? You know? Yeah. So, um, you know, editing Wikipedia is something that, you know, I was part of a acupuncture research, um, group back. I was in the UK at London, south bank that meant, um, every so often. And it was a project that we identified, like, we need to do something about this. This is nuts. Um, but, um, you know, and, but various, uh, people, uh, very, um, very noble worthy people have tried and failed to edit that page. And so I decided to go on as an experiment just to see what the deal was. And so, um, this was actually quite a few, this was back in 2016. Um, and so I registered as an editor and I learned enough about the rules of the game to make sure that I didn’t break any rules so that there was been no grounds for, you know, there being any problem. Um, and acupuncture is one of the top 10 most contentious pages on with the piece.
What about COVID,
Um, possible, but it doesn’t have the history. So, um, you can even, you can kind of look back and see the number of edits. I mean, I can only imagine there’s thousands and thousands of pages of conversation. A lot of it not very civil about what’s on that page. Um, so it gets, so you’re not even allowed to come on as an editor and start editing. Um, you have to kind of earn your stripes, but you can participate in the discussion. So I entered, I joined that discussion. I was, uh, respectful. I did not break any rules and I simply provided a very standard references, Cochrane, systematic reviews, you know, talking about different things. Um, and within a week I had been banned as an editor forever. Um, yeah, they, they accused me of something called sock puppeting, which is when an editor is banned and then comes back under a new name.
So they were basically an, I kind of went and looked at the person that they were accusing me of being, and it was interesting. Um, I can assure you that I’m not her because her, uh, her only Wikipedia page that she ever wrote, it was on, uh, Korean pop. Um, that’s, that’s not me. I have like plausible deniability, like, um, that song came out years ago. I was like the last one to hear about it. So yeah, so we’re not the same person. Um, what we had in common is that we were, um, up on the research and was able to reference it in a, in a valid way. So we were basically just you report faithfully and accurately and fairly reporting the science. Um, and that’s why they thought I was hurt, which is a little bit sad. Um, more recently, Larry Sanger who’s one of the co-founders of Wikipedia, um, has spoken out on really, you know, when, when Wikipedia was initially founded, it was really, um, central part of it was, um, a neutrality policy so that that anybody could edit it and that it would reflect a plurality of views.
And, uh, he is pointed out how it very soon veered from that course. And now, you know, there’s like huge companies that really control that content. Um, in the case of the, of the acupuncture page, the individuals that I was, you know, being banned by, or being named cold by, or being criticized by, um, these were really early adopters of Wikipedia editing. So a certain personality and they, none of them have medical backgrounds and none of them have research backgrounds. Um, they’re mainly they have pharmaceutical backgrounds, um, in this case, I don’t think so. Um, I’ve never found evidence to support that. Um, but, um, but certainly they have a specific point of view that does not come from, um, a deep understanding of the subject matter. Um, and that they’ve been effective at kind of keeping us all out. Um, at one point, you know, we did, um, start a, uh, a kind of a petition and a movement to kind of call attention to the towel. Crazy. This is it’s, you know, acupuncture is recommended by governments all around the world and it’s included on health insurance. I mean, at this point, as I said, it’s really not alternative medicine in that way. Um, and we were not able, they just listed by their, their neutrality policy. So
It sounds like you tried to confuse them with the facts
I did. I w it was too easy. Um, so yeah, so, so for those, you know what I understand, I mean, the, um, unfortunately Wikipedia is the single most referenced website in the world for medical information by doctors, not just the public. And so, um, that’s just, you know, kind of, unfortunately, a sign of the times these days is that we do have these kinds of centralized nodes of information that don’t necessarily reflect. Um, you know, that can often reflect a certain point of view. That’s not necessarily, um, in line with public’s best interest or at least, you know, in the case of acupuncture, just being able to here’s some information about it and not just a, you know, kind of a one-sided view.
Yeah. Well, is there anything you want to lead us with, uh, you know, whether it’s the direction of things are going or, you know, a particular place to reference studies or whatever, whatever you’d like to, uh, think would be helpful?
Uh, yeah, no, that’s a great question. Um, a couple, a couple of things. One is, you know, I mentioned that sometimes acupunctures, um, can refer to as an alternative medicine in a way to discount it and to, um, to, um, to basically say that it doesn’t have an evidence, but on the other hand, sometimes it gets lumped in with all wonder if that’s a Larry singer Wikipedia call it. Um, so sometimes it gets lumped in into this like kind of alternative medicine bucket and it gets undifferentiated. So it’s like, oh, you know, alternative medicine, like natural medicine, you know, massage and hung me up at the acupuncture. And, and, and it gets kinda lumped into this undifferentiated bucket and the danger there can be, as you know, that there can be an increasing awareness of the, um, unintended side effects of pharmaceuticals and people trying to find alternatives.
But, um, there, you know, what we can do for people can be really diluted if we get lumped into that bucket, because acupuncture has an incredible amount of evidence. And so, and it, and it is also a system of medicine or, you know, it’s part and parcel of the system of medicine, um, and of itself. So that’s a little bit of a danger that we want to be aware of is that we want an increase. Um, I guess, um, we, we want to be available for people who want an alternative, but also understand that we’re not kind of just like a wishy washy touchy, feely, um, system, um, not, not to disparage any of those things, which, you know, I been training in and I go see, and they’re helpful as well. Um, so that’s, that’s one thing I would say, just to be kind of aware of that, that pitfall, you know, what we find with acupuncture is now that the evidence is so good, um, a lot of different professions want to use it.
And so, you know, we need to again be mindful of, um, you know, where our true challenges are and how we address those skillfully. Um, Ellen had a question about how to educate patients. And so this may be, um, is a kind of good thing to come back. It’s like the, you know, first is be really aware of your audience and who you’re speaking to and what your intention is and what their needs are. Um, so, you know, depending on where you’re located in the, um, like background of your patients, some may want research and evidence. Um, often I find that comes from a fear of seeming foolish, you know, not to kind of psychoanalyze anyone, but people would just want to know that there’s not enough that they enjoy it and that, or that they feel better. They want to know that there’s, that there’s evidence some, just find it interesting.
Um, and many, you know, really just want to, um, to know if you can help them. And I think Al asked the question before, yes. About researcher testimonials. And I think, um, you know, I’m, I’m not a marketing guru, but I think testimonials and, and, um, kind of pro social proof probably is the more influential, well, I mean, a good place to look at it from a political, I mean, that’s a good we’re testing it. And the pharmaceutical ads don’t tend to emphasize uh evidence-based to emphasize couples skipping around and smiling. So, um, that’s, I think they’ve done their research on what works. So that kind of told me that they’ve done their marketing research. Yeah. But wiling is more effective to get people to purchase then, um, then, then lots of systematic reviews
Because not all testimonials are real. I tend to trust the research more than I do testimonials.
Yeah. And that’s, I think, uh, my understanding there is that that’s why you see a move towards testimonials that are more difficult to fake. So if you can get a video testimonial from a patient, it’s kind of, you can tell that that’s not an actress or an actor, um, and we’re, or people using their real names, um, that, so that social proof is going to have more value. And I think that really just on a psychological unconscious level that does have more, um, you know, it’s almost like people need the, some people need the research in order for them to stay for the conversation or to be open to the conversation so that when they see the social proof, um, they’re, they’re, they’re, um, you know, which is different than a patient kind of coming across acupuncture. And then we just, you know, presenting tons of systematic reviews at them.
Um, I think what we know from a marketing research and psychology is that the social proof is probably gonna have more of an impact, but we want to, we want to just at the top, down in the bottom up, so the bottom up is you, um, influencing, uh, you know, people let it, I should say, letting people who we can, who might benefit from our services know that we’re there and that we can help them. But at the same time, we also want to make sure that if we have systems of healthcare that are being paid by different government institutions, that, that, that awareness is happening on that level as well.
Sure. Oh, is that a multi-faceted approach? Well, thank you so much. I really appreciate you coming on. Cause you know, it’s nice sunny summer day. So, um, you know, w we can talk again soon and go into some more specifics and thank you everybody for watching. And next week we have as a host Tsao-Lin Moy. So I hope you’ll tune in to see her. And again, thank you to the American Acupuncture Council and, um, Virginia Doran of luminous beauty.com this season. Thank you.