Episode 97 – The Second Poke, Take Two

Aaron takes a second stable at the second acupuncture story, then Shea scares us with tales of Canada past.

Welcome to Interesting If True, the podcast that sticks our sharp voices right into your ear-y meridians.

I’m your host this week, Aaron, and with me are:

I’m Shea, and this week I learned there is no winning at parenting, only damage control.

Acupuncture recently stuck itself back in my life. Heh, needle puns. So I’m going to get right to the point and … umm… No, first I’m going to do a recap but I couldn’t find a acupunctuating way to say that… haaaaa

Check out episode 53 for our complete intro into acupuncture.

Briefly, from episode 53’s intro:

Acupuncture was initially described in the Shi-Chi text, cerca 90 B.C.E., it describes 11 “mo” or vessels that hold chi. About a hundred years later there are 12 mo and chi flows in the body. Over the next two thousand years the 12 mo turn into hundreds to thousands depending on who you talk to – because there is no standard. In the early 1900s China, like the rest of the world, became focused on the industrial revolution of the western world and sought to adopt western, science based, medicine (such that it was at the time).

The Chinese Communist Party all but outright rejected traditional medicine:

Our men of learning do not understand science; thus they make use of yin-yang signs and beliefs in the five elements to confuse the world… Our doctors do not understand science: they not only know nothing of human anatomy, but also know nothing of the analysis of medicines; as for bacterial poisoning and infections they have not even heard of them… We will never comprehend the ch’i even if we were to search everywhere in the universe. All of these fanciful notions and irrational beliefs can be corrected at their roots by science. 1

And so yes, chi is an irrational belief and that is the last official quote that will be based on reality.

Traditional medicine — again, not yet TCM, we haven’t made it to that branding yet — was on its way out, from 1927 to 1936 the Chinese Journal of Physiology has nothing to say on the topic.

Acupuncture, plainly, is a theory of healing — not a medical science — based on philosophy not results, processes, or even simple observations.

The foundation of acupuncture is the belief that one’s chi or (Qi if you want to be correct or charge an iPhone) needs tending. Under normal, desirable conditions your chi flows through your body freely along pathways in the body called meridians. Think of this as the Force flowing through a Jedi’s Force-circulatory or Force-lymphatic system. Illness, then, is caused by chi blockages or imbalances, and not the cool kind Ty Lee or the Kyoshi Warriors can inflict — and yes, I am shamelessly reusing my Avatar jokes from episode 53, they’re that good… according to my mom, who says I’m very funny indeed.

The “treatment” if you will, is to insert a now-tiny, ultra-thin, needle into the body where the meridians overlap to improve the flow or balance of your chi because… needle. I want to step aside and note though that thin needs are kinda new, back in the day, this was probably done with a medical ice pick or surgical grade splinter.

This is, obviously, nonsense.

Despite thousands of years and many times many more attempts to analyse it no one has ever proven the existence of, much less their ability to manipulate, chi by any name. Raki, cupping, dry needling, and all of their ilk are, at best, magical-thinking nonesnse and at worst, a tragically poor substitute for actual medical intervension.

There’s a reason Randi’s millions went unclaimed.

Anywho… along comes a plucky little dictator by the name of Chairman Mao Zedong and his Cultural Revolution. Tens of millions are dying from starvation and deceases and Mao can’t help everyone even if he wanted to. Not even close. But he can placate everyone by encouraging the use of the newly branded Traditional Chineise Medicine, or TCM. It doesn’t work, and the Communist Party knows this, but it will stop the complaints and give the appearance of doing… something… in the face of so much needless suffering and death. So they went with it.

By the early 1970’s acupuncture began taking hold globally. Dodgy studies coupled with public demonstrations that were little more than magic shows captured the wests imagination and suddenly acupuncture could do anything — including kill Jet Lee’s enemies in Kiss of the Dragon.

These days TCM in general and acupuncture specifically are worth billions globally. The botanicals acupuncture industry was valued at 38.97 billion with a B dollars in 2020, and is expected to go up by nearly 20% by 2027 according to Grand View Research, an industry analysis firm. Other, less top-of-Google firms estimate between 30 and 150 Billion by 2030. Which is, admittedly, a big ass gap but even at the low end that’s more than enough money for unscrupulous doctors, insurers, and charlatans to sell you dangerous, unhelpful, nonsense.

It’s no surprise then that Party General Secretary Xi Jinping supports it and has partnered with some 70 countries globally to export and boost the industry. This includes training more TCM practitioners, I refuse to use the word “doctors”, paying for studies in support of TCM, and censoring (read, killing) dissenting opinions. Chinese scientists and researchers who have questioned TCM in recent years, especially with regard to the toxic nature of some “treatments” have… shall we say, retracted their statements.

Which brings us up to current.

As some of you know my wife Ashley suffers from chronic pain and is therefore inundated with assholes offering worthless opinions. It also means that things like acupuncture come up frequently in the various FB/Reddit/etc groups she’s in. Recently, acupuncture was suggested for a nerve pain sufferer and was anecdotally supported by others because “insurance pays for it.” Naturally, this has dominated my focus and pushed back my AI story until eventually.

Part of the reason MSS and The Good Thinking Society of Skeptics with a K fame (pod fame anyway) have saught to end homeopathy on the NHS, and other woo too of course, is because of this argument — it must be valid if doctors prescribe it and/or insurance will pay for it.

It lends an air of credibility to be able to say that Medicare and Medicaid, governmental services with treatments purportedly overseen by regulatory agencies like the FDA, approve of acupuncture. It lends authority to acupuncturists and other quacks to be able to say they work with, talk at, or even visit prestigious institutions. It’s why well known medical institutions like Harvard Medical or the Mayo Clinic are pressured to investigate alt-med claims and, because they generally do real science and refuse to deal in absolutes, allow naturopaths and their ilk to say “see, these groups don’t denounce us outright, so there’s something there.”

Proximity to real qualifications engenders faith in pseudoscience and the snake-oil salesmen know it. So, does insurance cover acupuncture? Damn skippy they do. Did you think that any insurance company in America was going to leave their piece of that 30 billion dollar pie untouched?

Blue Cross Blue Shield, covers acupuncture for, according to their health plans 101 site, chromic pain that does not respond to “other forms of treatment, like drugs or physical therapy” and “nausea due to surgery or chemotherapy.” In other words, they’ll cover acupuncture as long as you either are or have tried everything else and you’re solidly in the “we got nothing else, may as well” camp. Sounds familiar…

United Healthcare’s Medicare Advantage policy guideline details, briefly, that they will cover more or less the same: lower back pain that is chronic, not associated with surgery or pregnancy, and is non specific — that is, it has non systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease). Given that, they’ll cover 12 visits in 90 days, and up to 8 sessions more if the patient demonstrates an improvement, up to the hard limit of 20. Something tells me they don’t get to 20 often… Either way, this all, again, boils down to “nothing else worked so here’s this to shut you up.”

Speaking of Medicaid, those United guidelines come directly from section 1862(a)(1)(A) of the Social Security Act. Which itself suggests you refer to the National Coverage Determination section 30.3.3 for specific coverage criteria.

Medicaid will, following the 2020 centers for Medicare & Medicaid Services (CMS) decision to fight the opioid epidemic, cover acupuncture for lower back pain. They’ll cover 20 treatments per calendar year from a “master’s or doctoral-level degree in acupuncture or “Oriental Medicine” from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine.”

I looked at this “qualification” by the way and I will be coming back to it in a future episode. For now, I’ll simply say that those practitioners are neither masters, nore doctors, of anything.

These changes in coverage come directly and explicitly from policy changes designed to fight a previous terrible decision the federal government made: saturating the market with opioids.

“Expanding options for pain treatment is a key piece of the Trump Administration’s strategy for defeating our country’s opioid crisis,”

US Department of Health and Human Services (HHS) Secretary Alex Azar said in a statement.

“President Trump has promised to protect and improve Medicare for our seniors, and deciding to cover this new treatment option is another sign of that commitment. Medicare beneficiaries will now have a new option at their disposal to help them deal with chronic low back pain, which is a common and sometimes debilitating condition.”

And now I’ll prove what high-class host I am by ignoring the obvious parallels this essay could be drawing between Drumph and Mao Zedong.

I deserve a fucking medal for leaving such low-hanging fruit on the vine.

Continuing “while a small number of adults 65 years of age or older have been enrolled in published acupuncture studies, patients with chronic low back pain in these studies showed improvements in function and pain.”

And then, they linked the studies!

The first link goes to The National Center for Complementary and Integrative Heath, or not-doctors, at the NIH. The study, titled “Page not found. The page you’re looking for isn’t available” was brief and concluded that I should email info@nccih.nih.gov to let them know the name of the page I was trying to access…


The second link goes to the Mayo Clinic’s clinical trials research page. The study is… still seeking participants. Also, it’s called “Acupuncture Therapy for COVID Related Olfactory Loss” which is, to my admittedly untrained mind, not about lower back pain.

Shocking, I know, that links provided from the Trump Administration wouldn’t go to their purported destination, but then, I may well be the first person to click through on their sources…

So, I did some Googling. In the JAMA Open Access Journal a host of researchers from the University of Pennsylvania’s Perelman School of Medicine, Department of Psychiatry, ran a meta study of sorts to find out just want the state of insurance coverage of acupuncture is.

And I’m confidant they found out exactly what was covered and where because:

Drs Nielsen and Dusek reported receiving partial support through grant U01 AT010598 (Acupuncture in the Emergency Department for Pain) from the National Center for Complementary and Integrative Health, National Institutes of Health. Dr Dusek reported receiving a philanthropic gift to University Hospitals from the Fowler Family Foundation that provided support for Dr Dusek’s time on the article during the conduct of the study. No other disclosures were reported.

So… as far as analyzing a study goes, finding that the nutters seeking to sell their snake oil paid for the study and shmoosed the researchers is about as big a red flag as you can get. In this case, however, it also stands to reason that they were very motivated indeed to find gaps in billable coverage for their greedy, needle-baring, masters.

The study was done in the lead up to the aforementioned 2020 policy change providing Medicare and Medicaid funding for acupuncture.

They found, through Heyward J, Jones CM, Compton WM, et al. Coverage of nonpharmacologic treatments for low back pain among US public and private insurers. JAMA Network Open. 2018;1(6):e183044. doi:10.1001/jamanetworkopen.2018.3044, that about a third of some 45 commercial, Medicaid and Medicare Advantage health plan insurers, covered acupuncture. Given the 2020 coverage changes, that number will have grown significantly. Also, to maintain compliance an insurer would need to meet the requirements I listed above, so we could say that all Medicare and Medicaid insurers allow for some type of acupuncture. At least, as far as my understanding goes.

Returning to the study, of those surveyed (yes, this was a survey data set) they found that in 2010 0.4% of respondents had seen an acupuncturist at least once. In 2019, that number was doubled to 0.8%. Which is staggering growth, doubling ones market, but also I think gives a clue into why estimations of the future value of acupuncture are so astronomically high.

Of the 1344 acupuncturists (meaning the study was of roughly 168000 people) 69% where female, and 57% where white. Which tracks with the GOOPy nature of women’s healthcare – that is, most women aren’t believed, or if they are, their pain isn’t taken seriously resulting in referrals, or desperate cold calls, to acupuncturists who will at least give you more quality one-on-one time. Obviously, this is a tragic example of medical sexism, but also a frustrating example of how quickly women in pain are turning to anyone who will give them the time of day.

The study found that spending on acupuncturists was 593$ on mean in 2010, and roughly twice that at $1021.57 in 2019. Of that, insurance actually seems to pay for very little. Out of pocket was $375.51 in 2010 $to 554.25 in 2019. The difference wasn’t statistically significant and the increase was largely attributed to the average frequency increase per acupuncture user from 5.4 to 8.2 visits per year. Briefly, this means that about a third of insurers covered less than half of the costs associated with acupuncture while insurance coverage from 2010 to 2019 rose by about 9%. The study also briefly touches on acupuncture being a lower sunk cost than most pharmaceuticals, meaning that if your company’s product is profitable by way of not helping people, you’re probably all in on recommending TCM. Still, half of respondents reported no coverage for their acupuncture, meaning they paid out of pocket for their pointy nothing.

So, does acupuncture work? No, of course not and I’ll go into it more for my already begun acupuncture and back pain story on an upcoming episode. Until then, can we say that insurance coverage of acupuncture is a sign of it being a valuable treatment? Sure, so long as “valuable” means “profitable” not “efficacious.”

Basically, it would seem that acupuncture was created and sustained by people who kind of had nothing to lose. Adopted by despots seeking to dull the anguished cries of their dying people. And promoted by charlatans and amoral corporate entities looking to make a buck off the back-pain of the desperate.

Most insurers covered acupuncture in a “welp, nothing else has worked and we have to refer you somewhere” approach until the Trump Administration carved out an exception for it during COVID to try to win some points with a population suffering and dying needlessly… which I think is where this story began eh Orange Mau?

  • Kwok DW. Scientism in Chinese Thought. New Haven; 1965:135. https://www.mayo.edu/research/clinical-trials/cls-20517580
  • A scoping review of acupuncture insurance coverage in the United States. https://doi.org/10.1177/09645284209642
  • The Intersection of Dissemination Research and Acupuncture: Applications for Chronic Low Back Pain. https://journals.sagepub.com/doi/full/10.1177/2164956120980694
  • Does Insurance Cover Acupuncture? | Accurate Acupuncture https%3A%2F%2Faccurateacupunctureaz.com%2Facupuncture-insurance%2F
  • Trends in Insurance Coverage for Acupuncture, 2010-2019. https://jamanetwork.com/ on 02/12/2023
  • https://www.medicare.gov/coverage/acupuncture
  • https://www.bluecrossmn.com/health-plans-101/acupuncture-what-does-health-insurance-cover
  • Does Medicare cover acupuncture? | UnitedHealthcare
  • Medicare Will Now Pay For Acupuncture In Part Due To Opioid Abuse
  • Acupuncture Therapy for COVID-Related Olfactory Loss – Mayo Clinic https%3A%2F%2Fwww.mayo.edu%2Fresearch%2Fclinical-trials%2Fcls-20517580
  • NCCIH Study: https%3A%2F%2Fwww.nccih.nih.gov%2Fresearch%2Fresults%2Fspotlight%2F110209.htm
  • United coverage https%3A%2F%2Fwww.uhcprovider.com%2Fcontent%2Fdam%2Fprovider%2Fdocs%2Fpublic%2Fpolicies%2Fmedadv-guidelines%2Fa%2Facupuncture.pdf

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WTF Canada

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So it’s been a bit since I have actually sat down and written a story so this one took a bit of time. I was originally writing about failed science projects that turned into major innovations but while looking for information I fell upon a meme mentioning that Canada was feared by the Germans in WWI, like the geese people were terrifying. So that threw off everything I was researching and I had to change gears entirely because WTF Canada!

If Steve was here I would let him give you an intro to WWI because he is at that age when men know everything about war, since he isn’t I’ll give you a very brief intro. From Nat Geo Kids,

”Lots of history books have been written on World War 1 facts and why it started. But it all boils down to the fact that Europe had split into two large families of countries. The Allies — the British Empire, France, Belgium, Russia and later, the USA — were in one family. And the Central Powers of Germany, Austria, Hungary, Bulgaria and Turkey were in the other. On 4 August 1914, Germany invaded Belgium, and so, standing by its promise to stick up for Belgium, Britain declared war on Germany. The world was at war…”

Nat Geo Kids

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