I still like the description of acupuncture as a theatrical placebo. It describes the process and the results of acupuncture quite nicely.

There are any number of ways patients can be fooled into thinking they are getting acupuncture and have an effect. My favorite being that you can induce an acupuncture effect in a rubber hand. It demonstrates clearly that acupuncture effects are in the mind of the punctured.

Another way to approach acupuncture as placebo is to see if there is an effect when patients are unaware that they are getting acupuncture.

In Acupuncture versus usual care for postoperative nausea and vomiting in children after tonsillectomy/ adenoidectomy: a pragmatic, multicentre, double-blinded, randomised trial children were randomized to usual care plus acupuncture or usual care.

There are two interesting aspects of the study. First, the acupuncture was given after the anesthesia was started

After induction of anaesthesia, the anaesthetists needled, at an angle of approximately 30°, at PC6 (Neiguan) bilaterally with Seirin needles no 3 (0.20)×15mm to a depth of approximately 7 mm and removed the needles before entry to the recovery unit. PC6 is located at the wrist between the tendons of the palmaris longus and flexor carpi radialis, proximal to the palmar crease. There was no manipulation of the acupuncture needles.

and ALL the parents were told their children received acupuncture because

First, we assumed that there was a relationship between parental treatment expectancies and treatment outcomes. Second, we assumed that parental beliefs about group allocation could activate or deactivate treatment expectancies. To avoid these biases, which tend to produce placebo effects, we told all parents that their child would receive acupuncture,…

And the results?

Acupuncture added nothing. Nor surprise there. It would have been even more interesting if half the acupuncture parents were told there was no acupuncture and half the placebo parents were told there was. But such is life.

As the authors note

acupuncture may not be effective beyond placebo

I would substitute 'is' for 'may not be'. What is interesting was the response of some true believers.

Not only can qi manifest in rubber hands,

… general anaesthesia can block the effect of acupuncture, as can the use of local anaesthetics. Acupuncture treatment can be effective after the surgery once the anaesthetic has worn off, but not during the period of anaesthesia itself.

The quibblers do not mention Chinese mysticism as a mechanism, but who would have thought sevoflurane, propofol and remfentanil, could prevent the unblocking of qi?

Of course anesthesia blocks acupuncture. Unconscious people cannot respond to placebo. They also quibble over the type and duration of acupuncture, motivated reasoning at its finest. But I see it as yet another study to demonstrate that the effects of acupuncture are entirely placebo.

Acupuncture is Oakland, there is no there there.