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 commitm