Effectiveness, the Plaque and the Person: What Acupuncture Can Teach Us About Medicine in 2026

Following the essay “Acupuncture, a way out of crisis?”: a deeper reflection drawing on Kuhn, Bachelard and Freitag

Picking up the thread where we left it

In the first essay, I offered a Kuhnian reading of the present situation: Western medicine is going through a period of crisis, acupuncture carries a radical pragmatism, and the two paradigms are perhaps less in competition than in complementarity. That was the broad stroke. But this critical tradition, from Kuhn down to the Québec sociologist Michel Freitag, opens up sharper tools than I drew on then, and I want to engage them more seriously here, even if it means asking a little more of the reader. Three ideas, each reinforcing the others, strike me as especially useful for thinking about what Chinese medicine is in Québec in 2026: effectiveness as a new criterion of scientificity, the plaque of operativity as the structure of modern medicine, and the illusion of science’s autonomy in a system where money largely decides what gets studied.

Three angles, one argument: TCM does not arrive in our system as an exotic survival. It arrives, strangely, as more epistemologically modern than the medicine that still believes itself in search of the truth of the body.

1. Effectiveness, or the hidden convergence

One of Kuhn’s most unsettling theses, confirmed by the philosophy of science after him, is that science has, in practice, given up the idea that it is approaching a universal truth of nature. What it accumulates are capacities for action, precise predictions, plaques of operativity. Popper already put it negatively: science doesn’t accumulate certainties, it accumulates rejected errors. With Kuhn we go a step further: what makes a paradigm prevail is not that it is true, but that it is effective, that it allows prediction and action upon the world. Effectiveness becomes the criterion. This distinction between efficacy measured in a trial and effectiveness observed in the clinic is taken up in Does acupuncture work? An honest answer.

This is a major shift, and it has largely gone unnoticed by the public. Yet it is everywhere in contemporary medicine. Take something as ordinary as acetaminophen: probably the most prescribed drug in the world, used for over a century, and its exact mechanism of action remains, to this day, poorly understood. Hypotheses come and go (enzyme inhibition, action on the cannabinoid system, central modulation of pain) without any of them winning consensus. We prescribe it anyway, because it works. That’s pragmatic reasoning, not explanatory, and it is exactly the posture of evidence-based medicine: never mind why, the point is that clinical trials show an effect greater than placebo. Evidence-based medicine is, like it or not, a tilt toward effectiveness as the criterion. Acetaminophen is just one example among countless common medical interventions we know work without knowing precisely how.

This is exactly the ground on which Chinese medicine has always operated. For two thousand years, acupuncture has evaluated its acts by their observable effects on the patient’s body. It never claimed that Liver Qi stagnation is an anatomical reality. It held that this concept, used according to certain rules, produces reproducible results. Judged by the very criterion contemporary science has given itself (it works, we continue; it doesn’t work, we adjust), TCM is not behind on that pragmatic turn: it has never practised any other way. That isn’t superiority; it’s an instructive coincidence.

The difference isn’t that one is scientific and the other not. The difference is that biomedicine handles its own pragmatism poorly. It keeps presenting itself to the public as a quest for the truth of the body, when it has become, in daily practice, a system of interventions evaluated on their statistical effectiveness. TCM has always owned that its concepts are tools, not truths. There is, I believe, an epistemological honesty there that we need.

2. The plaque of operativity, or why the chronic patient disappears

The second tool comes not from Kuhn but from Michel Freitag, whose critique of the fragmentation of knowledge informs what I propose to call, extending him, a plaque of operativity: a domain where a science can predict and act with growing precision, but which communicates less and less with its neighbours. Kuhn had described the movement: as a paradigm develops, it narrows the range of phenomena it concerns and deepens its specialization, at the price of what he calls, with a certain melancholy, the loss of the coherence of the whole. Freitag gave that fragmentation its critical reach.

Modern medicine has followed exactly this trajectory. In the 19th century, the family doctor saw the whole person. Today, the typical chronic patient in Québec sees a cardiologist for the heart, an endocrinologist for diabetes, a gastroenterologist for digestive trouble, a rheumatologist for joint pain, a neurologist for migraines and, with luck, a family doctor trying, in fifteen minutes, to hold it all together. Each specialist is remarkably competent within their plaque. But between the plaques, no one. The patient becomes the only junction point of their own file, and is often precisely the person least equipped to play that role.

The Québec context makes this structure especially acute. According to the government’s data on access to front-line care, about 1.5 million Quebecers still had no family doctor as of autumn 2025, and the share of the population with an assigned doctor has been receding for years. The collective registration mechanisms, presented as solutions, guarantee neither continuity nor follow-through. And the front line, the one place that in theory crosses the plaques, is exactly the place under strain.

Acupuncture, in this landscape, doesn’t sit on a plaque. It doesn’t treat an organ. It doesn’t define itself in opposition to another specialty. It observes the person as a whole: their sleep, digestion, emotions, pain, energy, cycle, stress, seasons. Not because it claims to cure everything (it doesn’t) but because it is built on a transversal logic. When someone consults for migraines, the session doesn’t stop at the migraines: we ask about their sleep, their digestion, their cycle, their stress. Not because acupuncture would claim to fix everything (it doesn’t) but because the reading of the body is integrated from the start. What that changes is not guaranteed; what it opens is a conversation that the division into specialties makes difficult elsewhere.

This is not a marketing advantage. It is a structural difference between two paradigms. Biomedicine, by construction, fragments. TCM, by construction, integrates. In a health system where fragmentation reaches new heights, where collective registration replaces ongoing care and the emergency room becomes the default safety net, there is real clinical value in seeing someone for an hour, without interruption, asking questions about the whole body and the whole life. That value isn’t mystical. It is epistemological. It follows directly from the fact that acupuncture was never carved into plaques.

3. The illusion of autonomy, or why some questions are never studied

The third tool extends Kuhn in a sociological direction, and here some care is needed. Freitag again, in his critique of postmodernity, described at length how contemporary science loses its cognitive autonomy to a techno-capitalist logic in which funding flows, industrial interests and political agendas steer what gets studied. For Freitag, this is a catastrophe. And to be honest, he did not mobilize this critique to defend Chinese medicine, which he probably never discussed. But the observation he makes is useful here, and it is documented well beyond his work: modern medical research is, like any social practice, shot through with pressures it acknowledges poorly. Money goes somewhere, it orients minds, it creates a plaque, it produces results, and those results then justify putting in more.

This observation has a direct and rarely stated consequence: some questions go unstudied not because they are uninteresting, but because they aren’t patentable. A molecule can be patented. An acupuncture protocol cannot. A clinical trial for a new drug attracts tens of millions of dollars in private funding. A clinical trial for an old, non-proprietary therapy attracts crumbs, and must, on top of that, justify its very existence. This is not a critique of pharmacology. It is an observation about the economic structure that determines what gets studied.

This changes how we should read the often-repeated argument that “there isn’t enough scientific evidence on acupuncture.” The absence of evidence is not neutral. It reflects, in large part, an absence of funding, which itself reflects an absence of commercial interest. And yet, despite these unfavourable conditions, the evidence accumulates: for chronic pain, migraines, chemotherapy-induced nausea, anxiety and insomnia, meta-analyses published in leading medical journals document clinically significant effects. Not miraculous. Not universal. But real and reproducible.

Bachelard, the great French epistemologist, framed a thesis this section illustrates in its own way: “we come to know against prior knowledge.” For him, science doesn’t progress by docilely piling up facts, but by breaking with the certainties it first gave itself, by overcoming what he called epistemological obstacles: those ideas that seem clear precisely because they’ve been repeated too often. The notion that “anything not validated by Western medicine isn’t serious” is, to my mind, exactly that kind of obstacle, a self-evidence gone invisible because it is everywhere. Recognizing that research is steered, funded and political is not to discredit modern medicine, which does extraordinary things. It is to exercise the critical break Bachelard called for, at the very place where the dominant self-evidence asks us to stop thinking.

A medicine for the Québec to come

Put the three pieces together (effectiveness as criterion, the plaque that fragments, the economic steering of research) and you get a sharper diagnosis of this cultural moment. Our health system is not only in a budgetary or organizational crisis. It is in an epistemological crisis. It has lost the coherence that lets a doctor see a human being rather than a file; it handles its own pragmatism poorly; and it mostly studies what is profitable to study.

In this landscape, acupuncture’s place is, I believe, clearer than is usually said. It is not an exotic add-on for curious patients. Nor is it an alternative claiming to replace biomedicine; the idea would be absurd, and no serious person in the profession defends it. It is a place where certain epistemological qualities that modern medicine has lost continue to exist: the pragmatic ownership of models as tools, the integrated reading of the person, attention to the long time of the consultation, the possibility of giving meaning to what happens to the body.

In Québec, in 2026, this has very concrete value. When a million and a half people have no family doctor, when specialty waits stretch out, when the very sense of “caring” blurs in a saturated network, having access to a trained professional who takes an hour to understand what is happening in a body is no longer a luxury. It is infrastructure. It is not the only infrastructure we need. But it is one, and it already exists, and it is accessible.

Kuhn thought paradigms were incommensurable. I believe he was right at a fundamental level, and wrong at a practical one. At the fundamental level, you can’t ask TCM to prove the existence of meridians in the language of the MRI. At the practical level, though, two medicines can coexist in the same person, each bringing what it knows how to do. That, in the end, may be the only progress possible: not the triumph of one paradigm over the other, but their lucid cohabitation in the life of a patient who needs both.

This essay is part of a broader reflection on the place of acupuncture in Québec’s health landscape. On the mechanisms themselves, see the review of the physiological processes of acupuncture and “The black box is everywhere”. If the perspective interests you, the earlier essay on Kuhn, pragmatism and acupuncture, “Acupuncture, a way out of crisis?”, lays the groundwork this one builds on.

At the clinic, in the Plateau-Mont-Royal, we take the time: a first session runs 75 to 90 minutes, depending on the practitioner. Book an appointment. About our approach: the clinic and its clinicians.