payamtorabi's Space

payamtorabi's Space

payamtorabi  //  

Sep 29 / 3:44pm

You asked what I thought of acupuncture...

So I set up a blog so I could write down my thoughts on this in more than 140 charachters.

First of all, I think we should separate the act of sticking needles into people to help with various problems and the ritual of acupuncture, which, with talk of "ashi" points and olfaction is quite patently nonsense (scientifically).

It may well be that sticking needles into people does have some effect on their experience of symptoms: most likely through placebo but also perhaps through something along the lines of the gate control theory of Pain [1]

The problem is that the vast majority of trials done into acupuncture are so poorly designed that you could not make a reliable conclusion from them. However, the absence of a conclusion should, in my opinion, lead to us erring on the side of no-benefit. It is the responsibility of those who are advocating a treatment to provide evidence for it, not to the rest of society to find evidence against.

If acupuncturists want to be taken seriously by healthcare professionals they need to design placebo controlled trials with sample sizes big enough to detect a clinically significant difference between placebo and acpuncture.

An example of the systematic review of evidence from trials was published in the BMJ in 2009 [1]. This review found an effect of acupuncture on pain but stated it was unlikely to be clinically relevant. This means that the effect size in any individual patient was too small for the benefit to be of any practical use. Sadly, most of the included studies were poorly designed and so reliable conclusions are hard to make on their basis.

A perusal of literature on acupuncture finds that the vast majority of systematic reviews of evidence have similar or worse conclusions. Notably, several of these have been done by the cochrane collaboration [3] which is a world leader at carrying out careful systematic reviews of evidence.

Incidentally, I have no problem with patients being offered placebo needles or even placebo acupuncture. The problem I have is with patients being given information that has no basis in scientific evidence by practitioners who revel at being 'outside the box' when actually they are following a lucrative tradition in quackery which has probably been around for almost as long as language. This deception is disempowering these patients from making decisions about their health which are grounded in fact by people who they wrongly assume would not con them.

Placebo cures can work at improving patients' symptoms without the need for such deception [4] and given that evidence, it seems that the resort to quack explanations is entirely unnecessary. Explain to patients that although there is almost certainly no organic process going on when they have needles stuck in them, it helps symptoms through a "mind-body healing process", and perhaps the practice can achieve benefit without deception: and that, I would say, is what we should aim for.

[1] http://en.wikipedia.org/wiki/Pain#Gate_control_theory

[2] http://www.bmj.com/content/338/bmj.a3115.abstract

[3] www2.cochrane.org

[4] http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015591