Like a zombie, acupuncture shuffles on, oblivious to the slings and arrows of scientific evidence. It’s too bad. Once upon a time, before researchers figured out reasonable ways to separate the effect of the acupuncturist’s needling from the rest of the patient interaction, there was the tantalizing possibility that acupuncture actually did something. Needles are physically entering the body, so the thought that it could affect biological processes wasn’t completely far-fetched. Acupuncture could totally work, right?
Maybe not. Just like we don’t believe the claims of drug companies without critical analysis, we can’t believe the claims of acupuncturists without good evidence; after all, they’re the most heavily invested, financially and psychologically, in convincing people that it improves health. Instead of taking their claims at face value, researchers started to study acupuncture, and the first evidence to start rolling in suggested that acupuncture was effective. Oh happy day! Time to start referring patients? Unfortunately, early studies couldn’t tell if the needles were actually doing anything, or if it was all a very nice placebo effect that was generated by the patient-acupuncturist interaction. Eventually, researchers developed sham-acupuncture techniques so that patients were unaware if they were getting real acupuncture or not, and started taping the sessions to ensure that the practitioners acted essentially the same with both real and sham acupuncture patients. The much higher-quality evidence started to accumulate, and the better the research was, the more likely it was to show no effect beyond placebo. This is disappointing, considering its early promise, but just like physicians stopped bloodletting when they realized it didn’t help patients, so too must we leave acupuncture to the dustbin of history as we pursue more effective treatments.
Or so I thought. Being published in the Archives of Internal Medicine this week is a systematic review and meta-analysis of acupuncture . Considering the results of the best systematic reviews on the topic have concluded that acupuncture provides a very nice placebo effect and nothing more, you have to wonder why they didn’t focus on a different topic where their efforts might be of more benefit to patients. But I digress…
So we have yet another systematic review on the topic. What does this one say? I’ll quote the abstract’s conclusion in its entirety: “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.”
Systematic reviews are great. When done well, they tell us about the current state of knowledge on a topic. The results of systematic reviews are, appropriately, used to inform health policy and patient care. So when a systematic review of the effect of acupuncture on chronic pain concludes in favour of a treatment, we should take notice, especially when the methods were, in my opinion, mostly sound. So won’t I be recommending acupuncture, and why are the good people at Science-Based Medicine thoroughly unimpressed? Because the researchers have wholly overstated their review’s results and essentially ignored well-understood biases. Reading the research yourself, you can quickly see that the effect sizes, such as they are, are minuscule beyond placebo, and the obvious biases probably make up for what little difference exists. They have, essentially, confirmed what we already knew: acupuncture provides a very strong placebo effect for chronic pain.
It’s extremely disappointing to me that the authors exaggerated their conclusions and that the journal has allowed them to get away with it. What’s worse, the media has taken their inappropriate conclusions without critique. Recommending an expensive but ineffectual treatment that is based on a prescientific model of the body is, in my opinion, unethical. Bad journalists. Bad! But it isn’t all the journalists’ fault, of course; sometimes the truth just doesn’t make good news. So here’s the unexciting and unsexy truth that they won’t tell you: acupuncture is a medical practice that has, quite simply, failed to live up to the claims of its practitioners and proponents. Can we please spend our research dollars and years finding treatments that do?
- Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. Published online September 10, 2012. doi:10.1001/archinternmed.2012.3654.