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Acupuncture in the BMJ

A new review appeared in the BMJ today. It is by Madsen et al., from the Nordic Cochrane Centre, Copenhagen. Here are the conclusions.

The analgesic effect of acupuncture is small and cannot be distinguished from bias resulting from incomplete blinding.

The analgesic effect of placebo acupuncture is moderate but very variable as some large trials report substantial effects.

The effect of acupuncture seems to be unrelated to the type of placebo acupuncture used as control.

The results confirm, yet again, that there is essentially no difference between “real” acupuncture and sham acupuncture. All that talk about meridians and Qi really is so much mumbo jumbo.

The average effect (the diamond at the bottom) is essentially zero.

It has often been supposed that acupuncture is a theatrical placebo, but because of the placebo effect it produces more pain relief than (non-blind) controls. This study confirms that there is likely to be such an effect, but it also finds that the size of the placebo effect is too small to be useful to patients. Here is the comparison between sham acupuncture and no acupuncture at all.

The results of different trials are very variable, but the average effect (diamond at the bottom) favours sham acupuncture over no acupuncture at all.

But how big is the effect? The numbers along the bottom of the graph are ‘standardised mean differences’. The average value of -0.42 (95% confidence limits -0.6 to -0.23) between ‘no acupuncture’ and ‘sham acupuncture’ corresponds to a difference of about 10 points on a 100 point scale. This difference is big enough to be real, in the sense that it isn’t just chance. But is it big enough to be useful to the patient? Probably not. Madsen et al conclude

“a consensus report characterised a 10mm reduction on a 100 mm visual analogue scale as representing a “minimal” change or “little change”. Thus, the apparent analgesic effect of acupuncture seems to be below a clinically relevant pain improvement.”

This makes nonsense of the Pittilo report. Notice that these results, yet again, make nonsense of the proposals in the gamma-minus Pittilo report, to pseudo-regulate acupuncture, and to have degrees in the subject.

Cochrane reviews of Acupuncture : and a bad report from BBC

Two new Cochrane reviews appeared last week, Acupuncture for tension-type headache, and Acupuncture for migraine prophylaxis.

You can’t blame subeditors for the appalling title of the BBC’s report on Acupuncture ‘works for headaches’. The content is pretty misleading too. (The link is to a version saved at 19.35 on 21 January 2009.). Furthermore, like far too many of the BBC reports, it is anonymous. One has no idea to blame This is important, if only because the BBC news site is so influential. Twelve hours after posting the misleading title has been copied all round the world.

In the Guardian, Ian Sample had a much better report, Even’fake’ acupuncture reduces the severity of headaches and migraines. Sadly the print edition had the title “Acupuncture aids migraines, researchers

find”, but that can be blamed on subeditors who have a problem with reading (in fact Sample had seen neither title).

The BBC report seemed to call for a complaint. This is what I sent.

I wish to complain about the report on acupuncture at http://news.bbc.co.uk/1/hi/health/7838231.stm The title itself was highly misleading “Acupuncture works for headaches” is precisely the opposite of what was shown, namely that it is no better than sham acupuncture controls. The article goes on to say “The traditional explanation of its effects involves tapping into a network of “meridians” around the body to regulate the flow of an energy called “chi”. Acupuncture points are located at various positions along these meridians.” It is not said that there isn’t the slightest reason to think this is true (or even means anything) , and that the work which is being reported is strong evidence that it’s not true “Acupuncture is still regarded as a “complementary” therapy, but is increasingly being viewed as a potential mainstream treatment for certain conditions, such as chronic pain” That is wrong. University of Salford , for example has just closed its acupuncture course after a number of us have pointed out that it is teaching things that aren’t true “The endorsement by the Cochrane Collaboration is likely to lead to further calls for it to be made more widely available on the NHS” It is exactly the opposite of an endorsement. It is one more nail in the coffin of acupuncture as generally understood. This article, I contend, is partial and misleading. Unfortunately it is anonymous.





Follow-up

Today’s BBC report on the BMJ paper is almost as partisan as the one that I just complained about. “Confusion on acupuncture benefit ” exaggerates greatly the amount of confusion. Worse still, it quotes only two well-known advocates of acupuncture, people who make their living from it. No independent scientific voice is to be heard.



One of those cited is Adrian White. He is described as “a researcher into acupuncture at the Peninsula Medical School”. There is no mention of the fact that he is also Editor in Chief of the journal Acupuncture in Medicine. The other person who is quoted is Mike O’Farrell, the chief executive of the British Acupuncture Council. What do you expect him to say?

I’ve just sent another complaint, about today’s BBC report. The more the merrier.

The BMJ itself published an editorial on the Madsen paper. It seems very odd that they should have chosen the editors of the BMJ-group journal, Acupuncture in Medicine, to comment on a paper that sounds the death knell for the subject from which they make their living. Needless to say, the editorial attempted to wriggle out of the obvious conclusions. Worse still, the Health editor of the BBC web site referred to the editorial in his defence, in response to my complaint.

Channel 4 News does a lot better than the BBC, or the BMJ editorial, with its report Acupuncture ‘fails to relieve pain’

“Claims that acupuncture can relieve pain have been undermined by the results of a new study.” “senior researcher Asbjorn Hrobjartsson said: “Our findings question both the traditional foundation of acupuncture…and the prevailing theory that acupuncture has an important effect on pain in general”. “

The Daily Telegraph also, like almost everyone else, did better than the BBC, with “Acupuncture ‘has almost no effect in relieving pain’”

“The pain relieving effects of acupuncture are so small that they may be clinically irrelevant, according to a review of research into the treatment.”

Even Metro, the free London Newspaper, is more accurate then the BBC. They carry a short report “Acupuncture ‘has no medical point’.”

“The pain-relieving effects of acupuncture compared with a placebo are so small they may be clinically irrelevant.”

New review puts in doubt traditional foundation of acupuncture. Believe it or not, that is the title of the report on Madsen et al from the Prince’s Foundation for Integretad Health! Don’t get too excited though. They haven’t even bothered to look at the original paper, but merely cite the dreadful BBC report. Much prominence is given to the acupuncturists, White and O’Farrell, and the important finding isn’t mentioned at all. Another gamma minus.



