Trick or Treatment—The Undeniable Facts about Alternative Medicine (Electronic book text)

It has taken several years to design, develop and test the telescopic needle, and it has taken several more years to arrange and conduct clinical trials using it. Now, however, the first results have begun to emerge from what are arguably the highest-quality acupuncture trials ever conducted.

These initial conclusions have generally been dis appointing for acupuncturists: they provide no convincing evidence that real acupuncture is significantly more effective than placebo acupuncture in the treatment of chronic tension headache, nausea after chemotherapy, post-operative nausea and migraine prevention. In other words, these latest results contradict some of the more positive conclusions from Cochrane reviews. If these results are repeated in other trials, then it is probable that the Cochrane Collaboration will revise its conclusions and make them less positive. In a way, this is not so surprising. In the past, when trials were poorly conducted, the results for acupuncture seemed positive; but when the trials improved in quality, then the impact of acupuncture seemed to fade away. The more that researchers eliminate bias from their trials, the greater the tendency for results to indicate that acupuncture is little more than a placebo. If researchers were able to conduct perfect trials, and if this trend continues, then it seems likely that the truth is that acupuncture offers negligible benefit.

Unfortunately, it will never be possible to conduct a perfect acupuncture trial, because the ideal trial is double-blind, meaning that neither the patient nor the practitioner knows if real or placebo treatment is being given. In an acupuncture trial, the practitioner will always know if the treatment is real or a placebo. This might seem un important, but there is a risk that the practitioner will unconsciously communicate to the patient that a placebo is being administered, perhaps because of the practitioner’s body language or tone of voice. It could be that the marginally positive results for acupuncture for pain relief and nausea apparent in some trials are merely due to the slight remaining biases that occur with single blinding. The only hope for minimizing this problem in future is to give clear and strong guidance to practitioners involved in trials to minimize inadvertent communication.

While some scientists have focused on the use of telescopic needles in their trials, German researchers have concentrated on involving larger numbers of patients in order to improve the accuracy of their con clusions. German interest in testing acupuncture dates back to the late 1990s, when the national authorities voiced serious doubts about the entire field. They questioned whether they should continue paying for acupuncture treatment in the light of the lack of reliable evidence. To remedy the situation, Germany’s Federal Committee of Physicians and Health Insurers took a dramatic step and decided to initiate eight high-quality acupuncture trials, which would examine four ailments: migraine, tension-type headache, chronic low back pain and knee osteoarthritis. These trials were to involve more patients than any previous acupuncture trial, which is why they became known as mega-trials.

The number of patients in the trials ranged from 200 to over 1,000. Each trial divided its patients into three groups: the first group received no acupuncture, the second group received real acupuncture, and the third (placebo) group received sham acupuncture. In terms of sham acupuncture, the researchers did not employ the new stage-dagger needles, as they had only just been invented and had not yet been properly assessed. Instead, sham acupuncture took the form of misplaced or superficial needling Due to their sheer size, these mega-trials have taken many years to conduct. They were completed only recently and the emerging data is still being analysed. Nevertheless, by 2007 the researchers published their initial conclusions from all the mega-trials. They indicate that real acupuncture performs only marginally better than or the same as sham acupuncture. The conclusions typically contain the following sort of statement: ‘Acupuncture was no more effective than sham acupuncture in reducing migraine headaches.’ Again, the trend continues — as the trials become increasingly rigorous and more reliable, acupuncture increasingly looks as if it is nothing more than a placebo.

Conclusions