North East man stabbed in back*

By Keir Liddle

If there is one thing that annoys me more than anything else about the media it’s articles about alternative health treatments that appear to be little more than adverts for the services of various quacks. I have ranted about this at length before when the Daily Record promoted the services of Nuffield health and when the Scotsman uncritically sang the praises of reflexology and now it appears it is the turn of the Press and Journal to bear the brunt of my ire.

The reason they have roused my anger? Running a story that amounts to almost nothing more than an advert for acupuncturists. The article describes how “acupunturists claim” they can cure fertility problems, insomnia, irritable bowel syndrome, migraine and perhaps most galling of all depression.

Is there any evidence to back up the claims of Acupuncturists regarding what they can and can’t treat?

In the case of depression a systematic review summarise the existing evidence on acupuncture as a therapy for depression. RCTs were included, in which either manual acupuncture or electroacupuncture was compared with any control procedure in subjects with depression. For meta-analysis seven randomised comparative trials involving 509 patients were included. The results of these seven trials are contradictory and even systematic reviews of these data do not arrive at uniform conclusions. However the authors of this review determined that concluded that the evidence from controlled trials is insufficient to conclude whether acupuncture is an effective treatment for depression.

A systematic review of systematic reviews was also conducted to explore if acupuncture could treat depression and eight systematic reviews including seventy-one primary studies were found. Five of the reviews arrived at positive conclusions and three did not. All the positive reviews and most of the positive primary studies originated from China and there are reasons to believe that these reviews are less than reliable. The authors conclude that the effectiveness of acupuncture as a treatment of depression remains unproven.

Claims that acupuncture can treat insomnia were addressed by another systematic review in which We identified 433 possible relevant articles however the methodological quality of these was poor and only included 10 acceptable RCTs. None of these suggested any benefits from acupuncture on sleep scores and the authors concluded that because of the paucity and of the poor quality of the data, the evidence for the effectiveness of acupuncture for the symptomatic treatment of insomnia is limited. Although they suggest that there is room for further, rigorously designed trials to confirm these results.

The authors also conducted a systematic review to determine the overall effectiveness of acupuncture to illustrate again how poor research is in this are out of Seven hundred and nine possibly relevant studies identified only 10 RCTs meet the inclusion criteria. Even still the methodological limitations of the included trials make their contribution to the current clinical evidence of acupuncture somewhat limited. It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions. The authors note however that acupuncture remains steeped in controversy as some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response.

The above information can be found in “Complementary Medicine: the Evidence so far” a document produced by Edzard Ernst and his former research team.

The journalist who wrote this puff piece concludes that because the following day they are tired, but relaxed and generally more at ease with the world that they can  finally see the point of acupuncture. Perhaps rather than relying on their own personal experience they should have looked at the evidence before advising to “bring on the needles”.

(*Those unawares of the relevance of the headline are advised to look here)

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0 Responses to North East man stabbed in back*

  1. This is something I find incredibly frustrating. I think people tend to give more credence to a newspaper article than they would an advert, yet such articles often seem to make statements which are misleading, exaggerated and lacking substantiation – and crucially, beyond the reach of the ASA.

    One recent example I (and others)complained about was the Guardian G2 piece on osteopathy supposedly being a suitable treatment for asthma and pneumonia (blogged by myself here http://josephinejones.wordpress.com/?s=guardian+osteopathy) and by Martin Robbins here http://www.guardian.co.uk/science/the-lay-scientist/2011/jun/15/2).

    I eventually managed to get them to put a clarification under the original article but I believe this was in part because Martin had blogged it and also because I had complained to the PCC (who didn’t actually get involved) and made a fuss on Twitter. As far as I’m aware, the Guardian did not respond to other complainants.

    A big concern of mine at the time was that the article was promotional and uncritical, yet (as the ASA confirmed), it did not qualify as advertising. Deputy Editor of G2, Tim Lusher, even defended the inaccuracies of the piece using the argument that it was a ‘first person’ piece.

    I think writing blogs and complaints about such pieces is important in the fight against misleading health and science reporting.

  2. Graeme Donald says:

    I have a couple of issues about the critiquing of this article.

    First of all, the author is correct about the adoption of acupuncture into NICE guidelines for LBP and recognises that the evidence base is growing (which indeed it is). Not once in the article does the author evaluate the strength of the evidence, presumably as they do not have the requisite expertise to do so. The overall tone of the article doesn’t imply that the evidence base is irrefutable although, as a corollary, I would be interested to listen to a balanced rebuttal on brain imaging studies demonstrating, for example, deactivation of areas like the periaqueductal grey or nucleus raphe magnus. I would also be interested to hear opinions on studies linking acupuncture to levels of neurotransmitters like GABA, glutamate and adenosine.

    Secondly, the article is clearly written for consumers rather than suggesting that acupuncture should be available for all the listed indications on the NHS. Thus, the burden of evidence is not so relevant. The general public are aware that acupuncture is a complementary intervention and know full well that it ignites debates over its plausibility. It is completely their right to choose to part with their cash for a treatment if they so wish. If they wanted to pay for a family of leeches to be stuck to them, so what? Is there a healthcare ethical tenet more important than self-determination and autonomy?

    Finally, very briefly and playing devil’s advocate a bit, on the alleged placebo effect. If any treatment affects the patient somatically then that effect cannot be denied. Would you deny a patient the final positive outcome simply because you disagree with the treatment?

    I’m not saying concerns around the evidence base aren’t justified, they are. But it has to be acknowledged that there is a comparative lack of resources invested in CAM research and, consequently, the methodological rigor of trials is adversely affected.

  3. If you provide links to the studies mentioned above than a rebuttal would actually be possible. No evidence base is irrefutable but the case against acupuncture for most conditions is fairly strong.

    The contention is that acupuncture cannot treat depression or insomnia is supported by evidence supplied with the post. That the original article is focused at consumers does not make the burden of evidence irrelevant.

    It simply means that the argument becomes about marketing a therapy using misleading claims and if the claims above were made in an advertisment they would fall foul of ASA regultaions and the likely adjudication would be that the advert would have to be removed.

    I appreciate you are playing devils advocate on the placebo effect but by definition no placebo based treatment would have a somatic effect.

    You can thank Prince Charles intervention for removing a large source of research into CAM – as he lead to the “retirement” of Ernst because the high quality evidence that he provided tended to show negative outcomes for most CAM modalities tested.

  4. Graeme Donald says:

    No probs – here some links:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692758/
    http://www.nmr.mgh.harvard.edu/~vitaly/PDF/hui_brainres_2009.pdf
    http://www.ncbi.nlm.nih.gov/pubmed/20494626
    http://www.acupuncturesociety.org.uk/pdf/research/neural%20mechanism%20of%20acupuncture.pdf
    http://www.sciencedirect.com/science/article/pii/S1566070210000676
    http://www.ncbi.nlm.nih.gov/pubmed/16046146
    http://sunlightacupuncture.com/downloads/nature_acupuncture2010.pdf

    I don’t think you got what I meant by lack of resources in CAM research – Ernst wasn’t the only person in the world researching this area. I am one and personally know many more – we all either work in NHS or university settings, hardly the hallmark of back-door quacks. Never mind the fact that Ernst was originally given the job because of his pre-existing antipathy to complementary technqiues – hardly suggestive of open-minded scientific inquiry. I’m talking about the dichotomy that CAM researchers face – the ‘mainstream’ criticising CAM interventions because of their lack of evidence vs. the institutional bias against funding such studies.

    Also, i didnt say that the evidence base is irrelevant in articles targeted at consumers – I said it was less relevant. Consumers know full well that a question mark hangs over the efficacy of acupuncture.

    And even although the article wouldn’t pass the scrutiny of the ASA if it was an advert – that is a moot point. The article isn’t an advert. You can’t evaluate something on the basis of it being something other than what it is.

  5. Ersnt has said that about 5 percent of alternative medicine is backed by evidence, with the remainder being either insufficiently studied or backed by evidence showing lack of efficacy.

    Hardly indicative of a closed mind.

  6. Graeme Donald says:

    I am not advocating ‘alternative’ medicine. I would be, and have been, the first person to refer a patient to a doctor when they have presented with an undiagnosed complaint. My aim is for ‘integrative’ medicine – where the best of both worlds are employed to give the patient the best outcome.

    And my last word on Ernst – I would be have been pleased had he conducted more primary research. He didn’t. Subjecting an area of research to systematic reviews ad nauseum is only so useful – especially when the size of the evidence base remains relatively small compared to allopathic medicine.

  7. Graeme Donald is right about one thing. The evidence base concerning acupuncture is indeed growing. And almost every new study adds another nail in the coffin of the silly myth of acupuncture, which is not so much ancient “wisdom” as a post-war trick of Mao Tse-Tung to boost Chinese nationalism.

    Just about every study shows sham and real acupuncture are indistinguishable. The latest study doesn’t even show any useful placebo effect -see http://www.dcscience.net/?p=4439
    The fact that the authors of that study concluded that acupuncture was useful despite what the data showed merely shows the pathetic intellectual standards that prevail in the alt med business.

  8. Pingback: The 21st Floor » Blog Archive » Skeptics News: Acupunctured lung

  9. Alex Wassall says:

    Graeme Donald, not meaning to put words in the authors mouth but…

    With at least two of those studies funded by the NIH/National Center
    for Complementary and Alternative Medicine and the others (that i can see) involving Korean, Chinese and Japanese researchers it would seem that you failed to read the article in full “All the positive reviews and most of the positive primary studies originated from China and there are reasons to believe that these reviews are less than reliable.”

    The links that you have given are to research funded by an organization which has a vested interest in seeing positive results or conducted by individuals who likely have a cultural bias. So it is no surprise the results are more positive(interestingly they are not big effects even in these studies, I would say much of what is classed by the authors as positive data are artifacts of the studies design or simply noise in the data however I will freely admit that I am not really qualified to make that assessment and I have a bias myself) this is one of the reasons why good science bloggers make use of “systematic review[s] of systematic reviews” rather than making assumptions based on one papers limited data-set

    (I realize you provided 7 papers, but all on different effects, for a systematic review, I understand, you need studies that all meet specific criterion)

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