Wednesday, July 1, 2009

Acupuncture: Evidence

So the other day I was at a friend’s house and the topic of acupuncture came up. Now, I’m one of those hard-line skeptics about “alternative” medicine, and I happened to have read several credible sources stating that acupuncture doesn’t work (is no better than a placebo treatment). But not everyone wanted to take me on my word, so I promised to produce the evidence. Here we go.

First, a caveat for those who want to do their own internet research: there are a large number of biased websites out there, on both sides. If you go to the websites of people who practice acupuncture, you’ll find links to many articles which indicate that acupuncture is beneficial. Don’t trust them! For example, on this website:

The Fertile Soul

You’ll find the oft-cited claim that acupuncture helps with in-vitro fertilization. Yet, the study linked is a poor one, and the most systematic review to date on the subject, here:

Cochrane Collective

Concludes: “Acupuncture performed on the day of ET [Embryo Transfer] shows a beneficial effect on the live birth rate; however, with the present evidence this could be attributed to placebo effect and the small number of women included in the trials. Acupuncture should not be offered during the luteal phase in routine clinical practice until further evidence is available from sufficiently powered RCTs [Randomized Clinical Trials].”

Translation: poorly conducted studies are inconclusive. Internet researchers should also be warned about overzealous skeptic sites, which will publicize the negative results that suit them, but not take the time to consider studies which seem at-odds with their views.

The best place to get your scientific evidence concerning medicine is, of course, from recent, systematic meta-analyses of randomized clinical trials published in leading medical journals. Here is one such meta-analysis, published in BMJ. The article is: “Acupuncture treatment for pain: systematic review of randomized clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups” by Matias Vested Madsen, Peter C Gøtzsche and Asbjørn Hróbjartsson and it is available for free here:

Meta Analysis

This article is recent, being published in 2009.

It is also systematic. A systematic meta-analysis looks at all the articles in a large database(s) that meet the inclusion criteria. According to the study’s authors: “We searched the Cochrane Library, Medline, Embase, Biological Abstracts, and PsycLIT. The last search included all trials published before 1 January 2008.”

Furthermore, it is published in a leading medical journal. According to wikipedia: “BMJ is considered to be one of the ‘core’ general medical journals; the others being the New England Journal of Medicine, (N Engl J Med), the JAMA, and The Lancet.”

The authors reached the following conclusions: “A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear.”

To sum up: acupuncture treatments for pain are not clinically significant, and they may not even be statistically significant, once bias is accounted for. That seems pretty damning to me.

Still not convinced? I knew you wouldn’t be. So I direct you to one of my favorite science bloggers, Orac, over at Respectful Insolence.

Acupuncture 1

Acupuncture 2

Acupuncture 3

Acupuncture 4

Orac is a medical doctor, and much more knowledgeable than me. In the above blog posts, he dissects a number of studies and meta-analyses. He testifies:

“When I first became interested in ‘alternative medicine’--excuse me, I mean ‘complementary and alternative medicine’ (CAM)--I viewed acupuncture somewhat differently. No, I never bought the traditional explanation that sticking thin needles into the skin somehow alters the flow of qi in order to induce a therapeutic effect. That is no more plausible than reiki or therapeutic touch. However, there are needles breaking the skin in acupuncture. It was, at least to me, not entirely implausible that that might have some sort of physiologic effect. Then I had to go and ruin that lovely kumbaya feeling towards CAM by actually going and looking at the scientific literature on acupuncture… When I actually bothered to do that, I soon realized that the evidence that acupuncture is anything more than a highly elaborate placebo is shockingly thin. More like nonexistent, actually.”

You should read his posts, or the articles he links to, and see if you aren’t equally converted.

Finally, here’s a press article to stew on:

AP Report

It begins: “Ten years ago the [U.S.] government set out to test herbal and other alternative health remedies to find the ones that work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do.”

Your tax dollars at work!