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Studying Acupuncture, One Needle Prick at a Time

Rating

3 Star

Studying Acupuncture, One Needle Prick at a Time

Our Review Summary

Let’s be clear:  this is a difficult topic.  But this article provided an overly optimistic view of acupuncture’s therapeutic effects by selectively reporting the results of four clinical trials.  These included two sham-controlled trials on the treatment of chronic knee pain and one sham-controlled trial on the management of chronic back pain.

Curiously, it also included discussion of a small study comparing acupuncture to an antidepressant for hot flashes among breast cancer patients.  By its design, this study wasn’t capable of separating the specific treatment effects of acupuncture from placebo responses. Yet it is presented as if it were relevant to this issue.

The column offered a variety of rationales on why acupuncture might not produce optimal results in conventional, sham-controlled clinical trials. But it didn’t balance out this discussion by considering whether the growing number of trials questioning acupuncture’s treatment impact might simply be correct.

The story included quotes from four researchers or independent experts. However, three of the four appeared to be proponents of acupuncture.

Revising Study Results

An example of the article’s apparent tilt towards acupuncture came in discussion of a recent trial on the treatment of painful knee osteoarthritis from Texas. That study concluded that both acupuncture and sham acupuncture produced identical improvements in pain scores: roughly one point on a seven-point scale (J-MAP).

However, the New York Times article proposed altering that conclusion through sleight-of-hand.  It noted that the patients would have received a different, non-standardized program of acupuncture in the “real world.” And that the study conclusions could be revised to suggest that acupuncture “works even when administered poorly.”  

The columnist didn’t discuss the possibility that acupuncture might actually perform worse in a real-world setting where patients don’t have to meet strict study inclusion criteria. And the article didn’t consider whether a one-point improvement on a seven-point pain scale would be considered evidence that a treatment “works”.

Overall, the article did not provide a clear view of the larger body of evidence on the risks, benefits, availability, or costs of acupuncture for any condition. And it did not adequately stress the key take-home message in this area: that sham-controlled clinical trials have not yet documented that acupuncture has a clinically important treatment effect—and that this is a gaping hole in its evidence base.  (Manheimer et al., 2007; Sherman et al., 2009).

 

Why This Matters

Acupuncture is a widely publicized complementary/alternative therapy for pain and other physical and psychological symptoms.

However, acupuncture is not widely utilized in the United States. Only about 4% of the U.S. population had ever tried acupuncture, according to a nationwide study in 2002, and only about 1% had utilized it recently.

One of the major obstacles to broader use of acupuncture is a lack of scientific evidence that it is superior to sham or fake acupuncture.

In several areas of medicine—such as the treatment of knee pain, headache, and chronic back pain—acupuncture appears to be superior to usual treatment or no treatment. However, it does not appear to offer any clinically significant benefit over a sham procedure—according to recent reviews of the evidence. (Manheimer et al., 2007;  Sherman et al., 2009).

Proponents of integrative medicine argue that patients shouldn’t be denied these needling treatments, whether the benefit comes from a placebo effect or not.

However, insurers and other third-party payers generally will not provide reimbursement for drugs, devices, or medical procedures that don’t provide a specific therapeutic benefit.  They would conclude that these therapies are uNPRoven.

So determining whether acupuncture is superior to sham acupuncture is a key scientific question that may determine the future of this highly publicized treatment.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The article didn’t address costs or reimbursement issues.

If acupuncture could be shown to be efficacious for common health conditions, its relatively low cost could be viewed as a major selling point in a world of spiraling treatment expenditures.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

Mixed bag. 

On the knee arthritis study, the story didn’t explain what "an average reduction of one point on a scale of 1 to 7" for pain relief really meant to people. It says "critics contend that the study was poorly designed" but didn’t explain how it was poorly designed. That could be letting critics get away with potshots without explaining whether their criticism was well-founded.

On the NIH knee arthritis study, it said "acupuncture significantly reduced pain and improved function" but that doesn’t meet our standard for quantifying the benefit. What does "significantly" mean in their lives? Again, in this case, the story said "that result has been called into question" but this time the story explained why. 

On the Henry Ford Hospital study of hot flashes in breast cancer patients, the story said the results were "striking" but again didn’t quantify what that meant.

So we can’t give this a satisfactory score but it didn’t meet the true spirit of our criterion.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The article didn’t discuss or quantify potential harms associated with acupuncture. However, potential adverse effects would not likely serve as an obstacle to wider utilization of this treatment. When performed with sterile disposable needles by competent practitioners, acupuncture appears to be a relatively safe treatment approach.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The article discussed the use of acupuncture for three clinical indications: chronic knee pain, chronic back pain, and hot flashes after radiation therapy for breast cancer. 

The article didn’t provide a satisfactory overview of the evidence in any of those areas. 

Prospective patients could very well come away from reading this article with the impression that acupuncture is an effective treatment for all three conditions. Yet the scientific evidence is inconclusive.

Does the story commit disease-mongering?

Satisfactory

The health conditions discussed in this article are vexing and real. There was no suggestion of disease mongering.

 

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The article quotes many sources – most of them involved in the research in question.  One interviewee appeared to be independent of any of the studies being discussed.

Does the story compare the new approach with existing alternatives?

Satisfactory

The article mentions several alternative treatments for the three conditions discussed in the article—and, in the online version at least, the study links can lead readers to further information.

 

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The article does not discuss the availability of acupuncture in the United States. This is an important question. There appear to be significant obstacles­—relating to geography, licensing, and reimbursement— to the widespread availability and utilization of acupuncture.

 

Does the story establish the true novelty of the approach?

Satisfactory

The article stated in the first sentence that acupuncture has a 2000-year history.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The article clearly did not rely on a news release.

Total Score: 5 of 10 Satisfactory

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