This story is about a small but intriguing study that tests four different methods to manage the kind of hot flashes experienced by women who have been treated for breast cancer. Testing acupuncture, “sham” acupuncture, the drug gabapentin and a placebo pill, it found that real acupuncture was better than the other three. The story includes plenty of interesting commentary on the placebo effect and its role in the treatment of hot flashes. It would have benefited from a bit more detail on what acupuncture and ‘sham’ acupuncture entails, some sense of the magnitude of effects from these treatments, and an explanation of potential study limitations.
Hot flashes are a persistent and bothersome symptom for women having gone through menopause, and the effects of breast cancer treatment can make those symptoms more severe. Because hormone replacement therapy is not seen as an option for women who have had breast cancer, there is a need for alternative treatments, including non-drug treatments like acupuncture so it is good that this kind of research is being done.
There is no discussion of costs of any of the treatments studied.
The benefits of the treatments were measured at 8, 12 and 24 weeks after receiving the treatment yet the magnitude of those effects are not quantified nor explained in any detail. Measurements looked at frequency and severity of hot flashes but we don’t have any idea what the baseline was, or how that may have changed due to the different modalities. We’re told that acupuncture had the greatest effect, but not how big that effect was or how meaningful it was for patients.
Acupuncture is likely safe but we have no idea if the women who received it, the sham acupuncture or gabapentin experienced any adverse effects of those treatments.
The story includes a very detailed and interesting discussion of the placebo effect and its potential impact on the results. And because there was sufficient detail about what was compared to what, what kind of women were involved in the study, and how long they were studied, the story deserves a Satisfactory rating here, although more detail in a few areas would have been welcome. There were only about 30 women in each arm of the trial and was this enough to see statistically-significant differences in the hot flash scores or not? This aspect of the study isn’t addressed, although the paper itself cautions, “Our trial was not powered to examine the efficacy of acupuncture or gabapentin,” and that “Without a no-treatment group, the responses cannot be separated from that of natural history or regression to the mean.” Some explanation of that caveat would have been useful. More specifics on what exactly constituted acupuncture and sham acupuncture would have been helpful as well (“sham” acupuncture means non-penetrating needles put in spots not used for real acupuncture).
There is no evidence of disease mongering here.
The fact that two of the study authors consult for Pfizer, which makes gabapentin, merited a brief disclosure/acknowledgment in the story, and the lack of such disclosure is the basis for our Not Satisfactory rating here. We did enjoy the observations of outside expert Dr. Gary Deng, who was consulted about the effects of placebo and had some interesting comments to share with readers. We wish the story had also included a direct expert comment regarding the quality of the study and the patient-care implications of the findings.
The study was all about comparing alternatives so by that means, rates a satisfactory score.
Acupuncture is widely available and while the report did not establish the availability of the treatment, consumers certainly know about it. The story could have noted that insurance may not pay for acupuncture treatment, however. Gabaptentin is described as a drug that’s typically used to treat nerve pain, and readers can work out from that that the drug is available.
Close call here, but the story doesn’t really establish what is new about the research. There are questions raised in previous studies about whether real acupuncture is more effective than a sham treatment or if the benefit from the needling is all essentially a placebo effect. Researchers also wonder whether the acupuncture placebo effect is bigger than the effect seen with placebo pills because of all the attention patients get from the acupuncture session that they don’t get with a pill. The story does allude to the question, but doesn’t specifically address the fact that these issues have been raised in previous research on pain and that’s why the new study in women with hot flashes is important.
The presence of an outside observer’s comments, and the lack of exaggeration of the findings, would suggest that this story goes beyond any news release.