From Abracadabra to Zombies
Acupuncture & What They Don't Teach in Medical School
Date. 30 March 2014. Another improperly done and ineptly reported acupuncture study has appeared. Julie Medew is the health editor for The Age, an Australian newspaper with an online presence. She authored an article yesterday with the headline
Acupuncture as effective as drugs in treating pain, trial shows
The headline is accurate but falsely implies that acupuncture was effective, which most people will probably take to mean that acupuncture, by some as yet undiscovered means, really relieves pain. Many people will also jump to the conclusion that this is a good thing because drugs have side effects and acupuncture doesn't. Is that true? It's not obviously true or intuitively true. We need evidence before we should accept such a claim. Many people will also jump to the conclusion that this is a good thing because acupuncture is cheaper than pain pills. Is that true? If it is, it is not obviously true or intuitively true. Where's the evidence?
Anyway, the study was done by the Royal Melbourne Institute of Technology's [RMIT] school of health sciences in conjunction with emergency physicians at four hospitals. I'd never heard of RMIT until yesterday. The website says it is a university and the health sciences webpage says:
The School of Health Sciences engages in teaching and research in Complementary Medicine, Nursing and Midwifery, and Psychology.
We recognise that many of the greatest advances in Science are made at the intersections of disciplines. With our strong interdisciplinary approach we have set our sights on establishing an evidence base for the quality, safety and effectiveness of interventions for the ageing population and those with chronic diseases. Our research findings inform clinical teaching and advance the treatment of patients.
One can only hope that the quality of research in other areas investigated by this institution is superior to that reported on by Ms. Medew. According to her, the "randomised controlled study of about 550 patients" gave acupuncture to some and a"strong oral analgesia, such as Endone, Panadeine Forte, Voltaren and Valium" to others. Medew reports that Dr Michael Ben-Meir "said it showed acupuncture offered the same level of pain relief as analgesic drugs when patients rated their pain one hour after treatment." You read that right. The conclusion that acupuncture is as effective as pain pills was based on asking the patients about their pain level one hour after treatment. Was there a group of patients in the study who were give a dummy pain pill or fake acupuncture? No, but there was a group given both acupuncture and a pain pill. Guess what? After one hour, their reported pain level didn't differ from those given only acupuncture or only a pain pill.
What about four or eight hours after treatment? Was there any difference in reports? What kind of rating system was used? Why was there no control group? The reader of The Age should expect the journalist to ask these and a few other questions.
One of the chief investigators conducting the study is the head of the school of health sciences at RMIT, Professor Charlie Xue. He is a "registered Chinese medicine practitioner." Xue said that until now very little research had been done on the use of acupuncture for acute pain in hospital settings. Let's hope future studies are conducted with more rigor. Medew reports that about 10 per cent of Australians use acupuncture in community-based clinics. It would not surprise me to find those clinics citing Medew's health report as evidence that acupuncture works. (While Xue's claim may be true for studies done in hospital settings, there have been many studies done on acupuncture and pain that show beyond a reasonable doubt that acupuncture is placebo medicine.)
One of the emergency physicians who participated in the study reportedly studied acupuncture nine years ago and uses it on his patients. He "said the results aligned with his own experience of its efficacy for acute pain. He said it was particularly good for people who did not want drugs, such as pregnant women, and for those whose pain was not relieved by Western medicine." He based these claims, I assume, on his own experience rather than on any properly conducted scientific research. The acupuncturist/emergency physician also said: ''I find acupuncture doesn't always help all patients, but occasionally it's the thing that really shifts them and gets them home and gets their symptoms resolved." The last I looked 'occasionally' was not a scientific term, nor was the expression 'shifts them.'
The only adverse effect on anyone in the study that was reported by Medew was "bleeding at the needling sites," mentioned by Professor Xue. I don't think he was talking about the patients who got pain pills only.
If you are wondering where you can read the entire study, you can't. According to Dr. Ben-Meir, "the data from the study is still being analysed and finalised for publication in a medical journal." I wonder what medical journal will accept a study that claims to have evidence that acupuncture is as effective as pain pills? I doubt if it will be a first-tier journal, where the minimum requirement would be that two control groups be used (one given dummy pain pills and one given fake acupuncture) to tease out the placebo effect. Another requirement will be that measurements of pain be done at more than just one time point after treatment.
You can read Medew's article by clicking here.