Musings of a phenomenologist

Science, psychiatry and random musings

It’s just a little prick

Posted by soveda on January 28, 2009

[BPSDB]

But does it do any good?

I’m referring to acupuncture which is being puffed, sorry reported on, by the BBC again today in this article.

Confusion you say, now what confusion would that be I wonder? Nothing to do with the media portrayal of previous studies surely.

The article refers to a new Cochrane review of studies into acupuncture vs. sham acupuncture. The idea behind sham acupuncture is to remove the postulated mechanism of action of acupuncture. A quick review of how acupuncture is said to work by its practitioners follows:

Acupuncture aparently stimulates the Ch’i meridians through the body and therefore helps to balance the levels and therefore cure your ailments. Sounds plausible no? No? Do I sense a need for evidence? Well frankly yes, the Cochrane review that has been published in the BMJ yesterday shows a small analgesic effect for acupuncture that is non specific and of debatable clinical relevance, the effect of placebo acupuncture could at times be marked and at others much smaller or non-existent. And overall the study authors could not differentiate or separate out the effects of the treatment ritual and the “needling”.

This doesn’t prevent an editorial in the BMJ from stating that the study shows acupuncture to be superior to placebo acupuncture. The basis for this assertion is this analysis, it shows a small statistically significant difference when the studies are pooled. The confidence intervals of the pooled data go from -0.26 to -0.08, I’m not certain how clinically significant this is but given that the numbers tend so close to 0 I am sceptical.

The comparison of sham acupuncture with no treatment shows a greater tendency towards favouring sham acupuncture but again the effect difference is small.

The BBC report states the following:

While traditional acupuncturists insert needles in acupuncture points located along what they describe as “energy meridians” – a concept for which many scientists say there is no evidence – sham acupuncture places needles away from these points.

However, the needles are still inserted beneath the skin in both varieties, and proponents of non-traditional acupuncture suggest that both varieties may be having a physiological effect – just not in the manner suggested by traditionalists.

Except that this is not true of all forms of sham acupuncture, some forms have retracting needles, some forms are comparing electrical stimulation to false stimulation. There is no set type of sham acupuncture.

This quote amuses me:

The British Acupuncture Council described the treatment as “a beneficial and effective therapy for a variety of conditions”.

Mike O’Farrell, the chief executive, said the latest study contradicted the majority of previous research in the area.

He said: “Acupuncture does work and research results consistently demonstrate the positive outcomes of treatment on patients.”

I thought the idea of a Cochrane review was to bring all the data together and analyse it more robustly and therefore includes the “majority of previous research in the area”.

Read the review for yourself here and decide. Simon Singh has written this article which explains the background rather better than I possible could.

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2 Responses to “It’s just a little prick”

  1. The Shrink said

    Ah, you tricksy wee scamp, you.

    I read BPSD and though “Behavioural and Psychological Symptoms of Dementia” since BPSD’s a term we use dozens of times each day, in that way. BPSDB? What’s this? A BPSD Bulletin, perhaps? A new dementia care resource to sleuth out?

    Imagine my crushing disappointment!

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