Science-Based Medicine: Guide to Acupuncture and Eastern Medicine

TCM (Traditional Chinese Medicine): New Developments

Contents:

  • 1. Introduction
  • Traditional Chinese medicine
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    1. Introduction

    Some of these specialists may also use or recommend other disciplines of Chinese medical therapies or Western medicine in modern times if serious injury is involved. Proponents have been working for decades to weaken standards of care for themselves and their treatments, change the rules of science, and carve out a favorable regulatory space in which to operate. VA goes full speed ahead with medical pseudoscience. Any individual diagnostic or treatment method within TCM should be evaluated according to standard principles of science and science-based medicine, and not given special treatment. Since therapy will not be chosen according to the disease entity but according to the pattern, two people with the same disease entity but different patterns will receive different therapy. This is an example of evidence of toxicity learned the hard way.

    The political, or perhaps commercial, bias seems to still exist. Acupuncture was essentially defunct in the West until President Nixon visited China in Despite his eminence as a political journalist, Reston had no scientific background and evidently did not appreciate the post hoc ergo propter hoc fallacy, or the idea of regression to the mean. Stories circulated that patients in China had open heart surgery using only acupuncture.

    The acupuncture needles were purely cosmetic. Curiously, given that its alleged principles are as bizarre as those on any other sort of prescientific medicine, acupuncture seemed to gain somewhat more plausibility than other forms of alternative medicine.

    As a result, more research has been done on acupuncture than on just about any other fringe practice. The outcome of this research, we propose, is that the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance. It seems that acupuncture is little or no more than a theatrical placebo. The evidence for this conclusion will now be discussed.

    We see no point in discussing surrogate outcomes, such as functional magnetic resonance imaging studies or endorphine release studies, until such time as it has been shown that patients get a useful degree of relief. It is now clear that they do not. We also see little point in invoking individual studies. Inconsistency is a prominent characteristic of acupuncture research: Consequently, it is very easy to pick trials that show any outcome whatsoever. Therefore, we shall consider only meta-analyses.

    The argument that acupuncture is somehow more holistic, or more patient-centered, than medicine seems to us to be a red herring. All good doctors are empathetic and patient-centered. The idea that empathy is restricted to those who practice unscientific medicine seems both condescending to doctors, and it verges on an admission that empathy is all that alternative treatments have to offer. There is now unanimity that the benefits, if any, of acupuncture for analgesia, are too small to be helpful to patients. If, indeed, sham acupuncture is no different from real acupuncture, the apparent improvement that may be seen after acupuncture is merely a placebo effect.

    Furthermore, it shows that the idea of meridians is purely imaginary. All that remains to be discussed is whether or not the placebo effect is big enough to be useful, and whether it is ethical to prescribe placebos. Some meta-analyses have found that there may be a small difference between sham and real acupuncture.

    Traditional Chinese medicine

    The crucial result was that even this bigger difference corresponded to only a point improvement on a point pain scale. The acupuncture and no-acupuncture groups were, of course, neither blind to the patients nor blind to the practitioner giving the treatment. It is not possible to say whether the observed difference is a real physiological action or whether it is a placebo effect of a rather dramatic intervention. Though it would be interesting to know this, it matters not a jot, because the effect just is not big enough to produce any tangible benefit.

    Publication bias is likely to be an even greater problem for alternative medicine than it is for real medicine, so it is particularly interesting that the result just described has been confirmed by authors who practice, or sympathize with, acupuncture. The patients were being treated for a variety of chronic pain conditions. The results were very similar to those of Madsen et al. Again there was a somewhat larger difference in the nonblind comparison of acupuncture and no-acupuncture, but again it was so small that patients would barely notice it.

    Comparison of these 2 meta-analyses shows how important it is to read the results, not just the summaries. Although the outcomes were similar for both, the spin on the results in the abstracts and consequently the tone of media reports was very different.

    See a Problem?

    But, by ignoring the problems of multiple comparisons, the authors were able to pick out a few results that were statistically significant, though trivial in size. Despite this unusually negative outcome, the result was trumpeted as a success for acupuncture. From the intellectual point of view, it would be interesting to know whether the small difference between real and sham acupuncture found in some recent studies is a genuine effect of acupuncture or whether it is a result of the fact that the practitioners are never blinded, or of publication bias.

    However, that knowledge is irrelevant for patients. All that matters for them is whether or not they get a useful degree of relief. It seems that they do not. There is now unanimity between acupuncturists and nonacupuncturists that any benefits that may exist are too small to provide any noticeable benefit to patients. That being the case, it is hard to see why acupuncture is still used. Certainly, such an accumulation of negative results would result in the withdrawal of any conventional treatment.

    Acupuncture should, ideally, be tested separately for effectiveness for each individual condition for which it has been proposed like so many other forms of alternative medicine, that is a very large number. Good quality trials have not been done for all of them, but results suggest strongly that it is unlikely that acupuncture works for rheumatoid arthritis, stopping smoking, irritable bowel syndrome, or for losing weight.

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    There is also no good reason to think it works for addictions, asthma, chronic pain, depression, insomnia, neck pain, shoulder pain or frozen shoulder, osteoarthritis of the knee, sciatica, stroke or tinnitus, and many other conditions. Acupuncture is no better than a toothpick for treating back pain. The article by Artus et al. Their Figure 2 shows that there is a modest improvement in pain scores after treatment, but much the same effect, with the same time course is found regardless of what treatment is given, and even with no treatment at all.

    We found a similar pattern of improvement in symptoms following any treatment, regardless of whether it was index, active comparator, usual care, or placebo treatment.

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    It seems that most of what is being seen is regression to the mean, which is very likely to be the main reason why acupuncture sometimes appears to work when it does not. Although the article by Wang et al. It would certainly be odd if a treatment that had been advocated for such a wide variety of conditions turned out to work only for PONV. Nevertheless, let us look at the evidence. The main papers that are cited to support the efficacy of acupuncture in alleviation of PONV are all from the same author: Even taken at face value, a relative risk of 0.

    The meta-analysis showed, on average, similar effectiveness for acupuncture and antiemetic drugs. Ninety percent of trials were open to bias from this source. Twelve trials did not report all outcomes. The opportunities for bias are obvious. In fact, almost all trials of alternative medicines seem to end up with the conclusion that more research is needed. After more than trials, that is dubious.

    It is clear from meta-analyses that results of acupuncture trials are variable and inconsistent, even for single conditions. What would you think if a new pain pill was shown to relieve musculoskeletal pain in the arms but not in the legs? The most parsimonious explanation is that the positive studies are false positives.

    Since it has proved impossible to find consistent evidence after more than trials, it is time to give up.