Mar 31 2014

Acupuncture – Science as Promotion

Almost weekly I see a new press release about an acupuncture study claiming benefits. While I have written extensively about acupuncture previously, and will continue to cover the topic, I can’t cover every little study that comes out. Most of the studies are utterly useless – they contain no control group, they are effectively pilot studies, they are of “electroacupuncture” (which is really just transdermal electrical nerve stimulation pretending to be acupuncture), or they are looking at some dubious biomarker rather than objective clinical outcomes.

Occasionally, however, an acupuncture study deserves a mention, in this case because it is particularly abusive.

Rachael Dunlop, my skeptical colleague from down under, sent me a report of an acupuncture study performed in Melbourne. News outlets are reporting the study at face value, in typical gushing terms, stating that “acupuncture is just as effective as drugs in treating back pain and migraine.”

It seems to me that this is the actual purpose of such studies – to produce positive news coverage. They are not designed to actually answer the question of efficacy.

In this case I can’t delve deeply into the methods and results, because the study has not yet been peer-reviewed and published. That’s right, the authors pulled a Pons and Fleischmann and announced the results of their study prior to publication.  This lends further to the appearance that the purpose of the study was the press release, not the data.

This is inappropriate for obvious reasons. The media now has to essentially take the authors words for what was in the study. It is difficult for them to interview experts not involved in the study on what it shows, because those experts don’t have access to the study. Who knows if the study will even be published.

Further, we already have a problem with the media sensationally reporting every preliminary finding as if it is a breakthrough. This is only worsened when we extends the press releases to unpublished results.

What we do know about the study is that it contained three arms: 1) standard medical treatment of pain, 2) acupuncture alone, 3) medical treatment plus acupuncture. The study was conducted in four emergency departments in Melbourne.  The authors are claiming that in their study acupuncture was as effective as drugs for back pain, sprained ankles, and migraine.

I, of course, have lots of questions about the protocol. For example, did the “acupuncture alone” migraine patients also get IV hydration? Perhaps this wasn’t considered a significant intervention, but hydration alone has the potential to significantly improve many ER migraine cases. It would be unethical to withhold something as basic as IV fluids for a dehydrated patient.

There are many potential problems with the study. How many outcomes did they measure, for example. Were there any objective outcome measures, or only subjective pain?

While such questions are important, the are mostly trumped by the one thing we do know about this study – there was no acupuncture control group. The study was unblinded, so everyone in the study knew if they were getting acupuncture or not. An unblinded study for a subjective outcome like pain is virtually guaranteed to generate a false positive. It cannot possibly decide the question of efficacy.

This brings me back to my original question. After thousands of acupuncture studies have been published, including many well-controlled studies with sham or placebo acupuncture, why would anyone want to go back to doing a preliminary unblinded acupuncture study that could not possibly settle any scientific questions about acupuncture?

Imagine if you will a pharmaceutical company doing an unblinded study of one of their drugs with a subjective outcome and then announcing  in a press release how wonderfully effective their drug was, before the study was even published. What if the same drug had already been shown to be ineffective in better studies that were blinded and controlled?


The current acupuncture study, even with the little information we are given, seems completely worthless. It may have been a reasonable pilot study thirty years ago, but there is simply no place for such a study at this time, after thousands of studies on acupuncture have already been published.

The only possible purpose of the study is to generate false positive results and then use those results as propaganda to promote acupuncture. Such a conclusion would be obvious if this were a pharmaceutical company doing something similar for one of their drugs.

I also think the press is irresponsible for even reporting this study. They should have waited until it was published and independent experts had a chance to peer-review the study.

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