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Acupuncture on the NHS?!

digital goldfish

Thinker
D
Joined
Jan 8, 2004
Messages
154
From today's Metro:

Acupuncture for migraine sufferers is effective and should be expanded across the NHS, scientists say. They tested 400 patients for a year, giving half acupuncture once a month and half NHS medication. The former took 15 per cent less medication, made 25 per cent fewer visits to their GP and ook 15 per cent fewer days off sick. The US-led team told the British Medial Journal that the cost of treating the acupuncture group was £403 - against £217 for the others, but the benefits justified the cost. Acupuncture involves diverting energy channels that flow through the body
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So..Personally, without seeing the study, i wouldn't like to comment, but my experience of migraines, and migraine sufferers, is that generally migraines can be controlled through relaxation techniques, and therefore, although there may be medicine available, which clearly helps, this experiment is no different to the homeopathic ones, where it is a placebo....but what do i know?!

edited to add: link to paper: http://bmj.bmjjournals.com/cgi/repr...DEX=0&sortspec=relevance&resourcetype=1,2,3,4
 
Limitations from the paper:

Control patients did not receive a sham acupuncture
intervention. One hypothesis might be that the effects seen in the
acupuncture group resulted not from the physiological action of
needle insertion but from the “placebo effect.” Such an argument
is not relevant to an assessment of the clinical effectiveness of
acupuncture because in everyday practice, patients benefit from placebo effects. None the less, good evidence from randomised
trials shows that acupuncture is superior to placebo in the treatment of migraine.7 16 Furthermore, this study was modelled on Vincent’s earlier double blind, placebo controlled trial in
migraine,17 which makes direct comparison possible. If placebo
explained the activity of acupuncture we would expect patients
in our control group, who received no treatment, to experience
smaller improvements than Vincent’s placebo treated controls,
leading to a larger difference between groups. However,
improvements in our controls (7.1% from a baseline headache score of 26.7) were similar to those in Vincent’s trial (10.5% from
27.2) and differences between groups are non-significantly
smaller in the current trial (4.1 v 8.1). This implies that our findings
perhaps cannot be explained purely in terms of the placebo
effect. That said, we are unable to rule out such an explanation
given our lack of placebo control.

Patients in the trial were not blinded and may therefore have
given biased assessments of their headache scores. Measures to
minimise bias included minimum contact between trial
participants and the study team, extended periods of anonymised diary completion and coaching patients about bias.
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So they haven't ruled out placebo, but don't think it's a factor.. I'm beginning to understand how difficult it is to conduct a fully controlled trial...
 
...made 25 per cent fewer visits to their GP...
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This sort of treatment is especially effective on us skeptics. If we visit the GP and they 'treat' us by homeopathy, acupuncture and other quack techniques, then we will be less likely to return for further 'treatment'.
 
[Edited for correction]
Another poorly controlled trial. I already know of people with migraines whom acupuncture was a total failure, and ended up costing the victms thousands of dollars. This is flagrant promotion of fraud. Acupuncturists have not even established that acupuncture points exist, and have lied about its effectiveness in the past, especially in arthritus, as well as many other disorders. For those of you who do not remember, this was all the rage in the late 1980´s. Now they tend to avoid the subject.
 
Quasi said:
This is a total lie. In the study, they did not just treat with acupncture, but also with a quiet, dark room. This is the stadard treatment for non pharmaceutical intervention of migraines. I know someone who suffers from chronic migraines, they spent over 5000 USD on acupuncture, and no effects whatsoever, and this from a "well known" licensed acupuncturist. Another total lie is that it costs less. The cost of all the worthless trinkets, plant garbage, and other consumables, in addition to the work time lost is enormous compared to proven pharmaceutical intervention. Complete liars all around. Of course, there is the Randi one million, which they should be able to win easily. Come on, prove me wrong. (/Crickets chirping.)
Unless you have been to or know someone practicing TCM, the article is extremely deceiving. In reality, TCM practitioners receive no real medical training, and instead are merely distributors for various quack products. To date, there has not been a single science based human clinical trial that shows any benefit at all from acupuncture, period.
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OK, you may very well be right, but it's not referred to in the study if they did. Also, i think you may have misread the article. it quite cleraly says that acupuncture costs twice as much than normal treatment, but that they think the benefits out-weigh the costs. As stated above, i am always dubious about such studies, but haveing read the study itself, it appears kosher.
 
digital goldfish said:



OK, you may very well be right, but it's not referred to in the study if they did. Also, i think you may have misread the article. it quite cleraly says that acupuncture costs twice as much than normal treatment, but that they think the benefits out-weigh the costs. As stated above, i am always dubious about such studies, but haveing read the study itself, it appears kosher.
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Yes, sorry, I edited it. I kind of jumped the gun here. I thought this was the recent US marketing push for acupuncture in migraines, but it was a different "study." I have read the article now, however I am still not convinced as I know of the failure of this therapy already, it looks very suspicious. This burst of advertising, as above, reminds me of acupuncturists pushing it onto arthritus sufferers. Same scam here, and the researchers make it sound so respectable! I think they give away free rose colored glasses to every MD that buys into this garbage. I am willing to admit I am wrong again if they win the Randi 1 million.
 
Quasi said:


Yes, sorry, I edited it. I kind of jumped the gun here. I thought this was the recent US marketing push for acupuncture in migraines, but it was a different "study." I have read the article now, however I am still not convinced as I know of the failure of this therapy already, it looks very suspicious. This burst of advertising, as above, reminds me of acupuncturists pushing it onto arthritus sufferers. Same scam here, and the researchers make it sound so respectable! I think they give away free rose colored glasses to every MD that buys into this garbage. I am willing to admit I am wrong again if they win the Randi 1 million.
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Well, i suggest people read the study itself and come to their own conclusions. If indeed it's entirely correct, maybe a few people can email/write to the BMJ and suggest they do further studies, with the jREF in mind. I suspect however, their argument will be that they simply don't have time, and that 400 people over a year period on an RCT basis is good enough.. we shall see..
 
I suspect that this will be promoted, will fail, then will be forgotten. In a few years the next acupuncture treatment will be advertised via uncontrolled trials, then failure, and the cycle will start again. I am more than willing to be proven wrong, I know how hard it is to live with migraines. At least I hope the results will be tracked, and that the results can be known over time. The governments insistence that pharmaceuticals be virtually absolutely safe, and then allow this nonsense to be fully implemented on sketchy data is beyond me.
 
There's a two page spread on this story in The Independent today and online here.

This caught my eye:-
The results were strong enough for researchers from the Royal London Homoeopathic Hospital, who helped to organise the trial, to urge the NHS to consider an immediate expansion of acupuncture services paid for by the taxpayer.
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'Self-interest' was the first word that came to mind upon reading that.

STJ
 
Thanks for that! I'm incredibly skeptical about these trials. I guess the point of publishing it in a peer reviewed paper is that someone else can have a go, and replicate the results.. We shall see what happens.
 
Acupuncture for Recurrent Headache
Clinical bottom line: There is no evidence from high quality trials that acupuncture is effective for the treatment of migraine and other forms of headache. The trials showing a significant benefit of acupuncture were of dubious methodological quality. Overall, the trials were of poor methodological quality.

Given the very small size of most trials, and their inadequate quality, the best conclusion is that there is no evidence for any effect of acupuncture in headache, unless and until someone does a large high quality trial that proves the opposite.
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It's possible that this might actually be the "large high quality trial that proves the opposite", but permit me to remain sceptical for a little longer.

They might also like to consider:

Harm from acupuncture
Comment: This refreshing little review points out that the seemingly innocuous, if done improperly or without care, can result in serious harm. The numbers of patients harmed by acupuncture in this literature review is difficult to assess, but runs into the hundreds. Choosing acupuncture because it is deemed harmless may be a poor choice.
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PS. "Researchers from the Royal Homoeopathic Hospital...." See how these woo-woos support one another! I don't suppose the homoeopathic "researchers" could turn their hands to showing whether their own remedies have any effect above placebo - or are inactivated by allopathic medication, or coffee, or the contraceptive pill, or airport security scanners, or even if some homoeopathic pharmacies are selling dud products (all excuses put forward for the apparent failure of homoeopathic treatments). Or even if they can distinguish their prepared remedies from the stock solvent (and win the million bucks, as an aside). No, can't do that, but let's all weigh in to support our colleagues, the acupuncturists.

Rolfe.
 
acupuncture? harmless? maybe it is viable, but it's as harmless as any invasive procedure. Break the skin, risk localized infection, blood clot, lung puncture, lost needles, hepatitis, nerve damage yadda yadda.... being treated by people who don't understand more than very basic anatomy, practiced by people who can't agree from one practice to another where the needles (or pressure) should be placed, or what benefit goes on, to what degree, who can't even put togther a viable double blind study..... must calm down...
 
Given that some members of the public 'believe' in acupunture, how is it possible to devise a trial to test whether it works or not? Either you stick needles in people, or you don't, so people presumably know whether they've undergone the treatment or not. I don't see how you can eliminate the placebo effect here.

I suppose if people were anesthetized during the acupuncture, and the acupuncture needles leave no tell-tale signs of having been inserted, then blinded trials might be possible, but I guess it would be considered unethical to subject even volunteers to unnecessary anesthetization.

Maybe animal trials would allow something to be proved (without anesthetics) as presumably animals would not be influenced by any acupuncture belief system. I suppose some animals suffer from migraine, and there is a method of measuring when they are suffering a migraine attack, and its severity?
 
ceptimus said:
Given that some members of the public 'believe' in acupunture, how is it possible to devise a trial to test whether it works or not? Either you stick needles in people, or you don't, so people presumably know whether they've undergone the treatment or not. I don't see how you can eliminate the placebo effect here.
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They've tried to get acupuncturists to agree on "non-acupuncture" sites where needling wouldn't be expected to show an effect, but that's hard as they can't agree on such sites. But it's one approach, members of the public probably understand even less about the correct place to put the needles than the acupuncturists do. So they wouldn't know if they were getting the real thing or the wrongly-placed needles.

The other thing they've tried is fake needles that retract into the handle, like stage daggers. The touch of the end on the skin is postulated to be hard to distinguish from a very fine needle going in.

It's not perfect, but at least some attempt is being made.

Rolfe.
 
ceptimus said:
Maybe animal trials would allow something to be proved (without anesthetics) as presumably animals would not be influenced by any acupuncture belief system. I suppose some animals suffer from migraine, and there is a method of measuring when they are suffering a migraine attack, and its severity?
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I don't think migraine can be diagnosed in animals. However, they do use acupuncture for other purposes.

Read here what a veterinary acupuncturist thinks he's doing and how he explains it. (That an allegedly qualified and experienced acupuncturist finds it necessary to spout such woo-woo says about as much as one needs to, in my opinion.)

Rolfe.
 
When I see statements like this:
Acupuncture involves diverting energy channels that flow through the body
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I have every reason to distrust the entire article.
 
I just saw the article on the acupuncture study on another website and was about to post it here but as usual someone beat me to it. My first thought was gee, the lack of a placebo is pretty blatant, isn't it? I guess I'd have to read the whole paper to know all the details but the article I read (on cnn.com) basically said that one group got regular treatment while the other group got regular treatment plus acupuncture. Can that really be what happened? It almost doesn't even seem worthwhile going to the trouble of doing a study if it's going to be done like that.

It'll be interesting to see what the reaction to it is. The article on cnn.com was pretty authoritative, many people will believe acupuncture works for headaches after reading the article. If they can show it works repeatedly in well designed studies then fine but I can't help but be skeptical when (or if) they didn't take the pretty obvious step of having a placebo.
 
arcticbiker said:
http://www.cbc.ca/stories/2004/03/15/canada/acupuncture_montreal040315

"The Quebec government wants 1,144 people who underwent treatment at an acupuncture clinic in Montreal to undergo a blood test for HIV and hepatitis."

Apparently, accupuncture can be harmful if the needles aren't properly sterilised...
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What do you expect? Acupuncturists do not believe in HIV, hepatitus, or other "germ theory" problems. Its all in the chi, and its flow through the meridians.
 
I've wondered that in the past. In healthcare, reused surgical instruments (just about any reused medical instrument used in some form of invasive procedure)have to be sterilised in an autoclave between uses. There are faily strict requirements about the autoclave settings etc.

Are acupuncturists required to follow the same standards?
 
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