MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

It is almost 10 years ago that Prof Kathy Sykes’ BBC series entitled ALTERNATIVE MEDICINE was aired. I had been hired by the BBC as their advisor for the programme and had tried my best to iron out the many mistakes that were about to be broadcast. But the scope for corrections turned out to be narrow and, at one stage, the errors seemed too serious and too far beyond repair to continue with my task. I had thus offered my resignation from this post. Fortunately this move led to some of my concerns being addressed after all, and they convinced me to remain in post.

The first part of the series was on acupuncture, and Kathy presented the opening scene of a young women undergoing open heart surgery with the aid of acupuncture. All the BBC had ever shown me and asked me to advise on was the text – I had never seen the images. Kathy’s text included the statement that the patient was having the surgery “with only needles to control the pain.”  I had not objected to this statement in the firm belief that the images of the film would back up this extraordinary claim. As it turned out, it did not; the patient clearly had all sorts of other treatments given through intra-venous lines and, in the film, these were openly in the view of Kathy Sykes.

This overt contradiction annoyed not just me but several other people as well. One of them was Simon Singh who filed an official complaint against the BBC for misleading the public, and eventually won his case.

The notion that acupuncture can serve as an alternative to anaesthesia or other surgical conditions crops up with amazing regularity. It is important not least because is often used as a promotional tool with the implication that, IF ACUPUNCTURE CAN ACHIVE SUCH DRAMATIC EFFECTS, IT MUST BE AN INCREDIBLY USEFUL TREATMENT! It is therefore relevant to ask what the scientific evidence tells us about this issue.

This was the question we wanted to address in a recent publication. Specifically, our aim was to summarise recent systematic reviews of acupuncture for surgical conditions.

Thirteen electronic databases were searched for relevant reviews published since 2000. Data were extracted by two independent reviewers according to predefined criteria. Twelve systematic reviews met our inclusion criteria. They related to the prevention or treatment of post-operative nausea and vomiting as well as to surgical or post-operative pain. The reviews drew conclusions which were far from uniform; specifically for surgical pain the evidence was not convincing. We concluded that “the evidence is insufficient to suggest that acupuncture is an effective intervention in surgical settings.”

So, Kathy Sykes’ comment was misguided in more than just one way: firstly, the scene she described in the film did not support what she was saying; secondly, the scientific evidence fails to support the notion that acupuncture can be used as an alternative to analgesia during surgery.

This story has several positive outcomes all the same. After seeing the BBC programme, Simon Singh contacted me to learn my views on the matter. This prompted me to support his complaint against the BBC and helped him to win this case. Furthermore, it led to a co-operation and friendship which produced our book TRICK OR TREATMENT.

5 Responses to Acupuncture for surgical conditions?

  • Firstly I would say as an acupuncturist I largely agree that the ‘acupuncture as anaesthesia’ obsession is unhelpful and probably misleading. But it’s a shame when you site publications that aren’t available in the public domain, without providing any details of the results. E.g. who was performing the procedures? What techniques were used? Were there any positive/encouraging results? Anyone stumbling on your post would come away with the impression that this area offers no potential at all, as you haven’t even said that more research of a higher quality is warranted. Would that be the correct conclusion?

    • Which publications are not in the public domain?! The original post links to the PubMed listing of the article Prof Ernst is discussing (click on the words “recent publication”). Here’s the URL for the full piece: http://onlinelibrary.wiley.com/doi/10.1111/ijcp.12372/pdf.

      For how many decades (or centuries) do papers on “alternative” medical approaches need to conclude that more research of a higher quality is warranted? In any case, the Lee & Ernst paper already pays some lip service to this flatulent canard. The penultimate paragraph says: “We recommend that researchers follow the CONSORT guidelines when designing and reporting clinical trials … and we recommend that future SRs [systematic reviews] do so as well to produce high quality SRs.”

      • Sorry, I meant it wasn’t available without payment.

        Surely there shouldn’t be a time limit put on correct, balanced scientific conclusions based on the available evidence? There seem to be a relatively small number of good trials in this area, so plenty of scope for investigation.

        • I didn’t get a paywall for the paper when I looked; but I guess there has to be one because it’s in a Wiley publication. It would be nice if Edzard Ernst (and all other scientists) stopped submitting their work to journals that still charge readers. One day scientists will get smart and publish their work online from their own institutions, allowing comments as the feedback that currently comes from peer reviewers.

          Nobody ever puts a time limit on any experimentation, but for things like acupuncture (a) there is no convincing rationale for its mode of action (if there are qi and meridians please provide the evidence) and (b) the many trials of acupuncture that have been done in various settings end up with at best mild effects. Not a realistic basis for putting more money and effort into research.

          Like most CAM, acupuncture seems to benefit the patient by providing them time with a sympathetic other. Addition of a seemingly erudite background rationale, whether or not it’s supported by any meaningful objective evidence, provides the same strength and comfort as religions, new age gobbledegook and a lot of other “spiritual” modalities. We’re complex systems, and health problems often result from or respond to subjective psychological factors when there is no tangible cause. I know the word “psychosomatic” causes resentment, but we all exhibit a lot of psychosomatic responses to events all the time — weeping, goosebumps, blushing and sexual arousal are examples. It hardly seems remarkable if some medical conditions, e.g. nausea and vomiting whatever the circumstances, chronic pain of all types, don’t contain a psychological component that is helped by sympathetic CAM. The problems arise when firm believers in the various forms of CAM suggest that it can have effects in diseases with well characterized and well evidenced causes.

  • In response to some of your points:

    * regarding rationale, here is a useful summary of ideas: https://chriskresser.com/chinese-medicine-demystified-part-iv-how-acupuncture-works The whole series of articles may help demystify acupuncture and some of the myths and mistranslations that have evolved over the years.

    * Very few trials have been done into what I would call ‘Classical’ acupuncture (see here for some example of developing research – http://www.xinglininstitute.org/current-research.html). Many trials use standardised versions of acupuncture, or practitioners with very little experience, and I am therefore not surprised the results are limited. But even so, the fact that there are well designed studies that show effects beyond placebo should be encouragement to delve deeper, as acupuncture has been shown to be a relatively cheap and safe therapy. I believe we will start to see some very interesting developments over the coming years as more people return to the roots of the therapy and trials are conducted into the older styles of the medicine. That’s not to say I think the TCM style is useless, just limited in comparison to what is possible.

    * I agree entirely that the practitioner’s manner can have a profound influence on results, and it is certainly a strength of CAM that patients tend to feel more listened to and that the process is more collaborative (hopefully WM will find ways of learning from this). But that doesn’t mean nothing else is going on.

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