MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Imagine an area of therapeutics where 100% of all findings of hypothesis-testing research is positive, i.e. comes to the conclusion that the treatment in question is effective. Theoretically, this could mean that the therapy is a miracle cure which is useful for every single condition in every single setting. But sadly, there are no miracle cures. Therefore something must be badly and worryingly amiss with the research in an area that generates 100% positive results.

Acupuncture is such an area; we and others have shown that Chinese trials of acupuncture hardly ever produce a negative finding. In other words, one does not need to read the paper, one already knows that it is positive – even more extreme: one does not need to conduct the study, one already knows the result before the research has started. But you might not believe my research nor that of others. We might be chauvinist bastards who want to discredit Chinese science. In this case, you might perhaps believe Chinese researchers.

In this systematic review, all randomized controlled trials (RCTs) of acupuncture published in Chinese journals were identified by a team of Chinese scientists. A total of 840 RCTs were found, including 727 RCTs comparing acupuncture with conventional treatment, 51 RCTs with no treatment controls, and 62 RCTs with sham-acupuncture controls. Among theses 840 RCTs, 838 studies (99.8%) reported positive results from primary outcomes and two trials (0.2%) reported negative results. The percentages of RCTs concealment of the information on withdraws or sample size calculations were 43.7%, 5.9%, 4.9%, 9.9%, and 1.7% respectively.

The authors concluded that publication bias might be major issue in RCTs on acupuncture published in Chinese journals reported, which is related to high risk of bias. We suggest that all trials should be prospectively registered in international trial registry in future.

I applaud the authors’ courageous efforts to conduct this analysis, but I do not agree with their conclusion. The question why all Chinese acupuncture trials are positive has puzzled me since many years, and I have quizzed numerous Chinese colleagues why this might be so. The answer I received was uniformly that it would be very offensive for Chinese researchers to conceive a study that does not confirm the views held by their peers. In other words, acupuncture research in China is conducted to confirm the prior assumption that this treatment is effective. It seems obvious that this is an abuse of science which must cause confusion.

Whatever the reasons for the phenomenon, and we can only speculate about them, the fact has been independently confirmed several times and is now quite undeniable: acupuncture trials from China – and these constitute the majority of the evidence-base in this area – cannot be trusted. The only way to adequately deal with this problem that I can think of is to discard them outright.

13 Responses to And this is why we might as well forget about Chinese acupuncture trials

  • You might be correct about that :

    “In other words, acupuncture research in China is conducted to confirm the prior assumption that this treatment is effective. It seems obvious that this is an abuse of science which must cause confusion.”

    all cannot be….. positive. (How about the vaccine industry? all vaccines have been shown to be basically safe and effective? One remains skeptical? Or to dismiss all doubts ?)

    Just imagine how your sentence would resonate ——if you say “non effective”.

    “In other words, ………. research in ……….. is conducted to confirm the prior assumption that this treatment is (non) effective. It seems obvious that this is an abuse of science which must cause confusion.”

  • @George: Even *if* all accupuncture trials were positive, you would expect around 5% of them to be false negative due to statistical reasons. Regarding vaccines, they have known and published limitations. For example non of them is 100% effective (nobody claims that, although some of them are in the 90% range) and there are also side effects. But both is tolerable for the gain of protection mediated by these vaccines.

  • It is unfortunate that politics outweigh medical research in China. That is the only way to put it.

    However, it is perhaps more easily recognised if one looks at topics other than medicine. It has long been accepted that certain political systems rewrite history and archaeology to suit their own ends. I just don’t understand why so many people are unwilling to accept that the same happens with medicine – and other branches of science.

    • Politics outweighing science and medical research is widespread throughout much of Asia. If we mention China then we must also mention India because its research output is increasingly being referenced by proponents of sCAM.

      I think it’s far too easy to blame politics. The outweigh likely has far more to do with preserving a sense national pride, which is steeped in ancient traditions. I’d write much more about this, but my writing would require a knowledgable editor to correctly and respectfully convey my message.

  • It would be interesting if someone could do a study on acupuncture trials conducted in the Middle East as well, because from the studies I’ve read, the researchers over there often publish overwhelmingly positive results of acupuncture trials as well.

    What about trial results from other non-Western countries such as Brazil, Turkey, etc? Russian researchers, for example, have also published overwhelmingly positive acupuncture studies. Are they also methodologically flawed like the Chinese? No trial published in Russia/USSR found a test treatment to be ineffective. (http://www.ncbi.nlm.nih.gov/pubmed/9551280)

    I think there’s something unusual going on here.

  • And this is what you call science?

    http://www.ncbi.nlm.nih.gov/pubmed/9551280

    :D

    I do not believe in this article’s findings, it’s pure propaganda… possibly on both ends.

    Instead, do professional studies testing accupuncture, or shut it.

  • Thank you Prof. Ernst.
    Till proof of the contrary, acupuncture has not scientific basis because it is “biased” :-) at its very base, that’s the existence of so called meridians: numerous paths connecting specific aligned skin points to a specific internal organ, face area, sense organ. If you study it with attention, the entire acupuncture meridian system is too much complex and ordered at the same time, that it’s very hard to judge it false. Or better, if it is not false is like Egyptian pyramids: we go to visit them, millions a year, but we cannot know “exactly” what is their original aspect and how they were conceived and used by ancient Egyptians. We cannot bring back the past entirely, because we go toward the future. Before to set new clinical studies on acupuncture efficacy, it would be to demonstrate the existence of the meridians.

    • Stefano Marcelli said:

      If you study it with attention, the entire acupuncture meridian system is too much complex and ordered at the same time, that it’s very hard to judge it false.

      Until there is some good evidence that this ‘meridian system’ even exists, I’m more than happy to judge it false, but why do you believe its complexity and order makes it hard to judge it false?

      Before to set new clinical studies on acupuncture efficacy, it would be to demonstrate the existence of the meridians.

      Why would any new study be different from all previous ones that show acupuncture to be little more than a theatrical placebo?

      • Hi Alan, thank you for revising my statements. I’m studying the acupuncture meridian system for 20 years religiously, and only for a decade scientifically. Question 1: it’s hard to judge it false because it could be applicable also to other mammals, even though ancient Chinese scholars never mentioned vet acupuncture and never draught points charts for other mammals. Please take a look here: http://tinyurl.com/p9xmlg9. Question 2: I said that acupuncture studies, both of clinical and experimental type, are biased because researchers are not independent and take meridians as granted. Skin points could have certain effects as they have different anatomies, and not because they pertain to given lines. Generally acupuncturists follow pricking instructions from their bibles and priests, non differently from other believers, in God, Jupiter or Shiva. That means “in absence of proofs”. With possible proofs the method of pricking could change and conversely its actually very poor effectiveness. It’s a “possibly”. I do not possess the truth, and all truths of mankind are relative, time-based, anyway. We individuals seems to be not too much different from the leaves of a deciduous tree. Regards.

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