MD, PhD, FMedSci, FSB, FRCP, FRCPEd

In recent blogs, I have written much about acupuncture and particularly about the unscientific notions of traditional acupuncturists. I was therefore surprised to see that a UK charity is teaming up with traditional acupuncturists in an exercise that looks as though it is designed to mislead the public.

The website of ‘Anxiety UK’ informs us that this charity and the British Acupuncture Council (BAcC) have launched a ‘pilot project’ which will see members of Anxiety UK being able to access traditional acupuncture through this new partnership. Throughout the pilot project, they proudly proclaim, data will be collected to “determine the effectiveness of traditional acupuncture for treating those living with anxiety and anxiety based depression.”

This, they believe, will enable both parties to continue to build a body of evidence to measure the success rate of this type of treatment. Anxiety UK’s Chief Executive Nicky Lidbetter said: “This is an exciting project and will provide us with valuable data and outcomes for those members who take part in the pilot and allow us to assess the benefits of extending the pilot to a regular service for those living with anxiety. “We know anecdotally that many people find complementary therapies used to support conventional care can provide enormous benefit, although it should be remembered they are used in addition to and not instead of seeking medical advice from a doctor or taking prescribed medication. This supports our strategic aim to ensure that we continue to make therapies and services that are of benefit to those with anxiety and anxiety based depression, accessible.”

And what is wrong with that, you might ask.

What is NOT wrong with it, would be my response.

To start with, traditional acupuncture relies of obsolete assumptions like yin and yang, meridians, energy flow, acupuncture points etc. They have one thing in common: they fly in the face of science and evidence. But this might just be a triviality. More important is, I believe, the fact that a pilot project cannot determine the effectiveness of a therapy. Therefore the whole exercise smells very much like a promotional activity for pure quackery.

And what about the hint in the direction of anecdotal evidence in support of the study? Are they not able to do a simple Medline search? Because, if they had done one, they would have found a plethora of articles on the subject. Most of them show that there are plenty of studies but their majority is too flawed to draw firm conclusions.

A review by someone who certainly cannot be accused of being biased against alternative medicine, for instance, informs us that “trials in depression, anxiety disorders and short-term acute anxiety have been conducted but acupuncture interventions employed in trials vary as do the controls against which these are compared. Many trials also suffer from small sample sizes. Consequently, it has not proved possible to accurately assess the effectiveness of acupuncture for these conditions or the relative effectiveness of different treatment regimens. The results of studies showing similar effects of needling at specific and non-specific points have further complicated the interpretation of results. In addition to measuring clinical response, several clinical studies have assessed changes in levels of neurotransmitters and other biological response modifiers in an attempt to elucidate the specific biological actions of acupuncture. The findings offer some preliminary data requiring further investigation.”

Elsewhere, the same author, together with other pro-acupuncture researchers, wrote this: “Positive findings are reported for acupuncture in the treatment of generalised anxiety disorder or anxiety neurosis but there is currently insufficient research evidence for firm conclusions to be drawn. No trials of acupuncture for other anxiety disorders were located. There is some limited evidence in favour of auricular acupuncture in perioperative anxiety. Overall, the promising findings indicate that further research is warranted in the form of well designed, adequately powered studies.”

What does this mean in the context of the charity’s project?

I think, it tells us that acupuncture for anxiety is not exactly the most promising approach to further investigate. Even in the realm of alternative medicine, there are several interventions which are supported by more encouraging evidence. And even if one disagrees with this statement, one cannot possibly disagree with the fact that more flimsy research is not required. If we do need more studies, they must be rigorous and not promotion thinly disguised as science.

I guess the ultimate question here is one of ethics. Do charities not have an ethical and moral duty to spend our donations wisely and productively? When does such ill-conceived pseudo-research cross the line to become offensive or even fraudulent?

9 Responses to Anxiety about an arguably unethical ‘pilot project’ conducted by a British charity

  • I contacted Anxiety UK last month when this first appeared. It was difficult getting information about this trial, but in answer to my questions, I’ve been told:

    Thank you for your interest in our acupuncture pilot project. You would need to become a member to access the pilot project and I’ve attached details of the membership scheme and you can either join online or by calling the office and joining over the phone.

    In order to access our acupuncture pilot project please find attached two forms to complete and details of the locations where we currently are offering this service:

    • A BAcC Referral form
    • Client equality monitoring form

    Please complete the forms and return them to services@anxietyuk.org.uk at your earliest convenience. Once received and payment has been made your referral will be allocated to an Anxiety UK Approved Practitioner who will contact you within two weeks.

    Anxiety UK requires payment up front of £40 to cover the cost of your first and last session of acupuncture. You will pay your practitioner the same rate of £20 per visit for all other sessions.

    PLEASE NOTE: we are unable to process applications without payment having been processed. Payment must be made within 28 days otherwise the referral will be considered as withdrawn.

    We will measure progress against GAD7 & PHQ9 evaluation scores for 4-6 sessions to see how clients improve before and after treatment, the only exclusion is that you must not be receiving any other form of therapy.

    Apologies for the delay but the pilot is unblinded and uncontrolled. This is a feasibility study looking at the possibility of setting up an acupuncture service for members of Anxiety UK. Practitioners will be delivering acupuncture according to their normal approach. REC approval has not been sought.

    I think this raises many serious questions.

  • I sit thinking how acupuncture is one of those Tooth-fairy-therapies that can be endlessly studied and reviewed producing rows upon columns of “Some studies show positive findings indicating there might be some effect so more studies are needed”-type conclusions.
    As long as someone can profit from believing in the theatricals of acupuncture and related acts, we will see attempts at “proving” it.
    Well over hundred reviews are listed in Cochrane library, with consistently negative results if you look past the hopeful secondary speculations it seems. It should be about time for Cochrane collaboration and similar organisations to declare enough is enough?

  • What a great partnership!

    I think anything that gives people with Anxiety and Depression some hope other than drugging them better is fantastic news.

    Let’s hope articles such as this one don’t get in the way of giving those with psychosocial problems something new to try.

    • ‘NEW’ is not a reasonable criterion in medicine; it should be about ‘effective’ and ‘safe’.

    • As someone who depends on medication to manage serious depression and anxiety, and likely will for the rest of my life, the only alternative therapy that might work for me is clocking dribbling cretins who scare the mentally ill away from real medicine and into useless and dangerous quackery. If you’re interested perhaps I should start recruiting for a single-arm unblinded trial?

  • For what it’s worth, I spoke with a lauded Chinese acupuncturist many years ago concerning anxiety. In his learned opinion, after 20 years of practice, acupuncture was rarely successful.

  • I recently saw a facebook advert for a study day for alternative practitioners to learn to use the language of evidence-based medicine. This seems to be of a piece with the “pilot study” described here; creating noise in order to bamboozle desperate and vulnerable people with a simulacrum of science. Clearly what is indicated by this case is a need for more scrutiny of health charities.

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