MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Acupuncture for hot flushes?

What next?

I know, to rational thinkers this sounds bizarre – but, actually, there are quite a few studies on the subject. Enough evidence for me to have published not one but four different systematic reviews on the subject.

The first (2009) concluded that “the evidence is not convincing to suggest acupuncture is an effective treatment of hot flash in patients with breast cancer. Further research is required to investigate whether there are specific effects of acupuncture for treating hot flash in patients with breast cancer.”

The second (also 2009) concluded that “sham-controlled RCTs fail to show specific effects of acupuncture for control of menopausal hot flushes. More rigorous research seems warranted.”

The third (again 2009) concluded that “the evidence is not convincing to suggest acupuncture is an effective treatment for hot flush in patients with prostate cancer. Further research is required to investigate whether acupuncture has hot-flush-specific effects.”

The fourth (2013), a Cochrane review, “found insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms. When we compared acupuncture with sham acupuncture, there was no evidence of a significant difference in their effect on menopausal vasomotor symptoms. When we compared acupuncture with no treatment there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than HT. These findings should be treated with great caution as the evidence was low or very low quality and the studies comparing acupuncture versus no treatment or HT were not controlled with sham acupuncture or placebo HT. Data on adverse effects were lacking.”

And now, there is a new systematic review; its aim was to evaluate the effectiveness of acupuncture for treatment of hot flash in women with breast cancer. The searches identified 12 relevant articles for inclusion. The meta-analysis without any subgroup or moderator failed to show favorable effects of acupuncture on reducing the frequency of hot flashes after intervention (n = 680, SMD = − 0.478, 95 % CI −0.397 to 0.241, P = 0.632) but exhibited marked heterogeneity of the results (Q value = 83.200, P = 0.000, I^2 = 83.17, τ^2 = 0.310). The authors concluded that “the meta-analysis used had contradictory results and yielded no convincing evidence to suggest that acupuncture was an effective treatment of hot flash in patients with breast cancer. Multi-central studies including large sample size are required to investigate the efficiency of acupuncture for treating hot flash in patients with breast cancer.”

What follows from all this?

  • The collective evidence does NOT seem to suggest that acupuncture is a promising treatment for hot flushes of any aetiology.
  • The new paper is unimpressive, in my view. I don’t see the necessity for it, particularly as it fails to include a formal assessment of the methodological quality of the primary studies (contrary to what the authors state in the abstract) and because it merely includes articles published in English (with a therapy like acupuncture, such a strategy seems ridiculous, in my view).
  • I predict that future studies will suggest an effect – as long as they are designed such that they are open to bias.
  • Rigorous trials are likely to show an effect beyond placebo.
  • My own reviews typically state that MORE RESEARCH IS NEEDED. I regret such statements and would today no longer issue them.

2 Responses to Acupuncture for treating hot flushes in breast cancer patients?

  • Even the National Centre for Complementary and Integrative Health uses the trope ” there is not enough evidence on other complementary health approaches for anxiety to draw definitive conclusions about their efficacy” or “the evidence is not convincing to suggest acupuncture is an effective treatment…”.

    What they mean is “there is no plausible evidence that…”
    Why are camists so coy?
    Shoddy use of English – or a deliberate attempt to mislead, misinform, and lie?

  • I predict that more rigorous trials will not show an effect beyond placebo, because neither reason nor solid evidence support the belief that sticking needles randomly into the body cures or relieves every illness known to man and woman. Random it is, because there is no unambiguous practice of acupuncture. Individual practitioners make it up for themselves, in terms of modality – Japanese, Korean etc., acupressure, auricular, electrical etc. – points selected and number of treatment sessions. And, of course, there is no scientific evidence that acupuncture points and consequently meridians, are actual, you know, things! How could such an inane practice possibly work better than placebo? The endogenous opioid thesis is far from being a demonstrated fact, and applies only for pain conditions. Finally, existing rigorous trials conjointly demonstrate the entirely predictable result: acupuncture acts precisely as a placebo acts.

    When trials conclude that further trials are needed, they should spell out clearly and exactly why they are needed, given acupuncture’s conflict with basic science, except possibly for pain conditions. For many acupuncturists, medical trials appear to be part and parcel of their livelihood. They know that acupuncture works, so they set out to obtain scientific confirmation of that fact. That, of course, is the exact opposite of the scientific approach, which tentatively tests hypotheses before determining their worth.

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