Gastro-oesophageal reflux disease (GORD) is a common, benign condition. It can be treated by changing eating habits or drugs. Many alternative therapies are also on offer, for instance, acupuncture. But does it work? Let’s find out.
The objective of this meta-analysis was to explore the effectiveness of acupuncture for the treatment of gastro-oesophageal reflux disease (GORD). Four English and four Chinese databases were searched through June 2016. Randomised controlled trials investigating the effectiveness of manual acupuncture or electroacupuncture (MA/EA) for GORD versus or as an adjunct to Western medicine (WM) were selected.
A total of 12 trials involving 1235 patients were included. The results demonstrated that patients receiving MA/EA combined with WM had a superior global symptom improvement compared with those receiving WM alone with no significant heterogeneity. Recurrence rates of those receiving MA/EA alone were lower than those receiving WM with low heterogeneity, while global symptom improvement (six studies) and symptom scores (three studies) were similar. Descriptive analyses suggested that acupuncture also improves quality of life in patients with GORD.
The authors concluded that this meta-analysis suggests that acupuncture is an effective and safe treatment for GORD. However, due to the small sample size and poor methodological quality of the included trials, further studies are required to validate our conclusions.
I am glad the authors used the verb ‘suggest’ in their conclusions. In fact, even this cautious terminology is too strong, in my view. Here are 9 reasons why:
- The hypothesis that acupuncture is effective for GORD lacks plausibility.
- All the studies were of poor or very poor methodological quality.
- All but one were from China, and we know that all acupuncture trials from this country are positive, thus casting serious doubt on their validity.
- Six trials had the infamous ‘A+B versus B’ design which never generates a negative result.
- There was evidence of publication bias, i. e. negative trials had disappeared and were thus not included in the meta-analysis.
- None of the trials made an attempt to control for placebo effects by using a sham-control procedure.
- None used patient-blinding.
- The safety of a therapy cannot be assessed on the basis of 12 trials
- Seven studies failed to report adverse effects, thus violating research ethics.
Considering these facts, I think that a different conclusion would have been more appropriate: this meta-analysis provides no good evidence for the assumption that acupuncture is an effective and safe treatment for GORD.
2 Responses to Acupuncture for gastro-oesophageal reflux disease? Nine reasons why I don’t think so
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Just wonder how much money would be saved if people can just accept that acupuncture is a placebo.
I see that some of the authors are from Beijing University of Chinese Medicine (BUCM). This university has been tasked with internationalisation of TCM including acupuncture, and therefore they will never report a negative result. For them TCM is not medicine, it is culture.
They have a finger in the pie all over the world. For example they are involved in Germany’s first ever TCM Hospital (http://www.tcm-klinik-koetzting.de/tcmen/tcm-klinik/index.php) and they are ‘assisting’ my former employer in setting up something similar in Sydney. https://frankvanderkooy.com/2017/05/16/western-sydney-universitys-wikipedia-page-updates-needed-a-new-tcm-hospital-coming-soon-in-sydney
I believe that they are also active in other EU countries as well
Xi Jinping has ordered – by law – that TCM and “western medicine” be given equal emphasis; that scientific technologies be untilized to promote TCM theories and practice, and that the integration of western and TCM medicine also be promoted. (My scare quotes. See Article 3, Order No. 59 of the President.)
What status does the President consider RCTs, systematc reviews, meta-analyses etc. to have? Western? Scientific? Integrated? Who can know for sure?
Chinese producers of such things must be mindful of Xi Jinping’s law. They wouldn’t want to break the law, deliberately or carelessly, I’m sure.
All things considered I don’t think we should expect a stream of RCTs etc. to emerge from China demonstrating TCM to be anything less than equal to “western” medicine.
The authors of this meta-analysis can probably rest easily in their beds, although their caveat that further studies are required to establish the efficacy of acupuncture for GORD, does rather pass the buck on.