MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

A comprehensive review of the evidence relating to acupuncture entitled “The Acupuncture Evidence Project: A Comparative Literature Review” has just been published. The document aims to provide “an updated review of the literature with greater rigour than was possible in the past.” That sounds great! Let’s see just how rigorous the assessment is.

The review was conducted by John McDonald who no stranger to this blog; we have mentioned him here, for instance. To call him an unbiased, experienced, or expert researcher would, in my view, be more than a little optimistic.

The review was financed by the ‘Australian Acupuncture and Chinese Medicine Association Ltd.’ – call me a pessimist, but I do wonder whether this bodes well for the objectivity of the findings.

The research seems to have been assisted by a range of experts: Professor Caroline Smith, National Institute of Complementary Medicine, Western Sydney University, provided advice regarding evidence levels for assisted reproduction trials; Associate Professor Zhen Zheng, RMIT University identified the evidence levels for postoperative nausea and vomiting and post-operative pain; Dr Suzanne Cochrane, Western Sydney University; Associate Professor Chris Zaslawski, University of Technology Sydney; and Associate Professor Zhen Zheng, RMIT University provided prepublication commentary and advice. I fail to see anyone in this list who is an expert in EBM or who is even mildly critical of acupuncture and the many claims that are being made for it.

The review has not been published in a journal. This means, it has not been peer-reviewed. As we will see shortly, there is reason to doubt that it could pass the peer-review process of any serious journal.

There is an intriguing declaration of conflicts of interest: “Dr John McDonald was a co-author of three of the research papers referenced in this review. Professor Caroline Smith was a co-author of six of the research papers referenced in this review, and Associate Professor Zhen Zheng was co-author of one of the research papers in this review. There were no other conflicts of interest.” Did they all forget to mention that they earn their livelihoods through acupuncture? Or is that not a conflict?

I do love the disclaimer: “The authors and the Australian Acupuncture and Chinese Medicine Association Ltd (AACMA) give no warranty that the information contained in this publication and within any online updates available on the AACMA website are correct or complete.” I think they have a point here.

But let’s not be petty, let’s look at the actual review and how well it was done!

Systematic reviews must first formulate a precise research question, then disclose the exact methodology, reveal the results and finally discuss them critically. I am afraid, I miss almost all of these essential elements in the document in question.

The methods section includes statements which puzzle me (my comments are in bold):

  • A total of 136 systematic reviews, including 27 Cochrane systematic reviews were included in this review, along with three network meta-analyses, nine reviews of reviews and 20 other reviews. Does that indicate that non-systematic reviews were included too? Yes, it does – but only, if they reported a positive result, I presume.
  • Some of the included systematic reviews included studies which were not randomised controlled trials. In this case, they should have not been included at all, in my view.
  • … evidence from individual randomised controlled trials has been included occasionally where new high quality randomised trials may have changed the conclusions from the most recent systematic review. ‘Occasionally’ is the antithesis of systematic. This discloses the present review as being non-systematic and therefore worthless.
  • Some systematic reviews have not reported an assessment of quality of evidence of included trials, and due to time constraints, this review has not attempted to make such an assessment. Say no more!

It is almost needless to mention that the findings (presented in a host of hardly understandable tables) suggest that acupuncture is of proven or possible effectiveness/efficacy for a very wide array of conditions. It also goes without saying that there is no critical discussion, for instance, of the fact that most of the included evidence originated from China, and that it has been shown over and over again that Chinese acupuncture research never seems to produce negative results.

So, what might we conclude from all this?

I don’t know about you, but for me this new review is nothing but an orgy in deceit and wishful thinking!

27 Responses to A new, comprehensive review of acupuncture turns out to be an orgy in wishful thinking

  • Indeed, and that is why the authors and those who assisted them ‘strangely’ comes from three Aus universities – Western Sydney University, RMIT (Melbourne) and Sydney University of Technology – all of whom have recently been implicated in ‘colluding’ with the Chinese Communist Party to internationalise TCM (incl acupuncture) in Aus. They are the classical ‘promotional researchers’ for which WSU won the Oscars (Bent Spoon Award) for quackery recently.

    You can read about their endeavours here;

    https://frankvanderkooy.com/2017/11/01/china-power-and-influence-part-1-tcm-and-the-aussie-academics-who-sold-their-souls/

    https://frankvanderkooy.com/2017/11/29/china-power-and-influence-part-2-tcm-and-the-role-of-the-australian-prime-ministers/

    • The National Institute for Complementary Medicine at Western Sydney Univeristy, should be renamed the National Institute for TCM.

      I managed to cull one single research project, past or present, of an indigenous medicine of Australia:
      Most Afia Akhtar, Australian native plants – a source of novel anti-inflammatory compounds.

      All credit to the young woman. Her research appears to be pharmacology based rather than confirmation-seeking bias.

      What a lonely path she treads.

      In Melbourne things are equally shameful. The WHO Collaborating Centre for Traditional Medicine is misnamed. The word “Chinese” is missing. The Centre is entirely devoted to TCM. Indigenous traditional medicine is invisible to Australian medical academia.

      Traditional Australian medicines exist but they are disappearing.

      By contrast, WHO Collaborating Centres in Vietnam, Japan and Korea all actively promote integration of their indigenous traditional medicines with modern medicine.

      Australia has handed over two Universities to promote a foreign traditional medicine rather than promote its indigenous traditional medicine.

      I can’t think of any reason why this should be, except commercial reasons. TCM has serious financial clout which aboriginal medicine has not.

      There are seven WHO Collaborating Centres in China and two more in Hong Kong and Macao all promoting TCM. Australia appears to want some of the action.

      TCM = $s. Under the pretext of the WHO’s policy of integrating traditional and modern medicine, TCM is carving out a world wide market for itself.

      I have no problem with academia genuinely studying traditional medicines to find out if they really work. Many excellent drugs have resulted from such research.

      What is going on in the WHO driven programme of integrating modern and traditional medicine is being gamed by those who make money out of it.

      • I was too hasty in saying that indigenous traditional medicine is invisible to Australian medical academia.

        There is some social research in use of indigenous Australian medicine at University of Technology Sydney, and there may be other relevant research in the country.

      • Because the NICM is right next to the Australian Botanic gardens I started a major drug screening exercise. The plan was to collect up to 2000 native plants and test against HIV, malaria etc I managed to get about 350 screened and it did yield a couple of very good leads.

        But then unfortunately I had to resign (i believe that I was even Afia Akhatar’s co-supervisor)

        So if anyone in Aus wants the screening results and want to continue please send me an email.

        • That kind of practical botanical-medicinal research makes perfect sense. By all means let us integrate traditional employment of medicinal plants with modern rigorous scientific methods of analysis. An out-of-Australia wonder drug could be out there in the bush somewhere – or even in the park!

          Instead the Collaborating Center has hived itself off to Chinese junk-medicine merchants.

          • That is how they discovered artemisinin.
            Problem is, that it takes a huge amount of effort, time and money with the risk being that you might end up empty handed. Because of this, WSU have decided to skip the science part and allow acupuncturists and TCM practitioners to use a Uni setting to promote their dark arts in exchange for easy funding. They have been extremely successful with this model. My fear is that other (better) unis in Aus will see that WSU is actually getting away with it and will start to follow their lead.

          • The fact is that TCM is a commercial product, like homeopathy. These products happen to be fake medicines. There is sub-industry in “research” in these products. Such decent evidence as exists shows the products to be fake medicines. However, the research goes remorselessly on and on and on. It’s become a marketing tool – as well as a nice little extra earner.

            This milking of an unsuspecting public will only stop when the medical profession loudly calls the fake medicines out. Meanwhile, many unscrupulous institutions are jumping aboard the gravy train.

            It’s sick.

  • The easily discovered initial bias of course immediately throws the whole thing into disrepute, which makes one wonder why these absurdities keep being published.
    The answer obviously is that there exists a ready market consisting of people who are absolutely determined to believe, in the face of disqualifying data such as mthe existing connections of those conducting the ‘research’.
    People of a religious mindset, in other words.The recently- departed Yvonne being a good example.

  • I’ve actually called these three universities (WSU, RMIT and UTS) the Australian ‘Hogwarts Schools of Magic’ – for their support of magic. And funny enough they even have ‘Quidditch’ teams where impressionable teenagers learn how to ‘fly’ with a broom between their legs, without smoking anything – so why doesn’t acupuncture work again?

    https://frankvanderkooy.com/2017/10/25/the-hogwarts-school-of-magic-is-not-real-why-then-do-australia-accredit-schools-of-magic/

    • I have seen and witnessed what the acupuncturist frankly called ‘Non traditional acupuncture.’ meaning he stuck the needles anywhere and found a positive result. All hokum, smoke and mirrors? Of course. But wait! I saw on TV a Vet using acupuncture on the hind leg to operate on a dog for a chronic dislocation of his legs . The dog seemed unperturbed. Clearly a tough guy! No particular evidence of course for effectiveness but interesting!

  • Hi, professor, I’d like to know if you have any thoughts on this trial:

    https://www.eurekalert.org/pub_releases/2017-12/s-asr112817.php

    That used, as far as I can say, this protocol:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705910/

    I wasn’t able to find the final paper, but the non-blinding of the acupuncturists throws the whole thing out, doesen’t it?

    • I would be reluctant to conclude that it proves the efficacy of acupuncture for the following reasons:
      – patients are assumed to be blinded [unaware of the treatment arm they were randomised to]. I would argue that this is not necessarily the case because a) real acupuncture elicited ‘de chi’, while sham acupuncture did not, b) sham acupuncture was shallow, while real acupuncture was not which is visible to the patient. unless the investigators did test the success of blinding patients [and they did not include this as part of their methods], we have to assume that many patients were de-blinded, which means their expectations alone can explain much of the findings.
      – acupuncturists were obviously not blinded. this means their verbal and non-verbal communication with the patients would have influenced the outcome. and they certainly had an interest in a positive result.
       
      from the little I have seen I fear that this is yet another trial suggesting that acupuncture is a ‘theatrical placebo’

  • Hello!

    I’m new this to crew. I recently commented on an old post not believing this blog was still being updated. My mistake! I seem to be on the complete other end of this spectrum in these discussions. NIH ie. NCCAM and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) did a clinical study in 2014 on acupuncture. I’m not sure if you’ve read the study but is that hogwash as well? This is an honest question–to be clear.

    I find these discussions interesting since I’ve begun studying for my PhD in Nutrigenomics. This isn’t to suggest that I know all there is to know about acupuncture but I have found and read studies that correlate much of these alternative medicines with newer studies on how nutrition effects genetic health, for example, the body’s ability to copy genetic data correctly and effectively or in how the body creates antibodies to fight off “foreign matter” which are common causes to “awakening” or erasing allergies.

    But, perhaps this blog is limited to acupuncture only?

    • I do not understand your comments – is it not clear what this blog is about? can you not see that there are multiple new posts every single week?

    • @Yasmin

      It is customary to provide a reference so others can discuss your arguments without first having to guess what you are referring to. I had a quick but unsuccessful look with my morning mug of coffee in hand, at what NIAMS etc. might have produced in 2014. Might you be referring to this work from 2004 and mistaking a reference to it from alternative branch media in 2014 to indicate the date of publication?

      Did you read that study yourself? It is perhaps not fair to use the term “hogwash” but if you had followed this blog for a while, you would have learnt how clinical studies like this can be set up to secure an outcome that can be interpreted to support your set assumptions. When I come back from work I look forward to have a look at your reference.

    • Welcome, Yasmin. Good luck with your PhD.

      You have the potential to add refreshing novelty to the discussions on this blog. But perhaps maybe you could invest 10 minutes of your time looking over the posts and comments before you write your stuff? Oh, and please do ask your PhD supervisor what training you can get in critical thinking.

    • Acupuncture is hogwash. That is an honest answer for you, to be clear. I know enough about the extensive clinical literature on acupuncture, to provide you with this honest answer.

      Professor Ernst knows a lot more than I do about the available evidence for acupuncture and many other CAM modalities – his job having been to assess such evidence as well as conduct research of his own. I don’t know of any more honest voice than his on this subject.

      I suggest you browse his site at your leisure and hope you will be the more enlightened for it.

  • I might have posted this abstract before, but it is just so hilarious, I have to post it again. This is how the NICM explains a negative acupuncture result – enjoy.

    Case report: Reflections on practitioner confidence in treating nausea and vomiting in pregnancy

    Australian Journal of Acupuncture and Chinese Medicine
    Volume 8 Issue 2 (2013)
    Grant, Lori-Ellen; Cochrane, Suzanne1

    Abstract: This case report describes a 25-year-old woman who presented with nausea and vomiting (NVP) in her seventh week of pregnancy. The treatment was not successful overall and resulted in both patient and practitioner losing confidence. The following reflective questions challenged my practice and led to an examination of what makes acupuncture work. – Why, after a course of acupuncture, did the nausea and vomiting continue? – What led to a loss of confidence in the effectiveness of acupuncture to treat this ailment? Multiple traditional Chinese medicine (TCM) research reviews show some benefit for nausea and dry retching using acupressure and acupuncture, and limited results for vomiting. Despite this, I found that my confidence was undermined by being out of touch with my own inner knowing or Yi. I needed to encourage the patient (‘Laura’) to take more responsibility for her own health and we both needed clarity around the treatment result expected.

    https://search.informit.com.au/documentSummary;dn=696093096278711;res=IELHEA

  • To summarise:

    We mustn’t blame the treatment – that can’t be wrong – the patient must accept responsibility for the failure of a treatment which is known to work – but perhaps not quite in the way we thought it was to supposed to. The same way prayer always works – but not necessarily the way you want, when you are praying. You may want not to die and pray for that but now you are dead and in a better place you realise that your prayer was misguided because you find out that you are totally happy with being dead. Your prayer was answered by the one who knows all. Can’t argue with that.

    Since acupuncture similarly is infallible, the fault must lie with us miserable specimens.

    • @LJ: Oh Wow what pith! Pope Frank may be calling to have you pen an article for Vatican Monthly….or perhaps have you surreptitiously offed by a dedicated Catholic-acupuncturist for undermining the catechism.
      Didn’t Garth Brooks similarly opine:
      “just because he doesn’t answer don’t mean he doesn’t care…
      Some of gods’ greatest gifts are unanswered prayers”…?
      His others being childhood cancer, cleft palate, drought and traditional Chinese Medicine I believe.

  • After reading this, one assumes that the esteemed Professor thinks that any finding of beneficial effect in research of acupuncture is ipso facto proof of that research’s invalidity a priori.

  • Richard, you assume, “one” doesn’t.

    Can you address Edzard’s criticisms of the report?

    If not, ipso facto, your tuppence worth ain’t worth a ha’penny.

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