The UK ACUPPUNCTURE RESEARCH RESOURCE CENTRE (ARRC) is a specialist resource for acupuncture research information; the only such resource in the land. It is funded by the British Acupuncture Council (BAcC) and was established in 1994 by the BAcC in partnership with the Foundation for Research in Traditional Chinese Medicine.
The ARRC organise an annual meeting. This year’s meeting is special because it is their 20th! It is scheduled to take place in London on 17th March. In case you are already busy that day, or you want to save the £120 registration fee, I have copied for you the programme below and am even able to inform you about the content of each lecture.
- Hugh MacPherson – Celebrating twenty years of acupuncture research
- Lee Hullender Rubin – The Impact of Whole Systems Traditional Chinese Medicine on In Vitro Fertilization Outcomes – A Retrospective Cohort Study
- Robert Davis – Beyond Efficacy: Conducting and translating research for policy-makers considering acupuncture reimbursement in a small, rural US state
- Lee Hullender Rubin – Acupuncture Augmentation of Lidocaine Treatment of Provoked, localized Vulvodynia – a Feasability and Acceptability Pilot Study
- Florian Beissner – A TCM-based psychotherapy with acupuncture for endometriosis
- Beverley De Valois – Using moxa on St 36 to reduce chemotherapy-induced pancytopenia: a feasibility study
- Ian Appleyard – Warm needle acupuncture for osteoarthritis of the knee: a pilot study
- Ed Fraser – Stand Easy: An Evaluation of the acceptability and effectiveness of acupuncture as a treatment for post-traumatic stress disorder for veterans in Norfolk
Having attended plenty of such meetings in my time, I can give you a fairly good idea about the contents of the 8 lectures. Below, I provide succinct (and slightly satirical) summaries of what the presenters will tell their audience on the 17th:
- Despite difficult circumstances, we (the ARRC) have done very well indeed. We managed to publish lots of papers, and we made sure that not a single one reported a negative result. That would be bad for business. We are optimistic about the future provided we get some funding, of course.
- Whole Systems Traditional Chinese Medicine has a profoundly positive effect on the outcomes of In Vitro fertilization. We are totally balled over! Only the most pedantic sceptics would have reservations and might argue that the study had no controls and was retrospective. But who cares, we believe in positive results, and therefore, we never listen to criticism.
- Because efficacy is a sticky issue in the realm of acupuncture, it is much wiser to tackle policy makers by persuading them that they can save money (lots of it), if they implement the abundant use of acupuncture. The evidence for this notion is flimsy to say the least, but policy makers do not understand the science (and neither do we).
- Our study showed that Acupuncture Augmentation of Lidocaine Treatment is extremely good for vulvodynia. We are very impressed, over the moon even. Of course, this was a feasibility study and we should really only conclude that a full study may be feasible, but let’s not be nit-picking.
- Based on my very extensive experience, I am able to confirm that TCM-based psychotherapy with acupuncture is an excellent therapy for endometriosis. Rigorous, controlled clinical trials do not exist, but my findings are so clear that, quite honestly, we do not need them.
- Using moxa on St 36 to reduce chemotherapy-induced pancytopenia is feasible. Isn’t that lovely?
- My trial of warm needle acupuncture for osteoarthritis of the knee showed most encouraging results. Of course, this was only a pilot study, and from it we should really only conclude that a proper study may be feasible, but let’s not be holier than thou!
- Our results demonstrate that acupuncture as a treatment for post-traumatic stress disorder is amazingly effective. A breakthrough! What is more, veterans found it most acceptable. The study is not rigorous, but I don’t mind. I advocate this treatment to be rolled out nationally as a matter of urgency.
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So, there you are; that’s all you need to know about the 20th annual meeting of the ARRC.
You don’t need to go.
I have thus saved you £120!
No, I don’t expect thanks – I prefer, if you would send half of this amount (£60) to my account.
34 Responses to Acupuncture fans, pay attention: this post can save you money – £120 to be exact.
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Great! I wiash all long meetings could be summarised this way. Wouldn’t it save time!
As usual, these people often prove to be their own worst enemies. The phrase ‘ we managed to publish lots of papers, and not one of them reported a negative result. That would be bad for business’ rings a few alarm bells.
As does ‘we
believe in positive thinking, and never listen to criticism’.
Oh, and there’s the bit about proof of efficacy being a’sticky issue’ and how it’s much more effective to emphasise the money to be raked in, and to appeal to policy makers’ budgetary concerns.
Cheque’s in the post!
I am seriously concerned about the premise of item 8.
Veterans with any form of anxiety (particularly PTSD) are particulary vulnerable to the blandishments of charlatans, quacks and crooks. Their gullibility must not be taken advantage of.
The greatest care has to be taken: (i) establishing the diagnosis – by a psychiatrist, not an amateur enthusiast or camist; (ii) ensuring that if it is proposed that needles be stuck into a patients skin, they give fully informed consent – understanding that the consensus of medical opinion is that acupuncture (‘belone therapy’ if we use Greek) is a theatrical placebo – irrespective of the enthusiasms of the acupuncturists. In other words, that they are being asked to engage in faith healing and prick induced auto-hypnosis.
I very much doubt Ed Fraser (item 8 above) has demonstrated that needling has any effect other than as a placebo. Unless he has controls, he does not know if it was his charisma or the needle which produced any beneficial effect – he is making a false claim and may be a fraud. Veterans will find any TLC ‘acceptable’. Who would not?
Conflict of interest: (i) I see many patients with PTSD (I do not treat them, I report on their musculo-skeletal injuries); (ii) My son served in Afghanistan and is still responsible for supporting those of his comrades with PTSD.
If acupuncture really made any difference – all doctors would recommend its use.
As it is, save the money spent on needles, training, journals, courses and conferences about chakras and medians, and improve counselling services. Please.
The unfortunate thing is that the US military and the Veteran’s Affairs people are already using it!
Of all the CAMs I’ve heard of, Wacky Accy is the only that seemed most feasible to me. It’s been enlightening to read and modify my view.
There’s a joy in using data to form opinions that will be modified by further research. I’ve always been bemused by those who seek to modify data instead of opinion: but they’re committed to a “profession”. Surely there’s enough data already to bring legal attention to those who distract folk from appropriate medical attention.
Are you meant to be a professional? Your views are rude at best, but hopefully it will help promote all of the publications you have written on the subject.
Perhaps you should try to understand that people are actually trying to help others, not deliberately hoax others. What a bitter, mixed up and most importantly wrong mind you have
i had forgotten the 1st rule of alternative medicine: never laugh and certainly not about yourself!
Gill said:
But are his views correct and evidence-based?
I don’t see anything wrong, except for the gathering of deluded people, talking about delusional claims, seeing patterns where there aren’t any and playing science with coincidental findings. Dr. Ernst is not bitter, mixed up or wrong. He’s just been getting negative results in reliably performed trials and evaluations for decades on end.
He is not rude, on the contrary, he is being quite kind.
Gill, I am interested that you contend ” you should try to understand that people are actually trying to help others, not deliberately hoax others.”
The motives of people who feel a vocation or desire to enter the healing professions are little better understood than many human motives. But when stirred to ‘heal, care, treat’ for a living, how does the individual choose what to do next? Many decide the most rational, effective, ethical, progressive profession is that of ‘medicine’. I did. Others might enter nursing, physiotherapy, clinical psychology or any of the other professions regulated by the Health and Social Care Council.
Some who are registered medical practitioners then consider what other modalities they might usefully engage, and are attracted to acupuncture. But as we all know, the vast consensus of trained medical opinion finds acupuncture to be a theatrical placebo. It may have a place in placating the distressed, and although the ethics are difficult, may have a role in a programme of caring, providing patients give fully informed consent.
But just what motivates folks who are not qualified doctors to take time, trouble, and spend on courses, conferences, books, and training in esoteric concepts for which there is no sound rational basis? During that ‘training’, surely they realise that needling has no effect beyond the placebo? And then the ‘sunk cost fallacy’ kicks it – they have gone to all that trouble to have a career, and now want a return on their investment – and so many will simply carry on with the pretence and rationilise their career paths as best they may.
‘Blind faith’ might be one answer, but some might indeed intend taking advantage of the gullibility of desperate patients whose condition makes them vulnerable to the charismatic blandishments of quacks, charlatans and frauds who make false claims and offer false promises, false hope.
How do you know what acupuncturists motives are?
‘But as we all know, the vast consensus of trained medical opinion finds acupuncture to be a theatrical placebo.’
@Richard Rawlins, do you have evidence to back that claim, out of interest?
Hi Tom
While Richard is away you could do some homework of your own to approach an answer to your question. As it happens there are people who have accumulated lists of reviews of acupuncture. And there are people who have scrutinised how acupuncture evolved from harmful ancient rituals to modern thin-needle theatricals, promoted for political reasons rather than scientific.
You can start with punching in “acupuncture” in the Cochrane database and perusing all the papers there. The folks at Friends of Science in medicine (you like science, don’t you?) have made an updated list of them with individual links and even added short comments that you should contemplate and evaluate for yourself.
If you disagree with their evaluation, please show us a list of your own but also please explain your reason for disagreement in each case.
Note that with thousands of trials and dozens of reviews, there are bound to be a few that happen to be “positive”, like your favourite one on migraine. This you will have to evaluate in the context of the totality of evidence, which most reviewers find resoundingly negative. Most scientists would conclude, in the context of the totality of evidence, that the most likely explanation for the “positive” items was mere chance along with a helping of bias and wishful thinking.
If this does not convince you, please tell us what you think you need in the form of better(?)evidence. Remember Tom, that evidence for the negative is a bit complicated.
Try, for arguments sake to devise a way of proving positively that the tooth fairy exists…
If you are not literally shaking the tooth-fairies hand and having her make a public appearance, you will first have to presume that the tooth-fairy simply does not exist, then you try to falsify your presumption. If you fail on most trials, then you will have to accept your presumption that she does not exist.
Because the efficacy of acupuncture is not self-evident, only indirectly presumed through effects that may be explained by other mechanisms and phenomena, then this same principle applies to the efficacy of acupuncture.
The evident fact is that trials of acupuncture efficacy have failed on all accounts except a small minority of trials… What do you think that means in terms of accepting or discarding the presumption (the a-priori null hypothesis, as it is called in science lingo)?
If the same results as in Cochrane’s collection for acupuncture, were the fact for a collection of closely related surgical interventions. How then Tom, would you think doctor’s should evaluate such procedures? Should they continue performing them just because some of the clients got better by chance and were happy to return for more, just because their back pain or whatever happened to get better but would in most cases have improved without the invasive procedure??
Remember that acupuncture is not without inherent risks:
http://norwaytoday.info/news/man-dead-acupuncture-treatment/
I am most grateful to Björn for providing such a comprehensive account.
Though I must be even more honest and admit that most doctors simply ignore acupuncture as not being worth the candle, and have not expressed their opinion about its being a ‘theatrical placebo’ as such.
But if needles do not engage placebo responses – how else do they work to help some patients ‘feel better’?
What is the problem with accepting the obvious – unless and until plausible reproducible scientific evidence demonstrates non-placebo related effects? And after 2000 years, we’re still waiting. Come off it and move on. Please.
Thank you Bjorn and Richard for your thoughtful replies. But I didn’t see a single piece of evidence in response to my question. So rather than taking the bait and get distracted, I’ll wait for either some good evidence to back up Richard’s original statement, or to back up the new revised one that ‘most doctors simply ignore acupuncture as not worth the candle’. Or could it be that, in the way I fool myself into thinking acupuncture has some value because of the hundreds of gullible self-selecting fools who tell me they’ve improved, you’re basing your OPINION on what your like-minded friends tell you?
I’ll start us off:
‘Of the respondents [1,247 physicians, nurses, physical therapists, and midwives], 96.9% were strongly in favor or in favor of offering CM, especially hypnosis (89.8%), osteopathy (85.5%), and acupuncture (83.4%), at the hospital for treating chronic pain.’
https://www.ncbi.nlm.nih.gov/m/pubmed/27450407/?i=10&from=acupuncture%20opinions%20doctors
Also, the poll at the end of the BMJ ‘head-to-head’ (the subject of this post) is currently 77% in favour of doctors recommending acupuncture for pain. Sadly doesn’t seem as though the Prof’s arguments are holding sway with the BMJ readership…
are you really that naïve?
polls are no substitute for proof of efficacy + polls are very easily manipulated.
Maybe you haven’t read the previous comments? I’m not claiming this is proof of efficacy in any way.
what do you think then that a poll of this nature really shows?
Tom!
What in the world do you mean when you say evidence??
A formal survey of medical opinion, for example? Surely you know what I mean?
A formal survey of medical opinion
Why? It would have nothing to do with the actual efficacy of the treatment.
Survey the Nation Basketball League in the USA and you will find some players believe the world is flat. Do you, then, believe the world is flat?
Oh Dear.
I did not expect this from you Tom. Despite all our efforts to explain and inform, you remain completely blind to simple logic.
You could just as well ask 100 children what they think of Santa Claus. Whatever result you would get, would not come anywhere near being evidence for or against his existence.
The same applies to surveys of any kind of opinion, be it the question of acupuncture or taste for Mojito cocktails.
If I may jump in, there is a slight misunderstanding. Tom did, indeed, not say something about efficacy but his original question was somewhat ambiguous.
It was the “medical opinion” part that Tom was requesting evidence for, not the “theatrical placebo“.
It appears that various formal surveys around show a rather positive attitude of health professionals towards acupuncture
–A cross-sectional study in Iran: From the text, it appears that a total of 69.2% (out of 146 participants) are inclined to learn about acupuncture or already know about it in varying degrees of depth (though noone uses it in practice).
–In a phone questionnaire in two Local Health Units in Turin, 317 general practitioners responded, leading to an overall observation that:
–In a descriptive survey in Poland, out of 89 senior and 81 junior doctors:
7 junior doctors and 24 senior doctors recommend acupuncture
64 junior doctors and 52 senior doctors accept acupuncture
10 junior doctors and 13 senior doctors discourage acupuncture.
The methodological framework of surveys is very important of course. A very interesting and enlightening systematic review of surveys regarding the UK is this, by Dr. Ernst and colleagues. A reported result is:
However, the methodological quality was poor for most of the surveys.
I think it gives a snapshot of opinion. Richard made a couple of very confident statements about the status of acupuncture in the medical world, without evidence. So I had a quick look at what evidence there was available – this is what I found. I’m talking about the journal link, not the BMJ poll (which of course doesn’t tell us much, but is another snapshot at least).
I think you are mistaken.
such polls usually show only how active the protagonists have been.
It is obvious to me that acupuncturists jump on such occasions making as much propaganda amongst like-minded people for casting a vote, while those who do not care about acupuncture simply continue not caring about it.
‘It is obvious to me that acupuncturists jump on such occasions making as much propaganda amongst like-minded people for casting a vote‘
A bit like the call to action at the end of your post (http://edzardernst.com/2018/03/should-we-recommend-acupuncture-for-pain-relief-what-do-you-think/)?
Anyway, as I said already, the BMJ poll doesn’t tell us much. But the survey I linked to reveals a bit more, at least about the opinions in one hospital. And it seems to suggest the opposite of what Richard says ‘we all know’.
my ‘call to action’ was not to cast a silly vote but to stimulate the discussion by writing a comment – what is to be said against that, pray?
Nothing wrong with that. But I don’t think anything different happens within the acupuncture world. I’ve seen people encourage others to leave comments on various articles, but I don’t remember any campaigns to ‘cast a silly vote’.
no, because you don’t think it’s silly
No, because I don’t remember any campaigns to cast votes on journal articles, whether I consider these polls silly or not.
@jrkrideau best to read the thread first – I’m not talking about efficacy!
This goes beyond the pale and starts to enter the animal cruelty arena:
https://www.sciencedirect.com/science/article/pii/S2005290113001301
@chris on Tuesday 13 March 2018 at 16:56
This paper is not about acupuncture research!
It describes electrostimulation, applied via needles, which has nothing to do with acupuncture. Calling it electroacupuncture is dishonest This is not to say that the experiment described is any less abominable.
Performing (or faking?) experiments on electrostimulation via needles and calling it acupuncture research is a common method of faking evidence for acupuncture.
@Bjorn, don’t tell me you haven’t read the thread either? For the third time, I’m NOT claiming that a survey has any bearing on whether or not acupuncture works! I simply asked what evidence Richard had for his statement that ‘the vast consensus of trained medical opinion finds acupuncture to be a theatrical placebo’. That seems to be the way things work around here – someone comes along and makes a statement, and someone else asks ‘where’s your evidence?’. So when in Rome…
I then provided some evidence to counter Richard’s statement, and have since received a volley of false accusations because nobody had grasped my point! Have I ‘explained and informed’ enough for you to ‘understand this simple logic’ now?!
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