Having previously criticised the abundance of mostly rather meaningless surveys in alternative medicine, I now should perhaps admit to having published my fair share of such investigations. The most recent one was only just published.
The aim of this survey was to conduct a follow-up of a previous, identical investigation and to thus ascertain changes in usage, referral rate, beliefs and attitudes towards alternative medicine during the last decade. A questionnaire was posted in 2009 to all GPs registered with the Liverpool Primary Care Trust asking them whether they treat, refer, endorse or discuss eight common alternative therapies and about their views on National Health Service (NHS) funding, effectiveness, training needs and theoretical validity of each therapy. Comparisons were made between these results and those collected 10 years ago.
The response rate was unfortunately low (32%) compared with the 1999 survey (52%). The main findings were similar as 10 years before: the most popular therapies were still acupuncture, hypnotherapy and chiropractic and the least popular were aromatherapy, reflexology and medical herbalism. GPs felt most comfortable with acupuncture and had greater belief in its theoretical validity, a stronger desire for training in acupuncture and more support for acupuncture to receive NHS funding than for the other alternative therapies. Opinions about homeopathy had become less supportive during the last 10 years. Overall, GPs were less likely to endorse alternative treatments than previously shown (38% versus 19%).
I think these findings speak for themselves. They suggest that British GPs have become more skeptical about alternative medicine in general and about homeopathy in particular. It would, of course, be interesting to know why this is so. Unfortunately we are merely able to speculate here: might it be the increasingly obvious lack of evidence and biological plausibility that matter? As a rationalist, I would hope this to be true but our data do not allow any firm conclusion.
Speaking about the data, I have to admit that they are rather soft. This was just a very small survey in one specific part of the UK. More importantly, the flaws in our investigation are fairly obvious. The most important limitation probably is the low response rate. It may be caused by a general ‘survey-fatigue’ that many GPs suffer from. Whatever the reason, it severely limits the usefulness of our paper.
So why publish the survey at all then? The answer is simple: we certainly do already have an abundance of surveys, but we have a dearth of longitudinal data. Because we employed the same methodology as 10 years ago, this investigation does provide a unique insight into what might have been happening over time – albeit with more than just a pinch of salt.
If you are speculating that GPs are referring less often to homeopathy due to ‘the increasingly obvious lack of evidence and biological plausibility’, perhaps it’s fair to draw the opposite conclusions about acupuncture?
perhaps – but why would one be a “speculation” and the other a “conclusion”? might bias be lurking here?
Heaven forfend that bias lurk anywhere on this site! But you’re right, I meant ‘speculate’. I speculate that the growing evidence base supporting the efficacy and safety of acupuncture is gradually persuading GPs to trust it more and more.
you might just be wrong again!
if you read the text properly you will find that the likely answer is not the clinical evidence, in this case, but the biological plausibility that GPs seem to attach to acupuncture.
How can I be ‘wrong’ any more than you are when I’m speculating, especially when you don’t present the details of the survey? From my own experience working in a GP health centre using acupuncture, I can say I was allowed to work there largely because of the evidence base. (I still get referrals from some of the GPs some years later due to the success of that project). This is of course even softer evidence than yours, but I don’t see why it’s ‘wrong’ to speculate that GPs may be influenced by the evidence base and safety record. It’s a hypothesis which I know to be true for at least some GPs.
“GPs felt most comfortable with acupuncture and had greater belief in its theoretical validity”
YOU ONLY NEED TO READ!!!!
Tom Kennedy said:
What growing evidence base?
Alan – it’s easy enough to do your own research on the Internet these days if you have the will. I’d suggest starting with the National Institute of Clinical Excellence (NICE), and the Acupuncture Research Resource Centre (ARRC).
The generally accepted rule is that if you assert a claim, you provide the evidence to substantiate it when challenged, otherwise everyone could go off on all sorts of wild goose chases and the discussions would likely stall. The onus is on you to substantiate that there is, indeed, a ‘growing evidence base’.
Alan – obviously it would be impractical to copy and paste lots of evidence here, but to get you started here is a link to a summary of evidence for acupuncture and headaches:
A cursory glance will show you there is good evidence, and that the evidence has been built upon in recent years. There’s plenty more out there if this has whetted your appetite.
here is the abstract of my overview of cochrane reviews which, i am sure you know, are considered to be the most reliable evidence available to date http://www.ncbi.nlm.nih.gov/pubmed/18789644 :
Many trials of acupuncture and numerous systematic reviews have recently become available. Their conclusions are far from uniform. In an attempt to find the most reliable type of evidence, this article provides an overview of Cochrane reviews of acupuncture. Such reviews were studied, their details extracted, and they were categorized as: reviews with a negative conclusion (no evidence that acupuncture is effective); reviews that were inconclusive; and reviews with a positive or tentatively positive conclusion. Thirty-two reviews were found, covering a wide range of conditions. Twenty-five of them failed to demonstrate the effectiveness of acupuncture. Five reviews arrived at positive or tentatively positive conclusions and two were inconclusive. The conditions that are most solidly backed up by evidence are chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. It is concluded that Cochrane reviews of acupuncture do not suggest that this treatment is effective for a wide range of conditions.
As Prof Ernst has pointed out, the best reviews of the evidence for acupuncture do not exactly show it to be what you seem to believe it to be.
Indeed, the better sham that is used – and the better researchers are at replicating the non-specific effects – the poorer the relative results for acupuncture; so the question is whether there are any specific effects left at all.
the most conclusive trials on this particular question, even the one by ardent believers in acupuncture, are negative!
“GPs felt most comfortable with acupuncture and had greater belief in its theoretical validity”
The second part of your sentence starts with ‘and’, so I assume it is separate from the first – why do they feel most comfortable with it? Surely you’re not seriously ruling out the possibility that evidence and safety are factors for some (many?) GPs? As I explained, this is just a hypothesis – why are you exasperated by it?
you should see me when i am exasperated! with you i am just mildly irritated.
Acupuncture can be great for mild irritation, and even full-blown exasperation – you’re welcome to a treatment on the house if you’re ever in Bristol 😉
But seriously, your survey suggests more than 60% of the GPs thought acupuncture was the most effective therapy. It doesn’t seem as though they were asked their opinion on the evidence base, but surely GPs are highly likely to be influenced by the evidence for any particular therapy?
opinion is the lowest level of evidence!
A large part of the survey is devoted to ascertaining opinion, is it not?
this is why i have pointed out in 2 previous posts how soft survey evidence is.
Regarding Cochrane reviews, as you are aware there are considerable problems when it comes to placebo controlled trials and acupuncture, especially if (like me) you believe that the skill of the practitioner is a vital factor in treatment outcome. If comparative studies were accepted (comparing individualised tretments performed by experienced practitioners vs standard treatment, for example), I’m certain the picture would look quite different. I think it is a measure of acupuncture’s potential that despite the restrictions imposed by RCTs there are still areas in which it comes out with significant results.
isn’t that dandy?
clinical trials are fine…as long as they show what i believe. if not, they are flawed. did you know that this attitude [which is endemic in alternative medicine] is one of the charackteristics of a quack?
I take great offence to that comment. I would have thought stooping to name-calling would be beneath someone of your apparent standing. My comments on the intrinsic problems with RCTs and acupuncture are widely accepted by sensible scientists.
i merely asked the question!!!
“My comments on the intrinsic problems with RCTs and acupuncture are widely accepted by sensible scientists”….yes, yes, yes, but onlt one comment before, you cited a review of clinical trials as evidence for acupuncture. this indicates to any sensible scientist that you like clinical trials, as long as they produce the notions you believe in.
BUT GUESS WHAT, TRIALS ARE FOR TESTING AND NOT FOR PROVING YOUR ASSUMPTIONS
I was asked to provide an example of the growing evidence base for acupuncture, and knowing that most skeptics/debunkers will pounce on anything less than clinical trials, that is what I provided. I could certainly provide many examples of clinical trials that show negative results too, of course. By their very nature, none of them, including the positive ones, are a fair reflection of acupuncture as practiced by trained clinicians in my opinion.
My hypothesis (assumption if you like) is that acupuncture is more beneficial when performed by trained professionals. How do you test this hypothesis when practitioners are blind to what they are doing, or untrained? It seems to me entirely reasonable to use comparative studies as fairer and more useful measures.
Of course, if there were any bias towards disproving the claims of CAM rather than giving a balanced overview, insisting solely on RCTs would be a rational choice.
you provide me with more and more evidence that you have no idea about clinical trials of acupuncture: the practitioner is never blind in sham controlled trials. is it not time you began to read up a bit and try to understand the issues at hand properly?
That depends on the methodology of course – there have been attempts to carry out triple blind laser acupuncture and electroacupuncture trials. More commonly, researchers insist on or prefer ‘acupuncture naive’ practitioners to carry out the treatments, which is fine if the aim is to investigate the simple biological effects of skin piercing, but it does not represent a fair assessment of traditional acupuncture any more than heart surgery carried out by a plumber.
ahhh! now we are talking laser!
in this case, we should also tell the reader that most of the rigorous laser-acupuncture studies were negative, and that, when faced with these trials, the acu-community invariably says: WE NEVER CLAIMED THAT LASER ACUPUNCTURE WORKS; SO THIS PROVES NOTHING!
I was pointing out that there are indeed examples of triple blinding in the field of acupuncture research – however I admit that’s probably of passing relevance to this debate. But you are sidestepping the crux of my point, as you often accuse others of doing. When clinical trials are exclusively used to assess the effectiveness of a complex and skilled intervention like acupuncture, a misleading picture is painted. Despite the problems mentioned, there is still a growing body of evidence of this kind for acupuncture. If other types of carefully carried out trials were also taken into account, a fairer and more accurate assessment would emerge.
no,no,no! if studies are included that do not adequately control for bias, the findings may turn out to be false positive.
Tom Kennedy said:
No. You were asked to back up your assertion that there was ‘a growing evidence base’. Cherry picking one trial does not demonstrate a trend.
You obviously didn’t look at the link. Several pieces of research were referred to.
The article you linked to (dated 2003) mentions some studies only on headaches, dated from 2000 to 2004 [sic]. Do you believe that demonstrates that there is a ‘growing evidence base’ for acupuncture?
It was one example to get you started. Here’s another:
In case you don’t have time to click the link, here’s the summary and conclusion:
In this Summary we present an overview that includes the most recent evidence on acupuncture for musculo-skeletal conditions gathered from clinical trials, systematic reviews and meta-analyses of randomised controlled trials. We first present evidence that acupuncture is more than a placebo. Second we present evidence that acupuncture is cost- effective. Third we report on the recent NICE review that recommends acupuncture for low back pain. Fourth we set out a case study of a trial of acupuncture for low back pain that was conducted in York, in part at the York Clinic, in collaboration with 39 York- based GPs. And finally we present the current evidence on treatment effects in patients with chronic musculoskeletal conditions, taking the common conditions one by one. The overall conclusion from this evidence summary is that acupuncture is an appropriate treatment option to be included for consideration by patients with musculo-skeletal conditions.
Based on the results of high quality randomised controlled trials, systematic reviews and meta-analyses, there is a growing evidence base that acupuncture works for a range of common conditions. There is also a consistent trend towards statistically significant differences between acupuncture and sham acupuncture. The cost effectiveness data presented above shows that the cost per QALY gained from acupuncture is well below the NICE threshold for those conditions that have been evaluated, and therefore sufficiently cost-effective to be a recommended as a referral pathway. Acupuncture has been recommended by NICE as a treatment option in primary care for persistent low back pain. Many York GP practices have been involved in referral of patients to the York Clinic for acupuncture trials, starting with the York Acupuncture for Back Pain trial 10 years ago.
“a consistent trend” ??? is that an acupuncturists’ way of saying there is no significant effect?
So, another summary article, written by an acupuncturist, (apparently) not peer reviewed, cherry-picking trials and reviews?
Why should I be more convinced by that than, say, the reviews referred to by Prof Ernst?
You might also like to read some of the criticism of the NICE guidelines for LBP.
…also, what are you doing with this post? To me, it seems as though you are using ‘soft’ evidence to push your own viewpoint. Isn’t that dandy?
i can tell you what i will not do with soft data of this nature -something you tries to do: draw any conclusion about the effectiveness of therapies.
Quote: ‘no,no,no! if studies are included that do not adequately control for bias, the findings may turn out to be false positive.’
By that you mean using trained and practicing acupuncturists I take it? That’s my point in a nutshell – if all possibility for bias is removed, real practitioners are removed, and along with them the skill that I believe is vital to consistent clinical success. To my mind, there are ample clinical trials that demonstrate a significant effect for various conditions, but they only tell part of the story. Because skill and experience are removed from the equation, using these studies alone will not give an accurate picture of what acupuncture can achieve. Which is a great shame I feel, as the NHS could be saving a lot of money by implementing multi-bed acupuncture for chronic pain and stress/anxiety for example.
clinical trials do not remove the skill of well-trained parctitioners, they test their effect!
you really have not understood trial methodology at all, it seems to me.
why don’t you inform youself properly before you write nonsense?
So the trials in the Cochrane review all used fully trained traditional acupuncturists? They were allowed to form a differential diagnosis through questioning, tongue and pulse diagnosis, palpation, physical assessment etc? They performed individualised treatments based on these assessments, including the requisite needle techniques? They were allowed to carefully search for and needle ‘ashi’ (tender) points as well as recognised traditional points? They could adapt their treatments in relation to the patient’s response as the course progressed? If that’s the case, I hold my hand up and agree I’m writing nonsense.
However, if not, these trials are not measuring the effects of acupuncture as practiced by most therapists, and therefore any conclusions drawn are not a fair reflection. No doubt you dismiss most of the above as ‘non-specific effects’, but they are integral to what we do.
and now you are demonstrating to us that you do not understand the nature od systematic reviews. they evaluate data that is by definition diverse. so some studies would meet your criteria, some only partly and a few not al all.
if you are postulating that only studies that meet all your criteria can show positive results, you are very much on your own and should do a meta-analysis of just those studies. IT IS THE PERSON WHO MAKES A CLAIM WHO HAS TO PROVE HIS ASSUMPTIONS, NOT THE ONES WHO DOUBT THE CLAIM!!!
If the trials done so far are not measuring the effects of ‘proper’ acupuncture (or the Cochrane reviews deliberately ignored them), are you saying there is no good scientific evidence for acupuncture? And if there is no good scientific evidence for acupuncture, where does that leave NICE and acupuncturists?
Since what acupuncturists can advertise is dictated, via the Advertising Standards Authority, by the robust scientific evidence, what claims are left for acupuncturists to make?
I feel this debate is going somewhat in circles, and it may be time to wrap up, so here is my closing summary.
I was initially motivated to comment because I felt the main post itself was an example of Ernst’s clear tendency to extrapolate negative conclusions about CAM wherever possible, and present his ‘facts’ under the guise of science, whilst ignoring or brushing over the positives. There seems to be very little balance to the arguments set forth here, so I tried to offer another plausible reading of the same data.
The discussion quickly broadened into the nature of clinical trials in general. I don’t think it is controversial to suggest that there are considerable problems when it comes to judging a complex intervention like traditional acupuncture. When the practitioners used are inexperienced, or they are limited to one-size-fits-all protocol-style treatments, it is unsurprising the results are mixed, but these problems are rarely discussed here as far as I can see. Instead, it is implied wherever possible that these treatments simply don’t work, or work only occasionally for a very limited number of conditions. You chose to interpret the current evidence base in this way. I, like many others, see it as the tip of the iceberg. The fact that a small number of restrictive trials show mixed or negative results for certain conditions does not mean acupuncture does not work for that condition. Whilst the evidence base is growing, there is a long way to go. If the researchers involved are open-minded, fair, and design their studies in a way that allow experienced practitioners to work holistically, this evidence base will grow and grow, I have no doubt about that. I am aware that some trials are more flexibly designed than others, but most classed as ‘rigorous’ are standardised, and therefore tell only part of the story.
I am entirely convinced by my own experience that in many cases, acupuncture is capable of relieving the suffering related to a considerable number of conditions, and everything I have said here is motivated by my desire to see more people benefiting from these effects. Even though I concede that I am not a scientist, and that my knowledge of clinical trials is limited compared to that of the other contributors to this discussion, I feel I’ve made some valid comments worthy of sensible debate. Unfortunately, my attempts have been met with arrogance and rudeness (it’s been implied that I’m a ‘quack’, and that I am writing ‘nonsense’), and a lot of SHOUTING AND EXCLAMATION MARKS!!! This is a pity, and not what I would expect from anyone genuinely interested in the balanced enquiry of real science.
Alan and Edzard, I wish you well, and hope the considerable energy you put into your vitriol ends up provoking more measured debate elsewhere.
i think your “summary” speaks volumes. i said it so often that i hesitate to state it again: an uncritical scientist is a contradiction in terms.
Tom Kennedy said:
The problem, succinctly put.
You are indeed an expert at word twisting. I am not postulating any such thing. As I mentioned above, I think it is a measure of acupuncture’s efficacy that positive results still emerge from restrictive trials at times. I am postulating that studies that allow trained practitioners to use their full range of skills as they would in the clinic are likely to produce more realistic and positive results than those that don’t. I’ll put a meta analysis of this type of trial on my list of things to do one day…
Alan – you imply here that I’m deluding myself, presumably. For the record (not that I expect this to sway you one iota), I consider myself to be rational and in fact quite skeptical by nature. I went into acupuncture training after successful treatment of my own, but nearly quit early on when I misunderstood and was put off by the Chinese concepts. I am very glad I remained open-minded enough to get through that stage, as I now enjoy what I do immensely and have seen many people benefit. That includes people who have been forced into coming by partners, and have very negative expectations. It includes cases that have not responded well initially, but when a different approach has been taken, radical progress is made. And perhaps most importantly, it includes many examples of people who have been failed by Western medicine.
If you feel my experiences, those of my patients, and countless others patients worldwide are of no consequence, that’s your prerogative I suppose.
the trouble, it seems to me, is that today you start from the premise that acupuncture works and try to fit all the available evidence around this assumption.this attitude is understandable – you woulld not be an acupuncturist otherwise – but it does not create progress. advances are generated by doubting, questioning, testing and critically evaluating.
I think we (almost) agree on this. I doubt, question, test and critically evaluate on a daily basis in my clinic, not in the same way as a clinical trial, but in a way that leads to gradually improving results. I think this is vital in any profession. And I absolutely see the importance and understand the concept of clinical trials, but I maintain that they (often) don’t produce a realistic measure of acupuncture’s true efficacy because of the need for standardisation etc. (again, I’m referring to the positive as well as the negative trials).
I will add that I agree complementary medicine (including acupuncture) carries with it the real danger of self-deception. I have come across many practitioners who have some pretty irrational ideas, and others who blindly accept every weird concept out there without questioning it. But we’re not all like that! There are a great number of acupuncturists (I can’t vouch for other disciplines) who see the traditional concepts not as ‘true’ in a factual sense, but as metaphorical guides to clinical success. There are also many of us interested in promoting good research, but we find it frustrating to see trials that don’t represent what we do being used to imply acupuncture is bogus, or useless for various conditions. That’s the long and the short of it.
the treatment in clinical trials does NOT need to be standardised! again, you show us that you do not understand this methodology.
Maybe it doesn’t ‘need’ to be, but am I wrong to think most Cochrane acupuncture trials are standardised?
there is no such thing as a cochrane trial. cochrane reviews summarise all available trials and most acupuncture trials will not be standardised as far as the acupuncture is concerned – this is my guess, i have not researched this question systematically.
some of my own reviews differentiated between type of acupuncture and generally the results did not differ between different types.
Tom Kennedy said:
You need to be aware of the well-known and well-understood biases that are present in a therapeutic encounter or trial. Amongst them are observer bias and subject-expectancy effect. A good introduction to the various biases can be found in this Wikipedia article on Experimenter’s bias.
That lists some 50-odd sources of bias that can affect and taint what we observe.
These biases are the reason we need to do properly controlled trials so we can understand what is really going on and whether any observed effect is, indeed, due to the specific effects of the treatment or whether they are due to non-specific effects associated with other aspects of the encounter. The better trials are the ones that understand the biases present and do their utmost to control for them. Basing conclusions about efficacy of treatments on personal observation is exactly what we should not be doing if we are truly interested in doing what is best for patients.
Thank you, I appreciate that you seem to genuinely be trying to inform me and no doubt your intentions are good. But I am aware of these biases, having studied statistics in the past. I also understand the benefits of well controlled experiments (I’m a fan of science!), but there is a point at which very real and (in my opinion) important skills are lost, and results subsequently suffer. Let me give an example:
When treating most types of muscular pain, I believe* careful palpation for tender spots relating to (but not necessarily at) the area of perceived pain is vital. You can get some success without doing this, but often not lasting change, depending on the individual situation. I also believe it is important that patients relax as much as possible during a treatment, partly because tight muscles are harder and more painful to needle, but there may well be more to it than that – this is speculation, but perhaps the messages sent to the body when a point is stimulated are received more readily when the sympathetic nervous system is subdued. So, I try to gain rapport with the patient to put them at ease, and I use massage techniques before and during the needling to help calm them.
Now, of course the questioning about sore spots, palpation, massage and the putting at ease may well have measurable effects on their own, but this is all part of a good treatment in my opinion, and to strip things down to simple standardised needle-sticking fails to embrace the complexity of the situation, and will inevitably lead to watered-down results.
I don’t expect this to alter your faith in the scientific method, but I hope you understand my viewpoint to some extent.
*When I say ‘I believe’, this is not blind belief, it is backed up by much trial and error, and many cases that suddenly respond well having found something I’ve missed previously.
and how does this differ from any other kind of medicine? physicians do not just precribe a drug; they do all the things you describe and more. yet it is only fair to demand that the treatments they use are of proven efficacy.
I can’t remember the last time a GP gave me a massage, but anyway… administering a drug lends itself nicely to placebo controlled trials in a way that a complex intervention like acupuncture does not. There is only one way to give someone aspirin (dosage apart), but there are myriad ways of performing acupuncture, for example.
I’m not suggesting proof of efficacy is not important, just that it is exceptionally hard to do with acupuncture in the way you require, and despite some useful, promising and growing data, the current picture is misleading in my opinion. I will try to elaborate further soon.
luckily we have given up opinion-based medicine a while ago.
there are lots of ways even for giving an aspirin (apart from different galenics, dosage etc): consider diagnosis, contra-indications, concommittant conditions and treatments, life-style, patient-preference…..
“I don’t expect this to alter your faith in the scientific method…” Excuse me, but the scientific method is the only thing we have that does NOT rely on faith.
If you really are a fan of science then for goodness’ sake start fanning its flickering flame instead of trying to blow it out. I implore you to read, and fully comprehend, You Are Not So Smart by David McRaney — this may help you to avoid confusing your personal anecdotal experiences with robust evidence. The plural of anecdote is not data.
That depends on your definition of faith. I think there are plenty of people who put their ‘faith’ in science almost exclusively, as if it is the only way to understand the world. The fact is, despite all the undeniable advances in certain areas of Western medicine that save and prolong life, countless numbers of people end up much worse off thanks to ‘evidence based medicine’, so it clearly has its problems. I’m not trying to ‘blow out the flame’, but raise some issues for discussion so that more progress might be made, not less.
Looking in a bit more detail at the Cochrain reviews of acupuncture over the last couple of days has only strengthened my opinions. I will try to summarise what I’ve learned when I get a chance.
i am glad to hear that you are learning
Tom, most (all?) proponents of CAM claim that double-blind randomized placebo-controlled trials are unsuitable for showing the true efficacy of the treatments. Okay, so let’s forget this scientific method and devise a better test method.
The most suitable method is staring everyone in the face: a competition between all branches of CAM. This would allow everyone to see the branches of CAM rated in order of their efficacy. When tests have been repeated enough times to produce reliable results then the proponents can put their heads together to formulate a unified hypothesis for how the best branches work and scrap the branches that don’t work very well or not at all. Think of the amazing benefits it would bring to patients and practitioners, plus the wonderful opportunity to advance medical knowledge and other areas of science.
Why is this not being done?
Yes, but that doesn’t make it true. Ususally it’s just special pleading to get around the inconvenient failure of DBRCTs of the CAM in question to demonstrate efficacy.
They don’t want a better method, they want one that makes it look as if their therapies work.
If it was to be sufficiently rigorous to produce reliable results, this “competition” would still need to involve randomised controlled trials (but comparing two or more forms of CAM with each other rather than CAM with a placebo control), so it would still up against the same objections (especially from the losers). Just comparing two sets of anecdotes wouldn’t get anyone anywhere.
As for a “unified hypothesis” of CAM, how can a ragbag of different systems such as herbal medicine, homeopathy, Ayurveda, acupuncture, chiropractic, etc., which rely on different (and often actually opposed) principles possibly have a single “unified hypothesis”?
Explaining a satire ruins it!
Those of you angry about CAM in general, who think no ethics committee should sanction acupuncture trials etc. etc., what are your thouhts on the areas that are emerging with positive results from the Cochrane reviews for acupuncture? Are they just wrong? Still just placebo? I’m interested to know how you justify this total dismissal.
personally, I don’t reject acupuncture per se. show me the evidence and’ if it is sound, I will go with it. in fact, many of my own reviews, books etc. are positive about certain areas.
That’s good to hear. But in that case why, for example, the latest blog title: ‘Acupuncture: if it looks like a placebo, feels like a placebo, behaves like a placebo, perhaps it is a placebo??’ Doesn’t seem to fit with your statement above. You can see how this could mislead a member of the public.
you need to read this http://edzardernst.com/2012/10/a-new-blog-on-alternative-medicine-why/. my blog is meant to be provocative in order to stimulate discussion. and anyway, I fail to see the contradiction, nor do I mislead anyone. I question claims in my area of expertise which are less than solid. and the claim that acupuncture is more than a placebo belongs in this category.
I have just posted on the acupuncture for stroke thread about the placebo/biological effect issue, so I won’t repeat myself here. Suffice it to say that there is plenty of evidence to suggest that acupuncture is more than placebo, including the Cochrane reviews that you mention above. Others will have to decide for themselves whether there is any contradiction or misleading going on here.
I did not say that there is no evidence, only that the Cochrane review is about clinical effectiveness and not about biological effects. thus it can only conclude about the former and not the latter.