The press officers of journals like to send out press-releases of articles which are deemed to be particularly good and important. Sadly, it is not often that articles on alternative medicine fulfil these criteria. I was therefore excited to receive this press-release which seemed encouraging, to say the least:
Medical evidence supports the potential for acupuncture to be significantly more effective in the treatment of dermatologic conditions such as dermatitis, pruritus, and urticaria than alternative treatment options, “placebo acupuncture,” or no treatment, according to a review of the medical literature published in The Journal of Alternative and Complementary Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers…
The abstract was equally promising:
Objectives: Acupuncture is a form of Traditional Chinese Medicine that has been used to treat a broad range of medical conditions, including dermatologic disorders. This systematic review aims to synthesize the evidence on the use of acupuncture as a primary treatment modality for dermatologic conditions.
Methods: A systematic search of MEDLINE, EMBASE, and the Cochrane Central Register was performed. Studies were limited to clinical trials, controlled studies, case reports, comparative studies, and systematic reviews published in the English language. Studies involving moxibustion, electroacupuncture, or blood-letting were excluded.
Results: Twenty-four studies met inclusion criteria. Among these, 16 were randomized controlled trials, 6 were prospective observational studies, and 2 were case reports. Acupuncture was used to treat atopic dermatitis, urticaria, pruritus, acne, chloasma, neurodermatitis, dermatitis herpetiformis, hyperhidrosis, human papillomavirus wart, breast inflammation, and facial elasticity. In 17 of 24 studies, acupuncture showed statistically significant improvements in outcome measurements compared with placebo acupuncture, alternative treatment options, and no intervention.
Conclusions: Acupuncture improves outcome measures in the treatment of dermatitis, chloasma, pruritus, urticaria, hyperhidrosis, and facial elasticity. Future studies should ideally be double-blinded and standardize the control intervention.
One has to read the actual full text article to understand that the evidence presented here is dodgy to the extreme. In fact, one has to go into the tedious details of the methods section to find the reasons why: All searches were limited to clinical trials, controlled studies, case reports, comparative studies, and systematic reviews published in the English language.
There are many more weaknesses of this review, but the inclusion of uncontrolled studies and even anecdotes is, in my view, a virtual death sentence to its credibility. It means that no general conclusions about the effectiveness of acupuncture, such as the authors have decided to make, are possible.
Such overt exaggerations are sadly no rarities in the realm of alternative medicine. I think, this begs a number of serious questions:
- Does this cross the line between flawed research and scientific misconduct?
- Why did the reviewers not pick up these flaws?
- Why did the editor pass this article for publication?
- How can the publisher tolerate such dubious behaviour?
- Should this journal (which I have commented on before here and which is one with the highest impact factor of all the alt med journals) be de-listed from Medline?
I don’t think that we will get answers from the people responsible for this disgrace, but I would like to learn my readers’ opinions.
5 Responses to Acupuncture research: where is the line between poor quality and scientific misconduct?
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“1. Does this cross the line between flawed research and scientific misconduct?” Yes. But it lets us see the authors’ (incompetent) mindset.
“2. Why did the reviewers not pick up these flaws?” Because the reviewers for this journal are probably biased and uncritical.
“3. Why did the editor pass this article for publication?” Any Altmed journal that publishes only robust research will swiftly go out of business.
“4. How can the publisher tolerate such dubious behaviour?” He or she makes money from the journal.
“5. Should this journal (which I have commented on before here and which is one with the highest impact factor of all the alt med journals) be de-listed from Medline?” No. We should all be able to know and access what is being published in the name of science and medicine, even if it’s rubbish. Medline is supposed to be a dispassionate data collecting service. If it starts making judgements about journal quality we’ll lose something.
What Frank said, except maybe #5. Not so sure it matters if we lose rubbish. The other problem is that now this “study” will be widely re quoted ad infinititum, and the average yahoo (in the Swiftian sense, not the inter webs sense) will believe the “evidence”.
The claims of peer review by this and other alt med journals are not true. It is a claim made only to try and increase the credibility of the research published but is merely cargo cult science. We should stop addressing these publications as if they were junior members of proper science and medical journals.
“Objectives: Acupuncture is a form of Traditional Chinese Medicine that has been used to treat…”
That sentence belongs to the Introduction section: it has no place in the Objectives statement(s) because it isn’t an objective. To me, it’s a bright red flag warning of quackery.
“Results: …In 17 of 24 studies, acupuncture showed statistically significant improvements in outcome measurements…”
“Conclusions: Acupuncture improves outcome measures in the treatment of…”
Hilarious! Since when did such a pathetic level of “statistically significant” become a synonym for “clinically significant”.
Researchers who conduct systematic reviews use an organized method of locating, assembling, and evaluating relevant studies to include in the review. The same review also found strong evidence that there is no difference between the effects of actual and simulated acupuncture in people with low-back pain.