MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The aim of this systematic review was to determine the efficacy of conventional treatments plus acupuncture versus conventional treatments alone for asthma, using a meta-analysis of all published randomized clinical trials (RCTs).

The researchers included all RCTs in which adult and adolescent patients with asthma (age ≥12 years) were divided into conventional treatments plus acupuncture (A+B) and conventional treatments (B). Nine studies were included. The results showed that A+B could improve the symptom response rate and significantly decrease interleukin-6. However, indices of pulmonary function, including the forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity (FVC) failed to be improved with A+B.

The authors concluded that conventional treatments plus acupuncture are associated with significant benefits for adult and adolescent patients with asthma. Therefore, we suggest the use of conventional treatments plus acupuncture for asthma patients.

I am thankful to the authors for confirming my finding that A+B must always be more/better than B alone (the 2nd sentence of their conclusion is, of course, utter nonsense, but I will leave this aside for today). Here is the short abstract of my 2008 article:

In this article, we test the hypothesis that randomized clinical trials of acupuncture for pain with certain design features (A + B versus B) are likely to generate false positive results. Based on electronic searches in six databases, 13 studies were found that met our inclusion criteria. They all suggested that acupuncture is effective (one only showing a positive trend, all others had significant results). We conclude that the ‘A + B versus B’ design is prone to false positive results and discuss the design features that might prevent or exacerbate this problem.

Even though our paper was on acupuncture for pain, it firmly established the principle that A+B is always more than B. Think of it in monetary terms: let’s say we both have $100; now someone gives me $10 more. Who has more cash? Not difficult, is it?

But why do SCAM-fans not get it?

Why do we see trial after trial and review after review ignoring this simple and obvious fact?

I suspect I know why: it is because the ‘A+B vs B’ study-design never generates a negative result!

But that’s cheating!

And isn’t cheating unethical?

My answer is YES!

(If you want to read a more detailed answer, please read our in-depth analysis here)

 

 

3 Responses to Chinese acupuncture researchers have finally discovered the obvious (but sadly, without realising it)

  • I’m a little confused here.
    I take the crux of Ed’s argument to be this: “I suspect I know why: it is because the ‘A+B vs B’ study-design never generates a negative result!” Implying (derisively) that adding Acupuncture (A) to Conventional Treatments (B), will:
    1) Never produce worse outcomes, and
    2) Sometimes produce better outcomes.

    But isn’t this just what medicine is? Experimental possible treatments that help a significant amount of the time, and
    harm a less significant amount of the time? Which we try once or twice, and then switch away from if they don’t help us? Isn’t this the same finding being taken from these studies?

    A few more things: I don’t do acupuncture. I think the more fair point to make is that Acupuncture is likely riding the placebo effect- which recommends us toward utilizing it AS a placebo, OR finding a better one.

    I apologize for not including citations or references, the papers I read seemed a little off the point.

    • “But isn’t this just what medicine is? Experimental possible treatments that help a significant amount of the time, and
      harm a less significant amount of the time?”
      perhaps – but with a trial design like this, even a placebo (or mildly harmful treatment) would appear to be effective.

    • But isn’t this just what medicine is? Experimental possible treatments that help a significant amount of the time, and harm a less significant amount of the time?

      Erm, no. Experimental treatments are correctly controlled during testing, as in ‘A+B vs C+B’ (where C is a placebo that practitioner and patient cannot tell from A), only becoming medicine if they pass those and subsequent tests.

      A correctly-designed trial asks: All else being equal, does the application of experimental treatment A produce a change in the live arm compared to the control arm?”

      In an ‘A+B vs B’ trial, all else is immediately not equal, because patients already know if they’re receiving the treatment or not. Letting patients know which arm they’re on contaminates the measurements, as how then do you tell how much (if any) change is caused by the medication and how much is caused by the patients’ own belief (and subsequent changes in behavior) that they should be getting better (or not). Such trials are defective by design, and anyone who understands trial design knows this, so the only reasons to perform them are incompetence and/or malfeasance.

      Think of the placebo as a placeholder, filling a visible hole left in the control arm’s treatment plan that would otherwise provide an obvious clue to patients as to which arm they’re on. When hoping to see clear signs of a signal within a hugely messy, noisy, complex system (humans and their biology), the last thing we need is pareidolia running amok.

      I think the more fair point to make is that Acupuncture is likely riding the placebo effect- which recommends us toward utilizing it AS a placebo

      A placebo is not a medical treatment, and passing it off as one is totally unethical. If acupuncture works no better than placebo then it should be discarded as ineffective, and attention turned to other, more promising avenues of investigation.

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