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

The new issue of the BMJ carries an article on acupuncture that cries out for a response. Here, I show you the original article followed by my short comments. For clarity, I have omitted the references from the article and added references that refer to my comments.

_________________________________________

Conventional allopathic medicine [1]—medications and surgery [2] used in conventional systems of medicine to treat or prevent disease [3]—is often expensive, can cause side effects and harm, and is not always the optimal treatment for long term conditions such as chronic pain [4]. Where conventional treatments have not been successful, acupuncture and other traditional and complementary medicines have potential to play a role in optimal patient care [5].

According to the World Health Organisation (WHO) 2019 global report, acupuncture is widely used across the world. [6] In some countries acupuncture is covered by health insurance and established regulations. [7] In the US, practitioners administer over 10 million acupuncture treatments annually. [6] In the UK, clinicians administer over 4 million acupuncture treatments annually, and it is provided on the NHS. [6]

Given the widespread use of acupuncture as a complementary therapy alongside conventional medicine, there has been an increase in global research interest and funding support over recent decades. In 2009, the European Commission launched a Good Practice in Traditional Chinese Medicine Research (GP-TCM) funding initiative in 19 countries. [7] The GP-TCM grant aimed to investigate the safety and efficacy of acupuncture as well as other traditional Chinese medicine interventions.

In China, acupuncture is an important focus of the national research agenda and receives substantial research funding. [8] In 2016, the state council published a national strategy supporting universal access to acupuncture by 2020. China has established more than 79 evidence-based traditional Chinese medicine or integrative medicine research centers. [9]

Given the broad clinical application and rapid increase in funding support for acupuncture research, researchers now have additional opportunities to produce high-quality studies. However, for this to be successful, acupuncture research must address both methodological limitations and unique research challenges.

This new collection of articles, published in The BMJ, analyses the progress of developing high quality research studies on acupuncture, summarises the current status, and provides critical methodological guidance regarding the production of clinical evidence on randomised controlled trials, clinical practice guidelines and health economic evidence. It also assesses the number and quality of systematic reviews of acupuncture. [10] We hope that the collection will help inform the development of clinical practice guidelines, health policy, and reimbursement decisions. [11]

The articles document the progress of acupuncture research. In our view, the emerging evidence base on the use of acupuncture warrants further integration and application of acupuncture into conventional medicine. [12] National, regional, and international organisations and health systems should facilitate this process and support further rigorous acupuncture research.

Footnotes

This article is part of a collection funded by the special purpose funds for the belt and road, China Academy of Chinese Medical Sciences, National Natural Science Foundation of China, the National Center for Complementary and Integrative Health, the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine, the Special Project of “Lingnan Modernization of Traditional Chinese Medicine” of the 2019 Guangdong Key Research and Development Program, and the Project of First Class Universities and High-level Dual Discipline for Guangzhou University of Chinese Medicine. The BMJ commissioned, peer reviewed, edited, and made the decision to publish. Kamran Abbasi was the lead editor for The BMJ. Yu-Qing Zhang advised on commissioning for the collection, designed the topic of the series, and coordinated the author teams. Gordon Guyatt provided valuable advice and guidance. [13]

1. Allopathic medicine is the term Samuel Hahnemann coined for defaming conventional medicine. Using it in the first sentence of the article sets the scene very well.

2. Medicine is much more than ‘medications and surgery’. To imply otherwise is a strawman fallacy.

3. What about rehabilitation medicine?

4. ‘Conventional medicine is not always the optimal treatment’? This statement is very confusing and wrong. It is true that conventional medicine is not always effective. However, it is by definition the best we currently have and therefore it IS optimal.

5. Another fallacy: non sequitur

6. Another fallacy: appeal to popularity.

7. Yet another fallacy: appeal to authority.

8. TCM is heavily promoted by China not least because it is a most lucrative source of income.

9. Several research groups have shown that 100% of acupuncture research coming out of China report positive results. This casts serious doubt on the reliability of these studies (see, for instance, here, here, and here).

10. It has been noted that more than 80 percent of clinical data from China is fabricated.

11. Based on the points raised above, it seems to me that the collection’s aim is not to provide objective information but uncritical promotion.

12. I find it telling that the authors do not even consider the possibility that rigorous research might demonstrate that acupuncture cannot generate more good than harm.

13. This statement essentially admits that the series of articles constitutes paid advertising for TCM. The BMJ’s peer-review process must have been less than rigorous in this case.

All this does not bode well for the rest of the collection. Looking at the two further acupuncture papers (see here and here) from the same BMJ issue, my fear that the uncritical promotion of acupuncture will be a prominent feature was amply confirmed.

9 Responses to A new BMJ article on acupuncture turns out to be a bonanza of logical fallacies, sloppy thinking, and uncritical promotion

  • Fortunately for sanity and scientific progress these articles are not in the BMJ’s printed version of 26th February: 376:295-336 No 8327 (or not in mine!).
    They are simply in the online ‘Opinion’ section.
    Only read by enthusiasts.

    But there is an excellent article in no. 8327 about Prince Charles involvement in complementary medicine – concluding that HRH was in a position of influence which, sadly, was “a golden opportunity that has been missed.”

    ‘Acupuncture’ is so called in English from the Latin: ‘acus’, a needle.
    Given the Greek for a needle is ‘belone’ we should style this form of treatment ‘Belonetherapy’.

    Of course acupuncture ‘works’ – it makes some folks feel better (for a while).
    And we know how it works – as a theatrical placebo.

    Traditional Chinese coins have a hole in their centre.
    So does their research about acupuncture (and much else besides).
    Sigh.

  • Should we campaign to have this paper retracted?

  • I was going to ask how on earth such a biased article could ever get published. Then I read the footnote. The BMJ sold out and let money get in the way of proper science. Very disappointing and concerning.

      • The BMJ’s new editor was editor of the Royal Society of Medicine’s Journal (JRSM).
        Therein he published a piece about HRH PC.
        He also publishe two (excellent) responses from Nick Ross and myself – so he ain’t all bad!

        The BMJ is the BMA’s organ, but has editorial independence – unless or until any matter really blows up.
        That’s scientific journalistic integrity for you.
        That’s why we need folks like EE, Sense about Science and HealthWatchUK to keep an eye on things for us – and for the sake of humankind!

        There are many commentators now declaring about Russia: “Told you so – I knew it wouldn’t stop there!”.

        So too we must be aware of the Chinese Government – who won’t stop until TCM is ‘fully accepted’ by all humankind as being valid and having ‘evidence’ acceptable to the scientific community, and to medical journals.
        (They’ve already got control of WHO).

        Sigh.

        RR
        Member of BMA Council, wrting in a personal capacity.

  • Once again, in this skeptical community, it seems that I have to fight on two fronts – against Edzard as well as against those bragging idiots in China and the West who claim that at present there is something like an “evidence-based Traditional Chinese Medicine (TCM)”.

    Let me begin with the Chinese. For some 15 years, I was a member of the editorial board of the “Journal of Integrative Medicine” in Shanghai. Once, I said to the editor:
    “Listen, we Westerns have so many questions about TCM. One example: For several thousand years, even the most stupid Chinese peasants know that to castrate a bull you have to cut off his testicles, not remove his kidneys. How is it possible that the testicles have never been integrated into TCM theory, so that even today the so-called “TCM universities” teach that the kidney(s) are responsible for vitality, sexuality and reproduction?
    Another example: The 12 regular acupuncture “meridians” are strictly symmetrical on the right and left half of the body. However, acupuncture theory teaches that each of these “meridians” is connected to a certain inner organ. How is it possible that even those “meridians” allegedly connected to non-symmetrical inner organs (e.g. heart, liver) run absolutely symmetrically on the outside of the body?”
    When he didn’t answer, I asked him “Don’t you think these are important questions?”
    “Of course they are important”, he said.
    “Then I have a suggestion”, I said. “As a Westerner, I know all those questions. You are the Chinese editor, and you know all the famous TCM experts. So, let us publish a book with the title “Open Questions of TCM”. Good?”
    “No”, he said, “not good”.
    I was stunned. “Why not?” I asked.
    He answered: “We Chinese ask all those questions as well, but no one can answer them. Asking questions which nobody can answer makes the experts and the authorities lose face. That’s why we cannot publish this book.”
    So this book was never published, nor was, for the same reasons, an essay with the same title in his journal – only that some time after this dialogue I was removed from the journal’s editorial board.
    Can there be anything more ridiculous than a so-called “science” which fears nothing more than scientific questions?

    Nevertheless, I am convinced that acupuncture is more than a mere placebo. We mustn’t forget that the needle causes a micro-wound, and that the wound-healing system is one of the most important mechanisms of advanced creatures. However, like our immune system being underused in our hygienic surroundings and needing to be stimulated by vaccinations, to me it seems logical that our underused wound-healing system needs stimulation as well. And that’s what acupuncture does – moreover, with an excellent setting which forces the patient to calm down for half an hour. For me, this is enough. We may take the important acupuncture points (though their specific abilities are still unproven) as a memory aid, and all the rest of acupuncture theory might be thrown into the garbage can: the basic TCM theory, the Five-Elements-theory, the “meridians”, the “flow of qi” and all those functional categories like “master points”, “influential points” or “xi-cleft-points”. Wouldn’t you agree?

    • “Nevertheless, I am convinced that acupuncture is more than a mere placebo.”

      Every quack is convinced that their particular quackery is more than a mere placebo. If it were true then the conclusion must be that placebos are more than mere placebos: utter poppycock.

      The actual explanation is boringly simple: those who tout their particular quackery to be more than a mere placebo are, in reality, clearly stating that they don’t know anything that’s worth knowing about placebos and nocebos, their reactions, and their effects.

      The reason for acupuncture being in the Wikipedia List of topics characterized as pseudoscience is not because science is unable to accommodate acupuncture, it is because supporters of acupuncture are unable to properly accommodate science and its methods.

      See also:
      https://en.m.wikipedia.org/wiki/Placebo

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