According to its authors, this study‘s objective was to demonstrate that acupuncture is beneficial for decreasing the risk of ischaemic stroke in patients with rheumatoid arthritis (RA).
The investigation was designed as a propensity score-matched cohort nationwide population-based study. Patients with RA diagnosed between 1 January 1997 and 31 December 2010, through the National Health Insurance Research Database in Taiwan. Patients who were administered acupuncture therapy from the initial date of RA diagnosis to 31 December 2010 were included in the acupuncture cohort. Patients who did not receive acupuncture treatment during the same time interval constituted the no-acupuncture cohort. A Cox regression model was used to adjust for age, sex, comorbidities, and types of drugs used. The researchers compared the subhazard ratios (SHRs) of ischaemic stroke between these two cohorts through competing-risks regression models.
After 1:1 propensity score matching, a total of 23 226 patients with newly diagnosed RA were equally subgrouped into acupuncture cohort or no-acupuncture cohort according to their use of acupuncture. The basic characteristics of these patients were similar. A lower cumulative incidence of ischaemic stroke was found in the acupuncture cohort (log-rank test, p<0.001; immortal time (period from initial diagnosis of RA to index date) 1065 days; mean number of acupuncture visits 9.83. In the end, 341 patients in the acupuncture cohort (5.95 per 1000 person-years) and 605 patients in the no-acupuncture cohort (12.4 per 1000 person-years) experienced ischaemic stroke (adjusted SHR 0.57, 95% CI 0.50 to 0.65). The advantage of lowering ischaemic stroke incidence through acupuncture therapy in RA patients was independent of sex, age, types of drugs used, and comorbidities.
The authors concluded that this study showed the beneficial effect of acupuncture in reducing the incidence of ischaemic stroke in patients with RA.
It seems obvious that the editors of ‘BMJ Open’, the peer reviewers of the study and the authors are unaware of the fact that the objective of such an investigeation is not to to demonstrate that acupuncture is beneficial but to test whether acupuncture is beneficial. Starting a study with the intention to to show that my pet therapy works is akin to saying: “I am intending to mislead you about the value of my intervention”.
One needs therefore not be surprised that the authors of the present study draw very definitive conclusions, such as “acupuncture therapy is beneficial for ischaemic stroke prevention”. But every 1st year medical or science student should know that correlation is not the same as causation. What the study does, in fact, show is an association between acupuncture and stroke. This association might be due to dozens of factors that the ‘propensity score matching’ could not control. To conclude that the results prove a cause effect relationship is naive bordering on scientific misconduct. I find it most disappointing that such a paper can pass all the hurdles to get published in what pretends to be a respectable journal.
Personally, I intend to use this study as a good example for drawing the wrong conclusions on seemingly rigorous research.
3 Responses to Effect of acupuncture on ischaemic stroke in patients with rheumatoid arthritis: a nationwide propensity score-matched study
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Statistics is a very complicated matter. Counting the cases is a very tough burden. So hard and so tough that homeopaths until today can’t do it correctly.
As far as I can see, there was done REAL acupuncture. So there was no real placebo study part, like with sham acupuncture.
This means that these patients had more treatments than the others. This leaves a wide field of opportunities to “work” on these patients, even if it is a more closer observation, which could lead to other necessary treatments.
The study authors have deliberately introduced confirmation bias. The study lacks equipoise. This is unethical, unscientific and unpublishable.
Proponents of pseudoscience have simple motivations to validate their nonsense: ignorance, belief &/or money; and their ‘research’ should be treated as ‘Fruit of the poisonous trees’ (to borrow a US legal term).
This study is being touted in every “update” list of articles in my inbox. It just appeared in ” Practice Update (Elsevier) ” and is listed as having been published in the list going to all Primary Care specialists. I suppose they’re now supposed to sell acupuncture to their patients based on this study in confirmation bias? Well, Elsevier is selling this kind of stuff to pre med and nursing students via their textbooks. So it’s not surprising they push articles like this on the lists of what primary care providers need to be UTD on.
Would I bet against Elsevier belonging to a corporation that also owns part of a school for acupuncture? The company promotes SCAM in so many of their recommended “must read” studies and “need to know” lists in addition to texts, I just wonder why.
(Sorry, came late to the party on this one due to R hand being tied up in stitches)