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

TCM

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Tuina, or Tui Na is based on the notion that imbalances of the life-force, qi, can cause blockages or imbalances that lead to symptoms and illness. Tuina massage is similar to acupressure in that it targets specific acupoints. Practitioners use fingers to apply pressure to stimulate these points.

Some people suggest that Tuina might benefit diabetic peripheral neuropathy (DPN), but the evidence is inconclusive. This review evaluated its clinical efficacy and safety for DPN treatment.

Ten databases were searched, covering the period from their inception to February 21, 2024. Relevant data were extracted from studies meeting the inclusion criteria, and a meta-analysis was conducted using RevMan
5.3 software.

A total of 24 randomized controlled trials (RCTs) involving 1,989 participants were included. Patients in the experimental group received Tuina in addition to routine treatments and nursing of DPN. Patients in the control group received routine treatments and nursing of DPN, including health education, dietary guidance, blood sugar control, and oral vitamin B or mecobalamin.

The meta-analysis showed that, compared to various control therapies, Tuina demonstrated a higher overall clinical efficacy rate and improved Toronto Clinical Scoring System (TCSS) scores, indicating that Chinese Tuina may provide benefits beyond conventional treatment. Furthermore, improvements were observed in the motor and sensory nerve conduction velocities (MNCV and SNCV) of certain specific nerves, such as the common peroneal nerve, sural nerve, and ulnar nerve. Although the differences in MNCV and SNCV of the tibial and median nerves were not statistically significant, the overall improvement in clinical outcome supports the notion that Tuina is superior to conventional treatment.

The authors concluded that Chinese Tuina therapy is a safe and effective treatment option for DPN. It can alleviate clinical symptoms and improve the MNCV of the common peroneal nerve as well as the SNCV of the sural and ulnar nerves. Its efficacy in the tibial and median nerves remains unconfirmed, highlighting a need for future large-scale, high-quality RCTs.

There are several reasons why I cannot accept the conclusion that Tuina is effective for DPN, e.g:

  1. All the RCTs were of the notorious A+B vs B design that – as discussed ad nauseam on this blog – does not control for placebo effects and thus never generate negative results.
  2. None of the RCTs were single or double blind which means that expectation and therapist influence would have impacted on the findings.
  3. All of the studes originate from China; we have often discussed why such studies are notoriously unreliable. Funding for the review was supported by the National Key Research and Development Program of China and Jilin Provincial Natural Science Foundation Project.
  4. Most of the studies are published in journals and/or laguages that are not accessible to non-Chinese readers.
  5. None of these serious limitations are discussed by the review authors.

I REST MY CASE

 

 

Today is World Cancer Day. It is an international day observed every 4 February to raise awareness about cancer, encourage its prevention, and mobilise action to address the global cancer epidemic. Cancer and so-called alternative medicine (SCAM) are closely linked, for instance, through the fact that large proportions of desperate cancer patients use SCAM, many in the hope to cure their disease. I have therefore often tried to instill some rational thought into the debate by discussing the emerging, largely negative evidence on SCAM for cancer. Here are just a few recent examples:

To mark the day, I had a look at what people post on ‘X’ about SCAM and cancer cure. Here are some of the more amazing assumptions, claims and comments that I found (warts and all):

  • The Princess of Wales, Kate Middleton has been diagnosed with Cancer – there is a high probability she has Turbo Cancer, caused by COVID-19 mRNA Vaccines she took in 2021.
  • Blue butterfly pea flowers (Clitoria ternatea) is one of the best CANCER KILLING and CANCER PROTECTIVE plants available to man.
  • Dandelion root far more effective in fighting cancer cells than chemotherapy.
  • In Kenya, research shows 76% of cancer patient who turn to traditional medicine instead of chemotherapy have drastically improved.
  • I’ve just been diagnosed w cancer and will approach it with nutrition, suppl,and cont’d exercise… other alternative therapies as well. Been an RN for decades and have witnessed the horrors and pitfalls of modern medicine. Must b your own best advocate.
  • I had a niece, a cousin and a friend die same week of the big C. was an eye-opener for me cause chemo did not help them at all….so looked at the alternative medicine….down in Mexico. but it was too late. cancer spread like wildfire.
  • I pray to God that no one has to suffer through cancer but I agree with you 1000% alternative medicine as a matter fact we already know that there are three that can cure cancer. I ivermectin is one and I can’t remember the other two.
  • Cancer has been proven to be eliminated with alternative medicine you denounce without a single study. I’m starting to think you hate the American people.
  • Next time you or your loved one gets cancer, use “alternative medicine“.
  • Most Doctors use drugs for treatment of symptoms because that’s how they are trained. No nutrition or alternative medicine is taught or encouraged. In cancer treat Drs are required to only recommend chemo because they could lose their license for alternative nedicine referrals.
  • Spiritual causes of illness, including cancer, are often explored within alternative approaches to healing and holistic philosophies. Although traditional medicine does not recognize spiritual causes, many spiritual traditions and energetic practices.
  • I pray that you look to alternative medicine, don’t listen to the current medical model as it is designed to keep people sick, western medicine does not heal. Chinese medicine does like others around the world. A primary cause of cancer is parasites. Western medicine doesn’t look.
  • Chemotherapy is brutal, attacking both cancer and healthy cells. Alternative solutions do exist, but mainstream medicine often won’t offer them. Take control of your research, explore your options, and question everything.
  • I cured my cancer symptoms using alternative medicine, including Ayurveda. Not drugs.
  • I’m a double cancer survivor and I was in a clinical trial testing chemo in 2013-2014. Chemo is poison and big pharma. Alternative medicine is better. Changed must be made. I love that PresidentTtump has done this. And I can’t wait for RFKJr to lead HHS.
  • Cancer kills you if you follow the advice of the medical establishment. There are many alternative cures for cancer and even more ways to prevent it in the first place. Do some research into naturopathic medicine if you truly want to be healthy.
  • Maybe Trump should redirect that 500 billion to alternative medicine/supplement/ivermectin research that will eradicate cancer. And what is causing cancer. Don’t need a mRNA cancer vaccine. We already have the tools to stop cancer
  • Please get checked for parasites which is what cancer is. Try alternative medicine and see how that works – I bet it does.
  • I have a friend who cured her own breast cancer with alternative methods. There are cures out there. Mainstream medicine just won’t recognize them.
  • Everything is fake in medical field nowadays. Not only petition but also pathogen hypothesis medical academic papers about virus, cancer etc.. We need to build an alternative medicine field ASAP.

[I could have gone on almost for ever]

 

I had not expected to find much wisdom on ‘X’, but what I did find truly horrified me. For every sensible Tweet, there seem to be 10 imbecillic and dangerous ones. Imaging a desperate cancer patient reads these lies, misleading claims, nonsensical statements and conspiracy theories!

To set the record straight, let me state these two simple facts:

There is no SCAM that would change the natural history of any form of cancer.

What is more, there never ill be one! As soon as a treatment might look promising as a cancer cure, it will be investigated by mainstream scientists and – if it turns out to be helpful – integrated into conventional oncology. In other words, it will become evidence-based medicine.

You don’t believe me without evidence?

Ok, then please read my book on the subject.

 

 

PS

And yes, there are some SCAMs that might have a role in improving QoL, but that’s a different topic.

 

Kampo medicine is the Japanese form of traditional herbal medicine that is still very popular in Japan. The word Kampo means ‘Chinese style’ in Japanese. Kampo developed out of traditional Chinese herbal medicine after it was introduced into Japan in the 7th century. In the early 20th century, Kampo was further influenced by modern Western medicine and science. The Kampo system is a pragmatic and simplified version of Chinese herbal medicine. Kampo medicines are standardised and not individualised as in Chinese herbal medicine. They are based on the current symptoms of the patient, interpreted in the philosophy of Kampo. Kampo diagnostics consider hypofunction and hyperfunction, heat and cold, superficies and interior, and yin and yang.

Today, Kampō is fully integrated into the Japanese national health care system, and numerous Kampo preparations are registered in Japan and reimbursable from public funds. These standardised formulas contain mixtures of herbal ingredients. They are manufactured under proper quality control. The most commonly used plants include liquorice, ginger and Chinese peony root. Most Japanese doctors routinely prescribe Kampo medicines, and most patients combine Kampo with Western medicine. Since 2002, the teaching of Kampo has been included in Japanese curricula of medical and pharmacy education.

The efficacy of Kampo medicines is often less solidly documented than one would hope or expect. There is a remarkable shortage of high-quality clinical trials. One review concluded that “Kampo medicines potentially play some roles in preventing or ameliorating side effects of anticancer agents. Supportive care with Kampo medicines for patients with cancer might lead to physical, mental, and nutritional improvement.” As Kampo medicines contain pharmacologically active ingredients, they can also cause adverse effects and might interact with synthetic drugs. Yet, the risks of Kampo are currently woefully under-investigated.

This case of severe liver injury following the administration of the Kampo medicine ‘Saibokuto‘ attempted to identify the likely causative crude drug inducing liver injury through a systematic literature review.

A 29-year-old woman developed severe liver injury approximately two months after Saibokuto administration, necessitating steroid pulse therapy for recovery. A literature search was conducted. Using PubMed and the “Igaku Chuo Zasshi (ICHUSHI) database,” two individuals independently selected studies published between January 1997 and February 15, 2023. The search focused on studies involving human subjects, published in either English or Japanese, and specifically investigated Kampo medicines categorized as over-the-counter or prescription drugs suspected as causative agents of drug-induced liver injury (DILI). Studies on health supplements, discontinued Kampo medicines, and autoimmune hepatitis, were excluded. As it is ethically impossible to rechallenge drugs that cause liver injury, this review primarily relied on case report literature.

Through the review, 37 cases (men/women: 12/25, including present case) were analyzed, including 32 reports (36 cases) from 3,055 studies that met the inclusion criteria. Notably, 65.9% of cases were associated with Scutellariae radix, with onset occurring within 45 (1-730) days and recovery within 35 (7-184) days.

The authors concluded that their case study and literature review underscore a prevalent association between liver injury and Kampo medicines containing Scutellariae radix. Vigilant liver function monitoring, particularly within the first 2 months of administration, is recommended, especially for formulations containing Scutellariae radix.

Radix Scutellariae (scullcap) is the dried root of the medicinal plant Scutellariae baicalensis Georgi. It has a long history of application in traditional herbalism. Six flavones seem to be its major bioactive constituents. All six flavones are pharmacologically active.

Scullcap has been advocated to treat arthritis, lung problems, hay fever, seizures, HIV or AIDS, and hepatitis. Scullcap applied to the skin has been used to treat psoriasis, sores or swelling, and hemorrhoids. The evidence that it is effective for any condition is far from convincing. Adverse effects of scullcap are equally under-researched.

The paper discussed above is a poignant remeinder of the ‘appeal to tradition‘: not everything that has been used for centuries is safe. Only proper scientific investigations will determine the risk/benefit profile of a therapy.

This study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.

The authors selected from a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics) 18–63 years old malignant breast cancer survivors who were experiencing pain and were ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.

Among 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients.

The authors concluded that, although adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.

Oh, dear!

Which institutions support such nonsense?

  • School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA.
  • School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA.
  • College of Korean Medicine, Kyung Hee University, Seoul, South Korea.
  • Integrative Medicine Program, Departments of Supportive Care Medicine and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
  • School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA. [email protected].
  • School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA. [email protected].

And which journal is not ashamed to publish it?

It’s the BMC Med!

The conclusion is, of course, quite wrong.

Please let me try to formulate one that comes closer to what the study actually shows:

This study failed to show that a ‘real world impact’ of acupuncture exists. Since the authors were dissatisfied with a negative result, subsequent data dredging was undertaken until some findings emerged that were in line with their expectations. Sadly, no responsible scienctist will take this paper seriously.

Two years ago, I reported about an acupuncture review that was, in my view, a fairly clear case of scientific misconduct. To remind you, here is my from 22/11/22 about it:

Acupuncture is emerging as a potential therapy for relieving pain, but the effectiveness of acupuncture for relieving low back and/or pelvic pain (LBPP) during pregnancy remains controversial. This meta-analysis aimed to investigate the effects of acupuncture on pain, functional status, and quality of life for women with LBPP pain during pregnancy.

The authors included all RCTs evaluating the effects of acupuncture on LBPP during pregnancy. Data extraction and study quality assessments were independently performed by three reviewers. The mean differences (MDs) with 95% CIs for pooled data were calculated. The primary outcomes were pain, functional status, and quality of life. The secondary outcomes were overall effects (a questionnaire at a post-treatment visit within a week after the last treatment to determine the number of people who received good or excellent help), analgesic consumption, Apgar scores >7 at 5 min, adverse events, gestational age at birth, induction of labor and mode of birth.

Ten studies, reporting on a total of 1040 women, were included. Overall, acupuncture

  • relieved pain during pregnancy (MD=1.70, 95% CI: (0.95 to 2.45), p<0.00001, I2=90%),
  • improved functional status (MD=12.44, 95% CI: (3.32 to 21.55), p=0.007, I2=94%),
  • improved quality of life (MD=−8.89, 95% CI: (−11.90 to –5.88), p<0.00001, I2 = 57%).

There was a significant difference in overall effects (OR=0.13, 95% CI: (0.07 to 0.23), p<0.00001, I2 = 7%). However, there was no significant difference in analgesic consumption during the study period (OR=2.49, 95% CI: (0.08 to 80.25), p=0.61, I2=61%) and Apgar scores of newborns (OR=1.02, 95% CI: (0.37 to 2.83), p=0.97, I2 = 0%). Preterm birth from acupuncture during the study period was reported in two studies. Although preterm contractions were reported in two studies, all infants were in good health at birth. In terms of gestational age at birth, induction of labor, and mode of birth, only one study reported the gestational age at birth (mean gestation 40 weeks).

The authors concluded that acupuncture significantly improved pain, functional status and quality of life in women with LBPP during the pregnancy. Additionally, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are still needed to further confirm these results.

What should we make of this paper?

In case you are in a hurry: NOT A LOT!

In case you need more, here are a few points:

  • many trials were of poor quality;
  • there was evidence of publication bias;
  • there was considerable heterogeneity within the studies.

The most important issue is one studiously avoided in the paper: the treatment of the control groups. One has to dig deep into this paper to find that the control groups could be treated with “other treatments, no intervention, and placebo acupuncture”. Trials comparing acupuncture combined plus other treatments with other treatments were also considered to be eligible. In other words, the analyses included studies that compared acupuncture to no treatment at all as well as studies that followed the infamous ‘A+Bversus B’ design. Seven studies used no intervention or standard of care in the control group thus not controlling for placebo effects.

Nobody can thus be in the slightest surprised that the overall result of the meta-analysis was positive – false positive, that is! And the worst is that this glaring limitation was not discussed as a feature that prevents firm conclusions.

Dishonest researchers?

Biased reviewers?

Incompetent editors?

Truly unbelievable!!!

In consideration of these points, let me rephrase the conclusions:

The well-documented placebo (and other non-specific) effects of acupuncture improved pain, functional status and quality of life in women with LBPP during the pregnancy. Unsurprisingly, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are not needed to further confirm these results.

PS

I find it exasperating to see that more and more (formerly) reputable journals are misleading us with such rubbish!!!

_________________________

Now – 2 years later! – the journal (BMJ-Open) has retracted the article and posted the following notice about the decision:

BMJ Open has retracted this article.1 After publication, multiple issues were raised with the journal concerning the design and reporting of the study. The editors and integrity team investigated the issues with the authors. There were fundamental flaws with the research, including the control group selection and data extraction, not amenable to correction.

I am delighted that this misleading paper is now officially discredited. Yet, I do have some concerns:

WHY DOES IT TAKE 2 YEARS TO IDENTIFY SOMETHING AS FRAUDULENT RUBBISH, WHEN IT TOOK ME ALL OF ~30 MINUTES?

Instead of just insisting on a triumphant ‘I TOLD YOU SO’, let me provide some constructive advice to reviewers and journal editors.

  • Many journal editors are to lazy to find reviewers themselves and ask the submitting author to name a few. Having myself published in the BMJ Open (the journal that published the paper in question) I fear that this might have been the case in the present instance. This habit invites poor reviews, e.g. reviews from colleagues who owe a favour to the submitting authors. It does not promote objective reviews and should be abandonned.
  • Papers on acupuncture originating from China (as the one in question) are very likely to be biased (or worse), as we have so often discussed on this blog. Editors should be extra careful with such submissions.
  • Reviewers who have in the past overlooked obvious flaws in a paper should be banned from further reviewing in future.
  • Editors should understand the reviewers’ comments only as guidelines and still have an obligation to check the actual submissions themselves. the responsibility for publishing an article lies with them alone.
  • Editors who repeatedly make such mistakes should be dismissed.

I think that adhering to these suggestions might improve the quality of published research … and, by Jove, this would be badly needed in the realm of so-called alternative medicine!!!

In China, acupuncture has been employed as an adjunctive therapy for coronavirus disease 2019 (COVID-19). Press needle acupuncture is a special type of acupuncture that provides prolonged stimulation to acupuncture points. This study assessed the effectiveness of integrating press needles alongside pharmacologic treatment in patients with mild-to-moderate COVID-19.

Patients hospitalized with mild-to-moderate COVID-19 symptoms between December 2022 and January 2023 were included in the study. The enrolled patients were randomly assigned to receive:

  • pharmacologic treatment alone (control group),
  • or both pharmacologic treatment and press needle acupuncture (intervention group).

Patients were evaluated for clinical outcomes, including symptom scores, deterioration rates, fever durations, and nucleic acid test results. The patients’ complete blood count and C-reactive protein levels were also analyzed using venous blood samples both before and after treatment.

Both groups exhibited a reduction in clinical symptom scores, but symptoms regressed faster in the intervention group. Nucleic acid test negativity was achieved faster in the intervention group than in the control group. The intervention group also had a lower deterioration rate. Furthermore, the increase in the lymphocyte count and decrease in C-reactive protein levels following treatment were more pronounced in the intervention group than in the control group.

The authors concluded that this study suggests that utilizing press needle acupuncture as an adjunct to pharmacologic treatment can be effective in patients with mild-to-moderate COVID-19 symptoms.

To understand this study better, we need to comprehend the nature of the therapeutic ritual. This is how the authors describe it:

For each session, press needles were inserted into acupoints and kept in place for approximately 24 hours. Only 1 side of the body (left or right) was treated in each session. The following day, press needles were removed from 1 side of the body, and new press needles were placed on acupoints on the other side of the body. Press needle acupuncture was performed by a qualified physician who had completed comprehensive acupuncture training. By contrast, patients in the control group solely received daily pharmacologic treatment, such as Lianhua Qingwen granules, with ibuprofen added as needed for fever management. Study participants were instructed to notify researchers of the appearance of clinical symptoms, and they were prohibited from participating in other studies during the trial period.

So, neither the patients nor the therapists were blinded. To call such a study “single-blind” is a bit odd! And are we really supposed to assume that the verum therapy did not generate placebo effects?

What we have here, I fear, is a classic example of a study designed such that it cannot possibly produce a negative result. It followed the A+B versus B design and employed a treatment that is bound to generate a sizable placebo response. What is even worse, the authors do discuss the limitations of their study but ignore the ‘elefant in the room’: ” this study had several limitations. The sample size was modest, and basic randomization was used without stratification based on comorbidities, which could have introduced bias.”

What do we call a study that cannot possibly produce a negative result?

  • A waste of resources?
  • Fraud?
  • Misleading?
  • Naive?
  • Unethical?

I leave the answer to you.

Advocates of so-called alternative medicine (SCAM) almost uniformly stress the importance of prevention and pride themselves to make much use of SCAM for the purpose of prevention. SCAM, they often claim, is effective for prevention, while conventional medicine tends to neglect it. Therefore, it seems timely to ponder a bit about the subject.

It makes sense to differentiate three types of prevention:

  1. Primary prevention aims to prevent disease or injury before it ever occurs.
  2. Secondary prevention aims to reduce the impact of a disease or injury that has already occurred.
  3. Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects.

Here I will includes all three and I will ask what SCAM has to offer in any form of prevention. I will do this by looking at what we have previously discussed on this blog in relation to several specific SCAM and add in each case a very brief evaluation of the evidence.

Acupuncture

Chiropractic

Herbal medicine

Homeopathy

Mind-body therapies

Osteopathy

Does Osteopathy Prevent Motion Sickness? – NO CONVINCING EVIDENCE

Supplements

Yoga

I hope you agree: this list is impressive!

  • Impressive in the way of showing how often we have discussed SCAM for prevention in one form or another.
  • Impressive also to see how little positive evidence there is for effective prevention with SCAM

Of course, this is merely based on posts that were published on my blog. Some will argue that I missed out on some effective SCAMs for prevention. Others might claim that I judged some of the the above cited articles too harshly. If you share such sentiments, I invite you to show me the evidence – and I promise to look at it and evaluate it critically.

Meanwhile, I will draw the following conclusion:

Despite the prominent place prevention assumes in discussions about SCAM, the actual evidence fails to show that it has an important role to play in primary, secondary or tertiary prevention.

 

Osteoarthritis of the knee (OAK) is a chronic degenerative musculoskeletal disorder that strongly affects the elderly population and decreases their quality of life. Pain, stiffness, and restricted knee movements are the major characteristic features of OAK. There are no studies available on the effect of the liver 7 (LR 7) acupuncture point on pain and range of motion. This study therefore tested the effectiveness of the LR 7 acupuncture point on pain and range of motion in chronic OAK patients.

Thirty-five subjects aged between 40 and 65 years were recruited from Government Yoga and Naturopathy Medical College, Chennai. Participants were included in the study after they fulfilled the eligibility criteria. The duration of acupuncture was 20 minutes (5 days/week) for 2 weeks. Baseline and post-intervention assessments were performed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the degree of knee flexion and extension was measured using a goniometer.

Pre- and post-trial outcomes were compared using paired t-tests. LR 7 acupuncture reduced the WOMAC score from 49 to 30 (p < 0.001), indicating that pain was alleviated. Treatment increased the range of knee flexion from 110 to 115 degrees and reduced knee extension (p < 0.01) from 16 to 9 degrees (p < 0.001). These findings indicate that acupuncture treatment improved the range of knee movement.

The authors concluded that the present study showed that 10 sessions of LR 7 acupuncture for people with OAK significantly reduced pain and increased range of motion. We conclude that LR 7 acupuncture is an adjuvant therapy for alleviating pain and managing OAK.

On several levels, this is a shocking paper:

  1. There already are many controlled clinical trials of acupuncture for OAK; thus there is no reason whatsoever to conduct and publish a trial that is methodolagically inferior to this body of evidence.
  2. The conclusions are incorrect; as the study had no control group, it is impossible to establish causaality between the treatment and the outcome. The pain reduction might have been caused by phenomena that are unrelated to acupuncture, e.g. placebo effect, regression towards the mean, social desirability.
  3. The authors state that they are “grateful to principal and faculities of government of yoga and naturopathy medical college and hospital for their support”. This means that they were misguided by a governmental medical college and hospital in planning and running a study that is a waste of resources and thus arguably unethical.

Research of this nature is dangerous:

  • It undermines the trust people put in science.
  • It makes a laughing stock of more serious attempts to test the value of acupuncture.
  • It misuses the cooperation of patients who give their time and good will to advance our knowledge.
  • It wasts precious resources.
  • It is an incentive for others to do similarly nonsensical pseudo-science.
  • It misleads patients and carers into believing in quackery.

The only valid conclusion that can be drawn from this paper is, I think, this:

The people involed in planning, conducting, supporting and publishing this study have little understanding of clinical research and should receive adequate education and training before they are allowed to continue.

The Canadian Kwantlen Polytechnic University (KPU) has announced that it will launch Canada’s first bachelor’s degree in Traditional Chinese Medicine (TCM). Greenlit by the B.C. government to fill what it calls rising demand in the labour market, the new program marks a major step in Canadian recognition of TCM. However, skeptics of TCM and other so-called alternative medicine (SCAM) remain wary of movement in this direction.

TCM is regulated in British Columbia, Alberta, Quebec, Ontario and Newfoundland and Labrador, with more than 7,000 licensed practitioners working in these provinces.

John Yang has worked for nearly a decade toward KPU’s bachelor’s degree, which will welcome its inaugural cohort starting September 2025. As chair of KPU’s TCM program, he hopes the new offering will boost its acceptance and encourage more integration with the Canadian health-care system. “The degree program can let the public [feel] more confident that we can train highly qualified TCM practitioners. Then there will be more mainstream public acceptance,” he said. “Currently we are not there yet, but I hope in the future there’s an integrated model.”

The degree will add topic areas like herbology and more advanced TCM approaches to the current diploma’s acupuncture-focused study, as well as courses in health sciences, arts and humanities, ethics and working with conventional health practitioners, says Sharmen Lee, dean of the B.C. school’s faculty of health. “You’re getting a much broader, deeper education that allows you to develop additional competencies, such as being able to critically think, to evaluate and participate in research, and all of those other things that a university-based education can provide.” Lee believes future graduates will be able to work alongside with biomedical professionals, with some becoming researchers as well — able to pursue post-grad studies abroad. “They start to understand the fundamentals of conducting research, of reviewing published studies and then … to critically analyze what that means so that they can apply that to their practice,” Lee said. “It’s going to help to elevate the practice of traditional Chinese medicine … in our province.”

With the World Health Organization (WHO) encouraging governments toward integrating traditional and complementary medicine into their health-care systems, there’s a need for researchers to develop strong evidence to guide policy-makers, says Nadine Ijaz, an assistant professor at Carleton University in Ottawa and president of the International Society for Traditional, Complementary and Integrative Medicine Research. “Most Canadians at some point in their lifetime are using some form of what we call traditional and complementary medicine: that might be acupuncture, chiropractic, massage therapy, vitamins, yoga … people who are participating in Indigenous healing ceremonies within their own communities,” she said. “How are governments to make good determinations about what to include? What is rigorous? What is safe? What is effective and what is cost effective, in addition to what is culturally appropriate?”

More research and scientific inquiry is a good thing, but it depends on the type of research, says Jonathan Jarry, a science communicator for the McGill Office of Science and Society and co-host of the health and medicine podcast Body of Evidence. Jarry said many studies on SCAM are low quality: too few participants, too short in duration, lacking follow-up or a proper control group. It’s an issue that plagues research on conventional therapies too, he acknowledged. “I’m all for doing research on things that are plausible enough that they could realistically have a benefit, but then you have to also do very good, rigorous studies. Otherwise you’re just creating noise in the research literature.”

Ijaz and a group of colleagues around the globe are working toward determining strong research parameters without forcing alternative approaches “into a box where they don’t fit.” For instance, a randomized controlled trial is the gold standard of research in biomedicine and excellent for studying pharmaceutical drugs and their effects, because participants in the control group get a placebo, perhaps a sugar pill, that means they can’t tell if they’re being treated with medication or not.  But it doesn’t work for studying acupuncture treatment, chiropractic or even psychotherapy, Ijaz pointed out. “If you’re getting an acupuncture treatment, you usually know that you’re getting a treatment…. It’s a little bit challenging to develop a placebo control for for those approaches,” said Ijaz. “When we apply that particular gold standard to researching all therapeutic approaches … it sort of privileges the issue in favour of pharmaceutical drugs immediately.”


“A randomized controlled trial is the gold standard of research in biomedicine and excellent for studying pharmaceutical drugs … but it doesn’t work for studying acupuncture treatment, chiropractic or even psychotherapy.” When I hear nonsensical drivel like this, I know what to think of a university course led or influenced by people who believe this stuff. They should themselves go on a course of research methodology for beginners rather that try brainwashing naive students into believing falsehoods.

To date, two open-label clinical trials have indicated that acupuncture may be more effective than standard medication for chronic migraine. However, drawing definitive conclusions from these trials is challenging. Studies employing a double-dummy design can eliminate the placebo effect and offer more unbiased estimates of efficacy.

This double-dummy, single-blind, randomized controlled trial compared the efficacy and safety of acupuncture and topiramate for chronic migraine. Participants, aged 18–65 years and diagnosed with chronic migraine, were randomly assigned (1:1) to receive:

  • acupuncture (three sessions/week) plus topiramate placebo (acupuncture group),
  • or topiramate (50–100 mg/day) plus sham acupuncture (topiramate group) over 12 weeks.

The primary outcome was the mean change in monthly migraine days during weeks 1–12.

Of 123 screened patients, 60 (mean age 45.8, 81.7% female) were randomly assigned to the acupuncture or topiramate groups. Acupuncture demonstrated significantly greater reductions in monthly migraine days than topiramate. No severe adverse events were reported.
The authors concluded that acupuncture may be safe and effective for treating chronic migraine. The efficacy of 12 weeks of acupuncture was sustained for 24 weeks and superior to that of topiramate. Acupuncture can be used as an optional preventive therapy for chronic migraine.

I beg to differ!

The authors claim that the participants, outcome assessors, and statistical analysts were blinded (masked) to the group allocations. However, the success of patient blinding was not tested. Why?

The authors state that, in the acupuncture group, “twirling, lifting, and thrusting were performed to produce deqi (a sensation of soreness, numbness, distention, or heaviness that indicates effective needling)… In the topiramate group, sham acupuncture was administered on non-effective acupoints, without manual deqi manipulations.” In other words, patients could very easily tell to which group they had been randomised.

This, in turn, means that a placebo effect – possibly enhanced by verbal or non-verbal communication from the (non-blinded) actupuncturists – has most likely caused the observed outcomes. I therefore feel the need to re-phrase the authors’ conclusions:

This study confirms that acupuncture produces a large placebo effect. Whether it has any effects beyond placebo cannot be determined by this study. Until this point has been clarified, acupuncture should not be used as a preventive therapy for chronic migraine.

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