AMA Publishing Group: Complementary and Alternative Medicine Topic Collection

Acupuncture's Elephant in the Room

Barrett S, London WM. — Mon, 22 Apr 2013 00:00:00 GMT

The optimistic article by Vickers et al did not consider an important point. Research studies may not reflect what takes place in most acupuncturist offices. Most acupuncturists are graduates of “oriental medical schools,” where they learn about 5-element theory, “energy” flow through meridians, and other fanciful traditional Chinese medicine (TCM) concepts that do not correspond with scientific knowledge of anatomy, physiology, or pathology. Practitioners of TCM typically rely on inappropriate diagnostic procedures (pulse and tongue diagnosis) and prescribe herbal mixtures that have not been sufficiently studied. Diagnoses based on TCM such as “Qi stagnation,” “blood stagnation,” “kidney Qi deficiency,” and “yin deficiency” may not jeopardize patients who are treated in an academic setting, where they have received a medical diagnosed before entering the study. But what about people with conditions that TCM-trained acupuncturists are not qualified or inclined to diagnose? Real-world evaluations of acupuncture should also consider the cost of unnecessary treatment.

Complexity of Sham Acupuncture

Huang W, Kutner N, Bliwise D. — Mon, 22 Apr 2013 00:00:00 GMT

While we are convinced that real acupuncture is superior to both sham and no-acupuncture control for various chronic pain conditions, as carefully reviewed in 29 randomized controlled trials (RCTs) (17 922 patients) by Vickers et al, the authors of that article also acknowledge that acupuncture, both real and sham, is likely to be associated with additional potent placebo and context effects, contributing to the total effects of acupuncture experienced by patients in routine practice.

Placing Acupuncture in Perspective

Ziegelstein RC. — Mon, 22 Apr 2013 00:00:00 GMT

The individual patient data meta-analysis by Vickers et al reported that acupuncture is effective for the treatment of chronic pain but that the effects are “relatively modest.” The authors base their conclusions on a well-conducted analysis of randomized controlled trials that compared acupuncture with sham or no-acupuncture controls. However, I believe that 2 important issues are not considered in their article or in the Invited Commentary that would help place acupuncture in better perspective for clinicians who wish to consider this modality as a possible treatment for chronic pain.

Placing Acupuncture in Perspective—Reply

Vickers AJ, Acupuncture Trialists' Collaboration f. — Mon, 22 Apr 2013 00:00:00 GMT

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