A significant amount of research is based on randomised controlled trials. This means that a patient group has been divided randomly into two or more arms. One arm was given the treatment being tested, and the other was given a supposedly inactive placebo; the latter constitutes the “control”. This trial design was originally developed to test new drugs. The placebo tablet can be a pill made from something inactive and unrecognisable to patients.
However, for more complex interventions like acupuncture, surgery or psychology, controls which are both inert and credible to patients, are harder to devise. Sometimes in trials, acupuncture appears only a little more effective than the sham placebo procedure used as a control. The latter may be where for example, patients unbeknown to them, have “irrelevant” acupuncture points needled.
These results are mirrored in placebo-controlled trials of surgery. In a systematic review (1) published in the respected British Medical Journal –
74% of the trials found improvements in patients in the placebo arm, and
51% of the trials found no difference between surgery and placebo.
In acupuncture trials, one explanation is likely to be that the sham procedures used by researchers are not actually inert. Thus when you compare real with sham treatment, the effects are closer than they would otherwise be. A more useful trial would compare one therapy against another, for effectiveness, safety and cost-effectiveness, because that would answer the question in the average GP’s mind when they are wondering how to help a patient with back pain say. “Should it be physiotherapy, acupuncture or exercise therapy?” No controls are then needed, and therapists in these trials can treat as they actually practise, rather than following a protocol devised by researchers. Otherwise we are trialling acupuncture say, not as it is actually practised.
With this in mind, I hope you will feel more informed when you see the research below, and any medical research in the news.
The University of York’s Department of Health Sciences has appointed a Professor of Acupuncture Research: Hugh MacPherson’s work includes conducting clinical trials and systematic reviews to evaluate the effectiveness and cost-effectiveness of acupuncture for a variety of conditions. He has also conducted neuroimaging studies designed to explore the potential mechanisms of acupuncture.
Acupuncture research has provided several useful spin-offs for modern western medicine. These include advances in neuroimaging, an improved understanding of chronic pain, better clinical trial designs, and the TENS machine (2). Finally, patients naturally enough, are often curious to know how acupuncture works. For a scholarly review by two respected authors, of what we know about acupuncture in general in the twenty-first century, take a look at Acupuncture and the Emerging Evidence Base.
(1) Use of placebo controls in the evaluation of surgery: systematic review. British Medical Journal, 21 May 2014.
(2) Unanticipated Insights into Biomedicine from the Study of Acupuncture. Journal of Alternative & Complementary Medicine, 2016.