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    Acupuncture: how its supporters move the goalposts

    6 July 2015

    I’ve always been suspicious of acupuncture. I had it once, and although the needles didn’t bother me the garbage being talked by the woman sticking them in certainly did.* Maybe it’s slightly more credible than homeopathy but then so is reading tea-leaves.

    Anyway, let me draw your attention to this blog post by Dr Edzard Ernst, who was disgracefully hounded out of his post as Professor of Complementary Medicine at Exeter University for doing his job – i.e., assessing the credibility of claims for alternative medicine and finding most of them deeply flawed.

    Ernst tears to pieces a paper in BMC Complementary and Alternative Medicine, the official journal of the International Society for Complementary Medicine Research (ISCMR).

    The paper suggests that something called ‘real-world research’ (RWR) is better at measuring the efficacy of acupuncture than randomised controlled trials (RCTs). And here are the principles of RWR:

    1. Acupuncture should be regarded as complex and individualised treatment;

    2. The study aim (whether to assess the efficacy of acupuncture needling or the effectiveness of acupuncture treatment) should be clearly defined and differentiated;

    3. Pattern identification should be clearly specified, and non-needling components should also be considered;

    4. The treatment protocol should have some degree of flexibility to allow for individualisation;

    5. The placebo or sham acupuncture should be appropriate: knowing ‘what to avoid’ and ‘what to mimic’ in placebos/shams;

    6. In addition to ‘hard evidence’, one should consider patient-reported outcomes, economic evaluations, patient preferences and the effect of expectancy;

    7. The use of qualitative research (e.g., interview) to explore some missing areas (e.g., experience of practitioners and patient-practitioner relationship) in acupuncture research.

    Uh-huh. Sounds reasonable? Not to Ernst. He writes that it immediately set off his ‘BS detector’. The authors insists that acupuncture is ‘complex intervention’ – meaning what? So are all drug treatments. He asks:

    Does that mean that drugs and all other interventions are exempt from being tested in rigorous RCTs? Should we allow drug companies to adopt the RWR too? Any old placebo would pass that test and could be made to look effective using RWR.

    So why are the authors of this paper – all from Chinese medical institutions – so desperate to introduce a new methodology? I’m sure one answer has occurred to you, and Ernst spells it out:

    I fear, the reason is that RCTs might show that it is not as effective as its proponents had hoped. The conclusion about the RWR is thus embarrassingly simple: proponents of alternative medicine want double standards because single standards would risk to disclose the truth.

    In plain English, this is called moving the goalposts. Supporters of alternative medicine do it all the time.

    * Oh, and it didn’t work.