The Trojan Horse of “Integrative Medicine” arrives at the University of Toronto

Trojan Rabbit
Medicine is a collaborative practice. Hospitals are the best example, where dozens of different health professionals work cooperatively, sharing responsibilities for patient care. Teamwork is essential, and that’s why health professionals obtain a large part of their education on the job, in teaching (academic) hospitals. The only way that all of these different professions are able to work together effectively is that their foundations are based on an important, yet simple, principle. All of us have education and training grounded in basic scientific principles of medicine. Biochemistry, pharmacology, physiology – we all work from within the same framework. As a pharmacist, my role might include working with physicians and nurses to manage and monitor medication use. A team approach is only possible when you’re working from the same playbook, and with the same aim. And in medicine, that playbook is science.

That’s why “integrative” medicine frightens me so much. Integrative medicine is a tactic embedding complementary and alternative medical practices into conventional medical care. Imagine “integrating” a practitioner into the health system that doesn’t accept germ theory. Or basic disease definitions. Or the effectiveness of vaccines. Or even basic biochemistry – perhaps they believe in treatments that restore the body’s “vital force” or manipulate some sort of “energy fields”. Instead of relying on objective signs and symptoms, they base treatments on pre-scientific beliefs, long discarded from medicine. There may be entirely different treatment goals, which are potentially antagonistic to the scientific standard. Imagine a hospital or academic setting where this occurs, and the potential impact on the quality of care that is delivered.

If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.
Mark Crislip

Dr. Crislip’s health care “cow pie” is an effective metaphor for the reality of “integrative” medicine. Medicine today is based on a single scientific standard, with an array of providers divided by specialty and expertise. Integrative medicine explicitly seeks to “integrate” providers that do not provide science-based care, and instead offer treatments that run the spectrum of useless, to unproven, to potentially dangerous. Positioning of these treatments and services as “integrative” is simply a Trojan horse, aimed at distracting health professionals and health organizations from recognizing the obvious – that “integrative” products and purveyors can’t meet the established standard of care.

The branding of alternative medicine as “integrative” medicine has been a marketing tactic for at least a decade, with proponents continually citing it as the future of medicine (a future, perhaps, with compromised scientific standards), and opponents simply pointing out that there is no compelling need to “integrate” treatments into medicine that are not grounded in high-quality science.

There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is “Eastern” or “Western,” is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. We recognize that there are vastly different types of practitioners and proponents of the various forms of alternative medicine and conventional medicine, and that there are vast differences in the skills, capabilities, and beliefs of individuals within them and the nature of their actual practices. Moreover, the economic and political forces in these fields are large and increasingly complex and have the capability for being highly contentious. Nonetheless, as believers in science and evidence, we must focus on fundamental issues—namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy.
Phil B. Fontanarosa & George D. Lundberd

Turning the clock back

Medicine wasn’t always grounded in rigorous science. In fact, it was very different just 100 years ago. Formal medical education varied dramatically from school to school prior to 1910, when the American Medical Association commissioned Abraham Flexner to evaluate American and Canadian medical education and make recommendations on their improvement. Flexner was highly critical of the education standards he observed, and recommended consolidating schools, increasing education prerequisites, enhancing the scientific rigor, and embedding the role of research in education. Flexner was also highly critical of dubious “alternative medical practices” and recommended the closure of under-performing institutions that continued to offer education and training based on principles other than science. Not all schools were evaluated to be weak. Highly rated schools included Michigan, Case Western Reserve, Johns Hopkins, and in Canada, McGill University and the University of Toronto.

The effects of the Flexner report on medical education and the practice of medicine (and affiliated professions, like pharmacy) can’t be overstated. Medical education, now grounded in a rigorous foundation of science, rejected and abandoned unscientific practices like naturopathy, homeopathy, chiropractic, and osteopathy. The result is the medical education and care you see today – and the consistent framework for health professionals. Of course, the purveyors and proponents of these now-rejected practices never fully disappeared. They retreated, regrouped, and fought back, craving the public legitimacy and credibility now offered to medicine and its related health professions. What was quackery became “alternative” medicine, and then “complementary and alternative” medicine (CAM), implying these practices could be used alongside other treatments. Today’s CAM is called “integrative” medicine. Old wine in a new bottle. Regardless of the qualifier, it’s simply an end run around the scientific standards that were defined back 1910.

All of this brings me to my hometown Toronto, and my alma mater the University of Toronto, and this job posting from the university:

Director – University of Toronto Centre for Complementary and Integrative Medicine
The Faculty of Medicine and the Leslie Dan Faculty of Pharmacy at the University of Toronto seek a Director to lead their new interdisciplinary program in complementary and integrative medicine, which will be housed in the new Centre for Complementary and Integrative Medicine (CCIM). The Centre will begin with two primary foci: Traditional Chinese Medicine and natural health products. It will support research and health professional education. Applications are invited for the position of Director for a 3-year renewable term effective January 1, 2014.

The mission of this new Centre is to facilitate, conduct, and obtain support for collaborative basic, clinical, and health services research in complementary and alternative medicine; to serve as an educational resource and to develop integrative curricula and educational programs on complementary and alternative medicine; to work collaboratively with other departments within both Faculties and their hospital partners to support the integration of evidence-based complementary and integrative medicine into existing clinical settings and clinical research programs.

Candidates must have a MD and/or PhD degree(s), a strong track record of scholarship and history of peer-reviewed extramural funding. The Director will be expected to maintain a vigorous and independent extramurally funded research program; to build productive collaborations within the University of Toronto and other local and global partners; and to grow CCIM into a nationally and internationally recognized Centre for natural products and complementary medicine education and research.

In addition to a record of academic excellence in a relevant area of research, the successful candidate will possess outstanding leadership, administrative management, communication, and relationship-building skills. The individual will bring an inclusive scholarly vision and strategies to enable the Centre to build and to sustain effective academic partnerships. Candidates should have demonstrated experience in multidisciplinary and collaborative academic environments. Candidates should have a track record of successful and innovative leadership in research and education, and must be eligible for academic appointment at the rank of Associate or Full Professor.

Much has been already been written about what’s now described as “quackademic” medicine. (Check out David Gorski’s talk on quackademic medicine and the evolution of quackery). Gorski started compiling a list back in 2008 of academic medical centers that offered one or more alternative medicine modalities. Disappointingly, U of T isn’t alone in its plan to push CAM, although this one is the first I’ve seen that includes two faculties: pharmacy and medicine. It’s a clever strategy: If the intent is to change the medical playbook, and the scientific foundation for medical care, you have to hit both the pharmacists and the physicians. Otherwise one will call out the other for quackery. Normalize it for both groups, and there’s less likelihood that either will notice. Most worrying is the explicit objective of pushing CAM interventions into university-affiliated hospitals. Again, normalize the pseudoscience with students, and then embed it in teaching centres, where other health professionals will see it. And finally, change the standard of care. The first salvo will be Traditional Chinese Medicine and then natural health products. None of this is surprising, given the Canadian context.

TCM: The invented tradition

“Even though I believe we should promote Chinese Medicine, I personally do not believe in it. I don’t take Chinese Medicine.”
– Chariman Mao, quoted in The Private Life of Chairman Mao

Traditional Chinese Medicine (TCM) is a collection of beliefs and practices that was accurately described in the 1930’s by a Chinese medical school dean as a “weird medley of philosophy, religion, superstition, magic, alchemy, astrology, feng shui, divination, sorcery, demonology and quackery.” Current practices that are labelled as TCM include herbalism, acupuncture, massage, energy therapy, and dietary interventions. Treatments are based on the idea that they are restoring “balance” or eliminating “energy blockages”. TCM moved from folklore to government embrace when Chairman Mao realized the potential for TCM in the 1950’s as a means of both boosting Chinese pride, but also to address acute physician shortages in a country of 500 million. Without Mao, there would likely be little TCM, so TCM is very much an “invented tradition”.

The “Traditional” qualifier in TCM gives away the game right away: TCM is simply an appeal to antiquity, the belief that because an idea has persisted, it automatically has merit. And just like the term “integrative”, it is yet another qualifier introduced to rationalize away the requirement to treat based on science-based principles. TCM is comparable to Traditional Western Medicine, except traditional “Western” practices that were demonstrably useless (e.g., bloodletting) were discarded from “Western” medical practice – in part because of Flexner’s work.

The remarkable thing about science-based medicine is that it knows no geographic boundaries. If it works, it works. The idea that the Chinese would respond differently to objective, scientific medicine is as absurd as thinking that “Canadian” medicine would differ significantly from “American” medicine simply because we Canadians love maple syrup, Tim Hortons coffee, and socialized health care. If a treatment objectively works, it’s simply called medicine – no qualifiers are needed. Artemisinin is an excellent example. The Chinese identified the herb Artemisia annua in the 1970’s as potentially effective against malaria. This wasn’t testing to see if it could unblock chi: researchers were looking at how effectively parasites were cleared from the body. Scientific research in China subsequently identified the active ingredient and isolated it. The use of the drug has spread worldwide – not as TCM, but simply as medicine. Unlike the herb, however, the drug is now synthetically manufactured, so the dose can be calculated precisely. And chemical variations of the drug have been developed that are consistently absorbed, resulting in a vastly safer and superior product than the herb itself.

Despite the problematic and unscientific basis for TCM, those that offer it must be licensed in Ontario. The two acts which practitioners are permitted to perform are:

  • Performing a procedure on tissue below the dermis and below the surface of a mucous membrane for the purpose of performing acupuncture.
  • Communicating a traditional Chinese medicine diagnosis identifying a body system disorder as the cause of a person’s symptoms using traditional Chinese medicine techniques

So TCM in Ontario encompasses two functions: The first is the ability to deliver a theatrical placebo which lacks any objective effects. The second is a reference to “traditional” diagnoses and treatment with “traditional” techniques – again, code for practices which are not based on scientific principles, but on historical one. In short, TCM in Ontario means objectively useless needling, as well as giving diagnoses of disease based on prescientific concepts, and giving treatments based on those principles.

TCM and natural health products

The support for TCM isn’t just coming from provincial regulators. Health Canada, the Canadian equivalent to the FDA, administers the Natural Health Product (NHP) Regulations, which are somewhat similar to the American Dietary Supplement Health and Education Act of 1994 (DSHEA). The NHP regulations, like DSHEA, effectively exclude the manufacturers of natural health products from meeting the regulatory standards for drugs. While the Canadian regulations have implemented important steps to improve manufacturing quality, the requirement to show product efficacy was effectively eliminated in the regulations. It’s a boon to manufacturers, but problematic to consumers, as there’s no guarantee that any product approved for sale actually works. Canadians now have access to hundreds of homeopathic remedies deemed “safe and effective” by Health Canada: even homeopathic insect repellent. On the supplement side, failed prescription drugs have been rebranded and marketed as a “natural supplement”, simply because there’s no barriers in place to their sale. And there are now hundreds of TCM products approved for sale. Health Canada approved the following labeling for horny goat weed (Epimedium sagittatum):

Traditional Chinese Medicine used to tonify the kidney and fortify the yang, for symptoms such as frequent urination, forgetfulness, withdrawal, and painful cold lower back and knees. Contraindicated in patients with fire from yin deficiency. If dizziness, vomiting, dry mouth, thirst or nosebleed occur, discontinue use.

In the science-based, reality-based world, there is no yang that needs to be fortified, just as there is no such thing as a yin deficiency. Yet your licensed TCM practitioner can sell you horny goat weed which is Health Canada approved to treat your forgetfulness and cold lower back. And if the University of Toronto is successful with its new Centre for Complementary and Integrative Medicine, this type of material may soon be “integrated” into its medical and pharmacy education. The entire concept is absurd. As an alumnus, I’m appalled and embarrassed. I like to think my pharmacy education was a good one. It was rigorous and grounded in the basic sciences (too much organic chemistry, I thought at the time). And I’ve trained alongside (and work with) many graduates of U of T’s medical school. The Faculty at both schools are among the best and brightest in Canada, and U of T has an international reputation for excellence in education. So it’s deeply disappointing to see this move by the university.

Conclusion

Moves to embed CAM into academic settings start with the assumption that “integrative medicine” is a good thing, in the absence of any data to show that is the case. Based on the information that does exist, it’s reasonable to assume that increasing the levels of “integrative” medicine at the University of Toronto will reduce and compromise the quality of medical and pharmacy education, and ultimately, the quality of care offered to patients. It’s sadly ironic that the University of Toronto, with a medical school lauded by Abraham Flexner in 1910, is now turning its back on those qualities, 103 years later.

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18 thoughts on “The Trojan Horse of “Integrative Medicine” arrives at the University of Toronto

  1. *sigh* U of Waterloo has also been offering a CAM elective at the school of pharmacy… with lots of “integration” with the adjoining medical school campus. What’s next, Jenny McCarthy delivering lectures on vaccines?

  2. Unfortunately the ever increasing preoccupation with profit has created such a huge conflict of interest, that so-called “science” (as opposed to “scientific method”) has tarnished its own image, creating doubts in the minds of all thinking people.

  3. bastante ignorancia refleja el autor, sus criterios estan llenos resentimiento que no aporta, por supuesto existen muchas cosas de las medicinas alternativas y complementarias o integrativas que son basura, al igual que en la ciencia. Porsupuesto que somos Troyanos inteligentes en pro de una revolucion medica y no a la deriva de magaobscuros propositos de la industria o supuestaciencia, bajo que leyes? es que acaso existe una tendencia galenica o newtoniana, lo mejor de todo es que el cambio de paradigmas no tiene freno. Viva Troya!

    • Here is the google translate:

      ignorance rather reflects the author, his criteria are filled with resentment that does not, of course there are many things of complementary and alternative medicine or integrative are crap, as in science. Ofcourse we are smart Trojans towards a medical revolution and not drift magaobscuros purposes or supuestaciencia industry, under what laws? is that perhaps there is a tendency Newtonian galenica or, best of all, the paradigm shift is rampant. Live Troy!

  4. As someone who attended UofT for Math. I’m pretty disappointed in this turn of events. At the time my wife entered Medical School they were considered to be one of the hardest schools to get into and stay in. The faculty used to joke that no relationship has ever survived their neuroscience program.

  5. University of Saskatchewan’s Hospital is undergoing a lot of renovations and one of the initiatives is an integrative medicine clinic. I really don’t know what to think. I’ve seen presentations about integrative medicine and I too remain unconvinced of the supposed benefits to patients.

  6. I’m not so sure that all alternatives are bogus. Traditional Chinese Medicine is what gave us Sweet Wormwood for treatment of malaria, for example.

    TCM terminology is definitely different than the western way but I don’t see why to condemn it. If a patient changes their diet for the better based on a TCM practitioner recommendation, it’s all good. Oftentimes they make more sense than the western schooled nutritionists.

    • Science doesn’t care about the origin of the medicine. Just the method by which we validate it’s behavior.

      It’s worth noting that you can’t say for certain that Sweet wormwood was ever useful against malaria unless you first know that patients were receiving levels of Artimisinin which would result in an observable clinical effect. You could even question if it was ever even prescribed for malaria as 肘后备急方 the book it was written in says that it is effective against “fever” and “chills” – which are not specific to malaria.

      So you could argue that TCM didn’t make Artemisinin a medicine. Science did.

      • On that note, we didn’t know the molecular basis of many medications or even vaccines (like smallpox) but they were being used successfully.

        It seems to me that ‘science’ withdraws treatments until it is ‘evidence based’. We seem to need to re-invent the wheel and the wheel we do invent isn’t always moving things forward.

        So basically as far as I’m concerned a balanced view is where it’s at.

      • Drugs and treatments can be science-based and evidence-based when we don’t fully understand the mechanism of action (e.g., drugs to treat multiple sclerosis). What matters is that there is credible basic science and clinical evidence showing that the effects are both real and clinically meaningful.

        What’s certain is that once the mechanism of action of science-based treatments is better understood, it won’t be because of magical thinking (e.g., naturopathic vitalism, or acupuncture’s meridians), nor will it break physical laws of the universe (e.g., homeopathic dilutions to nothingness). Treatments that are based on these ideas for their action are deservedly labelled pseudoscience.

  7. My bias is that I am a medical doctor who trained at U of T, spent 5 years as an ER physician, and have now been treating chronic pain using integrative medicine for 7 years. And I have seen remarkable results in patients who would otherwise have been lost.

    My comment is that I completely understand the skepticism about this field, but this post, like many I have read, is not based on facts. Dozens of Natural Health Products have shown promise in double-blind studies, and hundreds of trials have found that acupuncture helps treat many chronic conditions.

    Those who are opposed to integrative medicine simply do not know that there is a huge body of evidence supporting its efficacy. In most cases, their concern comes from a visceral unease, and not a real appraisal of the facts.

    I agree that we need more evidence, and better evidence, before we embrace these methods for everyone. But it is a serious flaw in judgement to dismiss them outright, and it would be a tragic disservice to humanity to ignore their potential to make healthcare better.

    • From Richard’s bio: “He treats patients using a method of identifying and treating hidden blockages to unleash the innate healing power of the body that combines principles of acupuncture, osteopathy, homeopathy and a wide range of bioenergetic approaches.”

    • “He has worked with shamans, plant healers, gurus and traditional doctors, and met with dozens of healers from around the world.”…

      Do shamans, plant healers and gurus offer more scientifically proven interventions than already provided rheumatologists/pain specialist’s standards of care? Which natural products have proven benefits? What if those hundreds of acupuncture trials are so methodologically weak that the beneficial effect seen cannot be teased out from the placebo effect? If you agree that there are large placebo effects, and most CAM therapies rely on this, are your patients aware that the pain relief they may observe probably will be only slight and/or temporary?

      • So you and Scott don’t believe the word of Richard Nahas? After all, he’s only one doctor.

        What about believing a whole country then? I remember clearly over 40 years ago interviews by my local TV channel in Manchester UK asking doctors what they thought about this novel alternative treatment called acupuncture – there’s a large Chinese community in Manchester – and they all agreed that it was superstition, not based on « science », couldn’t be relied on etc etc. When pressed, some doctors said that it probably needed more study – at least they had an open mind.

        Today in Manchester you can get acupuncture treatment in those NHS hospitals that provide it. Do you think that the UK health authorities are offering this service because it doesn’t work or because they’ve got money to throw away on futile treatments? Do you think that after a period of trials in the UK where they found it to be ineffective they offered it anyway and have been doing so for years?

        Time, as the Americans would say, to wake up and smell the coffee.

      • “Today in Manchester you can get acupuncture treatment in those NHS hospitals that provide it. Do you think that the UK health authorities are offering this service because it doesn’t work or because they’ve got money to throw away on futile treatments?”

        It doesn’t necessarily matter if governmental agencies agree to cover certain therapies, since they are political entities who are subject to intense pressure from constituents, lobbies and “professional” associations. Even Prince Charles has undue influence on the NHS to promote unscientific therapies (see: http://www.telegraph.co.uk/news/uknews/theroyalfamily/10178121/Prince-Charles-in-secret-health-talks.html )

        In Canada, acupuncture is not covered at all and those who wish to receive this particular “treatment” have to pay out of their own pocket or through their private insurance. So by your measure, we can reasonably conclude that not all governments agree on the therapeutic benefit of acupuncture. Worse yet, NHS is eschewing the recommendations of The Parliamentary Science and Technology Committee AND the British Medical Association on the issue of homeopathy! (see: http://www.telegraph.co.uk/health/healthnews/9982234/Homeopathy-on-the-NHS-is-mad-says-outgoing-scientific-adviser.html )

        One last point: rarely, medical authorities can be wrong on a specific issue. Im referring to the BMA’s position on acupuncture. They released a statement in the early 2000s in which they promote the benefits of acupuncture. They made a report where they looked at the state of the evidence, but seem to have spectacularly failed in critically analyzing the handful of trials on back pain, dental pain and post-operative nausea. Here’s an evidence-based article which suports my statement: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118968/

        One of our most important goals here at science based pharmacy, and also at science based medicine, is to raise awareness of the importance of the scientific method and an evidence based practice. Clearly, the rise of websites like these and others like Centre for Evidence Based Medicine, BMJ’s Clinical Evidence, ACP Journal Club, and the good folks at RxFiles indicate that even health professionals – scientifically literate people – need objective resources and tools to develop a critical approach to medicine to develop “gold standards” of practice. Patients also need critical and objective information from these professionals in order to decide their best chances of leading a healthy life.

        So, the answer to your question about the UK health authorities wasting taxpayer money on futile treatments is unfortunately and evident yes.

  8. Per the the NHS web site page on accupuncture, section “Does it work” at http://www.nhs.uk/conditions/acupuncture/Pages/Introduction.aspx , the NHS only suggest it for lower back pain (and even then, refer the reader to their lower back pain guidlines http://www.nice.org.uk/nicemedia/live/11887/44334/44334.pdf which are quite detailed and suggest exercise and manual therapy, along with some other techniques, along with accupuncture); the page goes on to say:

    “There is some evidence that acupuncture works for a small number of other conditions, including migraine and post-operative nausea. However, there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used. More scientific research is needed to establish whether acupuncture is effective against these and other conditions.
    There is no scientific evidence for the existence of Qi or meridians. More research is needed before acupuncture’s method of action is fully understood.”

  9. In reply to Avicenna : OK, you think that the UK authorities are wasting their money. What about the German Govt? It’s been made available since 2006 (after 6 years of trials) for certain conditions as highlighted by Art Trique. Or the French Govt? Acupuncture along with 3 other “alternative” treatments have been given the green light (for certain conditions) earlier this year. Or the WHO in 2002 which published a list of 28 conditions for which there were reports of clinical tests showing favourable results in scientific litterature.

    All down to politics? or lobbying? Or just that acupuncture works in some cases for enough people to convince those responsible.

    No-one here (including me) is saying acupuncture is going to cure everything for everybody – but to denigrate it as not worthy of consideration is without foundation.

  10. As I said, it doesn’t matter scientifically that certain countries promote the use of alternative therapies. What truly matters is the evidence. What matters are fair tests – high quality randomized controlled trials – to investigate if the acupuncture has any SPECIFIC effects, and wether these tests consistently show positive results in the large majority of trials. That’s why arguing for alternative medicine’s merits on the basis that certain governments promote them is a red herring. Another explanation as to why certain countries promote acupuncture while others do not might be explain by this study, which suggest bias in country-specific trials:

    Vickers A, Goyal N, Harland R, Rees R. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials. 1998 Apr;19(2):159-66

    The authors showed:

    “Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR…”

    To be clear, I’m not arguing that acupuncture is probably ineffective based on which governments pays for the procedure. It’s mostly based on critical reviews by evidence based references like, you guessed it, science based medicine (http://www.sciencebasedmedicine.org/reference/acupuncture/). I know, I know, I should probably look up the studies myself and form my own interpretation to see if it matches up. Well, sure, its my day off. Why not?

    Searching Pubmed on acupuncture for pain meta-analysis in humans published in core clinical trials in the last 5 years (term: acupuncture; limits: meta analysis, 5 years publication, humans, core clinical trials) shows:

    Positive meta-analysis

    1) Acupuncture for chronic pain: individual patient data meta-analysis.
    Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K; Acupuncture Trialists’ Collaboration.
    Arch Intern Med. 2012 Oct 22;172(19):1444-53. doi: 10.1001/archinternmed.2012.3654. Review

    Negative meta-analysis

    1)Efficacy of acupuncture in fibromyalgia syndrome–a systematic review with a meta-analysis of controlled clinical trials.
    Langhorst J, Klose P, Musial F, Irnich D, Häuser W.
    Rheumatology (Oxford). 2010 Apr;49(4):778-88. doi: 10.1093/rheumatology/kep439. Epub 2010 Jan 25. Review

    2)Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups.
    Madsen MV, Gøtzsche PC, Hróbjartsson A.
    BMJ. 2009 Jan 27;338:a3115. doi: 10.1136/bmj.a3115. Review.

    I note that the positive study does not differ greatly from the other two. I mean that this meta-analysis DID find a modest positive result of acupuncture, but that the effect is greater in trials that compare only to usual care (i.e.: medications, manipulation, etc) BUT less effective when compared with sham acupuncture (a better control). This suggests that acupuncture may, at least partly, have non-specific effects (placebo effects).

    So there you have it: the current best evidence on acupuncture is conflicting and contradictory. Unfortunately, chronic pain is a very complex and difficult condition to treat effectively. But acupuncture doesn’t have consistent effects and to have governments subsidize this treatment is to agree to lower scientific standards to include anything that science tells us most probably don’t work. Like NHS’s decision to subsidize homeopathy.

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