Acupuncture article in NYtimes: Acupuncture and Osteoarthritis of the Knee Another Look

I've been meaning to comment on this blog post from the New York Times http://well.blogs.nytimes.com/2010/08/23/studying-acupuncture-one-needle-prick-at-a-time/?scp=4&sq=acupuncture&st=cse for some time now. It covers a number of issues concerning acupuncture research. It first cites a recent study from MD Anderson School of Medicine exploring osteoarthritis of the knee and the effectiveness of acupuncture. The link to that article is here.http://onlinelibrary.wiley.com/doi/10.1002/acr.20225/abstract. The study is actually trying to determine if the clinical attention given to the patients affected outcome, thus getting at the ever present problem of "placebo" in acupuncture research. What they found in the study is that acupuncture worked about the same as sham acupuncture. Because of that, the study's lead author concludes that acupuncture does not work, since in your typical drug study if the drug works the same as a placebo the determination is that the drug does not work. ( We will leave aside the issue that many drugs on the market now,Prozac for example, work no better than placebo and still enjoy widespread use.) But another way to parse the outcome of the study is that acupuncture works even if poorly administered. In this particular study the sham acupuncture was less stimulative, shallow needling, so the acupuncture defenders can claim that acupuncture was performed. The NYTimes article goes on to mention the German Insurance Company studies which showed that drug (analgesic) usage was dramatically reduced with acupuncture and sham acupuncture in back pain patients versus the controls, and that only 15% of acupuncture patients needed pain medication versus 29% of sham 59% of controls. German Insurance Companies now pay for acupuncture as a result of these studies, btw. The article also mentions the study comparing effexor to acupuncture covered in this blog post.(http://www.blogger.com/post-edit.g?blogID=6188135334037051688&postID=1694074355474832229)
The placebo issue still plagues acupuncture research, and keeps the discussion from going further than whether we can trust the studies, and then whether acupuncture really works or not. It gets tiresome, especially given the scant funding for acupuncture research. One veteran British acupuncture researcher I met at the latest Society for Acupuncture Research conference is recommending that we simply design studies comparing one dosage of acupuncture (time, frequency, length of treatment, point selection) to another so we can finally get beyond the underlying premise of the MD Anderson study, ie that it's the clinical setting or attitude that is determining outcome. You would think that the animal studies would put some of the placebo chatter to rest a bit, but it doesn't seem to.
I have no interest in dispensing placebos, nor am I interested in delivering acupuncture using specific points, if it would be just as effective to use any random points on everyone. It would save lots of time and the effort of charting. I am dedicated to studying and learning what the actual mechanisms of acupuncture are so that we can use it more effectively in a no nonsense approach. If studies repeatedly indicate that one point is as good as another, so be it. But I don't think we're there yet.
In the spirit of "first doing no harm" however, I wish that other treatment modalities were held to the high standard that acupuncture is and were better scrutinized for bias, placebo and safety.

Acupuncture as good as Effexor for Hot Flashes in Breast Cancer Patients

The Journal of Clinical Oncology has reported a study showing that acupuncture is as good, if not better, for hot flashes in breast cancer patients undergoing therapy. Breast cancer patients are susceptible to hot flashes due to the anti-estrogen medications given, but hormonal replacement is contraindicated. Effexor, an anti-depressant can be effective but does have some side effects. This study from Henry Ford Hospital in Detroit looked at acupuncture versus Effexor for hot flashes.
(J Clin Oncol. 2010 Apr 20;28(12):1979-81. Walker EM, Rodriguez AI, Kohn B, Ball RM, Pegg J, Pocock JR, Nunez R, Peterson E, Jakary S, Levine RA).

Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA. ewalker1@hfhs.org

"PATIENTS AND METHODS: Fifty patients were randomly assigned to receive 12 weeks of acupuncture (n = 25) or venlafaxine (n = 25) treatment. Health outcomes were measured for up to 1 year post-treatment.

RESULTS: Both groups exhibited significant decreases in hot flashes, depressive symptoms, and other quality-of-life symptoms, including significant improvements in mental health from pre- to post-treatment. These changes were similar in both groups, indicating that acupuncture was as effective as venlafaxine. By 2 weeks post-treatment, the venlafaxine group experienced significant increases in hot flashes, whereas hot flashes in the acupuncture group remained at low levels. The venlafaxine group experienced 18 incidences of adverse effects (eg, nausea, dry mouth, dizziness, anxiety), whereas the acupuncture group experienced no negative adverse effects. Acupuncture had the additional benefit of increased sex drive in some women, and most reported an improvement in their energy, clarity of thought, and sense of well-being.

CONCLUSION: Acupuncture appears to be equivalent to drug therapy in these patients. It is a safe, effective and durable treatment for vasomotor symptoms secondary to long-term antiestrogen hormone use in patients with breast cancer."

There was no inclusion of sham acupuncture in this study, which is always a sticking point for critics (no pun intended), but the results were clear and decisive.