German large controlled clincal trials in acupuncture for 4 conditions

[Guest guest]

Dear Colleagues,

 

You might want to check out an article that appeared in the UK

newspaper 'The Guardian' today, reporting on four large controlled

clinical trials (total - 500,000 patients) performed in Germany. It

is reported that acupuncture hasn't been found to work better than

sham needling for chronic back pain, chronic arthritis of the knees,

tension headache and migraine.

 

http://www.guardian.co.uk/health/story/0,3605,1170061,00.html

 

Medicine man

 

An end to 'free' acupuncture sessions? No wonder doctors and patients

got the needle

 

Edzard Ernst

Tuesday March 16, 2004

The Guardian

[Guest guest]

, " wainwrightchurchill " <

w.churchill_1-@t...> wrote:

It

> is reported that acupuncture hasn't been found to work better than

> sham needling for chronic back pain, chronic arthritis of the knees,

> tension headache and migraine.

 

I mentioned that finding a month ago and no one picked it up. what to make of

sham acupuncture. On one hand, acupuncture works,butit doesn't matter where

you stick the needles. On the other hand, I assume the patients thought the tx

was real. what would happen if you told the patients the experiment was to

see if they could bear torture. I wonder if the results would be different. :-)

 

This is kind of a big deal, too. If acupuncture works regardless of points

selected, but only if the patient believes they are receiving a therapeutic

procedure, we are in a bind. It is illegal to administer placebos and pretend

they are therapy. and if we spill the beans on the sham, then it won't work

anymore.

 

[Guest guest]

, " " wrote:

> , " wainwrightchurchill " <

> w.churchill_1-@t...> wrote:

> It

> > is reported that acupuncture hasn't been found to work better than

> > sham needling for chronic back pain, chronic arthritis of the knees,

> > tension headache and migraine.

>

 

 

this does not bode well for those concerned about chiros taking 300 hour

courses.

 

[Guest guest]

Re the German study in question.....

 

I read the Guardian article and also did about 5 minutes of research for

further articles on this study. It seems to me that this Guardian article

grossly

misrepresents the study and its outcomes. For one thing, the study is not

yet finished. For another, from what I read, the participant numbers were

nowhere near 500,000. I read that 6,000 participated. Then I read that only 68

patients participated in the " real acupuncture vs. sham acupuncture " part (for

migraine-type headache) - 34 patients for each method. Both groups were

needled on 'real' acupuncture points: GB 20, LI4, LV 3 and SJ5. And what is it

that is being reported on when the study says " no significant difference " ? As I

read the following excerpt, I don't see that it is reporting data about

efficacy of treatment, but rather patient response to the testing methods.

These

are very different things. The link for the article I am referring to is:

http://www.acupuncturetoday.com/archives2002/apr/04needle.html

Below is an excerpt from the article.

-RoseAnne S.

 

Patients in both groups received two treatments per week for five weeks, and

received acupuncture bilaterally at the same points (GB20, LI4, LR3 and TW5).

In the placebo group, needles were inserted, manipulated and left in place for

30 minutes, using a total of eight placebo needles per session. In the true

acupuncture group, slightly different needles were used (#8, 0.3 x 0.3

millimeters or #2, 0.2 x 0.15 mm) and were also left in place for 30 minutes

after

insertion.

To determine the credibility of the placebo needles, the investigators

subjected the volunteers to a three-part questionnaire. The first section asked

patients about their interest in and knowledge of acupuncture; the second

section

focused on the patients' acceptance of acupuncture as a treatment for

headache; and the third section measured the credibility and expectations of the

patients toward the actual treatment. To test credibility, the patients filled

in

the third part of the questionnaire after the first treatment. After four or

five treatments, patients were then asked to state whether they felt the needle

being inserted and whether they had felt the de qi sensation.

Researchers Find " No Significant Differences " between Treatments

Sixty-four patients answered the questionnaire. After tabulating the results,

the scientists found " no significant differences " between the groups'

responses in any section. In the interest section, the difference between the

true

and placebo acupuncture groups was two-hundredths of a point; in the general

acceptance section, the difference was seven-hundredths of a point; and in the

credibility section, the difference was less than half a point.

The placebo needle fared nearly as well when patients were asked about needle

insertion and de qi sensation. Every patient in the true acupuncture group

said they felt the needle being inserted; 28 patients in the placebo group said

they also reported a feeling of needle insertion. The fact that the

experimental needle design was able to fool more than 87% of the patients in the

placebo

group into thinking they had been needled shows that it was quite effective

in achieving its intended goal as a placebo. Although the experimental design

did not work as well as a true acupuncture needle, the researchers felt this

was due to the placebo needles being pressed down differently than real needles.

They added that " this problem can · be overcome by adequate training with the

placebo needle. "

In addition, only 34% of those in the placebo group reported feeling the de

qi sensation compared to more than 80% of those receiving true acupuncture.

Furthermore, although the placebo needles never punctured the skin, they

retained

the illusion that they were inserted for the duration of treatment. The

scientists reported that there were no instances of " spontaneous removal, " or a

needle falling out from its location, during the study.

The fact that more than a third of patients treated with the placebo needle

experienced de qi did raise some concerns among the scientists, who said that

the results of their experiment " · call into question the main claim of placebo

needles that they only are eliciting a placebo response. " To avoid producing

the de qi response, they proposed that future studies use non-acupoints for

placebo needling.

[Guest guest]

Even the background of these mega-studies is fascinating. In October 2000, the

German authorities decided that the evidence for acupuncture was not

sufficiently convincing for inclusion in the list of interventions qualifying

for reimbursement from health insurance companies. Henceforward Germans would

have to pay for acupuncture out of their own pockets, as do most people in

Britain.

 

>>>>This can be the beginning of the end. Studies with 500,000 patients are very

significant and if sham and real work the same what do we need a profession for?

Very troublesome news indeed

 

Alon

 

 

 

[Guest guest]

, " Alon Marcus "

<alonmarcus@w...> wrote:

> Even the background of these mega-studies is fascinating. In October

2000, the German authorities decided that the evidence for acupuncture

was not sufficiently convincing for inclusion in the list of

interventions qualifying for reimbursement from health insurance

companies. Henceforward Germans would have to pay for acupuncture out

of their own pockets, as do most people in Britain.

>

> >>>>This can be the beginning of the end. Studies with 500,000

patients are very significant and if sham and real work the same what

do we need a profession for? Very troublesome news indeed

>

> Alon

>

>

>

[Guest guest]

Jason, could you please describe specifically your " more energetic style " of

acupuncture?

How does it differ from TCM-style acupuncture as taught at American schools

(which I have found to be very similar to each other)?

 

Julie Chambers

 

 

 

 

Jason wrote:

 

I agree, this is puzzling, although maybe this is indicative more of

the current TCM herbal approach to acupuncture. Does anyone have the

procedures and styles related to this study??? I personally think that

the BASIC TCM style that most of us were taught is mediocre at best.

Therefore I am not surprised at the above results. Where would this

type of acupuncture be without herbs? I think without herbs the TCM

style of acupuncture is nothing more than glorified relaxation

therapy. This is precisely why I have explored a more `energetic'

style.. hey we might find out that this too is BS, but what I have

seen in the clinic does indicate that one can say, " It is VERY

different than basic slap them in TCM style. " Maybe others had better

training, but the PCOM training I had in acupuncture, in comparison,

is in retrospect, kind of humorous. Do others think that TCM

acupunture is a new Breed? Comments?

 

-

 

 

 

 

Chinese Herbal Medicine offers various professional services, including

board approved continuing education classes, an annual conference and a free

discussion forum in Chinese Herbal Medicine.

 

 

 

 

[Guest guest]

Hi all,

well, such results are seen here in Scandinavia also, seceral times, and also in

most homeopatic studies.

If you do the investigation double-blinded, then you WILL get zero results in

informative therapies like homeopathy and acupuncture, as the main source of

information comes from the intention, and the intention is gone when

double-blinded.

 

Are

 

Are Simeon Thoresen

arethore

http://home.online.no/~arethore/

 

-

Tuesday, March 16, 2004 10:05 PM

Re: German large controlled clincal trials in acupuncture for 4

conditions

 

 

, " wainwrightchurchill " <

w.churchill_1-@t...> wrote:

It

> is reported that acupuncture hasn't been found to work better than

> sham needling for chronic back pain, chronic arthritis of the knees,

> tension headache and migraine.

 

I mentioned that finding a month ago and no one picked it up. what to make of

sham acupuncture. On one hand, acupuncture works,butit doesn't matter where

you stick the needles. On the other hand, I assume the patients thought the

tx

was real. what would happen if you told the patients the experiment was to

see if they could bear torture. I wonder if the results would be different.

:-)

 

This is kind of a big deal, too. If acupuncture works regardless of points

selected, but only if the patient believes they are receiving a therapeutic

procedure, we are in a bind. It is illegal to administer placebos and pretend

they are therapy. and if we spill the beans on the sham, then it won't work

anymore.

 

Todd

 

 

 

Chinese Herbal Medicine offers various professional services, including board

approved continuing education classes, an annual conference and a free

discussion forum in Chinese Herbal Medicine.

 

 

[Guest guest]

> >>>>This can be the beginning of the end. Studies with 500,000

patients are very significant and if sham and real work the same what

do we need a profession for? Very troublesome news indeed

>

Yes, it is. But, on the other hand;

 

1) has any ivestigation shown that greater education (many courses) gives better

clinical results?

 

2) IF sham is equal to " real " in double blinded investigations, then we should

look if results in the clinic (non-blinded) are better that blinded.

 

Are Simeon Thoresen

arethore

http://home.online.no/~arethore/

 

 

[Guest guest]

I personally think that

the BASIC TCM style that most of us were taught is mediocre at best.

>>>>>Jason if we can not show some difference between needling anywhere and even

TCM acupuncture than i think any other claims are as suspect. I would like to

see the actual study to see how well is was done from the TCM and scientific

perspectives. I like you have found it necessary to step outside the acupuncture

i was taught, even though I was trained 1-2 times a week for almost three years

in Tong-style as well as my TCM training

Alon

 

 

[Guest guest]

, " Alon Marcus "

<alonmarcus@w...> wrote:

> I personally think that

> the BASIC TCM style that most of us were taught is mediocre at best.

> >>>>>Jason if we can not show some difference between needling

anywhere and even TCM acupuncture than i think any other claims are as

suspect.

 

Could you explain, it is a little unclear what you mean here...

 

I would like to see the actual study to see how well is was done from

the TCM and scientific perspectives.

 

I agree... I would love to put these styles to the test... Until then

I just go on what I observre...

 

I like you have found it necessary to step outside the acupuncture i

was taught, even though I was trained 1-2 times a week for almost

three years in Tong-style as well as my TCM training...

 

Maybe this is why so many step into stuff like NAET?

 

-Jason

[Guest guest]

, Julie Chambers <info@j...>

wrote:

> Jason, could you please describe specifically your " more energetic

style " of

> acupuncture?

> How does it differ from TCM-style acupuncture as taught at American

schools

> (which I have found to be very similar to each other)?

>

> Julie Chambers

 

Julie,

 

Let me preface this by saying: this was my training and other more

acupuncture based schools may be different... Also I don't think that

what I describe is exclusive to Japanese styles; (I remember Jason

Robertson? a few months ago discussing his experiences with a non-tcm

beijing doctor)... anyway...

 

First, I think it is odd that many believe that any kind of

acupuncture done my anyone works… Just merely poking some needles

into the skin will equally heal disease… This I hope will go to rest

with the studies that were just mentioned; clearly the MD acupuncture

could not even help the bread and butter diseases…I do not doubt that

just poking in needles changes the physiology of the body, and

probably for the better, I just believe there is another level. I have

experienced many styles of acupuncture and I think there is great

variety in results from styles and practitioners. (But this is only by

belief)…

 

A more energetic style is one that focuses on the `qi' felt by the

practitioner, creating immediate verifiable positive response in the

body. The specific style I am working with is non-insertion Japanese

toyohari style acupuncture. It's theory is based on Nan-Jing. The

techniques are what make the system… There is a tangible way to learn

to experience qi (not just hearing the patient say owww, or feeling a

physiological response of the body (a muscle twitch as the needle goes

in) – It is up to the practitioner, and there is a feedback system

that you can test with others, your perceptions… This is the key part

(for me) and which elevates it merely past basic subjective

beliefs.,.. Although we get into group subjectively, but that is

another story…. By not inserting the needling, One is working on an

energetic level (even though this at some point gets converted to

physiologically response), but there are few, if any, physiological

distractions from the patient, confusing the issue of what is going on

with the qi. In school, point location was purely anatomical, very

little energy was spent in learning to feel the different qi of points

– or finding 'the active point.' Technique was purely mechanical,

slamming needles into the skin until the body reacted. NO energy was

spent on what qi meant beyond this. The chief goal was 'can I get the

needle into the skin, at some x depth, without it hurting' [Note:

there was an elective Japanese course that did touch on some of this]…

Professors that I observed, also just put needles in, with no real

teaching or awareness of `qi' –(Probably due to these prof's being

herbalists)…

 

There is always the debate of point selection, and I have little to

say of this…Although, It probably does not matter as much as the

technique, but we also (in school) never really learned anything about

channel theory and how to pick points beyond the TCM herbal points

found in the basic textbooks… LI4, st36 etc… I do not believe that

points have all these long list of functions...

 

That is the basic idea, if this is off-topic, please let me know.. I

know this is the CHA.

 

Comments?

 

 

 

-

[Guest guest]

, " " <

@h...> wrote:

 

>

> I agree, this is puzzling, although maybe this is indicative more of

> the current TCM herbal approach to acupuncture.

 

the study did not show that acupuncture was ineffective. It worked quite well

for most patients. It is actually the opposite of what you say. bogus TCM

worked phenomenally. much better than placebo or glorified relaxation. but

sham acupuncture worked just as well. using a supposedly more sophisticated

style of acupuncture would not have changed the fact that sham acupuncture

had a very high effectiveness rate. rather than showing we need a more

sophisticated style to make CM work, this study is being interpreted as

showing that it does not matter at all what you do. It works regardless.

However it never ceases to amaze me how people can twist research to suit

their biases.

 

 

This is precisely why I have explored a more `energetic'

> style..

 

what the hell is energetic? are we back to CM is energy medicine?

 

what is energy? what does it have to do with CM?

 

[Guest guest]

Jason wrote:

 

A more energetic style is one that focuses on the `qi' felt by the

practitioner, creating immediate verifiable positive response in the

body. The specific style I am working with is non-insertion Japanese

toyohari style acupuncture.

 

Julie replies:

 

If it is non-insertion, then can you call it " acupuncture " ? Are you truly

not ever inserting acupuncture needles?

[Guest guest]

, " Are Thoresen " <arethore@o...>

wrote:

 

>

> 1) has any ivestigation shown that greater education (many courses) gives

better clinical results?

>

> 2) IF sham is equal to " real " in double blinded investigations, then we should

look if results in the clinic (non-blinded) are better that blinded.

 

 

I think people are mssing the point. by western medical standards, the results

of this study were phenomenal. It did NOT show that regular and sham

acupuncture both sucked equally. It showed they both were amazingly

effective. far more effective than placebo in all cases and even better than

WM in others. If one included better educated px or studied real clinical

patients, it would be hard to get better results than those already reported.

But even if that was the case, it would still not negate the significant results

that came from sham acupuncture. It would only show that trained acus could

do a little better in the clinic than newbies involved in research. but if you

think about it, that is a given in medicine. Individuals in a clinic can always

do better than the controlled research. Clinic maximizes placebo effects.

However research equalizes and averages differences in skill and training and

intellect. It tells you what the average patient with the average px can

expect. and remember if some px fall above the average, just as many fall

below. so an experienced idiot in a private clinic will do far worse than a

researcher, while a genious beginner will do better, perhaps.