Wednesday, October 12, 2016

Not quite placebo

This 2008 article, A Randomized, Controlled Pilot Study of Acupuncture Treatment for Menopausal Hot Flashes, evaluates the effect of acupuncture on menopausal hot flashes. I'm only interested in the methods used in this study. 56 women aged 44 to 55 are divided into three groups, receiving (A) "usual care" (i.e. no acupuncture or needle treatment), (B) sham acupuncture (needle points not on documented meridians), and (C) TCM (Traditional Chinese Medicine) acupuncture. The result shows that groups B and C have significantly less hot flashes than group A. In spite of a small sample size, this study can be said to show a positive effect of acupuncture. But more interesting is that both groups B and C show about the same effect, with C slightly more improvement during the early stage of the treatment. While A and B are both used as control groups, B is used as a placebo group. Therefore this study can also be said to prove that acupuncture is no better than placebo.

Alternative medicine supporters would quickly point out the difference in efficacy between groups A and C, and opponents make use of the lack of difference between B and C. But neither covers the full picture. Not all control groups are created equal, and a placebo may be designed incorrectly. This may be particularly relevant in the acupuncture study, where by convention a sham acupuncture is the same as true acupuncture except for the needle points. Unfortunately, more and more tests seem to show that such sham acupuncture is not sham enough, so to speak, although it probably also points out that the acupuncture point locations are not as important as traditionally believed.[note1]

(See also my March 27 posting of Acupuncture is removed from back pain treatment guideline in UK)

(See also A radical new hypothesis in medicine: give patients drugs they know don’t work. "His own randomized controlled trials found that giving patients open-label placebos — sugar pills that the doctors admit are sugar pills — improved symptoms of certain chronic conditions that are among the hardest for doctors to treat, including irritable bowel syndrome and lower back pain.... You don’t have to give a drug that’s more than placebo; the placebo effect itself is something".)

[note1] The acupuncture points used in group C of this study are as follows: CV-4 关元, KI-3 太溪, SP-6 三阴交, BL-23 肾俞, HT-6 阴郄, KI-7 复溜. I'll leave this list to TCM experts to judge the quality of this selection in treatment of hot flashes.