The Geman Acupuncture Studies

Submitted by Robert Felt on October 1, 2007 - 2:40pm.

There has been considerable discussion and an unusual amount of press coverage covering the German studies of acupuncture and their conclusions. This links to an example article. This discussion is a good example of how long it takes for the medical establishment to pay attention to work done on acupuncture and Chinese medicine. Stephen Birch covered this issue in his Ph.D. thesis at Exeter University, and in Understanding Acupuncture, a text that has been used in medical schools for nearly a decade.

The quote most germane to the discussions that have insued follows:

Some people reading these studies have noted that the lack of significant difference between the ‘real’ and ‘sham’ arms of the trials implies that it does not matter where one inserts the needles and that thus the theories of acupuncture are unnecessary [Ernst 2004]. This is an invalid conclusion. In order to answer questions about site specificity, or the relative role of the sites at which the needles are inserted, it is necessary to apply the same techniques to both those sites and the control sites [Baecker et al. 2007, Birch 2003]. This was not done in these studies. Both the sites of needle insertion and types of needling varied.

The full article considers these studies and their problems in detail:

Reflections on the German Acupuncture studies

Stephen's work on the core problem of placebo related to acupuncture is also available:

A Review and Analysis of Placebo Treatments, Placebo Effects, and Placebo Controls in Trials of Medical Procedures When Sham Is Not Inert

It is very important to understand these issues when responding to the less-than-perceptive press coverage -- including the medical press --  of any clinical trial of acupuncture.   Birch's conclusion to the "Review" article states it very well:

 The assumption that a sham medical procedure is inert when it is not introduces bias against the medical procedure for which the sham is used as a control. It makes it difficult to find significant differences between the sham and real procedure. The common conclusion from trials of medical procedures that the procedure was no better than placebo is misleading to the reader and is inaccurate. In these studies the conclusion is either wrong, or it is not possible to show that it is correct, thus making many of these trials difficult if not impossible to interpret and reviews of these trials open to question. Trials of medical procedures should stop stating that they are “placebo-controlled” or that their sham procedure is a placebo procedure unless they can present evidence that their sham is in fact inert and have validated it is a placebo treatment.