Vested interest: I wrote to the new editor of the BJGP a few months ago asking if I could write about Atos, their disability ‘assessments’, and general practioners, but had an unenthusiastic response. I put this to one side, I hope, to discuss their shiny cover which is very yellow, and gives big font joy to say that ”ACUPUNCTURE effective in a randomised controlled trial for patients with unexplained symptoms”. A quick google and several news outlets are taking this as fact.
I beg to differ.
80 adults were recruited with ‘unexplained symptoms’ (their term) ‘including fibromyalgia, headache and back pain’. (I don’t think these are ‘unexplained’, but anyway.) The patients had acupuncture, with a waiting list acting as a control group. Patients were asked to fill in a form ‘Measure Yourself Medical Outcome Profile’ at 26 weeks. Other surveys were asked of patients and medication use and GP consultation rates also measured at 26 and 52 weeks. The researchers say that
“The addition of up to 12 5-element acupuncture consultations to their usual care was feasible and acceptable and resulted in improved wellbeing and individualised (MYMOP) that was sustained at up to 12 months.”
First, we already know that acupuncture has similar outcomes to sham acupuncture: ie, it isn’t the ‘acupuncture’ that makes people feel better (if they do.) This fact wasn’t controlled for, which is, given current knowledge, a major problem. Second, the MYMOP scale improvements that were noted were small and fell over time in both the treatment and the waiting list group (it is worth noting that MYMOP is favoured by the British Flower and Vibrational Essences Association, as well as ‘integrated cancer care‘ centres.) This trend may be regression to the mean, things tending to get better over time, or it may be part of normal fluctuations, which the original paper on MYMOP showed happened to patients attending GPs. Third, there was a reduction in consultation rates with GPs in both control and intervention groups, but the rate remained higher in the intervention group than in the control group.
So what justifies the front page? I do not know. The authors would have us believe that “GPs may recommend a series of five-element acupuncture consultations as a safe and potentially effective intervention.” I think this is wrong in fact: I don’t see the evidence justifying this statement. I also think it that a recommendation like this is wrong because it misleads patients. There will be patients who will pay large sums for this intervention based on the headlines and who will not benefit from it.
There are many, genuinely holistic and evidence based interventions that can help people manage chronic and difficult conditions better. This isn’t one of them.
Update: DC has done a great piece on this paper, what is more, with graphs, which I am too inept to cut and paste here. Very very irritatingly I can’t link to the abstract or the text of this piece – neither seem to be on PubMed and the RCGP is behind a paywall. I have the paper journal beside me, which I am also too inept to scan in and make appear below. sorry.