Paterson and colleagues do not provide any evidence for their claim that acupuncture is effective for patients with multiple unexplained symptoms1 for two main reasons. First, their study did not test acupuncture at all, and second, there were so many methodological flaws that no conclusions of any kind could reliably be drawn. Had no needling taken place, and patients in the intervention group simply been given the same amount of time talking to their physicians, could the authors state with any conviction, that the results would have been different? This question could be readily answered with a properly designed trial, that Paterson et al rejected in favour of their ‘pragmatic’ design.
But it gets worse. The study was stopped early (probably because of the slow recruitment that is reported in the paper), and at an interesting point. The figure showing the Measure Yourself Medical Outcome Profile scores for both treatment groups reveals that (a) effect sizes were very small, and (b) that the score for the intervention group oscillated above and below the line for the control group. Conveniently, the study stopped when the intervention score was higher than the control score.
The rationale for the study, as explained in the introduction, was that these patients consume substantial health care resources. Yet there was no effect of the intervention on these resources. For example, consultation rates were unchanged. Paterson et al try to justify their choice of study design as being more representative of clinical practice. But as there was no benefit to clinical practice, why do the study at all? Or at least, they should draw a conclusion that makes sense with regard to the data.
It is interesting to see that patients received explanations of ‘five-element acupuncture’. Why were they thus misled as to how the body works, with misinformation that has no basis in science? Surely the days of paternalistic medicine are over? One has to wonder about a peer review system that allows such a flawed paper to be published. It does a disservice to science, and the damage is that it will be cited by opponents of evidence-based medicine, and even more patients will be misled.
- © British Journal of General Practice 2011