LETTER
Acupuncture is More Than Placebo Treatment To the Editor: I read with great interest the review, “The Placebo Effect: the Good, the Bad, and the Ugly” by Tavel.1 He provides evidence that the most potent placebo effects occur in acupuncture interventions, citing research that compares true acupuncture with sham acupuncture where both true and sham acupuncture give similar results. This raises several issues for comment. A comparison between an intervention and a sham intervention in acupuncture may give results that have internal validity due to the use of a randomization between a treatment and its sham intervention but lack generalizability or external validity. These results can lead to an underestimation of the benefits of the treatments tested.2 The real question when evaluating acupuncture interventions is whether the acupuncture treatment is as effective as standard of care or no treatment for the indication tested, and not to compare real acupuncture with a course of nonsensical acupuncture, as any needling done may have physiologic effects and would not be applied for the indication. Funding: None. Conflicts of Interest: None. Authorship: The author is solely responsible for writing the manuscript.
0002-9343/$ -see front matter Ó 2014 Elsevier Inc. All rights reserved.
Tavel also did not cite a more recent published metaanalysis of acupuncture for chronic pain conditions (back and neck pain, headache, osteoarthritis, and shoulder pain) in which 17,922 patients were analyzed and which reported that acupuncture was superior to both sham acupuncture and no-acupuncture controls for each condition tested.3 There are many clinical unanswered questions about the effectiveness of acupuncture, and it is time to consider its therapeutic effects compared with other therapeutic approaches in comparative effectiveness settings.4 The effectiveness of acupuncture is not solely due to a positive placebo effect. Mary van den Berg-Wolf, MD Department of Medicine Jefferson Internal Medicine Associates Thomas Jefferson University Bala Cynwyd, Pa
http://dx.doi.org/10.1016/j.amjmed.2014.06.022
References 1. Tavel ME. The placebo effect: the good, the bad, and the ugly. Am J Med. 2014;127(6):484-488. 2. Rothwell PM. External validity of randomised controlled trials: “to whom do the results of this trial apply?” Lancet. 2005;365(9453):82-93. 3. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: Individual patient data meta-analysis. Arch Intern Med. 2012; 172(19):1444-1453. 4. Coeytaux RR, Park JJ. Acupuncture research in the era of comparative effectiveness research. Ann Intern Med. 2013;158(4):287-288.
Acupuncture is More Than Placebo Treatment To the Editor: I read with great interest the review, “The Placebo Effect: the Good, the Bad, and the Ugly” by Tavel.1 He provides evidence that the most potent placebo effects occur in acupuncture interventions, citing research that compares true acupuncture with sham acupuncture where both true and sham acupuncture give similar results. This raises several issues for comment. A comparison between an intervention and a sham intervention in acupuncture may give results that have internal validity due to the use of a randomization between a treatment and its sham intervention but lack generalizability or external validity. These results can lead to an underestimation of the benefits of the treatments tested.2 The real question when evaluating acupuncture interventions is whether the acupuncture treatment is as effective as standard of care or no treatment for the indication tested, and not to compare real acupuncture with a course of nonsensical acupuncture, as any needling done may have physiologic effects and would not be applied for the indication. Funding: None. Conflicts of Interest: None. Authorship: The author is solely responsible for writing the manuscript.
0002-9343/$ -see front matter Ó 2014 Elsevier Inc. All rights reserved.
Tavel also did not cite a more recent published metaanalysis of acupuncture for chronic pain conditions (back and neck pain, headache, osteoarthritis, and shoulder pain) in which 17,922 patients were analyzed and which reported that acupuncture was superior to both sham acupuncture and no-acupuncture controls for each condition tested.3 There are many clinical unanswered questions about the effectiveness of acupuncture, and it is time to consider its therapeutic effects compared with other therapeutic approaches in comparative effectiveness settings.4 The effectiveness of acupuncture is not solely due to a positive placebo effect. Mary van den Berg-Wolf, MD Department of Medicine Jefferson Internal Medicine Associates Thomas Jefferson University Bala Cynwyd, Pa
http://dx.doi.org/10.1016/j.amjmed.2014.06.022
References 1. Tavel ME. The placebo effect: the good, the bad, and the ugly. Am J Med. 2014;127(6):484-488. 2. Rothwell PM. External validity of randomised controlled trials: “to whom do the results of this trial apply?” Lancet. 2005;365(9453):82-93. 3. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: Individual patient data meta-analysis. Arch Intern Med. 2012; 172(19):1444-1453. 4. Coeytaux RR, Park JJ. Acupuncture research in the era of comparative effectiveness research. Ann Intern Med. 2013;158(4):287-288.
