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Letters
Just to be sure I read with interest the recently published online article by Hasegawa et al.1 It was the title which first triggered my interest, including the phrase ‘double blind’. Wow, a double blinded study on acupuncture! This is of course the ‘highest’ level of research one can achieve in randomised controlled trials, and consequently highly appreciated among acupuncture researchers. However, it has been impossible to blind practitioners in acupuncture studies, as it is for other complex interventions (eg, psychotherapy and manual therapies). While reading the article1 it soon becomes evident that it is the assessors who are blinded in this randomised controlled trial. Is it then legitimate to call the study double blind? Some of my concerns are: ▸ Double blinding is a methodological issue which has strong implications in terms of blinding of the participants and those giving the therapeutic treatment in question—and not the assessors. Using the term as presented in Hasegawas et al’s title might mislead readers into thinking that the biases that double blinding is normally controlling for are avoided. However, as the readers will find out, this is not the case—the therapists are not blinded, which leaves the study open to important biases.2 ▸ Minor concerns relating to terminology for searching databases. For example, ‘double blind studies on acupuncture’ currently identifies very few studies, and I think it should continue to be the case. ▸ Although the Jadad scale is outdated, if it were to be used it would unfairly favour studies like the one in question, since one of the criteria is ‘described as double blind’.
There have been concerns regarding acupuncture terminology. This has resulted in agreement on the nomenclature of meridian and point names.3 Furthermore, a discussion paper in 2011 tried to summarise the issues relating to the use of the terminology of acupuncture itself
Acupunct Med April 2014 Vol 32 No 2
and also to put forward a consistent use of sham needling versus use of placebo needling.4 To my knowledge, the discussion around using the term double blind in acupuncture studies when it is only the assessor that is blinded has not been raised in relevant papers.5 I feel maybe it is timely to raise this issue. The transparency of acupuncture studies has been greatly improved by STRICTA, for example.5 Likewise, journals have an important place in setting standards for the correct use of research terminology, and I urge you to be more strict with authors in future. Terje Alraek Correspondence to Dr T Alraek, Department of Community Medicine, Faculty of Health Science, National Research Centre in Complementary and Alternative Medicine, NAFKAM, UiT The Arctic University of Norway, Tromsø 9037, Norway; [email protected]
Competing interests None. Provenance and peer review Not commissioned; not externally peer reviewed. To cite Alraek T. Acupunct Med 2014;32:201. Received 19 December 2013 Accepted 7 January 2014 Published Online First 24 January 2014 Acupunct Med 2014;32:201. doi:10.1136/acupmed-2013-010514
REFERENCES 1 Hasegawa TM, Baptista AS, de Souza MC, et al. Acupuncture for acute non-specific lowback pain: a randomised, controlled, double-blind, placebo trial. Acupunct Med 2014;32:109–15. 2 Park J, White AR, Stevinson C, et al. Who are we blinding? A systematic review of blinded clinical trials. Perfusion 2001;14:296–304. 3 A standard international acupuncture nomenclature: memorandum from a WHO meeting. Bull World Health Organ 1990;68:165–9. 4 Langevin HM, Wayne PM, MacPherson H, et al. Paradoxes in acupuncture research: strategies for moving forward. Evid Based Complement Alternat Med 2011;2011:1–11. 5 MacPherson H, Altman DG, Hammerschlag R, et al. Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORTstatement. Acupunct Med 2010;28:83–93.
201
Downloaded from http://aim.bmj.com/ on March 20, 2015 - Published by group.bmj.com
Just to be sure Terje Alraek Acupunct Med 2014 32: 201 originally published online January 24, 2014
doi: 10.1136/acupmed-2013-010514 Updated information and services can be found at: http://aim.bmj.com/content/32/2/201.1
These include:
References Email alerting service
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Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Letters
Just to be sure I read with interest the recently published online article by Hasegawa et al.1 It was the title which first triggered my interest, including the phrase ‘double blind’. Wow, a double blinded study on acupuncture! This is of course the ‘highest’ level of research one can achieve in randomised controlled trials, and consequently highly appreciated among acupuncture researchers. However, it has been impossible to blind practitioners in acupuncture studies, as it is for other complex interventions (eg, psychotherapy and manual therapies). While reading the article1 it soon becomes evident that it is the assessors who are blinded in this randomised controlled trial. Is it then legitimate to call the study double blind? Some of my concerns are: ▸ Double blinding is a methodological issue which has strong implications in terms of blinding of the participants and those giving the therapeutic treatment in question—and not the assessors. Using the term as presented in Hasegawas et al’s title might mislead readers into thinking that the biases that double blinding is normally controlling for are avoided. However, as the readers will find out, this is not the case—the therapists are not blinded, which leaves the study open to important biases.2 ▸ Minor concerns relating to terminology for searching databases. For example, ‘double blind studies on acupuncture’ currently identifies very few studies, and I think it should continue to be the case. ▸ Although the Jadad scale is outdated, if it were to be used it would unfairly favour studies like the one in question, since one of the criteria is ‘described as double blind’.
There have been concerns regarding acupuncture terminology. This has resulted in agreement on the nomenclature of meridian and point names.3 Furthermore, a discussion paper in 2011 tried to summarise the issues relating to the use of the terminology of acupuncture itself
Acupunct Med April 2014 Vol 32 No 2
and also to put forward a consistent use of sham needling versus use of placebo needling.4 To my knowledge, the discussion around using the term double blind in acupuncture studies when it is only the assessor that is blinded has not been raised in relevant papers.5 I feel maybe it is timely to raise this issue. The transparency of acupuncture studies has been greatly improved by STRICTA, for example.5 Likewise, journals have an important place in setting standards for the correct use of research terminology, and I urge you to be more strict with authors in future. Terje Alraek Correspondence to Dr T Alraek, Department of Community Medicine, Faculty of Health Science, National Research Centre in Complementary and Alternative Medicine, NAFKAM, UiT The Arctic University of Norway, Tromsø 9037, Norway; [email protected]
Competing interests None. Provenance and peer review Not commissioned; not externally peer reviewed. To cite Alraek T. Acupunct Med 2014;32:201. Received 19 December 2013 Accepted 7 January 2014 Published Online First 24 January 2014 Acupunct Med 2014;32:201. doi:10.1136/acupmed-2013-010514
REFERENCES 1 Hasegawa TM, Baptista AS, de Souza MC, et al. Acupuncture for acute non-specific lowback pain: a randomised, controlled, double-blind, placebo trial. Acupunct Med 2014;32:109–15. 2 Park J, White AR, Stevinson C, et al. Who are we blinding? A systematic review of blinded clinical trials. Perfusion 2001;14:296–304. 3 A standard international acupuncture nomenclature: memorandum from a WHO meeting. Bull World Health Organ 1990;68:165–9. 4 Langevin HM, Wayne PM, MacPherson H, et al. Paradoxes in acupuncture research: strategies for moving forward. Evid Based Complement Alternat Med 2011;2011:1–11. 5 MacPherson H, Altman DG, Hammerschlag R, et al. Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORTstatement. Acupunct Med 2010;28:83–93.
201
Downloaded from http://aim.bmj.com/ on March 20, 2015 - Published by group.bmj.com
Just to be sure Terje Alraek Acupunct Med 2014 32: 201 originally published online January 24, 2014
doi: 10.1136/acupmed-2013-010514 Updated information and services can be found at: http://aim.bmj.com/content/32/2/201.1
These include:
References Email alerting service
This article cites 3 articles, 1 of which you can access for free at: http://aim.bmj.com/content/32/2/201.1#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
