Acupuncture – the placebo duck

If it walks like a duck, and talks like a duck….. A common phrase, and applicable to the scientific view on acupuncture as placebo. Edzard Ernst has the latest reviews and research on the use of acupuncture in assisting in recovery from stroke.

He uses three examples:

Prospective, Randomized Controlled Trial of Physiotherapy and Acupuncture on Motor  Function and Daily Activities in Patients with Ischemic Stroke. Bai YL, Li L, Hu YS, Wu Y, Xie PJ, Wang SW, Yang M, Xu YM, Zhu B. J Altern Complement Med. 2013 Apr 21. [Epub ahead of print]

Acupuncture is less effective for the outcome measures studied than is physiotherapy. Moreover, the therapeutic effect of combining acupuncture with physiotherapy was not superior to that of physiotherapy alone. A larger-scale clinical trial is necessary to confirm these findings.

Acupuncture for subacute stroke rehabilitation: a Sham-controlled, subject- and assessor-blind, randomized trial. Park J, White AR, James MA, Hemsley AG, Johnson P, Chambers J, Ernst E. Arch Intern Med. 2005 Sep 26;165(17):2026-31.

Acupuncture is not superior to sham treatment for recovery in activities of daily living and health-related quality of life after stroke, although there may be a limited effect on leg function in more severely affected patients.

Acupuncture for functional recovery after stroke: a systematic review of sham-controlled randomized clinical trials. Kong JC, Lee MS, Shin BC, Song YS, Ernst E. CMAJ. 2010 Nov 9;182(16):1723-9.

For the chronic stage after stroke, three trials tested effects of acupuncture on function according to the Modified Ashworth Scale; all failed to show favourable effects.

Our meta-analyses of data from rigorous randomized sham-controlled trials did not show a positive effect of acupuncture as a treatment for functional recovery after stroke.

In Ernst’s words:

I would counter that the reliable evidence available to date is sufficiently conclusive to stop claiming that acupuncture is effective and thus give false hope to severely suffering, vulnerable patients.

And perhaps most importantly:

Moreover, I would advocate using the sparse available resources to help stroke victims with treatments that demonstrably work.

The Canadian Heart and Stroke Foundations  reports that 50,000 people have strokes, 14,000 of them fatal,  every year and 315,000 survivors are living with the after effects. This is a significant number of people who deserve to have the best treatment available. Wasting dollars and providing false hope are most certainly not in the best interests of these people, or indeed, taxpayers in general.

Acupuncture has been making inroads into main stream medicine, primarily through its popularity rather than its effectiveness. Some provinces are providing Medicare coverage and many private health plans already pay for sessions. Given the limited resources we have for all medical treatments, it is absolutely profligate to pay for placebos.

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