Acupuncture Research: Strategies for Establishing an Evidence Base
Edited by Hugh MacPherson, Richard Hammerschlag, George Lewith and Rosa Schnyer Published by Churchill Livingstone Elsevier London, New York, Oxford, 2008 Paperback, 261 pages, price £29.99
(Reviewed by Friedrich Staebler, EJOM Vol. 6 No. 1)
‘The authors and editors… are all pioneers who have a long track record of making significant contributions to our fundamental understanding of acupuncture and acupuncture research. They have now brought together their collective experience, knowledge and wisdom into a single, landmark book that represents the best and most insightful reflection on the state of acupuncture research in the Western world.’
The above is the first paragraph of Ted Kaptchuk’s foreword, and I quote it in full, since I completely agree with what it says, nor could I find better words to summarise what the book is about.
This book came into being as a result of a three-day workshop. It was based on cross fertilisation of ideas, information and inspiration, and ended up being very much a collective endeavour. The list of contributors includes leading acupuncturists and researchers with an international reputation.
The structure, aims and content of the book In 13 chapters, each written by different leading authors, the book identifies what research has been done to date and takes a close look at what methods have been used and still need to be developed in order to be fair to patients, practitioners, to acupuncture as a healing art and to the scientific understanding of what acupuncture is. It takes the reader through the fundamentals of research terminology, and shows how they are employed in acupuncture research, such as validity and bias, blinding, randomisation, sample size, and the multiple possibilities and pitfalls of using a placebo, to name the most obvious ones.
Various aspects of trial design are discussed (like qualitative and quantitative research, prospective and retrospective trials, efficacy, effectiveness, explanatory, pragmatic, comparative, cost effectiveness trial etc, the list is too long to be included here in full). Commonly used control procedures in acupuncture research are investigated, like sham acupuncture and minimal acupuncture, or non-penetrating methods like mock electrical TENS or the Streitberger needle, and the fact that it may not be possible to design a placebo control for acupuncture in the conventional sense of the word.
Several chapters are dedicated to the safety of acupuncture, the components of acupuncture treatment, the physiological dynamics of acupuncture (correlations and mechanisms), the exploration of the cultural contexts which gave rise to such diverse treatments as acupuncture and modern biomedicine, how different forms of acupuncture compare with each other, how acupuncture compares to other types of healthcare, the patient’s experiences and the use of patient-centred outcome protocols. The last two chapters look at how to engage acupuncturists in the research process, including some practical guidelines, and examine the direction which future strategies for acupuncture research most likely will need to take.
The book is written in a spirit of critical reflection, which doesn’t take sides while aiming at finding the strategies that can bridge the gap between current research evidence and the actual experiences of acupuncturists in the field.
Why I think you should read this book When trying to answer the question ‘Does acupuncture work?’ we are immediately confronted with a multitude of further questions depending on the viewpoint of the stakeholder (acupuncturist, patient, referring practitioner, NHS provider, insurer, scientist etc). For example: A patient may ask ‘Will the treatment make me better?’ while a scientist wants to know, ‘Does acupuncture perform better than a placebo?’
In the current climate we can no longer answer these questions by relying only on our experience and our belief in the unquestionable power of an ancient healing art. As a mature profession we need to subject ourselves to the examination of a scientifically proven, non-biased evidence base, which stands up to rigorous scrutiny, if we want to make the claim that acupuncture is helpful in improving health and curing diseases.
As acupuncturists we experience results on a daily basis, yet, despite a large and growing number of well conducted randomised controlled trials (RCTs), the evidence on the effectiveness of acupuncture is still inconclusive. The reasons for this are complex but they are hardly surprising as long as researchers think in reductionist biomedical paradigms, assuming uniformity in acupuncture theory and practice and trying to formulate a hypothesis on the basis of the either-or assumptive model which can be tested against a placebo.
The authors, in my opinion, have made a convincing case that we need a broader evidence mosaic, which accounts for greater complexity and diversity and avoids answering all questions with the methods of RCTs and meta-analysis alone. This book provides a summary of the long and painful process of how we need to unlock the mystery. It gives us all the key questions, relevant terms and details essential to be able to follow the debate, and it points the way to finding better models in clinical trial design to lead us out of the impasse.
As a practitioner who is not a researcher I sympathise with those of you who may not want to read about acupuncture research. However, the questions raised in this book, and in my opinion exceptionally well answered, and the depth of philosophical, scientific, medical and technical debate throughout, should be interesting to all acupuncturists if not to conventional and non-conventional medicine practitioners and scientists. If you are interested in the research quest, or thinking of getting involved, I would think this book is a must.
The book is dense, concise and no easy read but hugely rewarding. It made me aware that acupuncturists are leading the way in developing new research methodology, which is appropriate for complex and interactive treatment interventions. Reading this book made me feel proud to be an acupuncturist.
Friedrich Staebler Friedrich Staebler is a medical doctor and has been practising as an acupuncturist in London since 1983. He was the first chair of the Council for Acupuncture (CFA, UK) research committee in the 1990s.