RESEARCH

The Good, The Bad and the Masterful - Researching Practice
Mark Bovey
This article, written by the Co-ordinator of the BAcC's Acupuncture Research Resource Centre (ARRC), explores a range of research-related issues, examining recent progress in both pragmatic and speculative research, before moving on to look at what research to date has found regarding differences between practitioners and the implications of these findings. He concludes by reviewing all the systematic reviews published in the last 2 years (Feb 2008-2010), grouping them into condition categories (musculoskeletal; gastrointestinal, gynaecological etc.) and grading their findings according to the conclusions they reached regarding the effectiveness of acupuncture.
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The Pros and Cons of Sham Acupuncture
Mike Cummings
In this short but penetrating article the author, who serves as Medical Director of the British Medical Acupuncture Society (BMAS) and editor of the journal Acupuncture in Medicine, reviews the arguments for and against the use of sham acupuncture in clinical trials. He suggests that, until the effects of sham techniques are better understood, clinical research should be designed either to compare acupuncture with the best existing conventional treatments, or to evaluate its potential as an adjunct to conventional care compared to conventional care alone.

How Acupuncture is Actually Practised, and Why This Matters to Clinical Research Design
Claire M Cassidy
When practising acupuncturists are asked to explain what they actually do when delivering acupuncture care, a highly fluid and responsive picture of care emerges. This matches well with the East Asian medical explanatory model of Qi Flow. Their practice model gives approximately equal weight to the patient-practitioner relationship and the delivery of techniques of acupuncture such as needling. Most clinical trials of acupuncture care to date have, however, not utilised these features, but instead imposed a rather static 'sham' control model borrowed from biomedicine, which is guided by a different medical explanatory model and practice habits. Imposing one medical model on another medicine creates a methodological fault of model fit validity – in short, until acupuncture is clinically assessed as it is practised, we cannot know much about its capabilities. The author's hopes are that a) there will be more and larger studies of how acupuncturists think about and deliver care, and that b) future clinical trials will increasingly tend the issue of model fit validity and create trials that accurately assess and reflect the capabilities of acupuncture care.

Acupuncture Placebos
George Lewith
This strategic overview revisits some of the basic assumptions that relate to the clinical valuation of acupuncture. We look at the clinical and mechanistic evidence available to estimate both the specific and nonspecific effect size of acupuncture (efficacy and effectiveness) and consider the placebo within acupuncture trials. We hope that by taking a broad and rigorous approach we may arrive at a realistic and thoughtful evaluation of its relative value in comparison to placebo treatment.

"Defining best practice...? Elementary my dear researcher."
Andrew Flower
In this brief but engaging article, the author ruminates on the political nature of research and on the problems this poses for East Asian Medicine, and points to the fact that the thorny business of defining best (or at least 'good enough') practice is of central importance here. He concludes by offering a richly simple model - based on the Five Phases (wu xing) - for defining what best practice is.

Evaluating the Effect of Treatment from the Patient's Perspective
Charlotte Paterson
This paper argues that acupuncture should be evaluated on the basis of whether it improves people's health in ways that are important to individual patients. This focus on patient-centred outcomes and an individualised approach is in keeping with the underlying philosophy of East Asian medicine. In acupuncture practice there is an ongoing dialogue between the practitioner's expert knowledge and the patient's individual knowledge and experience of their health and illness. However when it comes to research, the patient's perspective and subjective experience is often removed, and other 'objective' criteria are used to assess whether the treatment is helpful. There is now, however, a move towards patient-centred outcomes and there are many scientifically sound questionnaires that can be used. Qualitative research has been used to understand what treatment effects acupuncture patients' experience, to prioritise and to develop a number of patient-centred questionnaires, or sets of questionnaires which attempt to measure these. In this paper I briefly describe this work, focusing especially on individualised questionnaires and their use in evaluating acupuncture and other complementary therapies. Using an example from cancer support care I explore how qualitative and quantitative methods can be combined to provide rich and meaningful evaluations of the effects of treatment.

Acupuncture/Moxibustion RCT for Distal Sensory Peripheral Neuropathy in HIV/AIDS: Rationale, Design, Methods, Procedure and Logistics
Joyce K. Anastasi, Bernadette Capili, Ann M. Chung, Richard Hammerschlag
Distal sensory peripheral neuropathy is a common neurological complication experienced by people living with the human immunodeficiency virus (HIV). Traditional Chinese medicine (TCM) may offer effective interventions in the management of its symptoms. To improve the quality and transparency of reporting acupuncture clinical trials, the Consolidated Standards of Reporting Trials (CONSORT) guidelines were developed in 1996 and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) recommendations were introduced in 2001. Incorporating international guidelines, this paper describes the development of a RCT including rationale, design, methods, procedures and logistics for a pilot study aimed at evaluating acupuncture and moxibustion for neuropathy associated with HIV. Using STRICTA guidelines as a template, aspects of clinical research design are explored to further optimise future studies of TCM.

Moxibustion and Immune Response A Review Study - Part 2
Merlin Young and Jenny Craig
A large amount of published research on the potential immunological effects of direct moxibustion remains relatively unexplored in English. In Part One of this study we featured the many indicators in the classical literature of East Asian medicine which suggest that moxa was used in ways that almost certainly had effects on the immune system and also identified more recent research. Here we explore the more recent research evidence which is often inconsistent, and attempt to draw some useable ideas from it. We also suggest a possible mechanism by which moxa dosage may influence the type of immune response. The conclusions, though tentative, seem worthy of deeper exploration. Specific strategies are suggested which might facilitate this.

Towards an Integrated Traditional Chinese and Western Medical System – Using Ménière’s Disease as an Example
Tony Reid
The potential benefits of an integrated Western and traditional Chinese medical system, while enormous, are likely to be hampered unless a critical evidence-based approach is taken to the evaluation of the strengths and weaknesses of both systems. The best available evidence in many instances is quite poor – on both sides. The evidence of traditional usage (particularly in TCM) is an undervalued resource that, for better or worse, will remain our best guide for many years to come. This paper discusses several key issues centred on how to make best use of this resource and develop a more sharply focused clinical arm of TCM.