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Acupuncture for Hot Flashes

ResearchBlogging.orgIn the most recent issue of The Journal of clinical Oncology is a study comparing acupuncture to Effexor in the treatment of vasomotor symptoms (hot flashes) in women with breast cancer who cannot take hormone replacement therapy. The study found that the two treatments are equivalent, with longer duration and fewer side effects from acupuncture. However, the study is designed as a pilot study (very preliminary) and therefore the conclusions are highly unreliable – given prior research, this raises the question as to why the study was performed at all.

The study included only 50 women, which is a small number for a clinical trial and alone means this is at best a preliminary study. There were 25 women randomized to one of two arms – either acupuncture or Effexor (which is standard treatment for vasomotor symptoms in women with breast cancer). However, the two arms were not blinded in any way, and there was no acupuncture control group – no sham or placebo acupuncture.

It is unclear why the researchers undertook a small unblinded study such as this, given that previous studies were better designed.

Acupuncture for Hot Flashes in Other Conditions

The largest literature for acupuncture and vasomotor symptoms is not in cancer patients, but in post-menopausal women. It is unclear if these two groups are comparable for treatment effects, but at least acupuncture for any vasomotor symptoms touches on the plausibility of this treatment in any context.

A recent systematic review of the literature included six trials in which acupuncture was compared to sham acupuncture – 5 of the 6 studies were negative. The reviewers concluded:

There is no evidence from RCTs that acupuncture is an effective treatment in comparison to sham acupuncture for reducing menopausal hot flashes. Some studies have shown that acupuncture therapies are better than hormone therapy for reducing vasomotor symptoms. However, the number of RCTs compared with a nonpenetrating placebo control needle or hormone therapy was too small, and the methodological quality of some of the RCTs was poor. Further evaluation of the effects of acupuncture on vasomotor menopausal symptoms based on a well-controlled placebo trial is therefore warranted.

This would seem to be sufficient evidence to conclude that acupuncture lacks efficacy. For those who believe that further research is required, it only makes sense to perform larger and more rigorous studies.

Acupuncture has also been studied for the treatment of hot flashes in men being treated for prostate cancer. A systematic review of this research concludes:

The evidence is not convincing to suggest acupuncture is an effective treatment for hot flush in patients with PC. Further research is required to investigate whether acupuncture has hot-flush-specific effects.

There was much less literature to review in this case, and there were no large blinded studies.

Acupuncture for Hot Flashes in Breast Cancer

A recent systematic review of studies looking at acupuncture for breast cancer side effects concluded:

In conclusion, the evidence is not convincing to suggest acupuncture is an effective treatment of hot flash in patients with breast cancer. Further research is required to investigate whether there are specific effects of acupuncture for treating hot flash in patients with breast cancer.

There were only three controlled trials comparing acupuncture to sham acupuncture, one positive, and two negative. The review also included some studies of electroacupuncture – but I maintain that electroacupuncture, which uses electrical stimulation through acupuncture needles, is not acupuncture (it’s electrical stimulation) and should not be considered in the same therapeutic category.

Conclusion

The history of acupuncture research in general has been that the technology of performing acupuncture studies and properly blinding them has actually improved. At first blinded sham acupuncture was the standard, but that was improved by sheathed non-penetrating acupuncture needles allowing for double-blinding.

Also, the general trend within clinical research of any question is to progress from small unblinded pilot studies to progressively larger and more rigorous studies, if warranted, until there are a few large well-designed trials that together sufficiently settle an issue.

Overall, the results of acupuncture for any indication are very similar to the results I outline above for hot flashes – small studies with mixed results, followed by better-designed studies that are mostly negative. For any indication the evidence is either inadequate or shows that acupuncture does not work.

This study is therefore of dubious utility. It is a very preliminary study in an area where there is already several more rigorously designed studies, trending negative. Given the overall acupuncture research, and the minimal prior plausibility, in my opinion there is already sufficient evidence to conclude that acupuncture probably does not work for hot flashes in patients with breast cancer. However, if researchers feel that there is some potential to acupuncture and more research is deserved, the only utility would be from a large rigorously designed trial – which this study definitely is not.

In short, this study changes nothing and is a step backwards. It does, however, result in another round of press releases with the very misleading title that acupuncture works for hot flashes.

Posted in: Science and Medicine

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32 thoughts on “Acupuncture for Hot Flashes

  1. Plonit says:

    The study included only 50 women, which is a small number for a clinical trial and alone means this is at best a preliminary study.

    ++++++++++++++

    Hmmm, no doubt this is a poor study, but I think this statement miseducates as to *why* large trials are (usually) needed. A clinical trial should be the *right* size for the study question, and a “small number” (for example 25 in each arm) can certainly be large enough to gather useful data depending on other factors such as incidence of outcomes being measured, and what size of difference is deemed clnically significant.

    For example, Max Sterne told me this story from his development of the anthrax vaccine. Six guinea pigs were vaccinated with what has come to be called the Sterne strain, six were not. Then all twelve were given given the ‘wild’ strain of Anthrax. The next day, he went to the ‘lab’ to find the six vaccinated guinea pigs alive with no apparent ill effects. The six unvaccinated guinea pigs had died.

    An atypically small number for a clinical trial? Perhaps, and larger trials on livestock animals were still in the future. But certainly not too small to get useful data, given the pathogenicity of anthrax.

  2. windriven says:

    Wow! Here we have a study N=50 with a list of co-authors that runs like the screen credits for Ben Hur. There are ten. Count them. And a look at their affiliations is instructive:

    -Department of Radiation Oncology, Henry Ford Hospital, Detroit;
    -Michigan Acupuncture, Novi, MI.
    -Center for Integrative Wellness, HFHS, Southfield;
    -Center for Integrative Medicine, HFHS, Northville

    and apparently all that icky math was done by:
    -Waterford Dept. of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit

    And just in case the affiliations list doesn’t make the point clearly enough, I offer this from the Henry Ford Health System (HFHS) website:

    “It is a state-of-the-art facility where highly trained practitioners provide therapies drawn from the best of the world’s healing traditions to help you achieve overall wellness and optimal health. Treatments include neuromuscular therapy, massage therapy, chiropractic care, acupuncture, and herbal and nutritional counseling.”

    Can I please ask: what the hell is going on with health care in this country when a “Hospital System” is going dewey-eyed over HERBAL COUNSELING???

    No wonder Detroit can’t build cars anyone wants.

  3. Plonit – you are correct, I glossed over some complexity there.

    To be precise, the size of a study determines its power, and power relates to the size of an effect that it can detect.

    But it is also true that small studies, even when powered appropriately, are still suspect because a few anomalous cases can distort the outcome.

    For this kind of analysis, this was a way underpowered study. When you combine small numbers with unblinded analysis, the results are uninterpretable.

  4. David Gorski says:

    It is unclear why the researchers undertook a small unblinded study such as this, given that previous studies were better designed.

    Oh, I think it’s entirely clear. These researchers are true believers. What really astounded me is that they didn’t include a sham acupuncture group in this trial. My guess is that, if they had, both the sham acupuncture and acupuncture groups would probably have performed equally, because that’s the result that’s virtually always obtained in rigorous trials of acupuncture versus sham acupuncture.

    FYI, although I respect the surgeons at HFH a lot (my best friend in my department, alas, has been lured away to HFH and will be leaving soon), HFH has clearly decided that woo is the way to go. Indeed, one of its satellite hospitals is totally steeped in this sort of stuff, with its Center for Integrative Medicine:

    http://www.henryford.com/body_academic.cfm?id=39059

    For instance, the hospital itself was designed using feng shui:

    http://www.henryford.com/body_wbloomfield.cfm?id=50423

    It has a chiropractor, an acupuncturist and herbalist, as well as a reiki master and practitioner of neuro-linguistic programming and the Yuen Method of energy healing:

    http://www.henryford.com/body.cfm?id=39151

  5. Tom S says:

    Yes, Steven Novella, you glossed over some complexity in your comment about the study including “only” 50 women. Of course you have to do that, otherwise you would never get an entry written.

    But the word “underpowered” in your comment responding to Plonit touches my hot button. I would like to see the word ripped from our vocabulary, never to be heard again. The fact is, there is some effect size for which the power is basically 100%. And, there is some effect size for which the power is near the floor of (usually) 5%. This is true of all studies. So one should really not comment on the power without also mentioning effect sizes.

    But again, how in the world will you ever get your blog written?

  6. windriven says:

    If you would like further insight into this study – to say nothing of your daily dose of comic relief – go to study co-author Susan Jakary’s website here:

    http://www.susanjakary.com/indexnf.html

  7. Dr. Gorski beat me to the punch.

    A less respectful answer would be that the researchers knew a small, unblinded study was the best/only way to guarantee positive results.

  8. crazyred says:

    I don’t understand how a ‘sham’ acupuncture arm would work. I would assume that the patients can actually feel the needles being inserted (or not)? Personally, the idea of acupuncture gives me the heebie-jeebies, but wouldn’t a patient know whether or not the needles are going in?

    Regardless of what a clinical study says or doesn’t, if these women find relief from acupuncture (mind over matter can be a strong factor), then is there any harm in doing that over taking effexor – they would not be skipping a drug that can save their lives (the chemo)? There is no drug without side effects as we all know, and if this acupuncture is perceived as helping the vasomotor symptoms, is there really any harm in skipping the effexor? Just a thought.

    Cheers!

  9. David Gorski says:

    Hmmm. I wonder why they didn’t use their own resident acupuncturist for this study.

  10. Harriet Hall says:

    crazyred,

    The sheathed acupuncture needle that doesn’t penetrate the skin has been shown to be an adequate placebo. In exit polls, patients could not guess whether they had been given the placebo or the “real thing.”

    Incidentally, more than one acupuncture study has skipped a placebo arm because researchers said placebo acupuncture was effective too – any stimulation of the skin caused an effect. They didn’t seem to realize that that destroys the whole rationale for the acupuncture rigamarole.

    Is there any harm? Prescribing placebos harms the physician/patient relationship by destroying trust and it is unethical.

  11. BKsea says:

    A red flag for me in this study is that they report approaching 94 eligible patients. 30 of these refused to participate because they did not want the drug. No one refused because they did not want acupuncture. To me, this does not seem representative of typical attitudes toward drugs versus acupuncture. It suggests to me that the participants had a predisposition to acupuncture. That could certainly lead to exagerated effects of acupuncture and higher reports of adverse effects from drugs given the lack of blinding. How were the subjects recruited? After referal for acupuncture perhaps?

  12. windriven says:

    @Dr. Hall

    “The sheathed acupuncture needle that doesn’t penetrate the skin has been shown to be an adequate placebo. In exit polls, patients could not guess whether they had been given the placebo or the “real thing.””

    Perhaps the patient couldn’t guess but what about the acupuncturist? And wouldn’t that impact the ‘double’ part of double blind?

  13. windriven says:

    @ Dr. Gorski

    “Hmmm. I wonder why they didn’t use their own resident acupuncturist for this study.”

    I was able to locate information on 8 of the 10 co-authors. All, with the exception of the biostatistician, seem closely associated with woo and some of them with fringe woo.

    That, of course, doesn’t mean anything in and of itself about the quality of the study. But it suggests that a high level of vigilance is in order.

    How is it that herbalists, acupuncturists, chiros and so forth have gotten accepted into mainstream medical facilities? And what is with having mom, dad, the cat, the dog and the neighbor’s babysitter listed as coauthors? I object because publication in a major peer-reviewed journal confers a legitimacy that IMHO has not been earned.

  14. crazyred says:

    Thanks Harriet, for the explanation of the sham acupuncture.
    I still get the heebie jeebies just thinking about it.

    Regarding placebo, a few questions/comments:

    If the patient indicates that they read that acupuncture may help their symptoms (regardless of the quality of the study) or heard from a friend that it helped, etc, and they wanted to try that before effexor for their vasomotor symptoms, would it be acceptable for the physician to step back and let them try it, with the reassurance that they can always try the effexor if their symptoms continue? I guess, how hard does a doctor lobby against an alternative treatment even if studies have shown it is no better than the standard of care, in this case being effexor? Could there be other things at work for patients who prefer acupuncture, say the extra 1:1 frequent in person contact with their acupuncturist who is not a busy doctor with a full schedule? Again, I am not a fan of acupuncture, but I am trying to understand why it may be perceived to work for some.

    About prescribing placebos, I remember reading an article that doctors do it more than we care to think…being that they prescribe drugs that they know have no effect on the condition being treated (which I think is different that trying a variety of drugs to see which gives the best response). What are your thoughts on that? It seems like a common practice though I agree it breeds mistrust.

  15. Tom – you missed my point. I did not bring up power or effect sizes – Plonit did. I was simply clarifying, perhaps not well, that it is not relevant to the point I was making about this study.

    Effect size is really irrelevant in this study. The fact is – it is a small study and is unblinded. Therefore the results are all but worthless – except as a pilot study, but the literature is already past that point for this topic. So it is worthless.

    Do you dispute this? I couldn’t tell from your bizarre comment.

  16. qetzal says:

    I don’t have full text access, so I’m curious. Did the authors say why there was no effort to use sham accupuncture or otherwise address blinding? Did they attempt to justify why their results were supposedly positive if the majority of larger, better controlled trials have been negative? Did they even discuss any of the previous negative findings summarized by Dr. Novella?

    And perhaps the most important question, why would the reviewers & editors let this into JCO?

  17. Scott says:

    Effect size is, strictly speaking, relevant even to small unblinded studies. If the 25 acupuncture recipients had all reported complete symptom relief, while the 25 Effexor recipients all died, that would be compelling evidence that acupuncture was superior to Effexor.

    Of course, the existing evidence was already sufficient to rule out that result as a credible possibility. But if such an effect WAS a credible possibility given existing knowledge, this study would have been valuable. The truly accurate statement would be that the small unblinded study is underpowered to detect an effect of size consistent with the existing research.

    IMO using “underpowered” as a shorthand for that is reasonable, but I’d have to say that Tom’s technically correct.

  18. I am assuming – for the outcome measures followed in this study. We already know people are not going to drop dead from either Effexor or acupuncture.

  19. pmoran says:

    Less easily dismissed is this systematic review giving similar results comparing acupuncture and drug prophylaxis of migraine.

    Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001218. DOI: 10.1002/14651858.CD001218.pub2

    I have previously tried to get this group interested in such studies, predicting that we were likely to see more of them.

    They surely challenge our preconceptions as to what constitutes good practice in some large arenas of everyday medicine. Note that eighteen out of 25 patients experienced ill effects in the Effexor group, and none at all in the 25 receiving acupuncture, yet the results were otherwise exactly the same.

    I agree the results are preliminary, but I personally have little difficulty in interpreting such findings as indicating that both treatments “work” mainly as placebo,

    They don’t mean that acupuncture has mysterious healing power, beyond that of the enforced relaxation during the treatment sessions, perhaps sometimes along with distraction/counterirritant effects, and the satisfaction of that irresistible compulsion to “do something” when distressed.

    There is another staggering implication here. Present understanding of placebo reactions allows us to predict that other studies might show some kinds of sham treatment working BETTER than accepted drugs.

    Remember that the format of the usual clinical trial seriously reduces the opportunity for placebo reactions. What would happen if you selected patients who believed they have previously had a good response to acupuncture, and provided intensive contact with a very charismatic therapist?

    There is a possible weakness in the above that is rarely picked up by other skeptics, because this line of thinking is generally off-limits — even though it is quite consistent with the available evidence.

    A clue — the objection is not ethical. That objection looks a bit lame if it requires the use of a side-effect prone drug as the first and only option for distressed patients when other methods may perform better in cost/risk/benefit terms.

  20. Harriet Hall says:

    windriven said,
    “Perhaps the patient couldn’t guess but what about the acupuncturist? And wouldn’t that impact the ‘double’ part of double blind?”

    That’s the biggest problem with acupuncture studies. No one has figured out a way to do a double blind study. The best studies are only single blind.

  21. Calli Arcale says:

    It would help if the acupuncturist (who knows who got the treatment and who didn’t) isn’t the one who collects the data, and isn’t allowed contact with the data gatherer.

    In the end, trials end up being attempts to answer questions about specific aspects. Is the needle important? Are the spots important? Does it matter if the acupuncturist is trained? Do the needles need to be twiddled or just left in for a bit? So far, the answers to each of those appears to be “no”.

  22. pmoran says:

    Calli, don’t we already have sufficient information on all those points? Only unimaginably mind-boggling new evidence could now reverse the view that acupuncture and its sham variants have no worthwhile effects beyond the elicitation of placebo reactions, possibly reinforced by other non-specific influences mentioned in my last post..

    The recent emphasis of certain elements of alt.med on these “pragmatic studies” shows that we have all but won that dispute. The proponents have given up trying to show that their methods work better than placebo. Of course they will mostly not subscribe to that choice of words, and will tend to waft on about “the mysteries of human healing” and more fanciful speculations .

    But I can agree with them in principle. We do need to know what “working as placebo” can mean within practical medicine. These studies are attempting to answer that, albeit in very imperfect ways. They apply the premise that it may not matter how treatments work if they are satisfying medical needs in a cost/risk/effective way.

    The usual double-blinded placebo-controlled trial cannot answer this question for obvious reasons.

  23. EricG says:

    @ crazyred

    surprised no one addressed this yet:

    “is there really any harm in skipping the effexor?”

    I know you have phrased it from the perspective of innocently letting them try something else for an induced placedo response before a drug intervention, but…

    http://whatstheharm.net/

    It simply becomes a slippery slope if CAM unsupported by evidence gets a free pass. I’m certainly not specifically advocating effexor; likewise, a patient certainly has the right to do whatever they wish with their informed consent.

    “About prescribing placebos, I remember reading an article that doctors do it more than we care to think…being that they prescribe drugs that they know have no effect on the condition being treated ”

    somewhat induces the logic of the big pharma shill gambit, in that there is a wide brush used to paint “many doctors” “much of the time” without the aid any specific scandal or whistleblowing. usually the result of viral scare stories like desiree jennings and such. However, if you do have such a story, I’m sure curious minds are interested.

    “Could there be other things at work for patients who prefer acupuncture, say the extra 1:1 frequent in person contact with their acupuncturist who is not a busy doctor with a full schedule?”

    great point, however two different things. I am no doctor, and have not seen one for some time, but the word on the street is that CAM practitioners have the upper hand in bedside manner. Unfortunately, it speaks little to the efficacy of any CAM treatment, including acupuncture.

    Be advised, I am not “calling you out” as it were, just bringing attention to oft cited ideas that do not possess exceptional merit.

  24. Harriet Hall says:

    crazyred,

    I have said this before: I would not recommend acupuncture to a patient, but if he brought the subject up I would say there is no scientific evidence that it works but that some people have thought it helped them and that I would have no objection to his trying it if only for the chance of a placebo response.

    It is unethical to prescribe treatments that we know are ineffective, but there are gray areas. I have heard doctors justify a very “iffy” antibiotic prescription for what is almost certainly a viral infection by saying they are hoping to prevent a bacterial superinfection. And sometimes we aren’t 100% sure that it is only a virus. It’s easy to rationalize and find an excuse for using a questionable treatment. It’s hard to define when that crosses the line to placebo.

  25. Zoe237 says:

    Very interesting pmoran.

    Probably a dumb question, but couldn’t such results point to a problem with Effexor not being effective? Maybe it doesn’t actually do anything and that it’s all placebo effect for the drug?

    Regarding placebo effect, pediatricians do it all the time for us moms- prescribe antibiotics for a probably viral infection. Or for a bacterial infection that may go away on it’s own (which is why I try to avoid going to the doctor for a few days with sick kids.) Doctors assume, probably rightly most of the time, that because you showed up they want you to do something).

    Here’s the link that somebody posted the other day on placebo effect.

    Oct. 24 (Bloomberg) — U.S. doctors regularly prescribe treatments such as vitamins, painkillers and antibiotics for their potential placebo effect, a survey found.

    Almost half of the rheumatologists and internists surveyed said they prescribed pills whose benefits derive from “positive patient expectations” two to three times a month, Jon Tilburt from the National Institutes of Health in the U.S. said in a study published today in the British Medical Journal.

    …“Prescribing harmless treatments like vitamins or over-the- counter painkillers to promote positive expectations without full disclosure of motivations might not raise alarm bells,” Tilburt said. “But prescribing antibiotics and sedatives when there is no clear medical indication could have serious adverse consequences for both patients and public health.”

    http://www.bloomberg.com/apps/news?pid=20601124&sid=ahaD1J6VIA.o&refer=home

  26. Mark Crislip says:

    ” We already know people are not going to drop dead from either Effexor or acupuncture.”

    My fav:

    Leg Med (Tokyo). 2003 Sep;5(3):170-4.
    An autopsy case of bilateral tension pneumothorax after acupuncture.
    Iwadate K, Ito H, Katsumura S, Matsuyama N, Sato K, Yonemura I, Ito Y.

    Department of International Health Development, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8519, Japan. iwadate.legm@tmd.ac.jp
    Acupuncture is one of the most popular complementary therapies in the world. Pneumothorax due to perforation of the lungs by needle insertion is one of the most common and serious complications of acupuncture treatment. Although there have been several case studies of pneumothorax induced by acupuncture, as far as we know there have been no reports on the pathological findings of autopsy cases. In this report, we describe the pathological findings of an autopsy case of bilateral tension pneumothorax after acupuncture. The patient suffered dyspnea and chest pain soon the completion of an acupuncture treatment, and died 90 min later. Several ecchymoses were macroscopically observed on the parietal pleura in the left and right thoracic cavity, suggesting that needles were inserted into the thoracic cavity and that the lungs were perforated. The many black spots we observed on the parietal pleura along the vertebral column microscopically consisted of a number of dust-like black pigments and macrophages containing these pigments. These spots seemed to have appeared because of the previous insertion of needles.

    PMID: 14568778

  27. crazyred says:

    EricG:

    I read the original article on msnbc, but here is a link from WebMD:

    http://www.webmd.com/pain-management/news/20081023/50percent-of-doctors-give-fake-prescriptions

    I see that someone else posted a different story above already.

    I think it’s interesting that some doctors will recommend vitamins when all else fails. Sometimes the expectation that something will help fix a problem that can otherwise not be seen or felt via normal diagnostics is all that a patient needs. We all feel stress and sometimes this can manifest as physical symptoms.

    This can become a problem however, when the initial work up was done incorrectly because the doctor had an incorrect assumption about the patient. Upon obtaining a second opinion, it is realized that tests that should have been performed were not and that there IS actually a medical issue that is not caused by ‘stress’ or ‘a super top secret hidden anxiety/depression disorder’.

    Note that I am a) not a doctor and b) I do work in the pharma industry. I am not a conspiracy theorist that thinks pharma creates diseases and sells crappy drugs on purpose purely make profits. Have they behaved badly ever…yes. But, the common goal is to improve the lives of people and alleviate suffering.

  28. pmoran says:

    Zoe237:”Probably a dumb question, but couldn’t such results point to a problem with Effexor not being effective? Maybe it doesn’t actually do anything and that it’s all placebo effect for the drug?”

    PM That’s a possibility, given the wariness we now have regarding pharmaceutical studies. However, a quick Pubmed survey suggests a modest effect for Effexor over “sugar pill”-type placebos and also over some of the other drugs that have been tried for hot flushes.

    Any such benefits are arguably counterbalanced by poor patient tolerance, with up to a quarter of subjects stopping the drug because of side effects. It is unlikely that this many patients are actually helped by the drug. Few patients continued on with the treatment voluntarily in one study that looked at that.

  29. EricG says:

    @ crazyred

    Understood. However, slightly different things. I am not certain, but I do not think there is any risk to taking a sugar pill…at least not as much as described here by faulty acupuncture (or chelation, chiropractic etc for that matter).

    I am not sure how I feel about prescribing placebos (especially considering phantom fibromyalsia type stuff…but likewise, im no doctor) but deferring to ineffective treatments with known risks with hopes of inducing a placebo is unethical. Of course, there remain shades of gray (hopelessly terminal stage 5(?) cancer…sure, why not) but my guess would be that a large portion of acupuncture treatment is for minor, chronic and/or nagging type conditions. In which case, I would be reluctant to “let them have a go at it” under the guise that I do in fact support it, when I really am looking to offer a placebo.

  30. Zoe237 says:

    Zoe237:”Probably a dumb question, but couldn’t such results point to a problem with Effexor not being effective? Maybe it doesn’t actually do anything and that it’s all placebo effect for the drug?”

    “PM That’s a possibility, given the wariness we now have regarding pharmaceutical studies. However, a quick Pubmed survey suggests a modest effect for Effexor over “sugar pill”-type placebos and also over some of the other drugs that have been tried for hot flushes.

    Any such benefits are arguably counterbalanced by poor patient tolerance, with up to a quarter of subjects stopping the drug because of side effects. It is unlikely that this many patients are actually helped by the drug. Few patients continued on with the treatment voluntarily in one study that looked at that.”

    Thanks. My bias is that, given a (false) dichotomy between acupuncture works and effexor doesn’t, I’m more likely to believe the latter.

    Still, it sounds like acupuncture has many less side effects than drug alternatives. I think the rationalizations (qi, energy points, whatever) are ridiculous, but I don’t understand the SBM obvious hate of the practice. Besides the huge waste of money and the VERY rare death (one out of millions and millions), I’m not convinced by “what’s the harm.” And SBM and the what’s the harm website are my sole sources of information about acupuncture. I wasn’t really biased either way before starting to read. Except that I’ve never believed that SOME practices in conventional medicine are all that based in science or evidence either.

  31. EricG says:

    @ zoe237

    “Still, it sounds like acupuncture has many less side effects than drug alternatives…”

    that is both the point and not the point (hold on, ill explain).

    first, it is important to be made aware of any and all side effects. presumably, the good outweighs the bad. I would be reluctant to take anything as nasty as chemo unless I was reasonably certain that my life was at stake.

    second, the expected benefits must also be communicated. if there are no benefits to acupuncture and only risks, that is an unethical approach to treatment – in terms of a “recommendation” or deferral. patient choice, however, is always tantamount.

    third, we are not going for a “lesser of two evils” here. which treatment poses the greatest chance for benefit? then, which poses the least threat for risks?

    having written this…I am not a doctor. Would anyone care to add to the point with greater detail and/or medical/scientific reasoning? (or refute it, if that be the case)

  32. BillyJoe says:

    pmoran,

    I’m not sure if this thread is still active.
    If it is, I can provide an answer to the following question:

    “Less easily dismissed is this systematic review giving similar results comparing acupuncture and drug prophylaxis of migraine.

    Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001218. DOI: 10.1002/14651858.CD001218.pub2″

    Hint:
    There do not seem to be any obvious methodological errors, but author’s conclusions are not justified by the results of their study.
    Cochrane does not always get it right.

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