The randomised control trial (RCT) was designed mainly for use within the pharmaceutical research. Simplified, an active pill and a dummy or ‘inert’ pill are compared for effectiveness. The active pill has to perform significantly better than the dummy pill for the effect not to be considered a placebo.
This RCT model suits the pharmaceutical industry because it’s easy to create a dummy pill. But when the RCT is applied to medical acupuncture, how do you create a credible dummy needle?
We know that inserting, or even bringing a non inserting ‘looks like you're getting acupuncture’ needle into contact with the skin will bring about specific physiological effects, over and above the placebo effect, regardless of where the needle is inserted? Any part of the body with nerve endings will do, and of course we know there are nerve endings all over the body!
Nonetheless the RCT has and is still used to try and prove therapeutic efficacy, ie does real acupuncture work better than ‘sham’ or dummy acupuncture.
But how do you define real acupuncture? Surely needling ‘acupuncture points’ as described within traditional chinese medicine should constitute real acupuncture? Unfortunately not, science tells us that there is no such thing in real, physical terms as an acupuncture point. So how can you miss, or needle a dummy point when the real thing does not exist.
What the research tells us is that medical acupuncture, regardless of where the needle is inserted will bring about pain relieving effects. A portion of this effect is of course a placebo response which accounts for some of the pain relief in just about every technique we use in medicine, including surgery interestingly.
But the needle will also evoke further physiological effects which influence pain which cannot be fully attributed to the placebo effect.
For some conditions such as osteoarthritis of the knee, and when needling myofascial trigger points, it may be more effective to insert the needle closer to the knee or the trigger points within the muscle. However for other more ‘centrally’ driven problems such as chronic headaches or fibromyalgia or certain types of chronic back pain, where the needle is inserted may be less relevant.
At the end of the day, the experts who understand the science of medical acupuncture would agree that the RCT is a flawed test of acupuncture’s value. What we we should be asking is does acupuncture work, and does it work better than other types of treatment such as drug therapy for certain conditions? Better still, how does acupuncture as part of a multimodal care model affect treatment outcomes. In other words how effective is medical acupuncture, not does inserting a needle here work better than inserting a needle somewhere else - which seems to be missing the point!?
