Thursday, August 03, 2006

Slate: Does Acupuncture Really Work?

Your Health This Month: Pains and Needles. By Sydney Spiesel. The appeal of alternative medical treatments these days is not in dispute; their efficacy is less clear. Each month, Slate’s medical expert Dr. Sydney Spiesel sifts through medical journals to find interesting and overlooked studies. Today he tells us about one recent study of acupuncture, and it contains both good and bad news.

Acupuncture: Of pains and needles.
Complementary therapies: Acupuncture, nutritional supplements, homeopathy, and naturopathy seem to many to offer safer, less invasive, more "natural" ways to deal with bodily woes than conventional medicine. They appeal to the desire for the spiritual and the mysterious. They may be less expensive. Their practitioners are often warmer and less pressed for time; they appear to pay attention to our whole selves and not just the broken parts. And some patients relish the increased autonomy: Instead of asking your doctor for a prescription, you can reach for a bottle of pills in the vitamin department of the supermarket.
The question: Do these treatments work? Sometimes yes and sometimes no. And sometimes for reasons practitioners don't anticipate. A particularly good example comes from a study reported recently in the Annals of Internal Medicine, conducted at the Universities of Heidelberg and Bochum in Germany by Hanns-Peter Scharf and his colleagues. The purpose was to help German insurers decide whether to pay for acupuncture, a practice of Chinese traditional medicine in which tiny needles are inserted to a shallow depth at specific locations in the skin.
The ailment: The researchers focused on acupuncture for osteoarthritis of the knee, a painful and debilitating joint inflammation that results from wear and tear in aging joints. It occurs in the majority of people by age 65, and in 80 percent by age 75. The knee is the most commonly affected joint. There is no cure. The standard treatment is anti-inflammatory drugs, which have their own risks; pain medication; and physical therapy. Ultimately, many sufferers have surgery, in which the damaged and painful knee joint is replaced with an artificial substitute.
The new study: Previously, some studies have shown the benefit of acupuncture for osteoarthritis of the knee, and others have not. For this study, Scharf and his colleagues looked at about 1,000 patients. The patients were divided into three groups. One group was treated with acupuncture. A second "sham acupuncture group" was treated with needles placed in locations that don't match those specified by traditional Chinese medicine. A third group received no needle treatments at all. All the patients had identical access to physical therapy and nonsteroidal anti-inflammatory medications. After 26 weeks, the subjects were all interviewed by people who didn't know which treatment they had received. The treatment was regarded as successful only if there was a 36 percent or higher improvement in knee function or pain relief.
The results: Acupuncture was clearly associated with improved function and pain relief. But it didn't much matter whether the treatment followed traditional Chinese medicine methods or consisted of needles placed in the wrong locations—both worked equally well. It is tempting to think that the physical act of placing needles caused the improvement, and that may well be the case. But there was another significant factor: The patients who got no needle treatment had substantially less contact with their doctors than the acupuncture patients, sham and real, had with their practitioners.
Conclusion: Should the German insurers pay for this complementary treatment? Well, without acupuncture, the patients in Scharf's study needed more physical therapy, more pain-killing medication, and more anti-inflammatory drugs. I sure wish I knew, though, what would happen if patients were treated without acupuncture but given more attention and care by their doctors.

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