Acubriefs Review and New Citations August 2004

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Acubriefs Review and New Citations

August 2004

To view this newsletter online (and this month's New Citations), visit

http://www.acubriefs.com/citations/08.04.citations.htm

 

From the Editor:

Are you ready for the Nobel Prize in acupuncture research? Well how

about one for clinical acupuncture research? I vote this year for the

work of Andrew Vickers.

 

Readers of Acubriefs know that I can be quite critical of current

acupuncture research, whether it has favorable or unfavorable results.

I've even argued publicly that current research may do more harm than

good. After reading the current articles by Vickers et al, I feel

refreshed - like someone on a Sunday morning who hears the message of

Easter preached. Vickers' approach to clinical acupuncture research

resonates with truth. It is a primary template for research in clinical

acupuncture for the foreseeable future. The study design honors

acupuncture as an adjunctive form of therapy and avoids the " either/or "

approach of conventional randomized control trials. It recognizes

context beyond the diagnosis, pill, or procedure.

 

Though Vickers's paper didn't bring tears to my eyes, as might the sight

of well-placed needles, there's beauty in his work. It's a beauty of

hard steel and precision that turns our head as it passes by. His recent

papers are representative of a paradigm shift in acupuncture research.

Seven years after the NIH conference we are at the dawn of pragmatic

acupuncture trials. Like a new art form, there will be critics and those

who hold fast to the comfort of the past. But there is a movement,

albeit sometimes circular, that must begin to propel forward. Like the

helix of life, our research designs must do a better job of revealing

the contextual nature of clinical acupuncture.

 

I am going to encourage readers to appreciate this art form directly.

The article is published online at the British Medical Journal's home

site. Acupuncture for chronic headache in primary care large,

pragmatic, randomized trial. Vickers AJ, Rees RW, Zollman CE, McCarney

R, Smith CM, Ellis N, Fisher P, Van Haselen R.; BMJ. 2004 Mar

27;328(7442):744. Epub 2004 Mar 15. (Full text at:

http://bmj.bmjjournals.com/cgi/content/full/328/7442/744 ; PubMed

Abstract with links to free full text article at

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dop

t=Abstract & list_uids=15023828 )

 

If the appeal and power of the first study wasn't enough, Vickers is the

second author with David Wonderling of: Cost effectiveness analysis of

a randomized trial of acupuncture for chronic headache in primary care.

Wonderling D, Vickers AJ, Grieve R, McCarney R.; BMJ. 2004 Mar

27;328(7442):747. Epub 2004 Mar 15.; (Full text at:

http://bmj.bmjjournals.com/cgi/content/full/328/7442/747; PubMed

Abstract with links to free full text article at:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dop

t=Abstract & list_uids=15023830 This is a jewel of a study and could be

the best example I've seen of an acupuncture intervention evaluated for

cost effectiveness. The product is not only sleek and powerful the price

is right!

 

What is more, Vickers makes it clear that he is concerned about what the

data actually reveals. There is a recent Vickers article that reviews a

common statistical problem related to using simple before-and-after

statistical comparisons in clinical trials associated with pain. Here

again, Vickers emphasizes the need for context to be appreciated when

evaluating acupuncture and its use in conditions associated with chronic

pain. By reassessing four previous acupuncture trials, he admonishes:

if the severity of baseline pain, and other characteristics of the

distribution regarding the population's pain levels over the course of

the study are not taken into account, the choice of the statistical test

and the power of the study can be compromised, along with its

conclusions. I predict this paper will also significantly change the

landscape of future clinical acupuncture trials and meta-analyses

thereof. The article is entitled: Statistical Reanalysis of Four Recent

Randomized Trials of Acupuncture for Pain Using Analysis of Covariance.

Vickers, A.J.; Clin J Pain 2004 Sept-Oct;20(5):319-23 PubMed Abstract

at:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dop

t=Abstract & list_uids=15322438.

 

So, I am calling for a celebration! Recently The Best of Both World's

Foundation, http://www.acubriefs.com/bbw/, was established to support

the work of Acubriefs and other efforts aimed at integrating acupuncture

and other models of health care into our western system. I would like it

to help celebrate the work of Vickers and other acupuncture researchers.

Please consider making a contribution, of either your time or your

money, to this charitable foundation. All contributions earmarked for

celebrating research accomplishments will be honored as such. I'm

envisioning a wingding of a celebration that will bring together

researchers from all over the world.

 

We might not duplicate the Nobel Prize ceremonies but in our way we can

strive to surpass them.

 

James K. Rotchford MD, MPH, Editor

 

New Citations August 2004 = 92

You may view the August 2004 New Citations at:

http://www.acubriefs.com/citations/08.04.citations.htm

Beginning January 2004, Acubriefs Newsletter is being published 4 times

a year. However, we will continue to publish monthly lists of recent

citations so that you may view the current additions to the Acubriefs

Database. You may search the entire database at our Search Page at:

http://www.acubriefs.com/search.htm

Acubriefs Newsletter has three objectives:

1. To provide a centralized resource for reviewing new citations on

acupuncture in English.

2. To provide annotated abstracts on citations of particular interest to

clinicians and researchers.

3. To facilitate access to citations quoted/reviewed. (Please let us

know if you have suggestions on how we might better meet these

objectives)

The editor for the newsletter is J.K. Rotchford MD, MPH, Past President

of the Medical Acupuncture Research Foundation.

 

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