RCT as a Research Model for Acupuncture

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http://www.bmj.bmjjournals.com/cgi/content/full/330/7501/1202?

ehom & eaf

 

 

 

 

Characteristic and incidental (placebo) effects in complex

interventions such as acupuncture

Charlotte Paterson , special training fellow in health services

research 1,

Paul Dieppe, director 1

 

1 MRC Health Services Research Collaboration, Department of Social

Medicine,

University of Bristol, Bristol BS8 2PR

 

" The specific effects of non-pharmaceutical treatments are not

always divisible from placebo effects and may be missed in

randomised trials.

 

The randomised double blind controlled trial has proved an

invaluable tool for testing the efficacy of new drugs. However, it

is now used to evaluate complex non-pharmaceutical interventions,

many of which are based on different therapeutic theories. For

example, randomised controlled trials are used to test

physiotherapy, a complex intervention with a basis in biomedical

theory, and acupuncture, which is often based on Chinese medicine.

In order to use a placebo or sham controlled design, an intervention

has to be divided into characteristic (specific) and incidental

(placebo, non-specific) elements. However, recent research suggests

that it is not meaningful to split complex interventions into

characteristic and incidental elements. Elements that are

categorised as incidental in drug trials may be integral to non-

pharmaceutical interventions. If this is true, the use of placebo or

sham controlled trial designs in evaluating complex non-

pharmaceutical interventions may generate false negative results.

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