Two more high quality trials have failed to show any benefit from alternative medicine.
Acupuncture no help for knee osteoarthritis
This trial is particularly interesting because osteoarthritis of the knee is the one thing that is always cited as a triumph for acupuncture. It is common to hear people talk about acupuncture as though it were the acceptable, or even accepted, face of alternative medicine. Perhaps that is because it is not so obviously preposterous as homeopathy. Sticking a needle into you obviously produces a signal in the brain. That is just sensory physiology. But the evidence that this produces any real benefit for patients is, in fact, almost thin as for homeopathy. This paper seems to have been done very well. It is another nail in the coffin of needle quacks.
Osteoarthritis of the knee is what was cited by the Prince of Wales in his speech to WHO. In that speech he stuck to things that he thought were safe, in contrast to the far more barmy claims on his own web site.
The paper is “Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial”, Foster et al. (BMJ 2007;335;436), and the British Medical Journal has made it available freely: read it here..
Patients were allocated randomly to one of three groups
- Advice and exercise (112 patients)
- Advice, exercise, and true acupuncture (112 patients)
- Advice, exercise, and non-penetrating acupuncture (115 patients)
The question of controls is crucial. In this trial, “non-penetrating acupuncture” was done with ‘stage dagger’ needles: blunt needles that retract into the handle, without actually penetrating the skin at all, but which create an illusion of insertion.
Patients were told that they would receive physiotherapy advice and exercise and “may receive acupuncture, using one of two different types of acupuncture needle”, but were not told that one type of needle would not penetrate the skin.
The bottom line
“Our trial failed to show that acupuncture is a useful adjunct to a course of individualised, exercise based physiotherapy for older adults with knee osteoarthritis.”
Our trial addressed the three important questions recommended by the House of Lords report on complementary and alternative medicine in 2000.
Acupuncture delivered by physiotherapists as part of an integrated package of health care with advice and exercise, for older adults with osteoarthritis of the knee, provided no additional improvement in pain scores compared with advice and exercise alone measured on the Western Ontario and McMaster Universities osteoarthritis index at six and 12 months. Small benefits were shown for pain intensity and unpleasantness but these effects were greater and sustained for longer in the group receiving non-penetrating acupuncture than in the group receiving true acupuncture. This finding makes it unlikely that the observed effects were due to needling effects of needle penetration, manual stimulation throughout treatment, and elicitation of the de qi sensation.
We have shown that there are no differences when a credible, non-penetrating acupuncture treatment, delivered under strict participant blinded conditions, and true acupuncture, involving needle penetration, manual stimulation, and elicitation of the de qi sensation are added to a course of advice and exercise. Indeed patient satisfaction, credibility of intervention at six weeks, and reduction in pain intensity and unpleasantness were significantly greater for the advice and exercise plus non-penetrating acupuncture group than for the advice and exercise group but not for the advice and exercise plus true acupuncture group.
Vitamins C and E and Beta Carotene fail again
Another good trial has confirmed the uselessness of these “supplements” (other than for making a great deal of money for supplement hucksters).
“A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women” Cook et al. Arch Intern Med. 2007;167:1610-1618. [Download the paper here].
Here is the summary taken from the invaluable Consumer Health Digest (a free weekly e-mail newsletter edited by Stephen Barrett, M.D., and cosponsored by NCAHF and Quackwatch), 16-08-07
|Antioxidants for cardiovascular disease flunk another test.
A 10-year double-blind, placebo-controlled study has found that women at high risk for cardiovascular disease derived no benefit from taking vitamin C (500 mg/day), vitamin E (600 international units every other day), or beta carotene (50 mg every other day).
The researchers looked at the incidence of myocardial infarction, stroke, coronary artery surgery, and cardiovascular disease death among 8171 female health professionals, 40 years or older, with a history of cardiovascular disease or 3 or more cardiovascular disease risk factors.
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