The June issue of the BJGP has a paper, ‘Acupuncture for “frequent attenders” with medically unexplained symptoms: a randomised controlled trial (CACTUS study)’.1 It has lots of numbers, but the result is very easy to see. Just look at Figure 2 (omitted from the print version, online only).1
There is no need to wade through all the statistics; it's perfectly obvious at a glance that acupuncture has, at best, a tiny and erratic effect on any of the outcomes that were measured. The effects, even if some are real, are obviously too small to be of any clinical significance. The paper is fascinating because it is the clearest demonstration I have ever seen that acupuncture is ineffective, and that it does not even have a worthwhile placebo effect. One may certainly criticise the lack of a sham acupuncture control group but, in a sense, that is what makes the paper fascinating. Despite the inability of the experimental design to distinguish between non-specific effects and genuine effects of acupuncture, next to no benefit was seen. The result may have been fascinating, but its significance was lost altogether on the authors. The conclusion of the paper said:
The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months.'1
The meaning of the paper was also lost on the Editor, who issued a press release:
‘Although there are countless reports of the benefits of acupuncture for a range of medical problems, there have been very few well-conducted, randomised controlled trials. Charlotte Paterson's work considerably strengthens the evidence base for using acupuncture to help patients who are troubled by symptoms that we find difficult both to diagnose and to treat.’
Both of these statements directly contradict what is actually apparent from the figure.
One wonders what went wrong. Presumably the referees, like the authors, were partisan when it comes to needling. We don't know because the Editor has declined to release the reports. It is harder to explain the press release. All one can conclude is that the paper had not been read very carefully before the press release was written. Mistakes of this sort do great harm to journals. The paper in question has already been analysed carefully in four blogs (two of them by GPs)2-5 and has been the subject of a devastating spoof in The Daily Mash.6 Had the Editor admitted the mistaken interpretation, one could have forgotten the matter We all make mistakes sometime. By refusing to admit that the paper and the press release were very misleading, the Journal has been brought into disrepute.
REFERENCES
- 1.Paterson C, Taylor RS, Griffiths P, et al. Acupuncture for ‘frequent attenders’ with medically unexplained symptoms: a randomised controlled trial (CACTUS study) Br J Gen Pract. 2011 doi: 10.3399/bjgp11X572689. DOI: 10.3399/bjgp11X572689. [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 6. The Daily Mash. Made-up medicine works on made-up illnesses. The Daily Mash, 2011. http://www.thedailymash.co.uk/index.php?option=com_content&task=view&id=3882&Itemid=77 (accessed 11 Jul 2011)