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edzard ernst md, phd, fmedsci, frsb, frcp, frcped. home about guest bloggers contact privacy rules contents recent comments lectures & talks just published recently published! blogroll doctors world wide friends of science in medicine gwup | die skeptiker informationsnetzwerk homöopathie institute for science in medicine james randi educational foundation naturopathic diaries respectful insolence science-based medicine the nightingale collaboration the quackometer zeno's blog acupuncture for alcohol withdrawal syndrome – another ugly fact kills a beautiful hypothesis published monday 22 october 2018 one theory as to how acupuncture works is that it increases endorphin levels in the brain. these ‘feel-good’ chemicals could theoretically be helpful for weaning alcohol-dependent people off alcohol. so, for once, we might have a (semi-) plausible mechanism as to how acupuncture could be clinically effective. but a ‘beautiful hypothesis’ does not necessarily mean acupuncture works for alcohol dependence. to answer this question, we need clinical trials or systematic reviews of clinical trials. a new systematic review assessed the effects and safety of acupuncture for alcohol withdrawal syndrome (aws). all rcts of drug plus acupuncture or acupuncture alone for the treatment of aws were included. eleven rcts with a total of 875 participants were included. in the acute phase, two trials reported no difference between drug plus acupuncture and drug plus sham acupuncture in the reduction of craving for alcohol ; however, two positive trials reported that drug plus acupuncture was superior to drug alone in the alleviation of psychological symptoms. in the protracted phase, one trial reported acupuncture was superior to sham acupuncture in reducing the craving for alcohol , one trial reported no difference between acupuncture and drug (disulfiram), and one trial reported acupuncture was superior to sham acupuncture for the alleviation of psychological symptoms. adverse effects were tolerable and not severe. the authors concluded that there was no significant difference between acupuncture (plus drug) and sham acupuncture (plus drug) with respect to the primary outcome measure of craving for alcohol among participants with aws, and no difference in completion rates (pooled results). there was limited evidence from individual trials that acupuncture may reduce alcohol craving in the protracted phase and help alleviate psychological symptoms; however, given concerns about the quantity and quality of included studies, further large-scale and well-conducted rcts are needed. there is little to add here. perhaps just two short points: 1. the quality of the trials was poor; only one study of the 11 trials was of acceptable rigor. here is its abstract: we report clinical data on the efficacy of acupuncture for alcohol dependence. 503 patients whose primary substance of abuse was alcohol participated in this randomized, single blind, placebo controlled trial. patients were assigned to either specific acupuncture , nonspecific acupuncture , symptom based acupuncture or convention treatment alone. alcohol use was assessed, along with depression, anxiety, functional status, and preference for therapy . this article will focus on results pertaining to alcohol use. significant improvement was shown on nearly all measures. there were few differences associated with treatment assignment and there were no treatment differences on alcohol use measures, although 49% of subjects reported acupuncture reduced their desire for alcohol. the placebo and preference for treatment measures did not materially effect the results. generally, acupuncture was not found to make a significant contribution over and above that achieved by conventional treatment alone in reduction of alcohol use. to me, this does not sound all that encouraging. 2. of the 11 rcts, 8 failed to report on adverse effects of acupuncture. in my book, this means these trials were in violation with basic research ethics. my conclusion of all this: another ugly fact kills a beautiful hypothesis. share this: click to share on twitter (opens in new window) click to share on facebook (opens in new window) click to share on google+ (opens in new window) click to share on linkedin (opens in new window) click to share on reddit (opens in new window) click to share on tumblr (opens in new window) click to share on pinterest (opens in new window) click to share on pocket (opens in new window) click to print (opens in new window) click to email this to a friend (opens in new window) posted in acupuncture , addiction , alternative medicine , bias , chinese studies , clinical trial , commercial interests , systematic review , tcm | leave a comment fraudulent acupuncture research? published sunday 21 october 2018 acupuncture research does not have a good name; if it originates from china, even less so. and this note in ‘acupuncture in medicine’ is not likely to change this image: fang j, keller cl, chen l, et al . effect of acupuncture and chinese herbal medicine on subacute stroke outcomes: a single-centre randomised controlled trial. acupuncture in medicine published online first 10 november 2017. doi: 10.1136/acupmed-2016-011167. this article is retracted by the editor-in-chief on grounds of redundant publication. the above article reports that a trial originally planned to be carried out at three hospitals was reduced to a single centre for reasons of cost. this is incorrect. the full three-centre trial was run and reported elsewhere ( scientific reports 6, article number: 25850 (2016) doi: 10.1038/srep25850). the scientific reports paper was accepted for publication prior to submission of the above paper to acupuncture in medicine . the third author takes responsibility for the mistake. all authors have agreed to this retraction. the abstract of the paper in scientific reports is here: to determine whether integrative medicine rehabilitation (imr) that combines conventional rehabilitation (cr) with acupuncture and chinese herbal medicine has better effects for subacute stroke than cr alone, we conducted a multicenter randomized controlled trial that involved three hospitals in china. three hundred sixty patients with subacute stroke were randomized into imr and cr groups. the primary outcome was the modified barthel index (mbi). the secondary outcomes were the national institutes of health stroke scale (nihss), the fugl-meyer assessment (fma), the mini-mental state examination (mmse), the montreal cognitive assessment (moca), hamilton’s depression scale (hamd), and the self-rating depression scale (sds). all variables were evaluated at week 0 (baseline), week 4 (half-way of intervention), week 8 (after treatment) and week 20 (follow-up). in comparison with the cr group, the imr group had significantly better improvements (p < 0.01 or p < 0.05) in all the primary and secondary outcomes. there were also significantly better changes from baseline in theses outcomes in the imr group than in the cr group (p < 0.01). a low incidence of adverse events with mild symptoms was observed in the imr group. we conclude that conventional rehabilitation combined with integrative medicine is safe and more effective for subacute stroke rehabilitation. i find all this odd in several ways: the publication of the acupuncture in medicine article does not seem to have been a ‘ mistake ‘ but plain scientific fraud, in my view. the paper in scientific reports (sr) was published in may 2016. therefore the reviewers and editor of aim could and should have spotted the fraud. in the sr paper, the authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article . as the authors were affiliated to three different departments of acupuncture, i feel this to be debatable. what do you think? 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