Intended for healthcare professionals

Rapid response to:

Primary Care

Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38238.601447.3A (Published 18 November 2004) Cite this as: BMJ 2004;329:1216

Rapid Response:

Blind leading the blind

The debate about blinding seems to have missed the crucial point that
patients will sense electroacupuncture [EA].

The authors state "The stimulation intensity [of EA] was as high as
possible, just under the pain threshold." [Rapid Response]. Surely, this
would compromise blinding. Patients would immediately guess that they were
getting active treatment, providing consent was truely informed and
patients had been told that there was a possibility of receiving a sham
intervention.

This information was absent from the published article because "The
data referring to the protocols for electrical stimulation were excluded
for reasons of space,..". [Rapid Response]

It is not clear whether this information was available to BMJ
referees when judging the merits of the study. Nevertheless, the
information about the use of EA as described in the published article
should have raised concerns about blinding, especially the authors' bold
claim that ".....factors reinforce our belief that the blinding procedure
applied was successful." [published article].

The BMJ should consider the use of the STRICTA recommendations [1]
when reviewing papers on acupuncture and it should ensure that full
details of technique-based intervetions are provided in the published
articles.

1. MacPherson H. et al. Standards for Reporting Intervetions in
Controlled Trials of Acupuncture. The STRICTA recommendations. Acupuncture
in Medicine 2002, 20(1): 22-25

Competing interests:
None declared

Competing interests: No competing interests

15 April 2005
Mark I Johnson
Professor of Pain and Analgesia
Leeds Metropolitan University LS8 2BG