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Analysis Acupuncture: How to Improve the Evidence Base

Evidence on acupuncture therapies is underused in clinical practice and health policy

BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-067475 (Published 25 February 2022) Cite this as: BMJ 2022;376:e067475

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Rapid Response:

Poking people on non-existent meridians: Falling from Charybdis to Scylla

Dear Editor

The recent flow of articles from China promoting acupuncture deserves comment.(1-3)

Firstly, a PubMed search for “acupuncture” hit 5,221 RCTs, the vast majority being negative or unreliable while other are inconclusive generating insufficient or weak evidence due to lack of objective outcomes and inability to blind acupuncturists. Last, it has been shown repeatedly that acupuncture studies originating from China never show negative findings (4,5), strongly suggesting one or more sources of bias.

Secondly, Chinese medicine is politicized.(6) In 1954 Mao Zedong wrote “Chinese medicine should be well-protected and developed” and President Xi Jinping recently claimed “Traditional medicine is a treasure of Chinese civilization embodying the wisdom of the nation and its people".(7) Recently, the Beijing Municipal Science and Technology Commission suggested that any criticism of Traditional Chinese Medicine (TCM) would attract legal consequences under the crime of “picking quarrels and stirring up trouble”.(8) Already in 2018, authorities detained a doctor for 100 days after he criticized the promotion of Hongmao Medicinal Liquor, a popular TCM remedy, calling attention to the toxicity of some of its ingredients.(9) These are U-turns from the 1822 decree of the Emperor of China excluding acupuncture from the Imperial Medical Institute as superstitious and irrational.

Certainly, patients deserve empathy, and modern medicine does not have all the answers. The pharmaceuticalisation of life, the translation of human conditions and unmet social needs into opportunities for pharmaceutical interventions, is a shipwreck.(10) However, poking people on non-existent meridians cannot be the adequate response.(11)

References

1 Lu L, Zhang Y, Tang X, et al. Evidence on acupuncture therapies is underused in clinical practice and health policy. BMJ. 2022;376:e067475. doi:10.1136/bmj-2021-067475

2 Zhang YQ, Lu L, Xu N, et al. Increasing the usefulness of acupuncture guideline recommendations. BMJ. 2022;376:e070533. doi:10.1136/bmj-2022-070533

3 Li H, Jin X, Herman PM, et al. Using economic evaluations to support acupuncture reimbursement decisions: current evidence and gaps. BMJ. 2022;376:e067477. doi:10.1136/bmj-2021-067477

4 Tang JL, Zhan SY, Ernst E. Review of randomised controlled trials of traditional Chinese medicine. BMJ 1999;319(7203):160‐161.

5 Vickers A, Goyal N, Harland R, Rees R. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials 1998;19(2):159‐166

6 Zhu Q, Horst M. Science communication activism: Protesting Traditional Chinese Medicine in China. Public Underst Sci 2019;28(7):812‐827

7 Huaxia. Xi stresses role of traditional Chinese medicine for "Healthy China". Xinhuanet 25 October 2019. Available at http://www.xinhuanet.com/english/2019-10/25/c_138502458_2.htm Accessed 1 March 2022.

8 Mengyao W. Walsh M Legal Experts Slam Beijing’s Plan to Make Defaming Traditional Chinese Medicine a Crime. Caixin 4 June 2020. Available at https://www.caixinglobal.com/2020-06-04/legal-experts-slam-beijings-plan... Accessed 1 March 2022.

9 Kuo L. Chinese doctor jailed for calling traditional medicine 'poison' issues apology. The Guardian 18 May 2018 . Available at https://www.theguardian.com/world/2018/may/18/chinese-doctor-jailed-for-... Accessed 1 March 2022.

10 Braillon A, Lexchin J, Blumsohn A, Hengartner MP. The "pharmaceuticalisation" of life. BMJ. 2019;365:l1972. Published 2019 May 8. doi:10.1136/bmj.l1972

11 Friends of Science in Medicine. Is there any place for acupuncture in 21st century medical practice? 29 July 2016. Available at https://www.scienceinmedicine.org.au/wp-content/uploads/2018/01/Acupunct... Accessed 1 March 2022.

Competing interests: AB is among industry independent experts on Jeanne Lenzer's list (https://jeannelenzer.com/list-independent-experts). Friends of Science In Medicine is an Australian not-for-profit organization which supports evidence-based medicine and strongly opposes the promotion and practice of unsubstantiated therapies that lack a scientifically plausible rationale (https://www.scienceinmedicine.org.au/)

02 March 2022
Alain Braillon
Retired senior consultant
Loretta Marron (Chief Executive Officer, Friends of Science in Medicine (FSM), Australia)
80000 Amiens, France