We are writing in response to the article “Acupuncture for chronic headache in primary care; large, pragmatic, randomized trial” by Vickers et al1. Cochrane review of the randomized trials of acupuncture for headache concluded the quality and amount of evidence are not fully convincing.2 However, we believe that this conclusion will remain status quo even after this large study by Vickers because Vickers’ study is not scientifically convincing at all.
The study design of Vickers’s trial was seriously faulted as the acupuncture sites used were highly individualized among patients. To make the situation even worse, the acupuncture sites selected, the depth and duration of needling, size of needle used for each patient were not recorded at all. Inadequately elaborated protocols of acupuncture in Vickers’s manuscript hindered other researchers to reproduce their results. Irreproducible results are invalid scientifically. Prescriptions of acupuncture by different methods give significantly different outcomes. Grouping acupuncture to different sites as one type of treatment is simply unacceptable as acupuncture sites in different location are seen to correspond to different physiological and anatomical features.3 Previous publications by the same authors concluded that the high proportion of positive results of Medline-indexed controlled trials in acupuncture conducted in East Asia and Eastern Europe was related to different level of methodologic rigor.4 In our opinion, the recent study by Vickers et al1 serve as a superb example of positive results attributed to lack of methodologic rigor.
Daniel K. Ng*
M Med Sc, FRCP
Consultant Pediatrician
Chung-hong Chan
BSc
Research Fellow
Department of Paediatrics,
Kwong Wah Hospital
Waterloo Road, Hong Kong SAR, China
References:
1. Vickers AJ, Rees RW, Zollman CE et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. 2004; 328: 444-0
2. Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G. Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
3. Vickers A, Zollman C. ABC of complementary medicine: Acupuncture. BMJ 1999;319:973-976
4. Vickers A, Goyal N, Harland R, Rees R. Do Certain Countries Produce Only Positive Results? A systematic Review of Controlled Trials. Controlled Clin Trials. 1998;19:159-166
Rapid Response:
not scientifically convincing at all
Dear Editors,
We are writing in response to the article “Acupuncture for chronic headache in primary care; large, pragmatic, randomized trial” by Vickers et al1. Cochrane review of the randomized trials of acupuncture for headache concluded the quality and amount of evidence are not fully convincing.2 However, we believe that this conclusion will remain status quo even after this large study by Vickers because Vickers’ study is not scientifically convincing at all.The study design of Vickers’s trial was seriously faulted as the acupuncture sites used were highly individualized among patients. To make the situation even worse, the acupuncture sites selected, the depth and duration of needling, size of needle used for each patient were not recorded at all. Inadequately elaborated protocols of acupuncture in Vickers’s manuscript hindered other researchers to reproduce their results. Irreproducible results are invalid scientifically. Prescriptions of acupuncture by different methods give significantly different outcomes. Grouping acupuncture to different sites as one type of treatment is simply unacceptable as acupuncture sites in different location are seen to correspond to different physiological and anatomical features.3 Previous publications by the same authors concluded that the high proportion of positive results of Medline-indexed controlled trials in acupuncture conducted in East Asia and Eastern Europe was related to different level of methodologic rigor.4 In our opinion, the recent study by Vickers et al1 serve as a superb example of positive results attributed to lack of methodologic rigor.
Daniel K. Ng*
M Med Sc, FRCP
Consultant Pediatrician
Chung-hong Chan
BSc
Research Fellow
Department of Paediatrics,
Kwong Wah Hospital
Waterloo Road, Hong Kong SAR, China
References:
1. Vickers AJ, Rees RW, Zollman CE et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. 2004; 328: 444-0
2. Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G. Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
3. Vickers A, Zollman C. ABC of complementary medicine: Acupuncture. BMJ 1999;319:973-976
4. Vickers A, Goyal N, Harland R, Rees R. Do Certain Countries Produce Only Positive Results? A systematic Review of Controlled Trials. Controlled Clin Trials. 1998;19:159-166
Competing interests:
None declared
Competing interests: No competing interests