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It all depends how you look at it.
An adverse event makes everyone nervous. The patient suffers, but often accepts the bad luck, though wanting to ensure that other patients don’t also suffer. Practitioners are deeply embarrassed and understandably defensive. The openness and objectivity that the topic demands are often difficult to achieve. And, in minority practices like acupuncture, adverse events can be used as a weapon to express prejudices and beat the acupuncturists round the head. We have tried to adopt a balanced approach to the report by Ogisawara et al of septic arthritis and psoas abscess after acupuncture, by publishing it in exactly the form resubmitted after review, and then by accompanying it by an editorial. We shall never be sure of the truth as to whether this event was or was not a consequence of acupuncture treatment. But it is worth noting that serious infections are vanishingly rare after acupuncture, probably because of the small number of bacteria that can occupy the tip of a needle; but also that, very occasionally, such events may occur and should be identified rapidly and treated appropriately. Fortunately, the eventual outcome in this case was good for the patient.
Guerreiro da Silva takes a lesson from the old style practitioners and takes a careful look at his patients, asking questions and noting everything down, with the aim of improving his own practice over his lifetime. With his colleagues, he ran a simple pragmatic trial of acupuncture for dyspepsia in pregnancy, and the results seem to open up a whole new area where acupuncture may potentially help our patients, particularly those who want to avoid medication.
Suzuki and colleagues look at the publications on acupuncture for respiratory conditions, in a novel systematic review; the findings will not change clinical practice, but could stimulate new research projects.
Regular readers of this journal will know that it stands for Western medical acupuncture – explained according to our current understanding of the body. Cheng looked again at the Chinese point locations for treating particular conditions, pursuing the idea that they should be explicable in neurophysiological terms. Not surprisingly, many of them match what we would expect, although of course the evidence base for the mechanisms of acupuncture is far from conclusive particularly for non-painful conditions though he does suggest an interesting explanation for the activity of the point ST36. He had to resort to naming one category ‘significance unclear’.
The Editorial section continues with Benham and Johnson’s thoughtful and well referenced look at the possibility of using needle sensation as a quantitative evaluation of the ‘dose’ of acupuncture. This is a desperately important topic, and until we have a much closer look at exactly how we should stimulate the needles in individual patients to treat particular conditions, acupuncture research is whistling in the wind.
Campbell offers readers another reflective type of paper that elucidates an aspect of acupuncture in a very clear way: this time, he notes how doctors, and perhaps clinicians generally, tend to look at a placebo effect as somehow unreal and unworthy. They seem to be looking partly with an instinctive, subconscious Cartesian dualism, although at the same time they recognise that psychological events are just as ‘real’ as other bodily events such as increase in blood flow in a limb. This confusion is emphasised in interpreting placebo-controlled trials, which involve deception, though fortunately in practice the ‘therapeutic relationship’ remains a valuable healing tool with unquestionable ethics.
Acupuncture is a subject that arouses opposing opinions – depending on how you look at it – and so we have started a Debate section in which proponents can present opposite sides of the argument. In this issue, the Editor joins many others who have expressed their frustration about the way NICE (the National Institute for Health and Clinical Excellence) analyses and interprets the evidence, and sets out specific areas where he disagrees with the acupuncture section in the recent NICE report on osteoarthritis. The health economist Latimer responds for NICE. Readers can judge the arguments for themselves, and are welcome to write about their own experiences with the NICE guideline.
And finally, how do you look at case reports? We include three – and any of them might change the way acupuncture practitioners look at their next patient.
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