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Each reader approaches a new issue of the journal searching for treasure. Each will have an individual taste for particular gems, but all agree that the biggest prize, especially for our patients, will be ‘acupuncture in medicine’ that is, the evidence-based use in health care of a scientific approach to acupuncture. This bumper issue contains some important signposts to the treasure trove, a glimpse of the big prize, and some other gems, but readers will need to explore every corner of the journal.
Our first signpost points to the ‘plausibility’ of acupuncture. So far, MRI studies have not delivered the their promised breakthrough in our understanding of its mechanisms. One problem is the difficulty of measuring the effect of ‘acupuncture’ overall: up till now, studies have measured the difference between ‘manipulation’ and ‘no manipulation’, as the needles remain inserted throughout. Here, Zheng and colleagues report two new MRI techniques—with the delightful abbreviations of ‘ReHo’ and ‘ALFF’—for measuring effects that are sustained after the needle is removed (figure 1). They showed changes in frontal lobe, cingulate gyrus and cerebellum. An expert editorial by Chae points out the limitations, especially the difficulties of separating brain responses to needling from responses to the other thoughts and emotions present at the same time. Chae points forwards to improved design for future studies. And, the following paper, from the same Guangzhou team, is another signpost, pointing this time to brain changes associated with de qi, using tomography scanning.
As well as plausible, acupuncture must be shown to be effective. Many readers will be aware of the recent Acupuncture Triallists’ meta-analysis of acupuncture for musculoskeletal conditions and headache, but if not, it is summarised in our Research Update. For us it shows clearly that acupuncture is ‘not just a placebo’, and signals a future in which sham controlled trials are superfluous. Sadly, not everybody reads the signs in the same way.
Plausibility, effectiveness, so what about cost-effectiveness? A large and thorough review by Kim and colleagues shows that acupuncture falls within the acceptable thresholds for several conditions and several countries.
So now to the glimpse of that treasure, located interestingly enough in Brazil, a driving and ambitious country. Costi and colleagues describe how acupuncture is now recognised as a medical specialty there, and integrated as an option into the national training curriculum. This shows what can be achieved by persistent, evidence-based advocacy. Let's hope Brazil's integration of acupuncture is a glimpse of the future.
Treasure hunters digging away in daily clinical practice will be encouraged by two reviews, of different sorts, of acupuncture for heel pain, and for tendinopathy. Those who deal with children in hospital will be entranced by the gem of a case series in which Anders and colleagues treated children with constipation—acupuncture as a first choice, not a last resort. Happy hunting.
Dr Alan Grant
The Editorial Board of Acupuncture in Medicine wish to express their deep gratitude to our founding editor, Alan Grant, who is retiring from the board after 31 years. It was he who had the original vision for the journal in 1981, at a time when professional assistance was paid for in bottles of wine, and when ‘in house’ publishing meant exactly that. Later, the journal's first ‘publishing house’ was a derelict building in a disused aerodrome! His mission statement is still fresh today: ‘So that doctors and medical students could see that acupuncture was sensible and could be practised on a safe, sound scientific basis’.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.