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The two main types of medical research—laboratory and clinical—are now thought of as two facets of what is called ‘translational’ research, sometimes explained as ‘from mechanisms to clinical effects’, and more colloquially as ‘from bench to bedside’. As usual, this issue includes contains both types of research study. However, when it comes to acupuncture, there is a third force, the sceptics’ movement. This includes narrow-minded intolerance expressed in public in pseudoscientific blogs and the less discerning press, as a substitute for reasoned debate.
Examples of anti-acupuncture prejudice against published evidence already exist, but in this issue Vickers and colleagues document a remarkable catalogue of personal insults and unscientific ignorance, in response to the Acupuncture Trialists’ Collaboration. It hardly seems credible that these detractors can try to use this kind of tactic in a discussion about health care for our patients.
This abuse leaves an unpleasant taste, so instead we shall go straight to the ‘bedside’ clinical setting. Molassiotis has recently published his own study of the effects of standardised acupuncture on fatigue in cancer patients, and here comments both on his own work and our papers on fatigue in both cancer and other chronically ill patients. Patients with this resistant fatigue can be encouraged to think that they may be helped by acupuncture. Molassiotis is clear that we still cannot say whether it is just the consultation or whether the needles themselves have an effect, but patients benefit from the whole process.
That indefatigable investigator Vas is reporting a study (n=406) that is both ‘bench’ and ‘bedside’. He and his colleagues turned their attention to moxibustion for breech presentation, with a three-arm study that compared it with moxibustion at a ‘sham’ site and with no moxibustion (usual care). As Smith's editorial points out, the sham control group could not be blinded and so would be expected to search the internet for information. But it still leaves an intriguing question: even if the mums knew they were in the control group, how does that knowledge change the foetus's position? So this journal's stance—that there is little if any scientific evidence that acupuncture's effects are ‘point- specific’—is significantly challenged by this quite robust finding: that the stimulation is effective over the little toe but not the great toe. The challenge is increased because the intervention consisted not of needling (which is implausible enough) but of burning a dried herb. We can predict the usual emotional response from the bloggers, but cooler heads will now take Smith's hint and find out if the effect can be reproduced by any form of heat, whether there are other factors such as maternal posture that could explain the findings, or whether the journal should reconsider its position.
Turning to ‘bench’ research, our last two original papers present new information on the (two) mechanisms of the local circulatory response to acupuncture. In an accompanying editorial, Lundeberg suggests that these mechanisms might explain some recently reported effects of acupuncture on tendinopathy, but he also emphasises the need for much more ‘bedside’ research to define precisely whether these mechanisms are relevant to clinical decision making.
Our map of Australia (figure 1) shows what's actually happening at the real ‘bedside’ there in the form of the number of GPs claiming for reimbursement of acupuncture services delivered to patients. Interestingly the numbers appear to have declined over time, but Wardle and colleagues point out this could be influenced by changes in claims procedures.
With a weighty review on obesity, a survey, clinic and case reports and many more, we invite readers to pursue with us the pathway from bench to bedside.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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