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  1. Adrian White, Editor

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When a control arm is not feasible, a careful, long-term observational study in a well defined, reasonably sized cohort of patients with good retention in long-term follow up provides the ‘best available evidence’ for more effective treatments. Results are particularly informative when the condition's long-term response is known to be poor, such as lateral epicondylitis. So the report by Valera-Garrido and colleagues deserves careful attention. In 36 consecutive patients, they applied a form of low-frequency electroacupuncture called ‘percutaneous needle electrolysis’ (PNE) to the tendon in areas of maximum tenderness and showing degenerative changes with ultrasound. The treatment videos are on our website. Patients also were given eccentric exercises. The response was usually immediate and lasting: all 30 who attended follow up at one year deemed it a success. This shows what can be achieved with precise diagnosis and needle placement. This is possible without ultrasound—but not possible without good knowledge of anatomy.

‘Good knowledge of anatomy’ is a mantra for safe practice of interventions such as acupuncture and surgery. But knowledge alone is not enough, as shown in a notable pair of pneumothoraces. In both cases, the patients were doctors attending acupuncture training courses. The highly experienced practitioners clearly know the surface anatomy of the pleura well, so there must have been additional ‘inadvertent’ events: in the first (Martins da Encarnação et al) probably neck muscle contraction caused by electroacupuncture, and in the second (Cummings et al) possibly movement of the hand while distracted by teaching, and then misjudgement of the depth of the needle: the video is also on our website. Martins da Encarnação points out that symptoms of pneumothorax can be mild and self-limiting and his case may not have come to light if the patient was not a doctor. There are several learning points here.

Are some patients more likely to have adverse events? Chung and colleagues looked at the data in their study comparing ‘real’ needling, minimal (superficial) needling and sham (blunt needles) acupuncture in patients with insomnia. Sure enough, blunt needling produced fewer local adverse effects, though interestingly the incidence of systemic effects was similar between the three treatments. The authors also found that having other medical conditions reduced the number of reported adverse events. In this case, new symptoms might be identified, but not given attention among all the others. Interestingly, anxiety and depression also gave some protection against adverse events, though not significantly after statistical correction.

Other conditions in this issue include fever of upper respiratory tract infection (URTI), retained placenta—and mastalgia, where the effect of acupuncture was called ‘magic’. As well as this ‘magic’, your editor, aiming always to be boringly responsible, felt nervous about Li's speculation that acupuncture's neuroprotective effect could imply some effect in reducing the expression of autistic spectrum disorder. However, to publish is not to condone. And our experimental studies do provide evidence of the extraordinarily widespread effects of acupuncture, at least in the laboratory: apoptosis, bone mineral density, vasomotor response, blood glucose and haemorrhagic stroke.

Dr Felix Mann

Acupuncture points don't exist; meridians don't exist’

We are saddened to learn of the death of Felix Mann. Acupuncturists from the 1970s will remember his challenging aphorism (above) which liberated them to think of acupuncture in terms of current physiology and pathology. Felix Mann was key in starting the revolution that produced both the separate approach known as Western medical acupuncture and the journal Acupuncture in Medicine.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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