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Independents' Day

RCT is too high a hurdle for acupuncture

I ran both the courses mentioned by the protagonists in your acupuncture debate ('Is acupuncture just a sham?').

Both were in London in 2003.

The British Medical Acupuncture Society foundation course principally aims to teach safe and effective acupuncture needling skills, rather than debate the evidence base in detail. When you have enthusiasm for a subject it is easy to slide into selective citation, and the same applies to scepticism. However, we do aim to give a balanced view of the evidence.

The double-blind randomised controlled trial is a hard hurdle for physical techniques, and sham acupuncture often involves needle penetration of the body, but we now have meta-analyses in pain conditions that show statistically significant benefits of acupuncture over sham. The differences are often small, and it is often said they are clinically irrelevant, but you cannot easily judge clinical relevance against a sham that is likely to be active. For example, in the largest sham-controlled RCT of acupuncture for back pain1, sham acupuncture performed twice as well as guideline-based standard care. It is unlikely that a truly inactive intervention could achieve such a feat.

From Dr Mike Cummings, medical director, British Medical Acupuncture Society

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