Karl-Ludwig Resch

A pilot study of acupuncture for tension headache, using a novel placebo

Tension headache is common, and treatment with acupuncture is frequently recommended, although the evidence of its effectiveness is contradictory. This small, randomised, controlled trial was designed as a pilot to test procedures in preparation for a multi-centre trial investigating the effect of acupuncture as a treatment for tension headache. Ten volunteers suffering from episodic, tension-type headache were recruited by local newspaper articles. Patients were randomised to receive either brief needling to tender areas or selected traditional points (Group A), or pressure from a cocktail stick supported within a guide tube to defined, non-tender and non-acupuncture areas (Group B). The patients’ view of the treatment sites was obstructed so that no indication could be gained as to which form of treatment was being given. Throughout the period of the trial, duration, frequency and intensity of headaches were recorded, from which the mean weekly headache index was calculated. There was no difference between the changes in weekly headache index in the two groups, comparing scores before and after treatment. However, Group A experienced a considerably higher number of headache-free weeks than Group B. The credibility of the two procedures was tested using a standard credibility questionnaire and a “final verdict”. One subject in Group B concluded that she had not received genuine acupuncture, but overall there was no statistical difference between the credibility of treatment in the two groups.

A meta-analysis of acupuncture techniques for smoking cessation

OBJECTIVE To determine the effectiveness of acupuncture for smoking cessation and to examine whether any individual aspect of trials is associated with an effect. DATA SOURCES All randomised controlled trials of acupuncture for smoking cessation that were listed in computerised databases or reference lists of relevant articles. STUDY SELECTION All randomised single-blind studies that compared acupuncture with sham acupuncture. DATA EXTRACTION Methodological data were extracted for quality assessment. Outcome data were extracted for rates of total smoking cessation at three intervals: early after treatment and after six and 12 months follow up. DATA SYNTHESIS Results were expressed as odds ratios of success over failure in intervention over control groups. The combined odds ratio for all studies was calculated. Repeated meta-analyses were subsequently performed on subsets of studies combined according to defined characteristics: acupuncture technique, number of attendances, country of origin, status of journal, and control procedure. The overall quality of studies was poor. The combined odds ratio for smoking cessation calculated for the earliest results after the end of treatment was 1.20 (95% confidence intervals (95% CIs) = 0.98 to 1.48). The combined odds ratio for smoking cessation after six months was 1.29 (95% CI = 0.82 to 2.01), and after 12 months was 1.03 (95% CI = 0.73 to 1.46). There were no significant effects of relevance among subsets of studies grouped according to defined characteristics. CONCLUSIONS Acupuncture was not superior to sham acupuncture for smoking cessation; no particular aspect of acupuncture technique was associated with a positive effect. The conclusions are limited by methodological inadequacies of studies and by the absence of testable hypotheses; design of future trials should avoid these deficiencies.

Methods of Economic Evaluation in Complementary Medicine

Complementary medicine often claims to offer therapies that are cheap, but hard evidence is still awaited. The methods of economic evaluation, which comprise cost-minimisation, cost-effectiveness, cost-utility and cost-benefit studies are considered in this article. This methodology has only recently evolved, and therefore there are few studies in complementary medicine which include any rigorous economic evaluation. An analysis is presented of treatment costs and some potential outcome measures for complementary medicine, and certain difficulties are outlined particularly in measuring quality of life and assessing its financial value. Complementary therapies have shown promise for certain indications, mostly in retrospective studies. It is concluded that more work needs to be done before we can be sure of the economic impact of complementary medicine, and that it is important to incorporate an economic evaluation more widely in future clinical trials.

Reviewer bias against the unconventional? A randomized double-blind study of peer review

OBJECTIVE To test the hypothesis that there is a reviewer bias against publication of a test of an unconventional drug. DESIGN Randomized, controlled, double-blind study of peer review. PARTICIPANTS Convenience sample of 291 medical doctors from a wide variety of specialties drawn from a list of conference participants. METHODS Reviewers were randomly assigned to receive one of two versions of a manuscript. Version M related to an in-vitro experiment on a mainstream drug (Metoprolol). The otherwise identical version V used a highly unconventional drug (beef spleen cell extract) for the same experiment. Reviewers were asked to complete a standardised evaluation sheet including visual analogue scales (VASs) on a set of predefined quality criteria. All participants were debriefed after completion of the study. RESULTS The response rate was 61%. There were no significant differences in VAS ratings between the two versions of the manuscript. Ratings covered the entire range of the VASs. CONCLUSION In the present setting, there was no evidence for a reviewer-bias against testing an unconventional drug. The low inter-rater reliability, however, suggested inadequate validity of peer review.

Smoking Cessation with Acupuncture? A ‘Best Evidence Synthesis'

Background: Acupuncture is a popular therapy for smoking cessation. The data on effectiveness are, however, contradictory. Objective: A best evidence synthesis, a