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Acupuncture for menopausal hot flushes

Study
Results
Comment

Evidence-based thinking occasionally means having to rub a few neurones together to make sense of something one reads. A perfectly good randomised trial of acupuncture, sham acupuncture, and oestradiol in menopausal women with hot flushes [1] is a useful test. It concluded that acupuncture and sham acupuncture work, but less well than oestradiol, and that acupuncture is a viable alternative, but not sham acupuncture. Is that a sensible conclusion based on the evidence?

Study

The report [1] presents data on three arms (acupuncture, sham acupuncture, oestradiol) of a five-arm study. There were 43 women in the three arms reported, who underwent two weeks of baseline data collection, and then 12 weeks of treatment, with later follow up which can be ignored, mainly because patient withdrawal reduces its value.

Acupuncture or sham acupuncture was given twice a week for two weeks, followed by once a week for 10 weeks. Sham acupuncture involved superficial needle insertion in the skin, one to five centimetres away from acupuncture points. Acupuncture involved electrostimulation and deeper insertion at true acupuncture points.

Results

The number of hot flushes over 12 weeks of treatment in the three groups is shown in Figure 1. There was no difference between acupuncture and sham acupuncture over 12 weeks, but oestrogen reduced flushes to below one per day on average.



Figure 1: Average daily flushes in postmenopausal women treated with acupuncture, sham acupuncture, or oestrogen





Comment

The obvious conclusion is that acupuncture doesn't work. Another conclusion, that drawn in the paper, is that this proves that acupuncture works by reducing daily flushes by half. We are treated to a long discussion that ambles through endorphins, effects of needles, is nothing if not comprehensive, as is the huge weight of statistical analysis used. But the headline conclusion found in the abstract (all that most will read) is that “acupuncture is a viable alternative treatment”.

This is the problem we often find, that the "non-active, active" control works as well as the active. Here, though, we can shine a little more light on this problem. Table 1 shows the start and end of trial daily flush rate in this randomised trial, and the results for oestrogen and placebo found in a Cochrane review of the effect of oestrogens [2].



Table 1: Average daily flushes in postmenopausal women at the start and end of treatment, in the randomised trial and in a Cochrane review



Time
Acupuncture
Sham acupuncture
Placebo
(Sys Rev)
Oestrogen
(RCT)
Oestrogen
(Sys Rev)
Start of treatment
7.6
8.1
9.3
8.4
5.9
End of treatment
3.5
3.8
3.9
0.8
1.4


It shows that the effects of oestrogen in the trial and review are about the same. It also shows that the effects of acupuncture or sham acupuncture are about the same as placebo. In other words, acupuncture is about as good as doing nothing, but it is much, much, more expensive.

When will alternative therapies really prove they work? While we wait will they stop fleecing people of huge amounts of cash for doing nothing?

References:

  1. Y Wyon et al. A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women. Climacteric 2004 7: 153-164.
  2. AH MacLennan et al. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. The Cochrane Database of Systematic Reviews 2004, Issue 4.

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