Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2004; 9: 38
To deepen our understanding of what elements of therapy make up incidental (placebo) factors in acupuncture and Chinese medicine and consider how this relates to the placebo-controlled trial design.
This theoretical paper draws on empirical evidence from three interview studies of patients with chronic illness having acupuncture and Chinese medicine (a total of 88 interviews), and other published qualitative studies. It relates this to the published literature on placebo effects and clinical trials.
Elements of therapy that have traditionally been considered to be incidental factors, such as ‘talking and being listened to’, contain aspects that are actually characteristic of acupuncture and its underlying paradigm of Chinese medicine. For example, patients come to understand that talking about all aspects of their physical, emotional and social life enables the acupuncturist to adjust the treatment at each session thereby treating many aspects at once. There is some evidence that similar characteristics may be evident in other non-biomedical therapies. In practice it is impossible to separate out these characteristic aspects of therapy from the incidental aspects. This challenges the assumptions of using placebo-controlled designs to evaluate therapies that are based on different paradigms. Such designs would underestimate the characteristic (specific) treatment effect.
There is preliminary evidence that placebo- or sham-controlled trials are inappropriate for demonstrating the efficacy of therapies that are not based on the bio-medical paradigm. Further research is being carried out to test this conclusion.
Medical Research Council Special Training Fellowship.
