Science communicators are no strangers to spin in the reporting of scientific studies, especially in Press Releases. This is a favorite tactic of aficionados and researchers alike in the so-called ‘complementary and alternative medicine’ (CAM), which includes acupuncture — a pre-scientific therapeutic modality originating in ancient China with roots in medical astrology and ignorance of human anatomy and physiology. I have earlier written several times on an issue that I continue to find rather perplexing: when it comes to publishing studies on CAM research, the usually-high publication standards of the premier open access journal PLOS ONE appear to be ignored, in the context of both primary research and systemic, quantitative and analytical reviews.
Those who read my regular posts (Yes, that rare breed of people…) are amply aware that I am no fan of pseudoscience and quackery, as well as the relentless invasion of quackery into academia, leading invariably to scientifically implausible, nonsensical “research”, for which Dr. Harriet Hall had aptly coined the term “Tooth Fairy Science” several years ago over at Science Based Medicine.
Last month, PLOS One published a study which held significant interest for me; as a long time sufferer from acid reflux (which is currently reasonably controlled by regular use of a PPI – Proton-pump inhibitor – class of prescription antacid), I was curious to dive into this Randomized Controlled Trial (RCT) study from Beth Israel Deaconess in Boston, in which the investigators observed that Patient-Provider Interactions Affect Symptoms in Gastroesophageal Reflux Disease (GERD) as well as dyspepsia and other acid-reflux related issues, which affect 2-4 out of every 10 people in Western world (similar statistics were observed in the Northern part of India). The name of the study medication, Acidil, wasn’t immediately familiar to me, but it turned out to be a ‘homeopathic preparation’, which – along with the placebo-controlled designed – piqued my interest further. Although the severity of GERD symptoms may fluctuate due to different reasons, it is usually not one of those self-correcting conditions in which homeopaths often claim beneficial effect. So, sufficiently interested, I delved deeper.
The world of alternative medicine – nowadays more fashionably known as complementary and integrative medicine (CIM), replacing the erstwhile CAM (A = alternative) – encompasses a wide range of practices. Some of these practices involve physical motion of parts or whole of the body, such as massage, Yoga, and Tai Chi; if one subtracts the dollops of mysticism, especially of Eastern origin, that have come to be associated with these practices, one finds that they perform much of the same functions as any other regular exercise regimen, providing similar benefits. A few practices employ dietary supplements (vitamins, minerals, various salts, et cetera) and folk-remedies based on herbal medicine (Traditional Chinese Medicine/TCM, Ayurveda, Siddha, Unani, Amachi, and so forth) – some of which may and do contain biologically active substances, but the evidence for those being functional, safe, and effective therapeutic modalities in actual clinical situations is extremely scant, and the wide-ranging claims made by the practitioners are mostly never backed up by solid, scientific empirical methods. (Further reading: 1. Veteran ScienceBlogger Orac explains how the multi-billion dollar Supplements Industry takes their adoring clients for a ride; 2. I argue how the recent accolades for work stemming from the use of herbal medicine as a resource is not a context-less validation that herbalism works.)
Yesterday, on October 5, 2015, one half of the Nobel Prize in Physiology or Medicine was awarded to scientist and pharmaceutical chemist Tu Youyou (alternatively, Tu Yo Yo, 屠呦呦 in Chinese), for her discovery of the anti-malarial Artemisinin. (The other half went jointly to William C. Campbell and Satoshi Ōmura, for their discovery of a novel therapy for roundworm infection.)
PLOS One seems to have done it again! I wrote a few days ago about how the peer review system at PLOS One seemed to give a free pass to acupuncture studies, when it came to seeking rigorous experimental evidence in support of the claims presented in the paper. I had shared the post via Twitter, and in response, someone from PLOS One had replied:
Classical homeopathy is scientifically implausible as a therapy, because there is no substance of any medicinal value left in the functionally-infinitely diluted nostrum. Naturally, there is no hard evidence supporting the therapeutic use of homeopathy, in terms of clinical benefit to the patient. Absent such support, homeopathy-peddlers generally push affordability and low cost as homeopathy’s unique selling point (USP). A large retrospective cost-analysis study, based on nearly 45000 individual German patients, gives lie to that myth.
Serious question: has the peer review system at the PLOS journals been doing a less-than-stellar job when it comes to evaluating complementary and alternative medicine (CAM) research for publication? If the answer is ‘yes’, why? Or if ‘no’, how does a paper like this go through PLOS ONE without some serious revisions? I refer to the systematic review and meta-analysis on effectiveness of acupuncture for essential hypertension, done by a group of researchers from the Tianjin University of Traditional Chinese Medicine (TCM) in China, led by Xiao-Feng Zhao, published on July 24, 2015, on PLOS ONE. The authors conclude that there is acceptable evidence for use of acupuncture as adjunctive therapy along with medication for treating hypertension. My perusal of the paper led to some major reservations about that assumption, as well as indicated some instances of sloppy writing which should have been corrected at the stage of review – but, strangely, wasn’t.
Early last month, I communicated in a blog post a few questions I had about a study in Electro Acupuncture published in PLOS One. It took the authors a while to get to them, but the senior and corresponding author of that study, Professor Kai-Liang Wu, of the Fudan University Shanghai Cancer Center, graciously wrote a detailed reply to my question a week ago. I am going to put his response in this space in blocks. For better comprehension, I shall put my questions in italicized letters followed by his response; the boldface types are for emphasis, mine. My comments are interspersed with the blocks.