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.
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.)
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:
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.
In the wake of my recent critique of acupuncture being touted as a remedy for allergic rhinitis, I was pointed (via a Twitter comment) towards a 2013 review in Evidence Based Complementary and Alternative Medicine, which purported to propose a mechanism for the much-claimed anti-inflammatory effects of acupuncture. There are several putative mechanisms, discussing all of which will make this post gargantuan. Therefore, I shall focus on the explanation involving the hypothalamus-pituitary-adrenal (HPA) axis.
Nasal allergies (a.k.a. Allergic Rhinitis, or hay fever) represent a frequent allergic disorder that reduces the sufferer’s quality of life, and has harsh economic implications in terms of healthcare costs and social productivity.
Much have been made in the media recently, of a February 2013 paper, published by a German group in the Annals of Internal Medicine, claiming that acupuncture may help relieve seasonal allergies. Always interested in examining the bold claims of efficacy by various forms of pseudoscientific, wannabe-medicine modalities (such as homeopathy, naturopathy, and so forth), I elected to go to the source; the paper was behind an annoying paywall, but thankfully, I had institutional access, and dove in.
Continued from Part 1… As I was saying, a study by Goldman et al. in the July 2010 issue of Nature Neuroscience, postulates that “Adenosine A1 receptors mediate local anti-nociceptive (i.e. pain reducing) effects of acupuncture.”
I stumbled a little right at the title. Anti-nociceptive effects of acupuncture? Where is the evidence that such an effect exists?