The sharp end of medical practice: the use of acupuncture in obstetrics and gynaecology

Authors


Sir,

Ewies and Olah have reviewed the trials of acupuncture in obstetrics and gynaecology. They conclude that hardly any randomised studies could be traced and call upon gynaecologists to drop their reservations towards acupuncture and to participate in randomised trials. Without apparent hesitation, their plea is supported by the editor. We are not convinced.

Acupuncture is an atavism, which finds its basis in the magical world of ancient China. It nearly disappeared after the introduction of ‘Western’ anatomical knowledge by the end of the 19th century. The revival of acupuncture in China resulted from Maoist propaganda and was exported to the West after President Nixon's visit to China in 19721. In a mood of postmodernism and cultural relativism, many physicians both in the USA and Europe lost much of their critical sense and came under the influence of the Chinese propaganda. The heterogeneity of acupuncture textbooks, the absence of scientific data and, a fortiori, the impossibility to integrate or at the least reconcile the theory of acupuncture with our knowledge of anatomy, physiology and pathology should have prevented this development. Unfortunately, this was not the case and research into the effectiveness of acupuncture started. An unanswered question is if such research is justified. It will not be simple to dispel the a priori scepticism, not even by properly randomised investigations. Who would, for instance, seriously consider an announcement by NASA that, from analysis of electromagnetic radiation from Saturn, it appears that this heavenly body is made of cheese? As Skrabanek2 convincingly argued, randomised trials of absurb statements are more likely to mislead than to illuminate, because extraordinary claims require extraordinary evidence. In this respect, the interpretation of unlikely results of scientific research does not differ from the Bayesian appraisal of findings that are certain, judged from strong empirical knowledge in clinical practice3.

In our view, Ewies and Olah present insufficient data to justify further research into acupuncture. The single acceptable trial with a positive result (correction of the breech position by moxa burnings adjacent to both little toes) has not been confirmed. The suggested physiological explanation for the effect seems is speculative. The WHO sees undeniable evidence “for the integration of acupuncture with conventional medicine”, but this is not convincing. This bold statement is not based on a well-founded scientific analysis. The fact that the WHO considers diseases such bacillary dysentery, paresis following stroke and sequelae of poliomyelitis as indications for acupuncture treatment is revealing. It is also of note that the anonymous author of the paper in the WHO chronicle of 1980 emphasised that the list of indications was not based on controlled clinical trials, but merely on ‘clinical experience’4.

We conclude that one certainly should keep an open mind in scientific research, but we should also keep in mind Kurtz's statement that, if one fails to demarcate scientific questions from obvious absurdities, one's open mind will change into an open sink5. Research of the effectiveness of acupuncture is wasted energy.

Ancillary