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Abstract

We appreciate the positive review by Maneerattanaporn and Chey of our recent study of acupuncture for irritable bowel syndrome (IBS) (Am J Gastroenterol 2009;104:1489–1497). Our study showed no difference between genuine and sham acupuncture, whereas both were statistically and clinically superior to usual care. We agree with important aspects of the review's interpretation of our study, including “at least one third of patients who receive acupuncture experience substantial benefits.” In fact, we believe our data suggest that this percentage may be higher. We are, however, perplexed that the authors consider “the most compelling explanation” for failing to show superiority to be that the true benefits of acupuncture were “masked by the lack of an appropriate sham condition.” Our validated sham acupuncture device was a nonpenetrating device where the “needle” had the appearance of penetrating the skin, but actually telescopes up the shaft of the handle (Lancet 1998;352:364–365) The sham device only superficially touched the skin ≥1 inch away from any known acupuncture points; therefore, we believe that this device is unlikely to hide the real effects of acupuncture. In fact, our results match the results of other larger randomized, controlled trials (RCTs) of acupuncture for different conditions such as low back pain (Ann Intern Med 2009;169:858–866), migraine (JAMA 2005;293:2118–2125), and knee osteoarthritis (Ann Intern Med 2006;145:12–20). These RCTs show that sham acupuncture is superior to usual care or even optimal care, but there is no difference between acupuncture and sham acupuncture. In other words, acupuncture has comparable clinical effectiveness but seems to lack efficacy beyond the ritual of treatment. This poses an interesting conundrum: Should patients receive efficacious treatment that may be beneficial and safe or should patients not receive such treatment because it lacks efficacy beyond the placebo (Lancet 2010;375:885)? The answer to this question is not easily determined by scientific experiments, but rather should be considered a health care policy issue and an ethical dilemma. Acupuncture for Irritable Bowel Syndrome: Sham or the Real Deal?GastroenterologyVol. 139Issue 1PreviewLembo AJ, Conboy L, Kelly JM, et al. (The Beth Israel Deaconess Medical Center, Boston, Massachusetts). A treatment trial of acupuncture in irritable bowel syndrome patients. Am J Gastroenterol 2009;104:1489–1497. Full-Text PDF