Weblog entry #329 for simonw
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#329
Not so NICE
Posted by simonw on Mon 1 Jun 2009 at 18:04
NICE are suppose to offer clinical guidance in the UK on how the NHS should treat their patients.
The latest guidance on low back pain recommends the use of acupuncture, and estimates it costs about £25 per session.
The report looked at various studies and concluded that acupuncture was a cost effective treatment for lower back pain compared to other therapies.
You might think it is an open and shut case. However the evidence they looked at (and discuss) makes a fairly clear case that acupuncture is a placebo. In nearly all the studies "sham acupuncture" - performs as well as acupuncture. This means that the "theory" behind acupuncture is devoid of content, so the waffle the practitioners spout is drivel..
Should this matter if the treatment is "cost effective"?
Well there are a few points that leap to my mind.
First, if we accept acupuncture is a placebo, we should ask is it the safest, and most cost effective placebo for the condition? With a 2 to 10% incidence of minor side effects, I suspect the answer is no.
There is also the encouraging of mumbo-jumbo. Since there is no evidence that acupuncture points matter, and given GP appointments are £18 (less than the £25 for acupuncture), it would seem more cost effective to have the GP, or a nurse provide sham acupuncture (using retractable needles would avoid puncturing the skin and reduce the risk further), than squander money encouraging the acupuncture nuts who think it is Qi. Indeed I suspect another 10 appointments with the doctor with or without needles would make any patient feel well cared for.
Third, one is directing people who are ill to people who are less medically qualified (There is no qualification required to be an acupuncture practitioner in the UK). Having a friend who lost her ability to walk, and then her life, due to "low back pain" which later turned out to be a malignancy, I don't want my taxes spent sending ill people to less qualified quacks for a placebo, when even qualified doctors may make a crucial error in diagnosis and could presumably adequately deliver suitable placebos if required.
I didn't see any discussion of the ethics of placebo treatments. Which is another topic altogether, but needs to be referred if this is the guidance issued.
The report recommended further research in all sorts of areas, some wiser than others, but if the best treatment we have for low back pain is a placebo, I'd be both extremely surprised, and thinking that where we need the research is in understanding the causes of low back pain.
I wonder what the comparison would be if you referred such patients to a succession of ten doctors, to see if a better diagnosis could be made.
The latest guidance on low back pain recommends the use of acupuncture, and estimates it costs about £25 per session.
The report looked at various studies and concluded that acupuncture was a cost effective treatment for lower back pain compared to other therapies.
You might think it is an open and shut case. However the evidence they looked at (and discuss) makes a fairly clear case that acupuncture is a placebo. In nearly all the studies "sham acupuncture" - performs as well as acupuncture. This means that the "theory" behind acupuncture is devoid of content, so the waffle the practitioners spout is drivel..
Should this matter if the treatment is "cost effective"?
Well there are a few points that leap to my mind.
First, if we accept acupuncture is a placebo, we should ask is it the safest, and most cost effective placebo for the condition? With a 2 to 10% incidence of minor side effects, I suspect the answer is no.
There is also the encouraging of mumbo-jumbo. Since there is no evidence that acupuncture points matter, and given GP appointments are £18 (less than the £25 for acupuncture), it would seem more cost effective to have the GP, or a nurse provide sham acupuncture (using retractable needles would avoid puncturing the skin and reduce the risk further), than squander money encouraging the acupuncture nuts who think it is Qi. Indeed I suspect another 10 appointments with the doctor with or without needles would make any patient feel well cared for.
Third, one is directing people who are ill to people who are less medically qualified (There is no qualification required to be an acupuncture practitioner in the UK). Having a friend who lost her ability to walk, and then her life, due to "low back pain" which later turned out to be a malignancy, I don't want my taxes spent sending ill people to less qualified quacks for a placebo, when even qualified doctors may make a crucial error in diagnosis and could presumably adequately deliver suitable placebos if required.
I didn't see any discussion of the ethics of placebo treatments. Which is another topic altogether, but needs to be referred if this is the guidance issued.
The report recommended further research in all sorts of areas, some wiser than others, but if the best treatment we have for low back pain is a placebo, I'd be both extremely surprised, and thinking that where we need the research is in understanding the causes of low back pain.
I wonder what the comparison would be if you referred such patients to a succession of ten doctors, to see if a better diagnosis could be made.
Comments on this Entry
I am not opposed to "alternatives" but unless they have been rigorously tested I'm not in favour of unsubstantiated mumbo-jumbo.
There may be something in acupuncture but I bet it's not the pressure point nonsense the practitioners go on about. There are plenty of beneficial chemical agents in lots of plants and their extracts but a lot of the tree-hugging waffle that goes with it is utter bunk too.
Next someone will be saying that homoeopathy does something and you can get it on the NHS....
--
"It's Not Magic, It's Work"
Adam
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