The Difference between Medicine and Marketing
January 10, 2014
by Jennifer Phillips, Ph.D.
I know that at least some of you read the post I authored last August on a newly published report on acupuncture treatment for retinitis pigmentosa. Since that time, there has been quite a bit of continued discussion in the Usher community surrounding the October publication of the study in the journal Clinical and Experimental Optometry, at which time the protocol was made available for other acupuncturists to purchase. Given this ongoing discussion, which has taken place alongside a marketing campaign for the practice where this procedure originated, it seemed like a good idea to post an update.
Let’s start with a brief recap of the conclusions of the published study itself. Recall that this was a very small clinical study (12 patients in all) with no control group. The full article is behind a paywall, but the abstract can be viewed here.
In the abstract, the authors state that six of 12 subjects had measurable, significant visual function improvements after treatment and conclude that
Acupuncture…may have significant, measurable benefits on residual visual function in patients with retinitis pigmentosa…These preliminary findings support the need for future controlled studies of potential mechanisms. (my bold emphasis --JBP)
The study design makes it difficult to say anything definitive about the efficacy of this treatment, and while the conclusion might be a bit optimistic, the authors are careful not to wildly overstate the significance of their study in print. On a scale of 1-10, where ‘1’ is personal anecdotes or testimonials and ‘10’ is a double-blind randomized clinical trial with 100 participants, I would award this study a ‘3’.
My biggest objections relate to the lack of prior probability for this treatment to be effective, based on the long, exceedingly negative track record of acupuncture studies over the years. In my original post, I linked to several peer-reviewed research articles describing well-controlled studies of acupuncture, showing a clear, inverse correlation between the quality of the study and the measurable benefit of acupuncture. In plain English, the better the study design, the worse acupuncture performs compared to the control group. Just in the past few weeks, another such study has made the rounds in the mainstream media. This study, published in the journal Cancer was a collaboration between clinicians at Harvard and Johns Hopkins. 47 women who were undergoing conventional therapy for breast cancer were given either real or sham acupuncture, and reported how well that treatment helped them manage the side effects of the cancer treatment they were all receiving. There was no significant difference in reported improvement of symptoms between the group who was actually getting acupuncture compared to the group who only thought they were. To those of us who have digested many similar studies over the years, this is completely unsurprising, and in my opinion the most beneficial thing to do with the large body of information amassed to this point is to ask: what role should the placebo effect play in helping patients manage disease or injury?
With regard to the Clinical and Experimental Optometry article, the bottom line is that this is one small study with no controls and some mixed results providing preliminary data to motivate further investigation. My opinion as a scientist is that the more appropriate place for such preliminary data would have been in the grant proposal for funding a larger, more rigorous clinical trial, rather than in a peer-reviewed medical journal, but as it’s out there for public consumption now, I think it is important to stress that the impact of the study should be interpreted prudently.
The reason I’m writing about this again is that you will likely soon be hearing, if you haven’t already, a different interpretation of this study’s impact. The practitioner who consulted on the Johns Hopkins acupuncture trial has increased his web-based marketing since the publication of the study, and has recently made an appearance on The Dr. Oz Show. I haven’t seen the program yet, so I don’t know what claims were made, but I do know that much of the information on his website and other media related to the treatment regimen for RP are not supported by the published data. If you happen to see the program or other promotional material from this practice, I hope that you will keep the above limitations of the Johns Hopkins study in mind. This practitioner is selling a product to the public, as well as to other acupuncturists who wish to purchase the protocol for use in their own practices. This is marketing, not medicine.
We all hope for a future where there are real, verifiable treatments for RP that will work objectively and scientifically, regardless of how much you believe in them. The study testing the efficacy of the acupuncture treatment currently available does not meet those benchmarks. If you choose to seek out this treatment, I truly hope that you will do so with the awareness that the most likely cause of any benefit you might receive will be the result of positive reinforcement and positive thinking. As I said above, the role of placebo treatments in managing disease is a medically valid question, but when such treatments are marketed as something beyond placebo, they are being oversold.