Book Review: Acupuncture Research: Strategies for establishing an evidence base. Edited by H MacPherson, R Hammerschlag, G Lewith and R Schnyer
Paperback, Size: 23.5 x 15.5 cm, Pages: xxvi + 261, Price: £29.99
Churchill Livingstone, Edinburgh (2007)
‘Not getting involved/abstaining from research and letting others determine what are the important questions to ask and how to address them, effectively means that acupuncturists will be giving up an important voice that will impact the future of their profession’
Wayne, Sherman and Bovey 2007
Understanding research, and how to do research, is now a key part of education for most acupuncture students, and can no longer be ignored by even the most dyed-in-the-wool traditionalist practitioners. For those outside the profession, such as policy-makers or potential patients, the results of acupuncture research can also be of vital importance.
This book is the planned outgrowth of a brainstorming meeting in York in July 2006 which brought together many of those who have pioneered acupuncture research in Europe, the US and Australia. After a thought-provoking Foreword by Ted Kaptchuk and an excellent Glossary, Hugh MacPherson and Kate Thomas introduce what they call the ‘evidence mosaic’ of research (rather than the usual ‘evidence hierarchy’, with systematic reviews at the top of the pyramid and ‘anecdotes’ at the bottom). Topics expertly covered in succeeding chapters include the history of acupuncture research, patients’ use and experience of acupuncture, its safety, measuring patient-centred outcomes, the ins and outs of uncontrolled and controlled trials, the components of treatment, the importance of clinical practice as the basis for research, some physiology, evidence overviews (meta-analysis and systematic review), how to engage acupuncturists in research, and an overview of future strategies in acupuncture research. Each chapter is comprehensively referenced, and there is a reasonable, if not brilliant, Index.
All but one of the seventeen contributors to the volume have current university affiliations. Perhaps as a result, although overall it is very readable, the book is sometimes a little dry and with perhaps a surfeit of discussion, as if written by committee. In a way of course it was, only one chapter out of all thirteen being written by a single author (the last, by George Lewith). Further, given the number of contributors to the volume, each with strong track records in various aspects of acupuncture research, some of the more contentious topics – such as sham needling or placebo – are inevitably covered several times, albeit from different angles. Research is always a collaborative effort, and acupuncture research in particular is bound to be multifaceted.
However, as acupuncture research develops in the future, it is inevitably going to require considerably more funding than has been available so far. As Claire Cassidy and Kate Thomas state in Chapter 3, ‘as researchers and as a profession, we need to develop avenues for funding, whether they are federal or private; we are in need of “angels”.’ Here this book is unfortunately less than helpful. George Lewith’s is the only chapter which includes a section on funding (‘A consensus about funding emerges’), and this is sketched in very general terms, although his statement that the whole 2005 research budget for complementary and alternative medicine in the UK only amounted to 0.0085% of that for all medical research, is starkly precise.
The practicalities of obtaining financial support for research projects – particularly for those conducted by practitioners outside a university context – could have been more fully addressed in Chapter 12 (Engaging acupuncturists in research – some practical guidelines). It would certainly be of interest to know how each of the authors in this book have managed to fund their research over the years. This may have revealed changing trends in funding, as well as particular clusters of potential “angels”.
Setting aside such quibbles though, each chapter is very well worth reading, providing many nuggets of information, thought and opinion to chew over. I cannot possibly do justice to all the chapters here (titles and authors can be found on the publisher’s website, see note 1), but two I would like to mention, for different reasons.
Chapter 12, on engaging acupuncturists in research, will be particularly useful for practitioners who wish to dip a toe in the water, and indispensable for students who have to create research projects manageable within the many constraints of a training course.
The final chapter (Future strategies for acupuncture research) is quite a contrast and deliberately challenging, with George Lewith questioning the importance of acupuncture points, drawing out structural parallels between consultations in acupuncture and conventional general practice (‘is the process of consultation the most effective treatment?’), and making the case for systematic observational studies rather than controlled clinical trials. His conclusion, that research may well upset a lot of our assumptions, as well as pave the way for the integration of acupuncture into conventional medicine, will make some traditionalist readers quite uncomfortable. As he says, ‘what will emerge over the next 20 years may only have a limited and tenuous connection with what practitioners feel they now define as “acupuncture”.’ Will he be right?
Acupuncture Research differs considerably from earlier edited books offering a scientific view of acupuncture, such as Acupuncture: A scientific appraisal (Butterworth-Heinemann 1999) or Clinical Acupuncture: Scientific basis (Springer 2001), even though many of the contributors are the same. It is more comprehensive and often less partisan, and far more relevant to those who require an overview of the many aspects of acupuncture research as well as those who wish to explore the complexities of ‘evidence’ and the risks and benefits of a scientific approach in depth. In conclusion, it is a timely book, and essential reading for all those involved in acupuncture research, whether as producers or consumers.
David Mayor is an acupuncturist in Hertfordshire, England. He is also editor of the textbooks Electroacupuncture: A Practical Manual and Resource (Churchill Livingstone) and Clinical Application of Commonly Used Acupuncture Points by Li Shizhen (Donica), both published in 2007. See www.welwynacupuncture.co.uk for more information.
Wayne P, Sherman K, Bovey M 2007 Engaging acupuncturists in research – some practical guidelines. In: MacPherson P, Hammerschlag R, Lewith G, Schnyer R (eds) Acupuncture Research: Strategies for establishing an evidence base. Churchill Livingstone, Edinburgh, 219-37
Note 1: Acupuncture Research. Elsevier. http://www.chinesemedicinetimes.com/product/216/0/acupuncture_research