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27 July 2010
The BJOG has published flawed acupuncture research claiming that acupuncture cannot induce labor. Perhaps one of the more difficult and lengthy treatments to perform, labor induction is typically over 70% effective with acupuncture. However, the proper protocols and procedures require a 3-6 hour acupuncture treatment in many cases. The study from Denmark published in BJOG merely used two 30 minute appointments. The study also failed to use the proper type of acupuncture needle. Choosing an ultra-thin needle for the study, the researchers failed to follow correct equipment procedures. The correct needle has a slightly thicker gauge. In addition, no report of standardizing the depth of needle insertion was reported. Moreover, the needles were applied by nurse midwives and not by skilled, licensed acupuncturists and electroacupuncture was not applied. Finally, points UB67, LI4, SP6, and GV20 were chosen by the researchers. However, standard procedure throughout China includes points UB31, UB32, LI4, SP6 and supplementary points SP6, GB21, Liv3, and UB60.
Studies conducted in China show a 72% effective rate for acupuncture labor induction using LI4 and SP6 with electroacupuncture. This method employs ipsilateral insertion on only one side of the body and electrical stimulation is applied for 6 to 8 hours at approximately 3 Hz at a mild, comfortable intensity level. This procedure is conducted on three consecutive days and is applied to alternate sides of the body each day. The study out of Denmark did not attempt to use electroacupuncture.
The researchers from Denmark from Herning Regional Hosptial and Aarhus University Hospital never had a chance to prove or disprove anything because their acupuncture procedure was flawed. A short excerpt from their published study reveals problems:
In the acupuncture group (AG), thin acupuncture Seirin B-type needles (Serin Corporation, Shizuoka, Japan) were used, whereas Park-Sham acupuncture needles were used in the control group (CG). In both groups, sticky tubes were used to conceal the type of needle used. The tube was fixed to the skin at the acupuncture point. The needle was then inserted into the tube. The real acupuncture needle penetrated the skin, while the sham needle had a blunt point so that the needle retracted into the needle handle and did not penetrate the skin.9,10 All the midwives were trained in acupuncture according to the guidelines described by Deadman et al.,8 and they were all regular practitioners of acupuncture, performing acupuncture treatments approximately five to six times a week.
This is an irresponsible study that fails to follow basic procedures. The problem may have arisen in trying to match the acupuncture procedure to the control group procedure. In order to have a double-blind randomized controlled study, neither the practitioner nor the patient may know whether or not acupuncture has been performed. Due to the complexity of this treatment, this is often not possible. For example, the raising and thrusting technique is necessary in many instances. During this procedure, the practitioner can and must visibly see the insertion depth of the needle varying. This technique was not employed in this study although it is standard procedure. Raising and thrusting is not a double-blind technique but rather requires careful visual monitoring by the practitioner. A better designed study might choose the LI4, SP6 electroacupuncture procedure. However, difficulties would emerge because the practitioner must ask the patient when she perceives mild electrical stimulation. Again, this breaks the double-blind aspect of the research. Overall, expect to see a lot of poor research on the effectiveness of acupuncture due to the limitations of double-blind research. Leaving out important acupuncture needle manipulation techniques is not standard procedure and will yield deficient outcomes.
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