3 generations of acupuncture research

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Since acupuncture was introduced to the West in the 1970s, research into its effectiveness has been ongoing. In the early years, Bruce Pomeranz, among others, published extensively on explanatory models. In the Netherlands, Gerben ter Riet conducted acupuncture research during that period. David Mayor has archived these very first studies in an online database, which is currently being updated.

In the 1990s, with the introduction of the EBM model in healthcare, these criteria were also applied to acupuncture research.

Research since then can be roughly divided into three generations or waves:

1. RCTs / Efficacy research
2. Effectiveness Research / Pragmatic Research
3. Systematize, Refine and Explain

1. RCT's/Efficacy Research

The initial wave of acupuncture research mainly consisted of randomized controlled trials (RCTs). In an RCT, the key question is: What is the specific effect of my treatment?
To answer this, research typically includes at least two groups: one receives the real treatment, the other a placebo or fake treatment. It is crucial that participants do not know which group they belong to, this is called blinding. In medication trials, the practitioner is also blinded, but in acupuncture this is not possible, which is considered a significant source of bias in acupuncture research outcomes.

At the start of this century, Germany conducted many studies known as the ‘GERAC studies’. These are often cited as evidence that no significant difference was found between ‘real’ and ‘sham’ acupuncture. Less well known is the fact that both real and sham acupuncture showed better results than conventional treatments.

In 2011, a group of trialists led by Andrew Vickers performed a meta-analysis based on individual data from 17,220 patients in these trials. They did find a significant difference favoring real acupuncture over sham.

2. Effectiveness research/pragmatic research
For acupuncturists worldwide, these initial results were unsatisfying. They sought a type of research better suited to personalized therapies like acupuncture.
In pragmatic or effectiveness research, the focus is no longer on the specific mechanism of treatment. Instead, the research environment is designed to reflect real-world practice as closely as possible. The key question here is: Does my therapy work as well as or better than the conventional treatment currently given for this complaint?

In this type of research, acupuncture generally performs well.
Mel Hopper Koppelman of the ‘Acupuncture Now Foundation’ has provided a clear overview of acupuncture research and its interpretation in a video.

3. Systematize, refine, and explain
Essentially, we know acupuncture works. The next step is to systematize the knowledge, refine hypotheses, and explain mechanisms of action. This means answering questions such as when acupuncture is effective and for whom. When is it better to use needles, and when should herbs or Tai Chi be preferred? This is a complex task that can only succeed with collaboration between all stakeholders: educational institutions, professional associations, and acupuncturists.

The Dutch Knowledge Centre for Acupuncture will continue to work towards these goals.

Johanna Biemans, MSc, Clinical Epidemiologist