3 generations of acupuncture research

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4. 3 generations of acupuncture research

Since the introduction of acupuncture in the West in the seventies, research has been conducted on its functioning. In the early years, explanatory models were published by, among others, Bruce Pomeranz. In the Netherlands, acupuncture research was carried out at that time by Gerben ter Riet. David Mayor has archived these very first studies in an online database. An update is currently being worked on.
In the '90s, when the EBM model was introduced in healthcare, these criteria were also maintained for acupuncture research.

Research since that time can roughly be divided into 3 generations or 3 waves:

1. RCTs/efficacy research
2. Effectiveness research/pragmatic research
3. Systematizing, refining, and explaining.

1. RCT's/efficacy research

In the first wave of acupuncture studies, mainly randomized trials were set up. In an RCT, you ask yourself: What is the specific effect of my treatment?
You try to answer this question by creating at least 2 groups in your research. One group receives the real treatment and the other undergoes a sham treatment. In this type of research, it is important that the subjects do not know which treatment they have received. This is called blinding. In research on the efficacy of medicines, the practitioner is also blinded, but in acupuncture, this is not possible, which is therefore seen as a major bias in acupuncture research.
In Germany, a large number of studies were conducted at the beginning of this century, known as the 'GERAC studies'. These studies are often cited to show that no significant difference was found between 'real' and 'sham' acupuncture. The remarkable fact that both real and sham acupuncture showed better results than conventional treatments is less known.
In 2011, the trialist group, led by Andrew Vickers, conducted a meta-analysis based on individual data of 17,220 patients from these trials. They did find a significant difference between the two acupuncture arms in favor of real acupuncture.

2. Effectiveness research/pragmatic research
For acupuncturists worldwide, these results were not satisfying. A type of research was sought that is better suited for a personalized therapy like acupuncture.
In pragmatic or effectiveness research, the question is no longer asked about the specific mechanism of action of a treatment, but a setting is created that reflects the practice as truthfully as possible. In this type of research, the question is asked: Does my therapy work as well as or better than the conventional treatment currently given for this complaint?
In this type of research, acupuncture performs mostly well.
Mel Hopper Koppelman of the 'Acupuncture Now Foundation' has provided a clear overview of research on acupuncture and how we can interpret this in a video.

3. Systematize, refine, and explain
In principle, we know that acupuncture works. The next step involves systematizing, refining hypotheses, and explaining mechanisms of action. Answering questions such as when acupuncture works and for whom. When is it better to use needles and when is it better to use herbs or Tai Chi? This is no easy task and will only succeed if all parties involved collaborate: educational institutions, professional associations, and acupuncturists.

The Dutch Acupuncture Knowledge Center will continue to work towards this goal.

Johanna Biemans, MSc, Clinical Epidemiologist