Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
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Chapter 11 / Acupuncture and CVD 175<br />
ACUPUNCTURIST BIAS<br />
When compared with surgery and pharmacological treatment, the<br />
risk of inducing bias is far greater in acupuncture treatment because of<br />
the extensive and prolonged contact between patient and doctor: 10–12<br />
consultations of 45 min, for a 3-wk period, in patients with angina pectoris.<br />
Accordingly, it is important to address the possible bias from the<br />
“Rosenthal Effect” induced by the acupuncturist. This effect is present<br />
in a range of experimental settings, for example, reaction time, animal<br />
learning, human learning, and ability testing (12). Furthermore, the size<br />
of this effect is substantial, with 95% confidence limits ranging from<br />
0.62–1.22 standard deviations (13). The importance of this in cardiovascular<br />
disease (CVD) is underlined by observations of the lethal, healing,<br />
and conditioning power of words (14), as well as the following examples<br />
of the physiological effects of human touch, a distinctive feature of<br />
acupuncture. Rats receiving a high-cholesterol diet and a one-to-one<br />
relationship with the investigator, including touch three times daily,<br />
showed a 60% reduction in diet-induced arteriosclerosis when compared<br />
with an untouched control group (15). When touched daily, premature<br />
infants in incubators increased their weight faster than infants in<br />
the same condition who were not touched (16). In patients with unconscious<br />
arrhythmias, manual pulse taking had a normalizing effect on the<br />
heart rhythm (17,18). In conclusion, acupuncture trials require an adjustment<br />
concerning the Rosenthal effect.<br />
COMMENTS CONCERNING THE “GRADING” OF CLINICAL AND SCIENTIFIC<br />
STUDIES ACCORDING TO EVIDENCE LEVEL<br />
The Agency for Health Care Policy and Research (AHCPR) of the US<br />
Public Health Service has suggested that studies be “graded” according<br />
to the following criteria:<br />
1. Well-designed, well-conducted, controlled trials<br />
2. Observational studies and small clinical studies<br />
3. Expert opinion/panel consensus<br />
As indicated in the previous section, this “grading” requires an adjustment<br />
in acupuncture trials. Accordingly, for the present evidence analysis,<br />
the “grading” has been adjusted as follows:<br />
1. Well-designed, well-conducted, controlled trials that demonstrate an<br />
effect of acupuncture at a 1% significance level. <strong>Alternative</strong>ly, welldesigned,<br />
well-conducted trials that have eliminated patient and acupuncturist<br />
bias and demonstrate an effect of acupuncture at a 5%<br />
significance level.