Sociology – Research Strategies in Complementary Medicine Wk 1
Activity 1
Read the article and reflect on whether the provided strategy for the future seems to be adequate.
Complementary medicine research in Australia: a strategy for the future
https://onlinelibrary.wiley.com/doi/full/10.5694/j.1326-5377.2004.tb06303.x
(Full link in lecture notes)
Learning process – Notes from Week 1
In Australia, we’re far behind the UK and USA in funding CAM research. I don’t remember all details of the strategy except that funding continues to decline in Australia. The recommendation is that the government uses the Goods and Services Tax from CAM products to reinvest in CAM research, however this may not be the solution the CAM industry needs due to funding still falling below what is required for successful research to be undertaken. Additionally there are risks in the private sector in funding their own research due to the criticisms being directed at them for self funding or the possibility of inconclusive results leading to more harm to the industry. I think the article may mention the need for CAM practitioners to become active researchers alongside their consulting processes with clients (or this might be from our lecture notes) still sorting through…
Activity 2
What is a ‘good’ placebo for acupuncture? Is it stimulation of non-acupuncture points, points thought not to be indicated, with superficial needling or with switched-off devices using ultrasound, electrical or laser stimulation?
I would have to agree to the above statement. Needling of Non-acupuncture points vs acupuncture points would be a good placebo,and best observed with a trained acupuncturist who can understand the purpose and philosophy and also the physiology in relationship to the mind, body, and spirit knowledge in TCM practices.
The practitioners recorded observations over time along with client feedback can provide mixed methods, including double blind, three armed trial, qualitative, and others (still learning which ones). Quantitative trials could be achieved if the research is well organised and documented clearly i think?
The body of research can be evaluated possibly drawing on the evidence hierarchy, the research house, and circular model – an example is that this research can relate to existing studies (meta analysis) which overall strengthens the research practice.
There is no difference in smoking cessation rates between acupuncture and most sham acupuncture but do you think there is a difference between acupuncture and other proven smoking cessation treatments?
I think that different treatments work differently for each person. Acupuncture might help reduce stress for example, therefore assisting a person with quitting, especially if they’re determined to quit by reducing their stress and by use of self care practices such as this.
There are many other CAM self care practices such as hypnotherapy, meditation, and relaxation. I quit at age 27 through mixed methods, determination, Nicorette gum for around 2 months, and meditation and prerecorded hypnotherapy sessions.
Can acupuncture be said to ‘not work’ (being no better than placebo) and ‘work‘ (being equally effective as a proven conventional treatment)?
Just thinking out loud as I’m not sure if this is all accurate…
No, I think it’s more that there just isn’t enough research, trials, or funding allocation for this. Alongside these factors, the evidence hierarchy can be limiting to CAM practices and findings, due to it not giving enough weight to qualitative, empirical, cohort studies, randomised controlled trials (the bottom half of the pyramid) and other forms of evidence.
Even long established and proven medical traditions in their own right such as TCM find it harder to meet the expectations of the evidence hierarchy in research. I think I read somewhere that homeopaths were the first to do double blind randomised controlled trials, however now overall evidence is weakened due to additional evidence required from factors such as the composition of the medicine and its interaction biologically, whereas it’s harder to measure the vital force.
The types of evidence collection need to evolve to gain credibility with narrower fields of research and funding. This may be achieved with the mixed methods strategies we’re learning in chapter 1 and beyond.
What matters most to patients? Is it whether a specific acupuncture technique is better than a questionable placebo technique or whether acupuncture helps patients more than no treatment or adds to standard treatment?
Both. If a patient is discussing with their GP their wellbeing, a doctor may want to have an understanding of the proposed treatment strategies of the patient or vice versa, the doctor may recommend acupuncture to the patient if there is sufficient evidence it might help in their situation. Overall the contribution to a patients wellbeing needs to be weighed up.
Class responses
1. Thanks for sharing these thoughts, Heather! The issue of research funding is a key concern for complementary medicine – the evidence base contributes to perceptions of credibility and this translates to access for patients who might not know to seek it out. We also need to explore innovative research methodologies that embrace the individualised nature of holistic treatments.
I’d love to hear other people’s thoughts about acupuncture and the difficulties conducting clinical trials using placebo – what do you think of ‘sham acupuncture’? Could there be other aspects to the therapeutic relationship that might still create a healing effect?
2. I like the brainstorm style of your notes Heather, so I thought I’d add another point to the bundle.
Perhaps this was already mentioned covertly, but I think it’s necessary to consider that, alongside acupuncture or its alternatives and/or placebo forms of acupuncture, there are so many other techniques for helping someone to quit smoking (nicorette, relaxation exercises, etc) and that perhaps people who are accessing acupuncture as an aid to quit are using some of these techniques alongside.
And that in any type of research it becomes super important to ask about other types of treatment so as to be able to appropriately categorise participants as to whether they are using acupuncture alone, or alongside other types of quitting-smoking treatment, CAM or otherwise. Which could certainly effect funding for research, for example: if 5 of the 12 participants are using nicorette as well as acupuncture, this would certainly put into question the efficacy of acupuncture.
Also, as already suggested, a therapeutic relationship potentially has an impact, as how somebody feels their need for comfort, being taken care of could make them more receptive to treatment.