Laughable “science” for ACC $24 million acupuncture waste

bullshit detector

The New Zealand Accident Compensation Corporation (ACC) should “support you if you’ve been injured by helping you get back to work and everyday life”. In theory the ACC is a great thing for New Zealanders. Unfortunately they dance to the political piper and the politicians don’t want to upset the true believers in acupuncture.

The result is a waste of our taxes to the tune of $24 million a year.

There is a lot of pressure on the ACC by scientists and by people like me that care about truth to stop wasting our money on snake oil cures. So the ACC commissioned a study to try to defend its ridiculous acupuncture spending.

Despite the study actually being flawed, it made some good recommendations. But did the ACC take any notice? No. And it took a group of us to launch Official Information Act (OIA) requests so that we could open this up to scrutiny.

We have now discovered via OIA that the ACC has been playing silly games (Mark Hanna’s excellent summary).

Here is the evidence :

The ACC response of 25Aug2104 shows it does not adhere to any science whatsoever in spending $24m for acupuncture in the last financial year. In particular it does not adhere to its own Review of the science.

The response says “ACC funds acupuncture for conditions where prescribed by the client’s medical profressional. This includes conditions other than musculoskeletal pain, and for non-chronic pain.”

So the statement ACC has previously made that it limits payments for certain conditions and to certain “modalities” is shown to be false.

In addition, the thin veneer of science it pretends to consult for acupuncture funding has now been released in redacted form. This internal ACC Review is entitled: “Pragmatic Evidence Based Review – The efficacy of acupuncture in the management of musculoskeletal pain” (Aug2011). I say ‘veneer’ because the Review does not say why it prefers one study over a Cochrane study which contradicts the internal Review conclusion.

The internal ACC Review makes two major claims (the second of which is backed up by no evidence whatsover):

1. “the effectiveness of acupuncture is most convincing for the treatment of chronic neck and shoulder pain. In terms of other injuries, the evidence is either inconclusive or insufficient.”

2. “The state of the evidence on the effectiveness of acupuncture is not dissimilar to other physical therapies such as physiotherapy, chiropractic and osteopathy.”

Chronic Neck Pain claim
On the first claim re chronic neck pain the Review claims “There is good evidence that acupuncture is effective for short term pain relief in the treatment of chronic neck pain.” Short-term is not defined. The Review relies on the source in their Footnote 23 to make this claim: Fu L, Li, J., Wu, W.,. Randomized controlled trials of acupuncture for neck pain: systematic review and meta-analysis. Journal of Alternative & Complementary Medicine 2009;15(2):133-45.
http://www.ncbi.nlm.nih.gov/pubmed/19216…

The Review notes: “the effectiveness of acupuncture for treating disability and long term pain in the neck remains unproven.”

So we have the Review saying acupuncture for short term pain relief works but not long term pain. However the Review does not say why this may not be a placebo effect. Indeed, the Review says, for example in relation to lower back pain, “Studies comparing effective conservative treatments (including simple analgesics, physical therapy, exercise, heat & cold therapy) for (sub) acute and chronic non- specific low back pain (LBP) have been largely inconclusive.”

Chronic Shoulder Pain claim
The Review claims “There is good evidence from one pragmatic trial that acupuncture improves pain and mobility in chronic shoulder pain.” However the Review then claims “With respect to shoulder pain, the best evidence comes from two RCTs 30 31 . One, a well-conducted pragmatic, multi-centre RCT 30 showed that that acupuncture improved pain and mobility compared to sham acupuncture or conventional therapy for up to three months post-intervention and the other 31 that reported that acupuncture improved pain in a mixed population significantly more than ‘sham’ acupuncture. This is contrasted with the finding
from a Cochrane review 29 of nine RCTs that there is “little evidence to support or refute the
use of acupuncture for shoulder pain although there may be short-term benefit with respect
to pain and function.” [numbers are Footnotes in the Review]

Unfortunately the Review appears to have mixed up its footnote numbers so it is impossible to assess which studies it is referring to. For example footnote 30 is: Santha CC. Acupuncture treatment for bilateral heel pain caused by plantar fascitis. Journal of the Acupuncture Association of Chartered Physiotherapists:67-74.

This is clearly an elementary mistake in the Review.

Footnote 29 which the Review says is a Cochrane Review is: Knight RR. Integration of manual therapy, rehabilitation and acupuncture in the treatment of a 17-year-old male professional football player with chronic medial tibial stress syndrome. Journal of the Acupuncture Association of Chartered
Physiotherapists:81-87.

This is clearly another mistake in the Review.

Other conditions
Despite the ACC admission that it relies on the “medical professional” and not the science to decide on what treatments the ACC funds, its own Review says: “There is no evidence to recommend the use of acupuncture for injury-related knee pain” and “There is no evidence to recommend the use of acupuncture for ankle pain.” and “There is a paucity of research for the optimal dosage of acupuncture treatment for treating shoulder, knee, neck and lower back pain.”

The link the OIA response provides in response to my request on which “modalities” of acupuncture or chiropractic it funds is:
http://www.acc.co.nz/for-providers/invoi…
This link provides no information whatsoever about modalities. Instead the page contains another link which to a pdf which provides a scale of hourly rates for various “treatments”, including $65.27 for acupuncture the chiropractic etc.

———
Further references

J Altern Complement Med. 2010 Sep;16(9):937. doi: 10.1089/acm.2010.0384.
Concern with meta-analysis of acupuncture for neck pain.
Trinh KV, Sy A.
http://www.ncbi.nlm.nih.gov/pubmed/20738…

http://online.liebertpub.com/doi/abs/10….
Li-Min Fu, Ju-Tzu Li, and Wen-Shuo Wu. The Journal of Alternative and Complementary Medicine. February 2009, 15(2): 133-145. doi:10.1089/acm.2008.0135.
Objectives: The objectives of this study were to assess the effectiveness and efficacy of acupuncture in the treatment of neck pain.
Data sources: The following computerized databases were searched from their inception to January 2008: MEDLINE (PubMed), ALT HEALTH WATCH (EBSCO), CINAHL, and Cochrane Central.
Review methods: Systematic review and meta-analysis were conducted on randomized controlled trials of acupuncture for neck pain. Two (2) reviewers independently extracted data concerning study characteristics, methods, and outcomes, as well as performed quality assessment based on the adapted criteria of Jadad.
Results: Fourteen (14) studies were included in this review. Meta-analysis was performed only in the absence of statistically significant heterogeneity among studies that were selected for testing a specific clinical hypothesis. While only a single meta-analysis was done in previous reviews, this review performed nine meta-analyses addressing different clinical issues. Seven out of nine meta-analyses yielded positive results. In particular, the meta-analysis based on the primary outcome of short-term pain reduction found that acupuncture was more effective than the control in the treatment of neck pain, with a pooled standardized mean difference (SMD) of −0.45 (95% confidence interval [CI], −0.69 to −0.22). Moreover, the meta-analysis with a pooled SMD of −0.53 (95% CI, −0.94 to −0.11) showed that acupuncture was significantly more effective than sham acupuncture for pain relief. However, there was limited evidence based on the qualitative analysis of the trial data to support the above conclusions. We provided a detailed analysis on the issue of heterogeneity of the studies involved in meta-analysis and examined the consistencies and inconsistencies among the present review and two other reviews conducted previously.
Conclusions: The quantitative meta-analysis conducted in this review confirmed the short-term effectiveness and efficacy of acupuncture in the treatment of neck pain. Further studies that address the long-term efficacy of acupuncture for neck pain are

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