RESEARCH METHODOLOGY POSTER PRESENTATION ABSTRACTS
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Salons 10-12.
THURSDAY, 5:30-6:15 PM
Paterson C, Dieppe P.
Distinct but not divisible: characteristic and incidental
(placebo) effects in acupuncture and Chinese medicine.
Medical Research Council, Health Services Research
Collaboration c.paterson@bristol.ac.uk
PURPOSE: The randomized double-blind placebo
controlled trial (RCT) requires that an intervention is divided into
characteristic (specific) and incidental (placebo, nonspecific) elements.
When this design is applied to acupuncture research the needling is
categorized as "characteristic" and everything else is categorized
as Ôincidental'. This paper explores to what extent the assumptions
that underlie the RCT design hold true for acupuncture when it is practiced
as part of Chinese medicine.
METHODS: This methodological paper draws on
empirical evidence from three published interview studies of patients
with chronic illness having acupuncture and Chinese medicine (a total
of 88 interviews), and relates this to the published literature on placebo
effects and clinical trials.
RESULTS: The lived experience of acupuncture
patients suggests that many of the assumptions that underlie the RCT
design, do not hold true for acupuncture. Firstly elements of the consultation,
such as talking and listening, that are categorized as incidental in
drug trials may be integral to acupuncture, and therefore part of its
characteristic effect. Within acupuncture consultations, although some
aspects of "talking and being listened to" are of an incidental
kind (such as "focussed attention" and empathy), other aspects
are characteristic of acupuncture and its underlying theory of Chinese
medicine. For example the particular way that a history is taken at
the initial consultation indicates to patients that everything about
them is of relevance to the diagnosis and treatment plan. During subsequent
sessions needle insertion is often varied to take into account any new
concerns: physical, emotional, and social. this analysis also challenges
the assumption that incidental and characteristic factors are distinct
and divisible. Drugs exist as material entities in the forms of pills
or injections, and can therefore be physically separated from most other
aspects of an intervention. However, in acupuncture the characteristic
factors include needling, aspects of talking and listening and aspects
of the diagnostic process and these elements are emergent and interwoven
into the whole intervention.
CONCLUSION: There are aspects of treatment,
other than needling, that are characteristic elements of acupuncture,
and these are distinct but not divisible from incidental factors. Consequently
the sham acupuncture design is inappropriate because it delivers these
other characteristic elements to both groups and will therefore underestimate
the total treatment effect that is characteristic of the intervention.
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