Inadequate Description of an Acupuncture Treatment Study for PCO

28 02 2012

To the Editor:

In the February issue of the Journal, Stener-Victorin et al. [1] have published an article that confuses concepts and methods of acupuncture. In the title of the publication, the authors refer to the effects of acupuncture; however, in the publication itself they refer to electroacupuncture. Electroacupuncture does not belong to the traditional treatment methods in Chinese Medicine [2-4]. Practitioners of acupuncture, as ourselves, are confused by such title-line statements. In addition to this, traditional acupuncture works with clearly and exactly defined acupoints in order to allow reproducibility and comprehension of any kind of treatment [5]. Stener-Victorin et al. fail to describe the points used in their therapeutic approach. They vaguely mention the use of acupoints, described as “…inserted bilaterally in acupuncture points in abdominal muscles and in muscles below the knee…” [1]. Their publication does not provide any reproducible thoughts that adhere to acupuncture. In addition to this, the use of acupoints related to muscular structures can be seen as a defined interrelationship within the concept of the Five Elements [6], as we demonstrated in 2009 [7].

In conclusion, for any practitioner of acupuncture, a clear diagnostic rationale for the institution of the treatment [8] is missing [in the article]. In days of evidence-based medicine [9], it would be worthwhile to include such criteria in order to improve the quality of the publication.

Roy Moncayo, MD and Helga Moncayo
WOMED, Innsbruck, Austria

References

1. Stener-Victorin E, Baghaei F, Holm G, Janson PO, Olivecrona G, Lönn M et al. Effects of acupuncture and exercise on insulin sensitivity, adipose tissue characteristics, and markers of coagulation and fibrinolysis in women with polycystic ovary syndrome: secondary analyses of a randomized controlled trial. Fertil Steril 2012; 97: 501-508.
2. O’Connor J, Bensky D. Acupuncture. A comprehensive text. Shanghai College of Traditional Medicine, 1st ed. Seattle: Eastland Press, 1982.
3. Porkert M, Ullmann C. Chinese Medicine, 1st. ed. New York: Henry Holt, 1982.
4. Matsumoto K, Birch S. Extraordinary vessels, 1st ed. Brookline: Paradigm Publications, 1986.
5. Ellis A, Wiseman N, Boss K. Grasping the wind. Brookline: Paradigm Publications, 1989.
6. Hicks A, Hicks J, Mole P. Five Element Constitutional Acupuncture, 1st ed. Edinburgh: Churchill Livingstone, 2004.
7. Moncayo R, Moncayo H. Evaluation of Applied Kinesiology meridian techniques by means of surface electromyography (sEMG): demonstration of the regulatory influence of antique acupuncture points. Chin Med 2009;4: 9.
8. Maciocia G. Diagnosis in Chinese Medicine. A comprehensive guide. Edinburgh: Churchill Livingstone, 2004.
9. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM et al.: Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ 2003, 326: 41-44.

Published online in Fertility and Sterility doi:10.1016/j.fertnstert.2011.12.053

The authors respond:

It is unclear what concept confuses the reader of our recently published article reporting secondary analyses of a randomized controlled trial (1). Acupuncture (Latin Acus, “needle,” punctura, “puncture”) is an integral part of Traditional Chinese Medicine (TCM), and over the last decade it has become established in Western medicine. Acupuncture also involves stimulation of the needles, which may be via manual manipulation, electrical stimulation or by heating (moxa). It is unfortunate if the reader becomes confused because we do not indicate the type of stimulation in the title. However, type of stimulation, which is a combination of manual and electrical stimulation of the needles, is clearly described in the article, although not the exact points since they have already been published in the primary article as referred to (2) and in an experimental part of the trial (3). In the primary article, electro-acupuncture is given in the title (2), which is already too long and therefore the main reason not to include “electro” in this article due to limited space (1). Importantly, exact points, stimulation (both manual and electrical), number of needles, depth of needle placement, treatment time, number of treatments, and such are reported in the primary article (2), and briefly in the present article, all according to the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) (4). Further, the acupuncture rationale in the present study is Western Medical Acupuncture according to STRICTA definition (4). The reader needs to check references and, if there is any uncertainty, they should contact the corresponding author. However, it seems that in this case it is rather the rationale that is a problem and that is clearly stated in both the primary and secondary articles. It is striking also that the comment refers to textbooks rather than scientific literature. In a scientific article we need to stick to science and, most importantly today, to increase the quality of acupuncture research by following the CONSORT and STRICTA (4, 5) guidelines as done in the present study (1-3).

Elisabet Stener-Victorin, PhD
Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China

References

1. Stener-Victorin E, Baghaei F, Holm G, Janson PO, Olivecrona G, Lonn M et al. Effects of acupuncture and exercise on insulin sensitivity, adipose tissue characteristics, and markers of coagulation and fibrinolysis in women with polycystic ovary syndrome: secondary analyses of a randomized controlled trial. Fertil Steril 2012;97:501-8.
2. Jedel E, Labrie F, Oden A, Holm G, Nilsson L, Janson PO et al. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab 2011;300:E37-45.
3. Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol 2009;297:R387-95.
4. MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A et al. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. PLoS Med 2010;7:e1000261.
5. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 2001;357:1191-4.

Published online in Fertility and Sterility doi:10.1016/j.fertnstert.2011.12.053

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