Letter regarding “Acupuncture—help, harm, or placebo?”

To the Editors:

We read with interest the recent article, “Acupuncture—help, harm, or placebo?” by Meldrum et al. (1). We have one observation and one area of concern regarding the authors’ conclusions. The observation is focused on the dismissal of the efficacy of any impact of acupuncture on pregnancy rates as a placebo effect. First of all, the placebo effect is not to be taken lightly, and in fact may well be responsible for the efficacy of antidepressant medications, which appear to positively impact the psychological well-being of millions of Americans (2). Second, many of the randomized controlled trials on acupuncture do show a statistically significant impact on pregnancy rates. It is quite possible that acupuncture may only be effective with specific patient populations, analogous to assisted hatching (3). Finally, authors may influence the conclusions of any meta-analysis by shifting the criteria to include/exclude certain studies.

The area of concern is the recommendation, in the last paragraph, for patients to seek out education on lifestyle choices via a cited website rather than undergoing acupuncture treatment. There is a strong implication that the information provided on the website is more beneficial than acupuncture. It does not feel appropriate for an article in a peer-reviewed journal to be promoting a non-academic website. In addition, within the website are recommendations with links to purchase multiple products, including a wide range of supplements from a single manufacturer, such as fish oil, vitamin C, vitamin E, folic acid, green tea extract, and CoQ10, none of which have randomized controlled trials to support their efficacy to increase pregnancy rates in the infertile population. In the section on stress, the link is to a website that promotes a downloadable stress management program, which cites a pregnancy rate of 83%, despite the fact that there has never been a study utilizing the program.

Inadequate Description of an Acupuncture Treatment Study for PCO

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].

Comment on Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study

To the Editor:

It is widely known that embryo quality affects pregnancy and live birth rates. Nevertheless, in their article, “Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study,” Zhang et al. do not mention the quality of transferred embryos at all (1). In addition, there is no information about ovarian stimulation protocols (GnRH agonist? GnRH antagonist? Recombinant or urinary FSH?), length of stimulation, endometrial thickness or day of embryo transfer. One might expect day-5 cycles to be different, for better or worse, considering that the interval between intervention [transcutaneous electrical acupoint stimulation (TEAS)] and embryo implantation would have been shorter.

Acupuncture: when classical meets modern

To the Editor:

We read with great interest the recent article by Moy, et al. (1)

After its mysterious origination over 2500 years ago, acupuncture had spread rapidly through Asia, and been applied in Europe since the early seventeenth century. (2) Based on controlled clinical trials, extensive data about the efficacy of acupuncture have been gathered over the past three decades, providing valuable insight into the experience-based practice. We have the following concerns about the present study:

Acupuncture and IVF trial

I have some real concerns about the implications and conclusions drawn from the study of Domar et al. (1).

This study explores the effects of one protocol on IVF treatment. The study was indeed attempting to make sure that this was as close to the same protocol as used in the 2002 study.