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

17 07 2013

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. Read the rest of this entry »

Intravenous immunoglobulin and recurrent miscarriage

10 03 2011

To the Editor:

Ata et al. (1) published a systematic review of randomized controlled trials (RCTs) testing intravenous immunoglobulin (IvIg) treatment of unexplained recurrent miscarriage (RM). They concluded that IvIg was beneficial neither in patients with primary nor secondary RM.

A significant limitation of the conclusions is that only 6 of a total of 8 relevant RCTs were included in the review comprising 272 patients. Two trials from our group (2,3) comprising 92 patients were excluded since, as stated in the article, “they also recruited women with antiphospholipid antibodies, and RM was defined as pregnancy loss before 28 weeks’ and 26 weeks’ gestation.” Read the rest of this entry »

Re: The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta – analysis.

2 09 2009

To the Editor:

We read the article by Tsoumpou et al. (1) with interest and commend the authors’ attempt to address this topical issue. The decision on what to do with regard to endometriomas in women having IVF remains an everyday challenge. The authors have done well to summarize the available data addressing this issue. Read the rest of this entry »