A letter to the editor of the British Journal of General Practice (The official periodical of the Royal College of General Practice and leading journal for family medicine in Europe):
Dear Professor Roger Jones,
Last month’s BJGP was noteworthy for several reasons. Most strikingly was the beautiful redesign and compelling headline, “Acupuncture: effective in a randomized trial for patients with unexplained symptoms”. Fantastic, I thought – groundbreaking research! So, it was with much anticipation that I removed the last shreds of cellophane to delve into your esteemed tome.
Sadly, it was wholly disappointing and somewhat incensing to read the actual acupuncture research. Heralded by you as “positive results” from a “randomized controlled trial” revealing “significant and sustained benefit [for patients] who frequently attend [GP clinics] with medically unexplained symptoms”. I fear these comments were more than liberal with the truth…
As a medically trained doctor who now works in education, part of my remit is to teach the scientific method to 16 and 17 year olds. I dare say that the methodological flaws present in the acupuncture trials would have been obvious even to them. The research used a very poorly defined patient group (‘medically unexplained symptoms’), had numerous patient selection biases and had failed to use a true placebo. This only scratches the surface; an internet search for ‘acupuncture BJGP’ will present you numerous articles that report the articles’ failings in great depth.
In an age where peer-reviewed journals are coming under increasing scrutiny, I do not envy your position. In part I can sympathise with the pressures of being a periodical editor having recently undertaken the role of editing a popular science magazine myself. However, your periodical has a very unique audience: Time-harassed GPs seeking the best evidence-based practice; many of whom will barely have the time to read past the editorial and abstracts. The high quality reader-friendly redesign is definitely a step forward, but it is imperative that content is to the same standard.
So it was with much surprise upon receiving this month’s (July) edition of BGJP to find no mention of the controversial acupuncture trials in either the letters section or the editorial. In all humility I strongly urge you to reconsider your unequivocal praise for this research. At the very least, please engage in discussion with your readers about the merits/failings of this research. June’s edition of the BJGP has been ridiculed as ‘Tabloid Medical Journalism’; for the sake of the profession’s reputation and, most importantly patient welfare, take action now and set the record straight.
Letter sent 2nd July 2011, a response is eagerly anticipated! (Links, images and emphases added to blog post)
The British Journal of General Practice has a readership of over 42,000 practitioners and is distributed free of charge to all UK GPs. Sadly, only the current issue is available for free download to the general public (at rcgp.org.uk)
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Reference to the said paper:
Paterson, C., Taylor, R., Griffiths, P., Britten, N., Rugg, S., Bridges, J., McCallum, B., & Kite, G. (2011). Acupuncture for ‘frequent attenders’ with medically unexplained symptoms: a randomised controlled trial (CACTUS study) British Journal of General Practice, 61 (587) : 10.3399/bjgp11X572689
4 responses to “Dear Mr Editor, Your Science Reporting Truly Sucks…”
I’m certainly in agreement without you here. To be fair, I think the deadlines for the journal may well mean that getting it in the next issue wasn’t feasible. I’d be very surprised and disappointed if it wasn’t in next month though.
Good point – I hadn’t considered deadlines in terms of letters – thanks for that (it will make me calm down a bit).
When I first read the article, I nearly tore it up in a rage (I reconsidered and thought it was such an exceptionally bad piece of ‘tabloid journalism’ that it was actually worth treasuring).
I was going to blog on it, then discovered that you had covered all the bases with your piece (hurrah to you!!)
I have no major issue with acupuncture, and have a very good friend who has gained huge benefit from it where conventional medicine has failed. However, such frankly irresponsible over-exaggeration of a study (it barely qualifies as ‘randomised controlled trial’), as in this case warrants a certain amount of feet stamping…
Cheers for commenting 🙂 (I’m going to have a cup of tea)
Good points were made in this blog post. I have also personally seen both benefits and no effects as results of acupuncture treatment. A possible mechanism for this type of over-exaggeration of benefits is that this type of result is welcomed more often than not, thus markedly increasing (and reflecting) the interest in certain interventions. Consequently, the pressure exists to do these types of studies, and many clinicians are striving to increase patient compliance with treatments, as patients are willing to comply with some treatments much more than others.
Thanks for commenting!
I agree. The only thing that this study really showed was that some kind of intervention (in this case acupuncture) was better than nothing. Hardly surprising really. A better study would have been to have used sham acupuncture and a comparison with other ‘complimentary’ techniques.
And yes, a negative result is far less likely to get published or attract any attention (but are just as important).