Delphi and Acupuncture

The Delphi method is a way to develop a consensus when there is uncertainly as to the best option.

A panel of experts is given a problem to which there is no clear answer. They respond, and those responses are sent back for review. Everyone considers the responses and reply again.  Rinse, lather, repeat until a consensus is reached.

How to treat latent tuberculosis in patients exposed to resistant strains? No good data, and the Delphi method can be used to try and determine the best expert opinion. Kind of.

There is no need to apply the Delphi method to well established interventions. There is no need for a consensus when the treatment is known. Everyone knows how best to treat latent TB after exposure to susceptible strains.

Acupuncture treatment was originally based on the fictional tongue and pulse diagnosis of Traditional Chinese Pseudo-Medicine, an understanding of disease divorced from anatomy and physiology. TCPM has all the validity of astrology. Acupuncture has since been mapped to modern medicine, akin to using astrology to guide the Hubble.

When you look at the individual studies of acupuncture in meta-analyses, you find there are rarely, if ever, two similar styles in the review. They are always comparing a wide range of fruits and vegetables rather than apples to apples.

Despite its antiquity and widespread use, acupuncture is not standardized. Acupuncturists make it up as they go along, or, it is individualized as the pseudo-medical world prefers it.

Amusingly, they have used the Delphi Method for a variety of real diseases for which they want to use acupuncture, because

The variability of published acupuncture protocols for patients… complicates the interpretation of data and hinders our understanding of acupuncture's impact.

No, it doesn't. It helps to clarify that acupuncture is at best a placebo. But acupuncturists are unable to recognize this.

While described for in vivo fertilization, the following applies to any use of acupuncture.

The treatment protocols used in many of the studies examining the use of acupuncture as an adjunct to embryo transfer (ET) vary between the acupuncture points selected, the frequency and duration of treatment, mode of stimulation, depth of needle insertion, and the role of co-interventions. This may be influenced by the different styles or traditions of acupuncture including traditional and classical acupuncture, auricular acupuncture, trigger point acupuncture, and single point acupuncture.

So they have tried to make up for its lack standardization by using the Delphi method for stress and vascular tone in women undergoing in-vitro fertilization, phantom limb pain, hot flashes, and tennis elbow among others.

Even then it was hard to get agreement. In the in-vivo fertilization Delphi method

80% agreement that TCM (n = 15), classical acupuncture (n = 12), and auricular acupuncture (n = 13) were suitable for our clinical trial. Fourteen of the 16 responders agreed that the protocol should be semi-standardised, incorporating some fixed treatment components and some individualisation. Seven responders expressed a first preference for the first treatment to be administered on day 8 of the ART cycle (around the time of scan and bloods), five expressed a second preference for day 3 (start of stimulation), and seven expressed a third preference for day 12 (trigger injection)

and only 80% could agree on the acupoints to be used.

And that was the basis for a clinical trial.

Eye roll

As I keep harping on, there is no monolithic acupuncture. There are innumerable acupunctures. But what do they all have in common?  No efficacy.

Points of Interest 04/11/2017
Points of Interest 04/10/2017