The Cochrane reviews. They give me pause. I understand the need and utility of systematic reviews and meta-analysis. They can give a nice overview of a topic and suggest the utility or lack thereof of a given therapy. But they are not always definitive and suffer from the problem of GIGO: garbage in garbage out.
GIGO is especially pertinent when the methodologies of systematic reviews are applied to pseudo-medical interventions.
My colleagues and I at Science-Based Medicine have written extensively about acupuncture (we have collected many of the essays in book form
The summary of acupuncture: it is not based in reality (there are no meridians or acupoints) and well designed clinical trials suggest the acupuncture only works for subjective endpoints if the patient thinks they are getting acupuncture and believe it to be effective. It does not matter where needles are placed or even if needles are used at all.
But that never stops the Cochrane collaborative, who will run anything and everything through their grinder to produce a meta-analysis sausage. Unfortunately, unlike sausage, I often know what goes into the meta-analysis.
Acupuncuture is the
We included all types of acupuncture practices, such as needle acupuncture, electroacupuncture, laser acupuncture, pharmacoacupuncture, non-penetrating acupuncture point stimulation (e.g. acupressure and magnets) and moxibustion. Acupuncture could be compared with control (no treatment or placebo) or another standard non-surgical intervention.
Acupuncture, as is often the case, is anything they want it to be. Talk about your "heterogeneous group of acupuncture and quasi-acupuncture." And, what a surprise, they did not find any evidence that acupuncture was effective for acute ankle sprain:
The currently available evidence from a very heterogeneous group of randomized and quasi-randomised controlled trials evaluating the effects of acupuncture for the treatment of acute ankle sprains does not provide reliable support for either the effectiveness or safety of acupuncture treatments, alone or in combination with other non-surgical interventions; or in comparison with other non-surgical interventions.
An application of reality, especially when seen through the lens of the information provided by high quality prior studies of acupuncture, would suggest the following suggestion would be a waste of time and money:
Future rigorous randomised clinical trials with larger sample sizes will be necessary to establish robust clinical evidence concerning the effectiveness and safety of acupuncture treatment for acute ankle sprains.
But for some reason the Cochrane group always suggests more studies. At least they did not suggest that it may be worthwhile for ankle sprain patients to test on an individual basis whether therapeutic acupuncture is beneficial for them.
They can only be that lunkheaded once. I hope.