- Email: [email protected]
The sharp end of medical practice: the use of acupuncture in obstetrics and gynecology
CORRESPONDENCE 1419
relativism, many physicians both in the USA and Europe lost much of their critical sense and came under the influence of the Chinese propaganda. The heterogeneity of acupuncture textbooks, the absence of scientific data and, a fortiori, the impossibility to integrate or at the least reconcile the theory of acupuncture with our knowledge of anatomy, physiology and pathology should have prevented this development. Unfortunately, this was not the case and research into the effectiveness of acupuncture started. An unanswered question is if such research is justified. It will not be simple to dispel the a priori scepticism, not even by properly randomised investigations. Who would, for instance, seriously consider an announcement by NASA that, from analysis of electromagnetic radiation from Saturn, it appears that this heavenly body is made of cheese? As Skrabanek2 convincingly argued, randomised trials of absurb statements are more likely to mislead than to illuminate, because extraordinary claims require extraordinary evidence. In this respect, the interpretation of unlikely results of scientific research does not differ from the Bayesian appraisal of findings that are certain, judged from strong empirical knowledge in clinical practice3. In our view, Ewies and Olah present insufficient data to justify further research into acupuncture. The single acceptable trial with a positive result (correction of the breech position by moxa burnings adjacent to both little toes) has not been confirmed. The suggested physiological explanation for the effect seems is speculative. The WHO sees undeniable evidence ‘‘for the integration of acupuncture with conventional medicine’’, but this is not convincing. This bold statement is not based on a wellfounded scientific analysis. The fact that the WHO considers diseases such bacillary dysentery, paresis following stroke and sequelae of poliomyelitis as indications for acupuncture treatment is revealing. It is also of note that the anonymous author of the paper in the WHO chronicle of 1980 emphasised that the list of indications was not based on controlled clinical trials, but merely on ‘clinical experience’4. We conclude that one certainly should keep an open mind in scientific research, but we should also keep in mind Kurtz’s statement that, if one fails to demarcate scientific questions from obvious absurdities, one’s open mind will change into an open sink5. Research of the effectiveness of acupuncture is wasted energy.
the more important is the question, how to advise patients about complementary medicine and how to evaluate its effects. Since negative prejudice is common, scientific evaluation of acupuncture is demanded. The aim of our department is to evaluate the clinical, biochemical and morphological effects of acupuncture in the field of obstetrics. Acupuncture has recently enjoyed a rapidly increasing popularity in Austria as a complementary treatment in prenatal care. We found a positive effect of acupuncture starting four weeks before term on the duration of labour by shortening the first stage1. This was associated with significantly elevated serum levels of PGE22. Acupuncture significantly reduced the need for oxytocin. Ultrasound examination revealed significant shorter cervical length after acupuncture at term, compared with controls. Acupuncture reduces the time interval between the estimated date of confinement and the actual date of delivery3. In a recent trial, we found that acupuncture favourably influences umbilical artery waveforms in uncomplicated pregnant women at term4. In our opinion, acupuncture does not mean the ‘sharp end of medical practice’; on the contrary, acupuncture in obstetrics is drug-free, clinically effective and cost-effective.
References 1. Zeisler H, Tempfer C, Mayerhofer K, Barrada M, Husslein P. Influence of acupuncture on duration of labor. Gynecol Obstet Invest 1998;46(1): 22 – 25. 2. Zeisler H, Rabl M, Joura EA, Husslein P. Prenatal acupuncture and serum prostaglandin E2 Levels during the first stage of labor. Geburtsh Frauenheilk 2000;60:638 – 640. 3. Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P. Acupuncture for cervical ripening and induction of labor at term — a randomized controlled trial. Wien Klin Wochenschr 2001;113(23 – 24):942 – 946. 4. Zeisler H, Eppel W, Husslein P, Bernaschek G, Deutinger J. Influence of acupuncture on Doppler ultrasound in pregnant women. Ultrasound Obstet Gynecol 2001;17(3):229 – 232.
Harald Zeisler & Peter Husslein Department of Obstetrics and Gynecology, University of Vienna, General Hospital Vienna, Austria
References PII: S 1 4 7 0 - 0 3 2 8 ( 0 2 ) 0 2 8 0 7 - 0 1. Skrabanek P. Acupuncture and the age of unreason. Lancet 1984;i:1169 – 1171. 2. Skrabanek P. Demarcation of the absurd. Lancet 1986;i:960 – 961. 3. Vandenbroucke JP, Craen AJM de. Alternative Medicine: a ‘‘mirror image’’ for scientific reasoning in conventional medicine. Ann Intern Med 2001;135:507 – 513. 4. Anonymous. Use of acupuncture in modern health care. WHO Chron 1980;34:294 – 301. 5. Kurtz P. Debunking, neutrality and skepticism in science. Skeptical Inq 1984;8:239 – 246.
C. N. M. Renckens Department of Obstetrics and Gynaecology, Westfries Gashuis, The Netherlands PII: S 1 4 7 0 - 0 3 2 8 ( 0 2 ) 0 2 8 0 6 - 9
Sir, Acupuncture has become more accessible and acceptable for many pregnant women. The more women choose this alternative, D RCOG 2002 Br J Obstet Gynaecol 109, pp. 1416 – 1430
The ORACLE I and II randomised trial results do not remove the need for prophylaxis against early onset Group B streptococcal disease Sir, On behalf of the Public Health Laboratory Service Group B Streptococcus Working Group, we consider it is important to point out that the findings of the well conducted ORACLE trials1,2 should not be extrapolated to the prevention of early onset Group B streptococcal infection with high dose intrapartum antibiotics (usually benzylpenicillin). In the ORACLE trials, neonatal outcome was not improved by oral co-amoxiclav or erythromycin, given in combination or separately, in spontaneous preterm labour without evidence of clinical infection. In preterm, prelabour rupture of membranes, a range of neonatal health benefits was found, but only for erythromycin given alone. Prevention of early onset Group B streptococcal sepsis requires high dose intravenous antibiotics rather than the low dose oral agents used in the ORACLE trials. These researchers examined a
relativism, many physicians both in the USA and Europe lost much of their critical sense and came under the influence of the Chinese propaganda. The heterogeneity of acupuncture textbooks, the absence of scientific data and, a fortiori, the impossibility to integrate or at the least reconcile the theory of acupuncture with our knowledge of anatomy, physiology and pathology should have prevented this development. Unfortunately, this was not the case and research into the effectiveness of acupuncture started. An unanswered question is if such research is justified. It will not be simple to dispel the a priori scepticism, not even by properly randomised investigations. Who would, for instance, seriously consider an announcement by NASA that, from analysis of electromagnetic radiation from Saturn, it appears that this heavenly body is made of cheese? As Skrabanek2 convincingly argued, randomised trials of absurb statements are more likely to mislead than to illuminate, because extraordinary claims require extraordinary evidence. In this respect, the interpretation of unlikely results of scientific research does not differ from the Bayesian appraisal of findings that are certain, judged from strong empirical knowledge in clinical practice3. In our view, Ewies and Olah present insufficient data to justify further research into acupuncture. The single acceptable trial with a positive result (correction of the breech position by moxa burnings adjacent to both little toes) has not been confirmed. The suggested physiological explanation for the effect seems is speculative. The WHO sees undeniable evidence ‘‘for the integration of acupuncture with conventional medicine’’, but this is not convincing. This bold statement is not based on a wellfounded scientific analysis. The fact that the WHO considers diseases such bacillary dysentery, paresis following stroke and sequelae of poliomyelitis as indications for acupuncture treatment is revealing. It is also of note that the anonymous author of the paper in the WHO chronicle of 1980 emphasised that the list of indications was not based on controlled clinical trials, but merely on ‘clinical experience’4. We conclude that one certainly should keep an open mind in scientific research, but we should also keep in mind Kurtz’s statement that, if one fails to demarcate scientific questions from obvious absurdities, one’s open mind will change into an open sink5. Research of the effectiveness of acupuncture is wasted energy.
the more important is the question, how to advise patients about complementary medicine and how to evaluate its effects. Since negative prejudice is common, scientific evaluation of acupuncture is demanded. The aim of our department is to evaluate the clinical, biochemical and morphological effects of acupuncture in the field of obstetrics. Acupuncture has recently enjoyed a rapidly increasing popularity in Austria as a complementary treatment in prenatal care. We found a positive effect of acupuncture starting four weeks before term on the duration of labour by shortening the first stage1. This was associated with significantly elevated serum levels of PGE22. Acupuncture significantly reduced the need for oxytocin. Ultrasound examination revealed significant shorter cervical length after acupuncture at term, compared with controls. Acupuncture reduces the time interval between the estimated date of confinement and the actual date of delivery3. In a recent trial, we found that acupuncture favourably influences umbilical artery waveforms in uncomplicated pregnant women at term4. In our opinion, acupuncture does not mean the ‘sharp end of medical practice’; on the contrary, acupuncture in obstetrics is drug-free, clinically effective and cost-effective.
References 1. Zeisler H, Tempfer C, Mayerhofer K, Barrada M, Husslein P. Influence of acupuncture on duration of labor. Gynecol Obstet Invest 1998;46(1): 22 – 25. 2. Zeisler H, Rabl M, Joura EA, Husslein P. Prenatal acupuncture and serum prostaglandin E2 Levels during the first stage of labor. Geburtsh Frauenheilk 2000;60:638 – 640. 3. Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P. Acupuncture for cervical ripening and induction of labor at term — a randomized controlled trial. Wien Klin Wochenschr 2001;113(23 – 24):942 – 946. 4. Zeisler H, Eppel W, Husslein P, Bernaschek G, Deutinger J. Influence of acupuncture on Doppler ultrasound in pregnant women. Ultrasound Obstet Gynecol 2001;17(3):229 – 232.
Harald Zeisler & Peter Husslein Department of Obstetrics and Gynecology, University of Vienna, General Hospital Vienna, Austria
References PII: S 1 4 7 0 - 0 3 2 8 ( 0 2 ) 0 2 8 0 7 - 0 1. Skrabanek P. Acupuncture and the age of unreason. Lancet 1984;i:1169 – 1171. 2. Skrabanek P. Demarcation of the absurd. Lancet 1986;i:960 – 961. 3. Vandenbroucke JP, Craen AJM de. Alternative Medicine: a ‘‘mirror image’’ for scientific reasoning in conventional medicine. Ann Intern Med 2001;135:507 – 513. 4. Anonymous. Use of acupuncture in modern health care. WHO Chron 1980;34:294 – 301. 5. Kurtz P. Debunking, neutrality and skepticism in science. Skeptical Inq 1984;8:239 – 246.
C. N. M. Renckens Department of Obstetrics and Gynaecology, Westfries Gashuis, The Netherlands PII: S 1 4 7 0 - 0 3 2 8 ( 0 2 ) 0 2 8 0 6 - 9
Sir, Acupuncture has become more accessible and acceptable for many pregnant women. The more women choose this alternative, D RCOG 2002 Br J Obstet Gynaecol 109, pp. 1416 – 1430
The ORACLE I and II randomised trial results do not remove the need for prophylaxis against early onset Group B streptococcal disease Sir, On behalf of the Public Health Laboratory Service Group B Streptococcus Working Group, we consider it is important to point out that the findings of the well conducted ORACLE trials1,2 should not be extrapolated to the prevention of early onset Group B streptococcal infection with high dose intrapartum antibiotics (usually benzylpenicillin). In the ORACLE trials, neonatal outcome was not improved by oral co-amoxiclav or erythromycin, given in combination or separately, in spontaneous preterm labour without evidence of clinical infection. In preterm, prelabour rupture of membranes, a range of neonatal health benefits was found, but only for erythromycin given alone. Prevention of early onset Group B streptococcal sepsis requires high dose intravenous antibiotics rather than the low dose oral agents used in the ORACLE trials. These researchers examined a