Claire Cassidy (USA)

Acupuncture is often characterised as an energy medicine because of its emphasis on the flow of qi. Is acupuncture actually practised that way - dynamic, emergent, active? Or is it formulaic? Data from my Acuperceptions Project, in-depth interviews with US professional acupuncture practitioners, shows that they do behave as if flow of energy were their guiding principle. This yields a medical practice distinct from biomedicine. The value of qualitative research is emphasised because the finding that acupuncture practice is complex and emergent suggests reasons why RCT sham trials have yielded puzzling results that practitioners say don't mesh with their experience or capabilities.

Sarah Fogarty (AUS)
Understanding eating disorders from traditional Chinese medicine

Aim:

1. To identify the TCM patterns of disharmony relevant to eating disorders.

2. To determine any significant differences in TCM presentation between eating disorders.
 

Four types of eating disorders (ED) are considered in this study:

•    binge eating disorder (BED)

•    bulimia nervosa (BN)

•    anorexia nervosa (AN)

•    eating disorder not otherwise specified (EDNOS)

A survey was administered to 196 sufferers of EDs to collect data on their current signs and symptoms, general health, ED history and demographic characteristics.

TCM patterns of disharmony relevant to EDs were identified from the literature and scored for severity in each individual. Results will be presented on the prevalence of different patterns in different EDs, and on how well the literature patterns related to what was seen in practice.

Morag Heirs (UK)
Systematic reviews and their contribution to knowledge

We will consider the basic principles of systematic review (SR) methodology and the particular strengths or weaknesses of this approach. SRs are often seen as inextricably linked with randomised controlled trials, and dismissed as unable to provide useful and relevant pictures of a varied evidence base. We will challenge these assumptions and explore how the SR approach can be used more generally with non-randomised studies, observational data, and qualitative research among other areas.

Dr Charlotte Paterson (UK)
CACTUS study: Classical acupuncture for treating unexplained symptoms

This study evaluated the use of classical five element acupuncture to treat people who consult their GPs frequently with ‘medically unexplained physical symptoms’. We will present the results of a trial with a ‘waiting-list’ design, whereby 80 patients were randomised to receive up to 12 sessions of acupuncture either immediately or after waiting six months. The evaluation includes self-report outcome questionnaires, GP consultation rates, interviews with 20 patients and a focus group with the acupuncture practitioners.
 

Patricia Ronan / Dominic Harbinson (UK)
Acupuncture for Schizophrenia: Research Challenges and Initial Results

The possibility of using acupuncture to treat schizophrenia has never been researched in the UK or Europe. Studies from China and the USA indicate that there are strong possibilities that this might be a successful treatment as an adjunct to antipsychotic medication or by itself. However, the studies that exist raise many questions, primarily in terms of acceptability amongst patients and professionals, but also in terms of how best to investigate the effect of such a complex intervention as acupuncture on such a complex condition as schizophrenia.
 

Here the challenges in designing a study that goes some way to addressing some of the questions about whether and how acupuncture might help in the treatment are discussed, including methodology, financing, ethical issues and recruitment of participants. There will be some discussion of the utility of a case study approach over and above a larger scale or quantitative study. First results will be discussed, with some reflections on the progress of the study so far and the response of mental health patients and professionals to their inclusion in the study.

Volker Scheid (UK)
Knowing illness and treating disease: East Asian medical perspectives

All physicians face the same problem: how to relate that which they see/hear/feel in their patients (concrete sense data) to what they think is wrong with them (an epistemology), and then how to translate their knowledge back into action (medical practice). Physicians belonging to the wider Chinese medical tradition have extensively debated this issue and come to very different conclusions. In this talk I will present various perspectives from late imperial and modern China and Japan. My goal is to show the wide spectrum of competing views, give some idea of the wider intellectual and cultural background to these debates, and relate them to concrete questions in contemporary research on acupuncture and Chinese medicine.

Sylvia Schroer (UK)
Acupuncture for Depression

Acupuncture for depression: a critique of the evidence base, and suggestions for future evaluations Depression is a chronic episodic illness that places a huge burden on individuals and society. In the current context of evidence based medicine, service commissioners and patients have, increasingly, come to rely on evidence to make care choices. This critique of the evidence base suggests that uncertainty remains about the value of acupuncture care, as it is routinely practiced in the West, for
treating depression, and this uncertainty has not been resolved by trials to date. Suggestions are put forward about designing acupuncture trials that are methodologically rigorous but have better 'model validity', where the treatment that is evaluated more closely resembles routine clinical practice. Recommendations are that studies should be exploring outcomes that are expected and hoped for by practitioners and their patients, and that could, potentially, be of more benefit to society from an economic perspective than evaluations of acupuncture care that is primarily geared up for short term amelioration of illness.

Kate Thomas (UK)
The long road to influencing evidence-based NHS decision-making; what can we learn from the low back pain story?

Last year saw the publication of the UK NICE guidelines (CG88) on the treatment of uncomplicated low back pain, in which acupuncture was recommended as a treatment option for the first time for NHS patients.

NICE (National Institute for Health and Clinical Excellence) guidelines shape NHS policy regarding drugs and services in areas where there is some uncertainty regarding best clinical practice. Low back pain is a common condition for which there are a wide range of interventions. At least 13 separate Cochrane reviews exist for different treatments.

Kate asks: What was the evidence that allowed NICE to come to its recommendation regarding acupuncture and how was this evidence generated? What was the process by which the evidence was reviewed and the guidelines produced, and what can this tell us about the evidence needed in the future? Finally, guidelines are only a start - what are the likely obstacles to the recommendations being adopted in practice?