Michal R. Pijak, MD
Potential Financial Conflicts of Interest: None disclosed.
Pijak M.; Acupuncture and Knee Osteoarthritis. Ann Intern Med. 2007;146:147. doi: 10.7326/0003-4819-146-2-200701160-00012
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Published: Ann Intern Med. 2007;146(2):147.
TO THE EDITOR:
Scharf and colleagues (1) reported that the addition of traditional Chinese acupuncture (TCA) was superior to conservative therapy but not to sham acupuncture for osteoarthritis of the knee. They suggest that “because complete blinding was impossible, this study does not allow us to determine whether the observed effectiveness of TCA and sham acupuncture was due to placebo effects, intensity of provider contact, or a physiologic effect of needling.” However, 2 related points need to be emphasized.
First, either placebo effects or “time effects” might have led to an overestimation of the differences between blinded and unblinded groups coupled with the narrowing of the discernable difference between real and sham acupuncture. For example, participants receiving real or sham acupuncture might experience a stronger placebo effect. Conversely, those receiving only conservative therapy might report worse results because of reduced patient–provider interaction (“ritual of treatment”) and their awareness that they were not given additional treatment.
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