Schnyer2000

A Randomized Control Trial of Acupuncture in The Treatment of Depression:
How to Bridge the Gap between Flexibility of Treatment and Standardization.
Rosa N. Schnyer, L.Ac. University of Arizona
One of the main challenges when designing acupuncture research studies is finding a way for staying true to the fundamental principles of Chinese medicine, while at the same time holding the projects to the highest standards of treatment research. Acupuncture is not a heterogeneous discipline and therefore, there is not a universal standard of acupuncture treatment care. If one is to draw from the rich diversity of the profession, it is often impossible to extract from the academic literature one established protocol to treat a specific condition, or to get a representative treatment approach by consulting just one practitioner. Established research methods aim at controlling all variables and rely on treatment standardization to minimize the effects of bias, chance variation, and confounding, and to assure replicability. Acupuncture does not aim at treating biomedically defined diseases and in fact, it is based on a sound theoretical framework of its own, that aims at including all possible variables to understand diverse clinical presentations in order to provide individualized treatment. Although, much controversy remains on the use of RCT’s in acupuncture clinical trials, RCT’s are still considered the gold-standard for investigating treatment efficacy, and are the expected The question arises then, is it possible to use research strategies developed in a biomedical context to investigate a medical system that is based on another world view? How do we determine treatment efficacy while maintaining fidelity of treatment? How do we address the question of blinding and “tease apart” the placebo response? It is inappropriate to conduct acupuncture treatment research by depriving the discipline of its greatest strengths: differential diagnosis and individualized treatment, yet the idea of individualized treatment seems to conflict with a standardized treatment approach. It is feasible, however, to deliver replicable, and standardized treatments that are tailored to the individual. By developing a treatment manual that promotes the systematic articulation of the theoretical framework (s) chosen, it is possible to attain standardization and maintain replicability, while at the same time allowing for individualized treatment. In collaboration with Dr. John Allen at the University of Arizona, and Dr. Rachel Manber at Stanford University, we have conducted several clinical trails using a manual based treatment approach to acupuncture, while investigating the issues of blinding, placebo, and expectations. We are currently conducting a full-scale clinical trial to investigate the efficacy of acupuncture in the treatment of depression in men and women ages 18-65 (U of A); a study to investigate acupuncture as a treatment for depression during pregnancy, and a study to look at the comparative efficacy of acupuncture and paxil in the acute and continuation treatment of depression (Stanford). The design, methods and results will be presented of a preliminary RCT to determine the efficacy of acupuncture in the treatment of unipolar depression in women ages 18-45 (funded in 1992 by the former Office of Alternative Medicine of the NIH --

Source: http://www.acupunctureresearch.org.uk/papers/Schnyer2000.pdf