Article type
Year
Abstract
Background: Empirical evidencesuggests that systematic review authors should exercise cautionconcerning the validity of Chinese-published randomized controlled trials (RCTs).
Objectives: To identify problems and propose solutions for issues in current research in traditional Chinese medicine (TCM), by conducting a systematic review of acupuncture for essential hypertension as a workedexample.
Methods: RCTs in acupuncture treatment for essential hypertension wereidentified in a systematicliterature search. We assessed the quality of included trials focussing on issues such as randomization methods, blinding, follow-up, and dropout rates.
Results: Study design and data from some trials conducted in China werefound to be susceptible to placebo effect, and expectation bias. The short-term antihypertensive effect of acupuncture was found to be similar tometoprolol. No long-term effects were reported in relation to acupuncture.Trial designsfrom countries other than China were found to be rigorous, with reliable quality and data. Thereported short-term antihypertensive effect was consistent in both Chinese and non-Chinese studies, but the rates of blood pressure elevation were inconsistent. We suggest that findings from Chinese studies may be influenced by reporting bias because of societal and cultural beliefs about acupuncture, and that the true long-term efficacy of acupuncture for essential hypertension has yet to be confirmed.
Conclusions: Reviewers and editors should aim to verify authenticity of Chinese-published RCTs; as well as the herbs used and their formulations, and differences in acupuncture prescriptions.It is neither possible nore feasible to synthesize TCM as simply Chinese medicine or acupuncture. A current priority is to carry out high-quality research to produce original evidence, rather than focussing on systematic reviews of literature that may lack rigour.
Objectives: To identify problems and propose solutions for issues in current research in traditional Chinese medicine (TCM), by conducting a systematic review of acupuncture for essential hypertension as a workedexample.
Methods: RCTs in acupuncture treatment for essential hypertension wereidentified in a systematicliterature search. We assessed the quality of included trials focussing on issues such as randomization methods, blinding, follow-up, and dropout rates.
Results: Study design and data from some trials conducted in China werefound to be susceptible to placebo effect, and expectation bias. The short-term antihypertensive effect of acupuncture was found to be similar tometoprolol. No long-term effects were reported in relation to acupuncture.Trial designsfrom countries other than China were found to be rigorous, with reliable quality and data. Thereported short-term antihypertensive effect was consistent in both Chinese and non-Chinese studies, but the rates of blood pressure elevation were inconsistent. We suggest that findings from Chinese studies may be influenced by reporting bias because of societal and cultural beliefs about acupuncture, and that the true long-term efficacy of acupuncture for essential hypertension has yet to be confirmed.
Conclusions: Reviewers and editors should aim to verify authenticity of Chinese-published RCTs; as well as the herbs used and their formulations, and differences in acupuncture prescriptions.It is neither possible nore feasible to synthesize TCM as simply Chinese medicine or acupuncture. A current priority is to carry out high-quality research to produce original evidence, rather than focussing on systematic reviews of literature that may lack rigour.