Integrative medicine questioned

Concerning the October 2017 ACP Internist article “Integrative medicine makes gains in back pain,” I was surprised at the suggested support that the article, as well as ACP's clinical practice guidelines, gave to acupuncture for low back pain. In my 50+ years of internal medicine practice, having seen countless patients with low back pain, I would venture the belief that both “tincture of time” and acupuncture would be equally effective for many patients. The former is reasonable and free, but the latter is a placebo that can be expensive.

In a recent communication in the Oct. 17, 2017, JAMA, Josephine P. Briggs, MD, director emeritus of the National Center for Complementary and Integrative Health at the National Institutes of Health, and David Shurtleff, PhD, its acting director, stated, “Nonspecific factors, including the effects of application of localized irritants and the effects of the patient-clinician interaction such as conditioning, positive patient expectations, and reduced patient vigilance, appear to account for much of the therapeutic benefits associated with acupuncture treatment.”

Medically unsophisticated patients, as well as some physicians, are unable to appreciate the value, or lack thereof, of placebo treatments and rely on respected medical pronouncements for help in this area. Supporting information with acknowledgment of the failings of such a controversial form of therapy should be provided lest it proves costly to our patients and results in loss of respect for our publications.

Carl E. Bartecchi, MD, MACP
Pueblo, Colo.