ArticlePDF Available

The Contribution of Acupuncture and Moxibustion to Healthcare: an Evidence-based Approach


Abstract and Figures

Patients deserve the “best of both worlds” when it comes to their healthcare. Ideally healthcare blends the best of both worlds by combining healthcare options from the perspective of both Western and complementary medicine. The synergy between modern medicine and complementary health care, and the value of blending these disciplines, has been the focus of this thesis. The aim was to identify the strengths and limitations of acupuncture and moxibustion, as described in Traditional Chinese Medicine, and evaluate how these therapies can be implemented in modern medicine, taking the perspective of patients, physicians, complementary therapists, health insurers, and healthcare policymakers. The thesis consists of three parts. Part one, the general approach, introduces the use of acupuncture in a general practice. The observational study presents the health-related quality of life in patients with musculoskeletal complaints in a general acupuncture practice. The aim of this pragmatic study was to gain insight into whether the HRQoL of patients undergoing routine acupuncture treatment for musculoskeletal complaints differs with that in a Dutch population sample; and to investigate changes in HRQoL during the course of acupuncture treatment. In the second part we discuss also using TCM in the diagnosing of patients with complex regional pain syndrome type 1. The pilot study reports a different TCM-approach to diagnose the patient with CRPS1, by questioning the menstrual cycle conform TCM, which might eventually lead to a new treatment approach. The topic of the third part of the thesis is breech presentation. Described is the development and tracking of nonvertex position (mainly breech position) throughout pregnancy and the prognostic value of ultrasound in predicting nonvertex presentation at delivery in the Generation R study. The aim was to get better information about the natural history of the position of the fetus that leads to breech at delivery. In addition, systematic review and meta-analysis of the existing literature about (randomized) controlled trials on the acupuncture-type interventions on Zhiyin (BL 67) was performed, to elicit a version of a fetus in breech position, including a letter about the same topic. Finally, the results of the modeling approach of a decision analysis and cost analysis of breech version by acumoxa offered to women with a breech fetus at 33 weeks of gestation are reported. In this modeling approach, with sensitivity analysis, also the selective use of a) Moxa, b) the manipulation using external cephalic version, and c) home-births was considered.
Content may be subject to copyright.
A preview of the PDF is not available
... Hopton and McPherson [7] conclude on the basis of a systematic review of pooled data from meta-analyses that acupuncture is more than a placebo for commonly occurring chronic pain conditions. In addition, in her thesis, van den Berg [8] recently demonstrated positive effects of acupuncture on obstetric health problems (breech presentation). Also, Servan-Schreiber [9] presents a series of recent examples of the transition from CAM to conventional medicine in depression treatment. ...
Full-text available
Background: Health economists have largely ignored complementary and alternative medicine (CAM) as an area of research, although both clinical experiences and several empirical studies suggest cost-effectiveness of CAM. Objective: To explore the cost-effectiveness of CAM compared with conventional medicine. Methods: A dataset from a Dutch health insurer was used containing quarterly information on healthcare costs (care by general practitioner (GP), hospital care, pharmaceutical care, and paramedic care), dates of birth and death, gender and 6-digit postcode of all approximately 150,000 insurees, for the years 2006-2009. Data from 1913 conventional GPs were compared with data from 79 GPs with additional CAM training in acupuncture (25), homeopathy (28), and anthroposophic medicine (26). Results: Patients whose GP has additional CAM training have 0-30% lower healthcare costs and mortality rates, depending on age groups and type of CAM. The lower costs result from fewer hospital stays and fewer prescription drugs. Discussion: Since the differences are obtained while controlling for confounders including neighborhood specific fixed effects at a highly detailed level, the lower costs and longer lives are unlikely to be related to differences in socioeconomic status. Possible explanations include selection (e.g. people with a low taste for medical interventions might be more likely to choose CAM) and better practices (e.g. less overtreatment, more focus on preventive and curative health promotion) by GPs with knowledge of complementary medicine. More controlled studies (replication studies, research based on more comprehensive data, cost-effectiveness studies on CAM for specific diagnostic categories) are indicated.
Background: The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). Methods: The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. Findings: The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with "trial flow", study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. Interpretation: We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
Background: Low back pain limits activity and is the second most frequent reason for physicians visits. Previous research shows widespread use of acupuncture for low back pain. Purpose: To assess acupuncture's effectiveness for treating low back pain. Data Sources: Randomized, controlled trials were identified through searches of MEDLINE, Cochrane Central, EMBASE, AMED, CINAHL, CISCOM, and GERA databases through August 2004. Additional data sources included previous reviews and personal contacts with colleagues. Study Selection: Randomized, controlled trials comparing needle acupuncture with sham acupuncture, other sham treatments, no additional treatment, or another active treatment for patients with low back pain. Data Extraction: Data were dually extracted for the outcomes of pain, functional status, overall improvement, return to work, and analgesic consumption. In addition, study quality was assessed. Data Synthesis: The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. For the primary outcome of short-term relief of chronic pain, the meta-analyses showed that acupuncture is significantly more effective than sham treatment (standardized mean difference, 0.54 [95% CI, 0.35 to 0.73]; 7 trials) and no additional treatment (standardized mean difference, 0.69 [CI, 0.40 to 0.98]; 8 trials). For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies. Limitations: The quantity and quality of the included trials varied. Conclusions: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.