Evidence from the Cochrane Collaboration for Traditional Chinese Medicine therapies. J Altern Complement Med

Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD 21207, USA.
Journal of alternative and complementary medicine (New York, N.Y.) (Impact Factor: 1.59). 09/2009; 15(9):1001-14. DOI: 10.1089/acm.2008.0414
Source: PubMed


The Cochrane Collaboration, an international not-for-profit organization that prepares and maintains systematic reviews of randomized trials of health care therapies, has produced reviews summarizing much of the evidence on Traditional Chinese Medicine (TCM). Our objective was to review the evidence base according to Cochrane systematic reviews.
In order to detect reviews focusing on TCM, we searched the titles and abstracts of all reviews in Issue 4, 2008 of the Cochrane Database of Systematic Reviews. For each review, we extracted data on the number of trials included and the total number of participants. We provided an indication of the strength of the review findings by assessing the reviewers' abstract conclusions statement. We supplemented our assessment of the abstract conclusions statements with a listing of the comparisons and outcomes showing statistically significant meta-analyses results.
We identified 70 Cochrane systematic reviews of TCM, primarily acupuncture (n = 26) and Chinese herbal medicine (n = 42), and 1 each of moxibustion and t'ai chi. Nineteen (19) of 26 acupuncture reviews and 22/42 herbal medicine reviews concluded that there was not enough good quality trial evidence to make any conclusion about the efficacy of the evaluated treatment, while the remaining 7 acupuncture and 20 herbal medicine reviews and each of the moxibustion and t'ai chi reviews indicated a suggestion of benefit, which was qualified by a caveat about the poor quality and quantity of studies. Most reviews included many distinct interventions, controls, outcomes, and populations, and a large number of different comparisons were made, each with a distinct forest plot.
Most Cochrane systematic reviews of TCM are inconclusive, due specifically to the poor methodology and heterogeneity of the studies reviewed. Some systematic reviews provide preliminary evidence of Chinese medicine's benefits to certain patient populations, underscoring the importance and appropriateness of further research. These preliminary findings should be considered tentative and need to be confirmed with rigorous randomized controlled trials.

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Available from: Lisa Susan Wieland
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    • "Complementary and Alternative Medicine (CAM) studies that fit the current “gold standard” of randomized, double-blind, placebo, or sham controlled designs frequently do not show an effect of the active treatment above that of the supposedly “inert” placebo [1–3]. This is often pointed to as evidence that CAM approaches are not active treatments; they show benefit only or largely through the placebo effect. "
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    ABSTRACT: CAM therapies are often dismissed as "no better than placebo;" however, this belief may be overcome through careful analysis of nonspecific factors in healing. To improve trial methodology, we propose that CAM (and conventional) RCTs should evaluate and adjust for the effects of intrapersonal, interpersonal, and environmental factors on outcomes. However, measurement of these is challenging, and there are no brief, precise instruments that are suitable for widespread use in trials and clinical settings. This paper describes the methodology of a project to develop a set of patient-reported instruments that will quantify the nonspecific or "placebo" effects that are in fact specific and active ingredients in healing. The project uses the rigorous instrument-development methodology of the NIH-PROMIS initiative. The methods include (1) integration of patients' and clinicians' opinions with existing literature; (2) development of relevant items; (3) calibration of items on large samples; (4) classical test theory and modern psychometric methods to select the most useful items; (5) development of computerized adaptive tests (CATs) that maximize information while minimizing patient burden; and (6) initial validation studies. The instruments will have the potential to revolutionize clinical trials in both CAM and conventional medicine through quantifying contextual factors that contribute to healing.
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    • "The systematic reviews indicated the potential benefit of CM for hypertension in terms of some outcome measures, but none of them drew a definite conclusion due to the poor quality of primary studies. Poor methodology and reporting quality of SRs about CM have caused widespread concern [115, 116]. According to preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, it was found that most of the included reviews have poor quality [117]. "
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    ABSTRACT: Hypertension is an important worldwide public -health challenge with high mortality and disability. Due to the limitations and concerns with current available hypertension treatments, many hypertensive patients, especially in Asia, have turned to Chinese medicine (CM). Although hypertension is not a CM term, physicians who practice CM in China attempt to treat the disease using CM principles. A variety of approaches for treating hypertension have been taken in CM. For seeking the best evidence of CM in making decisions for hypertensive patients, a number of clinical studies have been conducted in China, which has paved the evidence-based way. After literature searching and analyzing, it appeared that CM was effective for hypertension in clinical use, such as Chinese herbal medicine, acupuncture, moxibustion, cupping, qigong, and Tai Chi. However, due to the poor quality of primary studies, clinical evidence is still weak. The potential benefits and safety of CM for hypertension still need to be confirmed in the future with well-designed RCTs of more persuasive primary endpoints and high-quality SRs. Evidence-based Chinese medicine for hypertension still has a long way to go.
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    • "More medical researchers recognize that combining biomedical disease and TCM pattern diagnoses is essential when TCM is included with biomedical diagnostic approaches in clinical treatments. This approach has become a common practice model in China because it focuses on a better assessment of clinical effects [23]. The outcome of TCM pattern diagnosis on the evaluation of the clinical effect was reported using a retrospective analysis of multi-center, randomized, controlled trial data that showed a response rate of 80% if 10% of the patients were treated based on TCM symptoms and 98% if 20% of the patients were treated based on biomedical symptoms. "
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