The holistic approach in acupuncture treatment: implications for clinical trials

The objective of this study was to assess, in a nonclinical sample, the credibility of four commonly used acupuncture needling techniques as potential control conditions in clinical trials, and to determine the influence of nonspecific factors such as style (holistic versus nonholistic) and gender of the acupuncturist. Four groups of participants viewed a video simulation of either a female or a male acupuncturist whose style was either holistic or nonholistic. Four treatments were administered producing a three factorial 2 (gender) x 2 (style) x 4 (treatment) split plot design. We found that, regardless of acupuncturist style or gender, the treatment of needles that remained in place for 10 minutes was perceived to be the most credible. The Moxa-only treatment was viewed as the least credible. All four treatments were considered more credible when the acupuncturist was holistic and male. Irrespective of gender, the holistic acupuncturist was rated significantly more attractive, expert, and trustworthy. We conclude that, whereas perceptions of treatment differed, this was affected by the style and gender of the acupuncturist. Such nonspecific factors are inherent in the holistic approach and the degree to which they explain the effects of acupuncture over and above any physiological effect of needling is, as yet, undetermined. Our findings suggest that, in both clinical trials and the real life treatment situation, this now needs to be ascertained.