Developing a research strategy for acupuncture

This strategic overview revisits some of the basic assumptions that relate to the evaluation of acupuncture. We look at the evidence available to estimate both the specific and non-specific effect size of acupuncture (efficacy and effectiveness), and the opportunities afforded by modern imaging techniques that may allow us to associate specific neural substrates with particular clinical effects, such as acupuncture needling or placebo effect. We also argue for an augmented mixed methodology that integrates quantitative and qualitative clinical data, and basic mechanism studies as well safety and economic data to obtain a more rigorous and clear understanding of acupuncture. We also examine the value of both placebo-controlled trials and pragmatic acupuncture studies. We hope that by taking a broad, patient-centred and rigorous approach to acupuncture we may arrive at a realistic and thoughtful evaluation of its relative value in comparison to placebo treatment, conventional medicine and potential for integration into conventional clinical care.