Haake et al1 reported that real and sham acupuncture yielded the same results and were both vastly superior in reducing chronic back pain to standard care, which generated very disappointing outcomes. The authors offer various explanations for those “surprising results.”1 The findings become a little less amazing if we consider the following: the 2 acupuncture groups were treated by their physician at least 10 times for 30 minutes with a “hands-on” intervention. The third group essentially received 10 sessions of physiotherapy or a normal consultation with their physician. “Hands-on” treatment by your physician is certainly unusual these days and therefore perhaps more prone than treatment by physiotherapists or normal physician consultations to promote patients' expectation. This explanation would go some way toward explaining the “surprising results,”1 both in terms of good outcome for the 2 types of acupuncture and the relatively poor outcome of the usual care group. It might also have the following far-reaching implications: (1) the effectiveness demonstrated in this study1 is unrelated to acupuncture itself; (2) investing into acupuncture services would therefore be unwise; and (3) delegating treatments to others is less effective than administering them ourselves.
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