Ernst rightly emphasizes that personal contact between the patient and the physician and a manual therapy personally carried out by the physician produce a pronounced therapy-supportive effect on patients (as an added placebo effect). For that reason, all the German Acupuncture Trials used an equal length of treatment and attention to patients in the 2 acupuncture arms. The mean treatment duration in our chronic low back pain study1 was 30.5 minutes in all 3 therapy groups. The presence of the physician, however, was restricted in the 2 acupuncture groups to the time required to insert the needles (mean time, 8 minutes). The patient spent the remaining 20 minutes lying undisturbed on a bed in a separate room. In contrast to this, the physiotherapist in the standard therapy group often spent the full 30 minutes with the patient, at least if the patient obtained manual therapy. As described in our article,1 the patients received a combination of various treatments as prescribed by the current guidelines, including not only pharmaceutical therapy (95% of all patients took analgesics) but always, in addition, physiotherapy and/or massage and/or heat therapy, for example. It is of course possible that the delegation of therapeutic activity from the physician to a physiotherapist leads to a reduction in a placebo effect linked to the physician (point 3 by Ernst), but in compensation for that, the physiotherapist often treated the patient for up to 30 minutes, while the physician in the acupuncture groups did not spend even 10 minutes. With respect to point 1 by Ernst, we refer to our comprehensive discussion in the “Comment” section, in which we also examine the possibility of a “super-placebo” effect triggered by acupuncture but at the same time point out that the standard therapy is based on a genuine physiological action. This makes it difficult to attribute the large difference between acupuncture and standard therapy solely to a super-placebo effect of acupuncture.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early
dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.