Systematic reviews of acupuncture — are there problems with these?

In recent years, many systematic reviews of the clinical efficacy of acupuncture have been conducted. Almost every review found major problems with the quality of the clinical trials, making it difficult to draw clear conclusions about efficacy. The present paper explores a number of important issues involved in the design and conduct of systematic reviews of acupuncture. Examples are pointed out of mistakes in inclusion-exclusion criteria and problems with judgements about adequacy of test treatment in some reviews. More importantly, problems are identified with the criteria by which study quality is scored, especially with the Jadad summary scale, that appear to bias against finding acupuncture to be effective. Examples are also identified where the conclusions of systematic reviews appear to have been misstated by others summarizing findings of those reviews, thereby undermining the conclusions of those broader reviews. These findings suggest that the methodologies of systematic reviews of acupuncture need to be improved and that many systematic reviews need to be redone using improved methods.