Epigenetics PD and medical costs

Inspired by Hong et al 2020,[1] Deuel et al 2020,[2] and Tsai et al 2020.[3]

PD – Parkinson’s Disease

Before I launch into this blog, I want to clarify that the three subjects in the title are almost completely unrelated, apart from the fact that acupuncture figures in all three papers of course.

First up we have a short review paper on acupuncture effects in epigenetics.[1] It is quite a simple summary of the different mechanistic areas in epigenetics and some examples of acupuncture research that has influenced them.

They include:

These epigenetic processes influence whether or not genes are available for transcription, and whether or not messenger RNA is transcribed onto ribosomal RNA. Ultimately, this determines the proteins that are synthesised by a cell, and proteins affect almost every aspect of metabolism and cellular interaction.

The problem is that the whole thing is so complex that no single process can be isolated from all the others, so if a paper describes one effect of acupuncture on epigenetics, it is never the whole story, but just one view of one system in one state.

Next up is a narrative review of complementary therapies in PD.[2] The authors included 13 papers on acupuncture, 15 on Tai Chi, 8 on Qi Gong, 9 on yoga, and 9 on cannabis. The review reads well and is suitably cautious in its conclusions. Data from surveys suggest that the interest in complementary therapies in PD is increasing, with recent surveys from the US recording 50% to 74% use. This may reflect a growing influence of ‘Integrative Medicine’ in the US. Acupuncture appears to have some measurable effects in open studies, but less so in larger sham controlled studies, so the positive effects could be non-specific.

She went from rolling around in contortions on the floor to ice skating with turns and jumps…

I am reminded of a dramatic video shown by Lene Vase (whose research on placebo was the subject of a previous blog) in a presentation in Copenhagen in September 2019 at NMAC 3. The video was about a study on PD from the 1990’s (1994-95) based in Iowa. The lead researcher was Cynthia Macrae, and she performed a blinded study of stem cell injection into the brain in 40 patients with relatively severe PD. The video followed one participant from the sham group who had a very good functional response to the sham procedure. She went from rolling around in contortions on the floor in 1994 to ice skating with turns and jumps in 1995. In this study the response was predicted by expectation but not by group allocation.

So, I remain sceptical of the role of acupuncture in PD and have to say that the results for Tai Chi, Qi Gong, and yoga seem more convincing, although of course these interventions are never subject to sham controls but compared with usual care or alternative exercise controls.

migraine-related medical expenditure

Finally, I would like to mention a recent paper in the open access journal Medicine®. I have been seeing a lot of protocols for systematic reviews of acupuncture research published in this journal over the last year or so, all almost exclusively from China. But I do not remember ever highlighting a paper from this journal on the blog. This paper is yet another large retrospective cohort study from Taiwan, but this time with a cost twist. Newly diagnosed cases of migraine between the years 2000 and 2010 were retrieved from the LHID 2000 (see last week’s blog for an explanation of LHID 2000). The authors found 477 who had received 12 or more acupuncture sessions following diagnosis, and then matched them (4:1) with a control group by demographic factors, comorbidities, migraine treatment drugs and frequency of migraine outpatient visits. The control group comprised 1908 patients with migraine who received regular medical treatment only. The outcome measured was the migraine-related medical expenditure and visits within one year after acupuncture, and it was significantly lower in the acupuncture group as you might expect. The authors conclude that it is cost effective to add acupuncture to routine care in this patient group.

References

1         Hong H, Jing X, Liu S, et al. Epigenetic Landscape Changes Due to Acupuncture Treatment: From Clinical to Basic Research. Chin J Integr Med 2020;26:633–40. doi:10.1007/s11655-020-2852-x

2         Deuel LM, Seeberger LC. Complementary Therapies in Parkinson Disease: a Review of Acupuncture, Tai Chi, Qi Gong, Yoga, and Cannabis. Neurotherapeutics Published Online First: 12 August 2020. doi:10.1007/s13311-020-00900-y

3         Tsai S-T, Tseng C-H, Lin M-C, et al. Acupuncture reduced the medical expenditure in migraine patients: Real-world data of a 10-year national cohort study. Medicine (Baltimore) 2020;99:e21345. doi:10.1097/MD.0000000000021345

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Declaration of interests MC