Saturday, July 19, 2008
Infertile women who spend hundreds of pounds on acupuncture during IVF treatment are doing nothing to improve their chances of having a baby, the most extensive review of the evidence yet conducted has found. Acupuncture has no effect at all on pregnancy rates following IVF, according to a study that has examined all the high-quality trials to investigate its use by fertility clinics.
The findings, from a team at Guy's and St Thomas's Hospital in London, will dismay thousands of infertility patients, among whom acupuncture has become the most popular complementary therapy. While no official figures on its use are kept, demand is so great that several fertility clinics, such as Hammersmith Hospital in London, have set up on-site acupuncture services for their patients. Costs vary, but the Hammersmith unit charges $480 for an "IVF package" of four acupuncture sessions.
The new research, led by Sesh Sunkara, is a meta-analysis, in which the results of many high-quality randomised controlled trials are pooled to provide a more complete picture of a medical procedure's effectiveness. She said that while she had been open-minded about acupuncture before starting the investigation, she felt that she could not recommend it to patients. "If women come to me and ask if they should have acupuncture, I have to say there is no evidence that it helps," she told the European Society of Human Reproduction and Embryology conference in Barcelona. "Women are investing hope, energy and time in something that has not shown a definite benefit.
"The reason we chose to do this was that in our IVF clinic, every day we have patients who ask whether they should have acupuncture to improve their success rate. There have been all sorts of papers saying that sticking pins and needles increases the pregnancy rate, which have been widely reported in the media, and we are looking at women who are very vulnerable, who want to do everything possible to increase their pregnancy chances. "We wanted to look at this in an unbiased, open-minded way, to help us advise our patients. We wanted to know whether we should be doing acupuncture routinely and setting up a service in our clinic, or whether we should be advising people that there is no evidence that it works."
In the study, Dr Sunkara identified 83 trials in the medical literature, of which 13 were found to be of suitable quality to be included in the meta-analysis. The others were rejected either because they were commentary articles that did not include data, or because they were inappropriately designed.
Pregnancy rate and live birth rate were the only outcomes considered, and the results showed that acupuncture had no effect on either, whether it was used during embryo transfer or for pain relief while eggs were collected.
The research contradicts a similar meta-analysis that was published in the British Medical Journal in February, which suggested that acupuncture can improve pregnancy rates by as much as 65 per cent if performed when embryos are transferred to the womb.
Scientists behind the new work said that the BMJ study had overlooked a number of good studies that reached negative conclusions. Professor Peter Braude, who supervised the Guy's and St Thomas' team, said: "The BMJ paper didn't include all the studies, and if you include the negative ones there is no effect. We can't turn around and say it does not work, but there is no evidence it does and hand on heart we can't come out and recommend it."
Dr Sunkara said that more large randomised clinical trials of acupuncture in IVF were needed to settle the issue.
Paul Robin, the chairman of the Acupuncture Society, said: "I'm really surprised by these findings. I've been treating people for 20 years and in my experience treatment does seem to improve their chances of becoming pregnant. This study has shown that there's no proof that acupuncture can help - so that suggests that there should be lots more studies to examine the question. I'm convinced it can help."
Other studies that have claimed a benefit for acupuncture have hypothesised that it helps with relaxation during embryo transfer, which may boost the chances of a successful implantation and pregnancy. It has also been suggested that the therapy may increase blood flow to the womb.
CA: Legislature approves bill banning trans fats
California is poised to become the first state in the nation to ban restaurants and other food facilities from using trans fats, which are known to increase the risk of heart disease, under a bill approved by the state Legislature Monday and sent to the governor. The measure, passed with a bare majority, comes two weeks after a similar ban in New York City became fully effective. California doctor and consumer groups support the law, while restaurant groups have offered a lukewarm response. Gov. Arnold Schwarzenegger has not taken a position, a spokesman said.
Assemblyman Tony Mendoza, D-Artesia (Los Angeles County), who wrote AB97, said the measure is intended to promote the health of Californians. "When it comes to heart disease and diabetes, communities of color are leading the way," Mendoza said. "I figured that the use of trans fats in our restaurants is a leading contributor to that."
Mendoza's bill would require restaurants, hospitals and facilities with food-preparation areas to remove oils, shortenings and margarines with trans fats by Jan. 1, 2010, except for use in deep frying for dough and batter. Bakers would be given an extra year to figure out how to make goods free of partial hydrogenation. By Jan. 1, 2011, food preparation sites would have to be eliminate all ingredients with trans fats or face fines from $25 to $1,000. The bill exempts public school cafeterias, which must be trans fat free under a law that takes effect at the start of the coming year.
Mendoza's bill defines trans fat free as containing 0.5 grams of trans fat per serving, and the law would not apply to packaged goods, which cross state lines and are subject to FDA regulation. The bill also allows local governments to create trans fat ordinances, such as San Francisco's voluntary plan under which restaurants that pass a $250 inspection will be awarded a decal indicating that they are trans fat free. The city's law takes effect this month.
New York City's law has been a success, said Dr. Sonia Angell, director of the New York Health Department's Cardiovascular Disease Prevention and Control program. The department began phasing in a ban on artificial trans fats in December 2006, with the law fully in force on July 1. "At this point, all inspections have been going quite smoothly," Angell said. "Compliance has been at 98 percent. The evidence is very clear that trans fats are dangerous and very replaceable."
Dari Shamtoob, owner of the popular - and trans-fat-free - King Pin Donuts near the UC Berkeley campus, said he wonders why Berkeley has not implemented a law like New York City's. He fully supports a California ban. "I don't know what's stopped them, but these days they should," he said, "especially for the students. It's very important." Shamtoob began experimenting with oils free of trans fats in 2005 and perfected his recipes in 2006. He is waiting to buy a soybean oil that promises to be cholesterol free as well as trans fat free.
The switch increased King Pin's expenses, but the cost gap between the oils is closing. At first, Shamtoob said, trans-fat-free palm oil cost him 100 percent more than partially hydrogenated oil. Now the difference is 15 percent....
Meanwhile, California counties are worried that the bill contains no funding for implementation and enforcement, said Justin Malan, executive director of the California Conference of Directors of Environmental Health. "The thing in enforcement is that it's difficult to verify the absence of trans fat in hundreds of thousands of different products," Malan said. Adding requirements to the inspection process without financial support will result in cursory inspections, Malan said.
Legislators who voted against the bill said they prefer incentives rather than forced regulation. "The average population is mature enough to make their own decisions," said Sen. Sam Aanestad, R-Grass Valley (Nevada County). "I don't believe government was formed to tell citizens what they can and cannot do."
But attorney Stephen Joseph of Tiburon, a leader in the battle against trans fats, says now is the time for regulation. "The public has shown in survey after survey that they want this," he said. "I haven't heard a complaint from a company in years."
Joseph has sued McDonald's and Kraft Foods regarding trans fat information disclosure and use, and also led a successful, voluntary campaign in Tiburon to eliminate trans fats from restaurant kitchens. He views the elimination of trans fats as a form of consumer liberation rather than restriction. "Customers don't notice the difference. There's no loss of freedom of choice here. It's not freedom of choice for the customer when a restaurant owner puts something in the food and doesn't tell the customer," he said.
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