Physiological

Throughout this entire discourse on acupuncture and needling for painful problems, Dunning et al have shown an inability or unwillingness to address central points in our argument against the effectiveness of acupuncture and needling. In addition to arriving at vastly different conclusions regarding the current trial data, Dunning and colleagues have routinely shifted the focus of the debate and presented arguments that do not relate directly to the primary issue of acupuncture’s benefits. Further, Dunning et al have consistently demonstrated a fundamental misunderstanding regarding the philosophy and implementation of evidence based practice. Their present reply is no different as they commit several critical errors in their conceptualization of evidence based practice.

One of the most common arguments stemming from our recent post on acupuncture, Needle in the Hay, was that we as a profession should not overly rely on “1/3rd of the pillars of evidence based practice". This argument shows nothing more than a fundamental misunderstanding of what evidence based practice is. The concepts of evidence, clinical experience/expertise and patient values do not exist independently from one another. Nor can we pick and choose which of the three best suits a particular set of beliefs. In fact, we should stop referring to evidence based practice in terms of “pillars” altogether. It is an unhelpful metaphor that only serves to perpetuate a misinterpretation of the philosophy of evidence based practice.