On 2016 Dec 31, David Keller commented:

If placebo works as well as acupuncture, reduce healthcare costs with placebo acupuncture

The disadvantages of sending patients to a licensed acupuncturist for treatment include the high cost of acupuncture, which must be administered by a licensed acupuncturist, exposure of the patient to the influence of the acupuncturist, who may prescribe other unapproved treatments, such as untested herbal medicines, and the small but finite possibility of injury or infection from the needles. The sham acupuncture procedure in this study employed sharp toothpicks, tapped and twisted on the patient's skin without piercing it, which nevertheless yielded good patient blinding (by standard assessment).

The investigators chose not to include an observation-only arm in this study, to avoid introducing negative expectation effects and other complications. However, they cite the typically long-lasting duration of the fatigue encountered with Parkinson's disease [PD], and its treatment-refractory nature, thus making a strong argument in favor of treatment of PD-associated fatigue with acupuncture to achieve the substantial placebo benefit seen in both the acupuncture and control groups of this study.

The fact that acupuncture provides the same benefit as placebo sham acupuncture suggests that the observed benefits can be achieved at a lower cost by having physicians administer sham acupuncture as an office procedure. Sham acupuncture should be easy to learn and administer because it does not require the practitioner to study the concepts of Qi ("chee", life energy), meridians, nor any of the other complex conjectures at the basis of traditional Chinese folk medicine, nor to obtain a special license.

The question of whether it is ethical for a physician to perform and bill for a sham placebo procedure begs a similar question regarding the ethics of referral to an acupuncturist for treatments which do not differ, in effect, from placebo.

On 2016 Dec 31, David Keller commented:

If placebo works as well as acupuncture, reduce healthcare costs with placebo acupuncture

The disadvantages of sending patients to a licensed acupuncturist for treatment include the high cost of acupuncture, which must be administered by a licensed acupuncturist, exposure of the patient to the influence of the acupuncturist, who may prescribe other unapproved treatments, such as untested herbal medicines, and the small but finite possibility of injury or infection from the needles. The sham acupuncture procedure in this study employed sharp toothpicks, tapped and twisted on the patient's skin without piercing it, which nevertheless yielded good patient blinding (by standard assessment).

The investigators chose not to include an observation-only arm in this study, to avoid introducing negative expectation effects and other complications. However, they cite the typically long-lasting duration of the fatigue encountered with Parkinson's disease [PD], and its treatment-refractory nature, thus making a strong argument in favor of treatment of PD-associated fatigue with acupuncture to achieve the substantial placebo benefit seen in both the acupuncture and control groups of this study.

The fact that acupuncture provides the same benefit as placebo sham acupuncture suggests that the observed benefits can be achieved at a lower cost by having physicians administer sham acupuncture as an office procedure. Sham acupuncture should be easy to learn and administer because it does not require the practitioner to study the concepts of Qi ("chee", life energy), meridians, nor any of the other complex conjectures at the basis of traditional Chinese folk medicine, nor to obtain a special license.

The question of whether it is ethical for a physician to perform and bill for a sham placebo procedure begs a similar question regarding the ethics of referral to an acupuncturist for treatments which do not differ, in effect, from placebo.