Acupuncture: efficacy, safety and practice - a BMA report
(issued Sunday 25 Jun 2000)
Up to five million people may have consulted a therapist specialising in complementary and alternative medicine (CAM) in the last year with an incalculable extra number consulting a doctor or other health professional practising CAM. A new report from the British Medical Association, published today (25.6.00), looks at the usefulness, safety and availability of acupuncture - one of the most widely requested treatments.
Acupuncture: efficacy, safety and practice comes from the BMA’s Board of Science and Education and is launched on the eve of the Association’s week-long Annual Representative Meeting in London.
A postal survey of a random sample of UK family doctors carried out for the report found that almost half the GPs who responded had arranged acupuncture for their patients. An even higher number (58% of the 365 GPs) had arranged some kind of CAM for patients, with osteopathy and homoeopathy being next most popular (p67).
Dr Vivienne Nathanson, Head of Health Policy at the BMA, commented: “Of the 169 GPs who reported arranging acupuncture treatment for their patients 15% provided it themselves, 57% used another doctor, 24% used a physiotherapist and only 5% had used a Traditional Chinese Medicine practitioner.” Almost half of the GPs said they would like to receive some training in acupuncture in order to treat their patients in the future. The report states “Overall 79% of the GPs agreed that they would like to see acupuncture available on the NHS” (p76).
Is acupuncture effective?
The report evaluates the evidence for acupuncture as a treatment for back and neck pain, osteoarthritis, recurrent headache, nausea and vomiting, smoking cessation, weight loss, stroke and dental pain. Chapter two concludes that according to current evidence, acupuncture appears to be more effective than control interventions for nausea and vomiting (particularly for post-operative symptoms in adults), back pain, dental pain and migraine. Evidence is unclear about a specific response to acupuncture in osteoarthritis and neck pain cases. It considers that the jury is still out for its use in treating recovery from stroke, tension headache, fibromyalgia and certain joint dysfunctions. The report states: “Acupuncture appears not to be superior to sham acupuncture (used as a control in research) for smoking cessation and weight loss.”
Dr Nathanson commented: “We need to see more high quality research into the effectiveness of acupuncture. The National Institute for Clinical Excellence (NICE) has been established to look into the value of particular treatments. We think NICE is well placed to consider acupuncture and produce guidance for the NHS.”
How safe is acupuncture?
Complications after acupuncture generally fall into three categories: physical injuries, infections and other adverse reactions (p39). The BMA report states: “Many of the (physical) injuries can be avoided by ensuring acupuncturists are fully trained in anatomy and physiology, with particular emphasis on teaching the location and depth of major organs. Even the most basic first aid course has such a component.” (p40).
Inadequate or improper sterilisation techniques are a serious risk factor for infections and this is recognised by acupuncture professional bodies and reflected in their codes of practice, states the report (p42). Transmission of infections can be avoided if all practitioners use only pre-sterile disposable needles rather than re-usable needles which require sterilisation. Other adverse reactions can include more minor events such as bleeding on withdrawal of the needle, bruising, and drowsiness.
After examining all the relevant studies, the BMA report states “the incidence of adverse reactions to acupuncture appears relatively low.” (p48).
An increasing number of patients are asking their GP about acupuncture and both doctors and patients find it difficult to decide which practitioners are adequately trained and qualified. Dr Nathanson said: “Anyone within the UK can use the title ‘acupuncturist’ and in common with many other CAM therapies, acupuncture is not regulated by statute.” There are a number of organisations offering education and training with a considerable range of standards and levels. The report states: "there is a need for a consensus on the minimum standards of training required for all potential acupuncture practitioners.” (p59).
Recommendations in the BMA report include consideration to be given to the integration of acupuncture into the NHS. Guidelines on CAM for use by both GPs and patients are urgently needed, says the report. The Department of Health should select key CAM therapies including acupuncture for appraisal by NICE in 2001-2002.
The BMA wants to see a national surveillance system for the reporting of adverse events. It would also like to see a general list of all acupuncturists, medically and non medically qualified, to help NHS doctors in the referral process (p93). Other recommendations relate to the need for more research and funding, regulation, communication, and training.
Full details of the Recommendations in Acupuncture: efficacy, safety and practice will be available from Monday 26 June 2000 on the BMA website: www.bma.org.uk. The report is published by Harwood Academic Publishers at £12.99 (softback) or £24 (hardcover).
ISBN Number 90-5823-164-X.
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