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Q:  am an acupuncturist in Portugal and I wonder what  the parameter settings are to be able to exercise the profession in England

A:  There are very few parameter settings for the UK. In the absence of statutory/government regulation of acupuncture, it is in principle free for anyone simply to set up in practice. There is very little likelihood that statutory regulation will happen in the near future. The only laws which actually govern practice are the more general local, rather than national, laws about skin piercing which require practitioners to register or be licensed depending on where they choose to work. In Greater London it is a matter of
annual licensing unless you belong to an exempt membership body (the BAcC is one), in Scotland annual licensing unless you are registered member of regulated profession like doctors and physios (we aren't exempt), and everywhere else a one-off registration for every practice in which you work.

It used to be possible to set up in business with only the most rudimentary qualifications , but the last decade has seen many local authorities adopting byelaws (local laws) which require practitioners to have standards roughly in line with the degree level education recommended by the World Health Organisation.

As a citizen of an EU country you would be entitled to work here without a visa under the free movement of labour rules within the EU, so it would simply be a matter of deciding where to work, finding somewhere to work and the getting the appropriate license or registration. Setting up in business can be a slow affair. We advise new graduates that it can take two years or more to have a practice able to sustain them, and in the current recessionary times that may be even longer. We advise people not to give up their current work until they can comfortably switch to being free-standing practitioners, and for graduates for who this is a primary career to try to have some other form of steady income to keep them going.

Of course, joining a reputable professional association like the BAcC brings with it a great many resources and support, so we would obviously encourage you to give that serious thought if you do decide to come to work here.

 

Q:  i severed a nerve at the base of my thumb in an accident 2 years ago which was re-attached through surgery.  i still have quite a degree of numbness and
occasionly hypher sensitivity. can acupuncture help in any way?

A: This is quite a difficult question to answer. When we asked a similar question about nerve regeneration some time ago we said:

If there has been well-authenticated damage to a nerve then the chances of restoring its conductivity are very limited. If a nerve has been damaged beyond the body's ability to repair, then this severely limits what might be possible. There is a very small amount of evidence that acupuncture may be able to help nerve regeneration but this comes from the experimental end of the acupuncture world and often involves trials on animals, or 'ratpuncture' as some of our colleagues cheerfully dismiss it.

Obviously, though, we work in a different paradigm, and there are occasions where a symptom written off by conventional medicine as permanent and untreatable responds to acupuncture treatment. As you may be aware already from our website, the theories of Chinese medicine rest on a concept of energy, called 'qi' whose flow and balance determine good function and health in the body. If the flow is disrupted, as may be the case with accident, injury and occasionally surgery, then restoring the flow can
sometimes have significant effects.

The best advice that we can give is that you contact a BAcC member local to you to arrange for a brief face to face assessment. This will give them the information they need to assess whether in your specific case there are indications which point to the possible use of acupuncture.

In your case there might be slightly more reason for hope insofar as the injury which severed the nerve is almost certainly going to have had an impact on the superficial tissue which the sharp edge penetrated, and had you asked us the same question about scarring and the symptoms which you have we might have been a little more upbeat. In a recent answer about post-operative scar tissue we said:

There are times when the simple act of cutting tissue can cause a break in the flow of energy, and we have come across many cases where even a well-healed scar has blocked the flow in a channel. When you consider that there may well be thicker keloid scar tissue and adhesions as well as surface interruptions it is possible that
acupuncture treatment may offer some hope. and this particular expert has had one or two occasions when treatment along or across scar tissue has had disproportionately great effects.

It is best to realistic, though. nerve damage can sometimes leave the sorts of symptoms which you have, and they can often take a long while to diminish as the body learns to block the signals. There would nonetheless be good reason to talk to a BAcC member local to you, and possibly having a small number of treatments, but we would suggest that if you do, the number should be tightly controlled. In our experience these sorts of problems either respond quickly or not at all, and it is best not to develop
a treatment habit which runs to a dozen sessions with no result. This does not tend to play well with the patient.

Q:  BAcC registered acupuncturists' patients are prevented from giving blood. What does the BAcC intend to do about this parlous state of affairs?

A:  The current situation has moved on a little since our last press release in July last year:

The BAcC continues to receive calls and emails about the NHBTS policy that any patient who has had acupuncture treatment delivered by a practitioner who is not statutorily regulated has to wait four months before they can donate blood. This change to the NHSBT's donor criteria came into effect in late 2009,and with the statutory
regulation of acupuncturists now unlikely in the foreseeable future, this could mean that someone having regular treatment with a BAcC member would never
qualify to donate blood.

The BAcC has exemplary safety standards and campaigned vigorously to challenge this decision. We have since done our best to make sure that all of our members let their patients know that they must wait four months to donate blood or bone marrow products.

The official notification and rationale for the decision is available on

http://www.transfusionguidelines.org/docs/pdfs/dl_change_note_2009_32.pdf

and

http://www.transfusionguidelines.org/docs/pdfs/dl_change_note_2009_33.pdf

but some enquirers have found this difficult to locate on official sites.

The BAcC is fully committed to reversing this decision for the benefit of the patients of its members. The recent accreditation of the BAcC under the Professional Standards Authority Assured Voluntary Register scheme has given us hope that this new flagship scheme will provide the recognition of exemplary standards the BAcC needs for its members to be granted exemption from the deferral period for donation.

Since then, we have met senior officials in the NHBTS, and discussed with them how we might help to re-instate the donation of blood by non-statutorily regulated healthcare profesisonals, there having been no reported instances of blood borne virus transmission by acupuncture practitioners in the last decade. In order to change policy, however, there has to be evidence, and the NHBTS is proposing to conduct an analysis of previous screened donors to establish the level of risk. This study will take place later this year or early this year.

The wheels of bureaucracy turn slowly, and until that time anyone who has had acupuncture treatment from a BAcC member will have to wait four months until they are allowed to give blood.

The study mentioned in the press release has now progressed a great deal further, and the information which has been gathered will be given the full statistical analysis by August, we are told. It is also interesting to note that the Welsh Assembly has accepted the BAcC's accreditation with the Professional Standards Authority as a basis for exemption from its new licensing arrangements, and this opens up a potential second front if the statistical evidence is inconclusive.

The whole situation has been rather odd from the outset. Leaving aside all of the arguments about accountability and statutory recognition, the simple fact is that we all use single use disposable needles, and short of a practitioner with a blood borne virus inserting a needle in themselves and then into a patient, itself a criminal offence which even statutory regulation could not prevent, there is no possible risk of cross infection. However, by the time that this very simple fact became a part of the discussion the moment had long been lost. Indeed, there had been minimal consultation at the outset because the decision makers did not anticipate any adverse reaction to what they planned.

However, there's no point in re-hashing a poor process. We are where we are, and still working constructively to bring back into play the 10,000-15,000 donors we believe may have been lost as a consequence of this decision.

We have been asked this question on a number of occasions, and one of the more recent responses was:

There  are a number of small studies, two of which you can find here

http://www.ncbi.nlm.nih.gov/pubmed/14562135

http://www.ncbi.nlm.nih.gov/pubmed/10098953

which give some encouragement to the possibility that acupuncture in conjunction with conventional strategies can help men suffering from ED. However, the studies
are small and far from conclusive, so we couldn't give a definite and positive recommendation.

As a general comment we would say that there are many reasons why men can begin to suffer from ED. These can range from the simple fact of ageing and the effects
of conditions which become more apparent in older age, like mature onset diabetes, or to the problems associated with excessive drinking or smoking, through to the kinds of complex psychological issues which have arisen as a consequence of someone's life experience. Whether acupuncture can offer any help depends a great deal on the background against which the problem has arisen.

Traditional Chinese acupuncture is primarily concerned with the restoration of balance and flow in the energy of the body, and there are several distinct patterns of disease, or 'syndromes', in which poor flow or blockage of energy ('qi' as it is called in Chinese medicine) can cause erectile problems. If this were to be the case, and there were other confirming factors pointing to a specificsyndrome in the overall diagnosis, there may be some possibility that acupuncture could provide some help. However, if the cause of the ED lies in a pathological condition which means that there has been some permanent loss or weakening of blood supply to the sexual organs, or a complex psychological issue which would require specialist support, then acupuncture would be less likely to have any lasting effect.

Our only advice to you can be to seek the view of a BAcC member local to you and discuss the matter face to face, perhaps offering them a little more background
information on which they can give you a clearer assessment of whether they think acupuncture treatment may be of benefit.

We think that this is still the best advice that we can give.

We answered a similar question not that long ago and we think that our advice below still holds good:

There have been a number of studies and reviews of the effects of acupuncture on specific aspects of Type 2 Diabetes, two examples of which are:

http://www.ncbi.nlm.nih.gov/pubmed/18257350

http://www.ncbi.nlm.nih.gov/pubmed/20590731

However, as in many cases, there are not enough trials and not a consistent enough standard of methodological rigour to be able to draw any firm conclusions on which we could base positive recommendations.

One factor which our members do take into account when treating people with diabetes in any form is that acupuncture treatment may have the effect of kick-starting any residual function in the insulin-producing cells. For Type 2 this is less critical but for a Type 1 diabetic with a carefully balanced regime the addition of unplanned insulin in the system could tip them into an unexpected hypoglycaemic state.

Diabetes is not new, and was recognised in most ancient cultures, sometimes being diagnosed, as in ancient Greece, by the sweet taste of the excess sugar in the urine. Traditional Chinese medicine also recognised some of the groups of symptoms as distinct 'wasting-thirsting' syndromes, as our factsheet describes

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/type-2-diabetes.html

but as the factsheet also says, acupuncture is generally used alongside conventional treatment and is not offered as an alternative to it. Although it is becoming a more common condition, partly because of the increasing age of the population and partly because of the increasing levels of obesity and dietary weakness as well as being a hereditary condition, it remains a serious problem, and can lead, if not properly managed, to some very serious complications in later life. For this reason our members are always very keen to ensure that their treatment is a part of an overall management plan for the condition.

Each presentation is different, however, and you would be best advised to have a short conversation with a practitioner about whether they think acupuncture would benefit your particular presentation. Clearly we believe that regular acupuncture treatment is a valuable way of maintaining good health, but we have to take into account that many patients have specific outcomes, and try not to commit people to open-ended treatment if what they need or want may be more limited in scope.

We should perhaps add a more positive statement about the advantages of using acupuncture to help with the factors which predispose people to Type 2 Diabetes, like diet and exercise. Although we cannot make any specific claims about acupuncture having been shown to assist in weight loss or make someone fitter, there is no doubt that the dietary advice which is a part of the Chinese medicine tradition can be very valuable. It is often surprising how many people are eating the types of food which their
system, understood in Chinese medicine terms, are least able to cope with and which make their problems worse. Even something as simple as a slight variation
of diet based on an understanding of which foods help or hinder the system can have a surprising effect.

Each person is unique and different, however, and the best advice we can give is for you to visit a BAcC member local to you for advice.

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