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Ask an expert - general

154 questions

A: The short, and somewhat trite, answer is that they make sure that they are properly trained to begin with. Training in the UK, at least for entry to registering bodies such as the BAcC, requires a three year degree equivalent course which ensures not only that the basic knowledge is wired in but also that the bestg possible clinical practice is inculcated in the students. Knowledge without wisdom and good practice is irrelevant, and the crucial element in training is not being able to generate lists of symptoms and syndromes but to be able to respond to the unique problems which each patient brings to the clinic. This requires a great deal of supervised practice, in our view, to give practitioners the confidence to be able to adjust and refine their work to the patient's best advantage, and also to deal with situations where things don't go as well as they hoped. Knowing what to do is important, but knowing what to do when something goes wrong is the sign of true skill and mastery.
 
Making sure that someone follows best practice is an individual responsibility, but regulatory bodies such as the BAcC have the responsibility for checking that practitioners registered with it maintain their skills and develop as practitioners. As well as offering our own advice and support, with a great deal of valuable material being available on our website and through our professional journals we also have a mandatory requirement for members to undertake what is called CPD, Continuing Professional Development, which is aimed at making practitioners develop their skills after they have qualifed and for as long as they practise.
 
That, of course, is the carrot. The stick is that we have some very well defined rules of behaviour, skill and conduct to which  we expect our members to adhere, and we are always ready to take sanctions against someone who does not continue to meet or adhere to our standards. Expelling members is a rare event, but we do have occasion to ask members to up their game in terms of basics like good record keeping or respecting boundaries. The BAcC is a particularly well-behaved professional body, and disciplinary cases are rare. Above us, however, sits the Professional Standards Authority, a government agency with whom we are accredited, and its task is to ensure that professional associations such as ours continue to demonstrate that we are protecting the public by making sure our members are properly trained and accountable, and that members of the public have access to advice, support and pathways to complain if they are unhappy with any aspect of the treatment which they receive.  

Q:  Are there any acupuncturists specifically trained in non-surgical "face-lifts" who are members of BAcC and if so, are there any in Oxfordshire?
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A:  We find ourselves a little bit conflicted when we receive questions like this. There are a number of areas where are developing standards of expert practice. This in turn might lead to qualifications which would enable us to recommend specific groups of practitioners. However, at the moment the focus is on paediatrics and obstetrics, so although we are aware of a number of courses which offer postgraduate training in facial or cosmetic acupuncture, we have not yet agreed the standards against which they should be measured.
 
However, it is widely recognised by many of the trainers in this area that using facial acupuncture techniques without also attending to the underlying patterns of energy is not as effective. We always recommend, therefore, that if someone is conducting their own search for a practitioner they should ensure that the person is a fully trained professional acupuncturist, not someone who has learned a few specific techniques as an adjunct to beauty therapy. There are also some safety concerns about being treated by someone who is not a professional acupuncturist. There is no difference in health and safety terms between someone who uses ten needles a year and someone who uses ten thousand. The same scrupulous attention to hygienic practice is essential. We have some reservations about very short coirses which offer the technique and all of the safe practice essentials in a very time.
 
If you undertake a google search under 'facial acupuncture oxford' you will find a number of BAcC members whose standards you can trust and who have undertaken additional training in this area of work   
 

Q:  My farther has had his leg amputated 4 years ago and still has very painful phantom pains, can this be treated with acupuncture?

A:  Phantom limb pain can be a very distressing phenomenon.

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:

http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97

Hecker H. -U et al (2008) Color Atlas of Acupuncture 2nd Ed. Thieme, Stuttgart

Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142

Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112

Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213

Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

The mechanism by which the treatment works is not at all clear from a Western medical point of view. From a Chinese medicine perspective it is perhaps easier to make sense of the appearance of the pain from the fact that the channels which run through the affected area spread out across the body, and even in 'conventional' Chinese medicine treatment it is not unknown to treat a problem in the lower left limb by using points in the upper right limb. The fact that the opposite limb is missing would not necessarily render the treatment useless.

The best advice we can give, especially when there is so little case evidence to point to, is to visit a BAcC member local to your father for advice on his specific circumstances. There may be a number of initial soundings which he or she could make to determine whether treatment may be of benefit.

The problem with conditions like this is that there are case studies which offer encouragement, but nobody publishes the results of case studies where things don't work, so for the small number which have been successful there may be ten times as many where treatment was tried and failed. It is best not to over-excited by the fact that some treatments work. Everything works for someone, but that doesn't mean that somehing works for everyone.

We drew up a review paper some years ago

http://www.acupuncture.org.uk/arrc/public-review-papers/substance-abuse-and-acupuncture-the-evidence-for-effectiveness.html

which summarises the use of acupuncture treatment for a number of substance abuse problems, and as you can see in the paper, the evidence for the use of acupuncture is relatively positive, although the trials undertaken are often methodologically flawed and rather small to be used as a basis for definitive statements. The most recent systematic review in 2009 reached this conclusion, and nothing significant has been published more recently to change this view.

However, although mainstream acupuncture treatment is used to deal with the problems of alcoholism, there are a great many projects which use a more limited form of acupuncture, ear acupuncture or auricular acupuncture as it is often known. There are two very large national groups, NADA-UK ( http://www.nadauk.com/) and SMART-UK (http://www.smart-uk.com/) whose members offer the five-point protocol and other formula treatments for helping people to deal with the problems of alcohol, and details of where practitioners can be found are on both websites. A great deal of their work is done in drop-in facilities, and some provide additional support and counselling as a part of the service.

There are also a substantial number of practitioners who belong to the Microsystems Acupuncture Regulatory Working Group which is registered with the PSA-accredited Complementary and Natural Healthcare Council. This group includes a number of organisations whose members offer more sophisticated auricular treatment than simple protocols, and their details can be found here (http://www.macrwg.org/).

This does not mean that the ordinary BAcC member does not treat people with alcohol problems, and many do to great effect. Our experience, however, is that the group setting of the detox projects often adds considerable value to the treatment through the peer pressure and encouragement which abounds. It may still be worthwhile seeking the advice of a local BAcC member, however. There are huge variations in the experience of alcoholism, from falling down drunk to a simple realisation that the end of work day drink is becoming a necessity rather than a treat, and our members may well be able to provide exactly what someone needs.

Q:  Please could you tell me what the qualification "MAcS" stands for and what standing it has in Britain?

A:  As far as we are aware, the designatory letters 'MAcS' are used by only one UK acupuncture body, the Acupuncture Society. Details of the different varieties of membership of this body can be found here:
 
http://www.acupuncturesociety.org.uk/acupuncture/membership.php
 
As far as standing is concerned, there is no statutory regulation of acupuncture in the UK, so all designatory letters serve only to identify that a practitioner belongs to a professional body to which they are accountable for their professional conduct and safe practice. These also generally offer a guarantee of professional indemnity insurance cover, either through the association or as a condition of continuing membership.
 
The only scheme which kitemarks standards for voluntary registers is the Professional Standards Authority's Assured Voluntary Register scheme. The BAcC was one of the first professional bodies to meet their exacting requirements and members of the BAcC are allowed to use the PSA's kitemark on their promotional material.