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183 questions

Q:  I am currently a first year  student studying pharmacy in the National University of Singapore . I am currently doing my research on complementary and alternative medicine (CAM) and would like to know if anyone could share with me their views on whether acupuncture is a CAM and it's usefulness as a type of CAM .

A:  We'd love to be able to give you a brief answer to your question, but this is am immense subject capable of being pursued in dozens of ways.
 
The very brief answer, as far as the UK is concerned, is that the practice of acupuncture as a full time profession lies outside the mainstream of UK healthcare in the National Health Service, and to that extent it would deserve the title 'CAM'. However, over 2500 doctors and 6500 physiotherapists routinely use acupuncture within orthodox healthcare as 'another tool on the toolbox' and do so within their normal scope of practice for problems for which there is an evidence base. The style of acupuncture is characterised as 'western medical acupuncture' and is based on neurophysiological and segmental principles rather than eastern concepts of qi and yin/yang.
 
That said, there have been a number of conditions for which research over the last decade has brought traditional acupuncture slightly more into the mainstream of orthodox care through its inclusion in treatment guidelines issued by the National Institute for Clinical Excellence. NICE guidelines mean that doctors can offer modalities like acupuncture where they have been included, and some sub-contract these treatments to traditional practitioners.
 
There is, though, a very solid resistance from some sections of the orthodox medical community to greater inclusion of acupuncture as a CAM as well as CAM in general in orthodox healthcare, and the battle lines tend to get drawn up on the question of research. As long as the RCT (randomised double blind control trial) remains the gold standard, CAM therapies which work with multivalent outcomes and dynamic and evolutionary diagnostic patterns are never going to be adequately researched. At the same time those research studies which do manage to meet the criteria, such as the Paulus Protocol for assistance in IVF transfer, are so far from normal practice that trading on their success in research trials is risking undermining the individualised and dynamic diagnoses which underpin authentic eastern medicine.
 
As to its usefulness, as full time practitioners we are bound to say that as a system of medicine which focuses as much on preserving health and preventing disease as much as on treating illness and disease, we believe that its potential for benefit in western society is as yet nowhere near fully realised. Not only is there a huge mass of evidence from trials which near, but do not meet, RCT criteria, the growth of the popularity of acupuncture treatment in the west is largely by word of mouth and often predicated on the less definable outcomes which generate referrals - 'feeling better in myself', 'feeling more balanced.' We are a very long way from the orthodox profession recognising this as a valuable outcome of treatment, and where it happens it is largely written off as placebo effect. However, over time there will be studies which demonstrate that acupuncture treatment, along with treatment by other CAM therapies, contributes to better health over time. Those of us who have practised for a long time have plenty of anecdotal evidence suggesting that patients tend to stay well, but funding prospective studies over a decade may be beyond our means for the foreseeable future.
 
There are literally hundreds of papers about these kinds of questions, and you may find that some of the publications by the Kings Fund (www.kingsfund.org.uk) on CAM are worth looking at for an overview of the issues involved. The House of Lords Select Committee's on Science and Technology's Report from a decade ago (http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm)
 

Q:  I am a NHS doctor travelling in China for 5 weeks.  I wonder if you could recommend a school/organisation where I could do an introductory course to acupuncture.

There are a number of short courses in China, but it is a vast country and without quite knowing where you are likely to be it would be difficult to direct you to the appropriate training. There are, for example, a number of four-week courses in Nanjing and Huangzhou but when they describe them as intensive they really do mean intensive - four weeks of almost non-stop study from dawn to dusk and beyond. We are not sure that this would be consistent with travelling around at the same time.

We are duty bound to say, however, that we have argued for many years that the only good training in Chinese medicine is at a degree level or above, and although being a doctor would mean that you had covered a considerable part of the course syllabus both in your initial training and in your day to day patient care, we find ourselves a little conflicted at offering advice on training which could only be a very basic introduction. If it is intended as an exercise in familiarisation with the systems of Chinese medicine, that is a very different enterprise from one where the knowledge is translated into practice.

We hope that we do not sound patronising but we would also want to ask whether it is Chinese acupuncture which you want to find out about. Many GPs in the UK, as well as many physios, use a western style of acupuncture within their scope of practice and based on neurophysiological and segmental principles. The BMAS and AACP, the respective professional interest groups, run training courses for practitioners who wish to be able to integrate acupuncture into their clinical practice.

 

However, if it is Chinese acupuncture which you want to familarise yourself with , in which we would be delighted, then you may find it useful to contact the Association of Traditional Chinese Medicine, one of sister organisations consisting mainly of Chinse practitioners trained in PRC. (www.atcm.co.uk). They have close links with a number of training institutions across China and may well be able to give you specific contacts or arrange a bespoke package which fits in with your itinerary.

Q:  This is a general question. My 4 year old son has not been immunised against MMR. What is the attitude of the BAcC towards immunisation in general, and the MMR jab in particular.

A:  As a body regulating and representing traditional acupuncture the BAcC doesn't really have a formal view about the use of immunisation and MMR jab. Clearly these kinds of intervention have an energetic effect from a Chinese medicine perspective, and skilled practitioners should be able to take this into account when they are treating a patient. There is, though, a considerable danger in ascribing causation when looking at two systems of medicine which operate from entirely different paradigms, and this is a rather dangerous path to take. One could look at many aspects of modern life in this way, but while many lifestyle questions fall within the area of advice which a practitioner might give, the suitability of immunisation does not. One needs a thorough grounding in epidemiology to make these kinds of judgements, and we would be the first to admit that our profession does not have that kind of knowledge base.

It is often assumed that complementary healthcare professions are part of a broad leftish tendency with strong and often radical views on a number of social and healthcare issues, but the membership of the BAcC is a broad church which probably represents all shades of political opinion.

If a patient asks for advice on issues like this we always ensure that our personal views do not take on an authoritative air because of the practitioner/patient relationship, and invariably tell the patient that this is a matter for them to choose with advice from their GP. The GP is better placed to give them the objective statistical information they need. GPs, in our experience, are not all out and out proponents of immunisation, and have recognise over the last decade that a fully informed decision is better than a dictat from the doctor, so will make sure that patients are well-informed.

A:  If you use the power of google to see whether acupuncture can help with anosmia you may find a number of references but they will all lead back to a single paper:
 
http://aim.bmj.com/content/21/4/153.full.pdf+html
 
which is an N=1 case study, i.e. a practitioner writing up a note of treating a single patient, and very successfully too. However, that is all that there is, although there are a number of Chinese studies which have not been translated which appear to suggest that something can be done.
 
We would be very reluctant to give a positive recommendation on this basis alone, however. Evidence has to be a great deal more robust even from an Eastern perspective which is not bound by the so called 'gold standard' of the randomised double blind control trial before we would start to make claims for success.
 
The one thing which may have a bearing on your problem and which we cannot assess at a distance is the virus. Chinese medicine has an entirely different way of assessing viral infections, based as it is on an entirely different understanding of the physiology of the body. This rests on a fundamental belief on an energy called 'qi' whose flow, balance and rhythms are essential for good health and which can be compromised by all sorts of external and internal factors which manifest as disease. The skill of the practitioner lies in seeing what has happened and correcting it. There may an underlying connection between the virus you had and the olfactory function, and a practitioner may just believe that correcting blockages and flow may help. It may be worth visiting a BAcC member local to you for a face to face assessment.
 
However, our experience of trying to treat this condition has not been that good that we would regard acupuncture as first choice for its treatment.
 
 
 
 

A:  We must admit to being a little stumped by this question. We don't quite know what an 'acupuncture full body massage' is and we googled it without any real success.

The only thing that we can think of is that this is being used to describe a form of Chinese massage like tui na which uses a knowledge of the acupuncture points and channels to reinvigorate the energy, or 'qi', of the body. There are a number of variations on this theme, although we find it a little surprising that someone would describe this as 'acupuncture full body massage'. The other possibility is that someone offers both modalities, and this is some sort of shorthand for a session which might involve both.

We have to admit, though, that this did ring an alarm bell because there are, like it or not, a number of practitioners out there with very poor qualifications and training who offer all sorts of strange hybrids. We find this dispiriting, because anything which they do reflects on all of us, and this is why we have maintained our call for the statutory regulation of acupuncture for over twenty years.

However, we would not want to be unfair to someone who may be doing legitimate work. If they are, there is every probability that they belong to a reputable professional association with a published code of conduct and register, and equally a probability that they will be happy to explain exactly what they are doing and where they trained to learn how to do it. If neither is the case, or if you are not satisfied with the explanation, it is perhaps best to go elsewhere.

 

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