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Ask an expert - general

185 questions

A:  The great majority of traditional acupuncturists work in private practice. You can find them by using the search facility on the BAcC website (for our members) or through the BAcC's Yellow Pages and Yell.Com entries, or through looking at the acupuncture section of your local information networks. Many people now use the internet to locate practitioners near to where they live or work.
 
Finding acupuncture treatment inside the NHS is more difficult. Doctors and physios are limited to treating conditions for which there is a NICE guideline or for which there is a body of evidence which meets western standards. This can quite difficult to track down, and is usually quite limited as far as the number of sessions is concerned.
 

Q: What training do you need to become an acupuncturist? Also what could stop acupuncture from working?

A. The training required to become a member of the British Acupuncture Council is a three degree course or degree-equivalent course. Most new members come from colleges or universities whose courses have been accredited by the British Acupuncture Accreditation Board whose website (www.baab.org) provides useful links to all of the colleges and courses which are accredited, as well as useful background information on the course contents.

There are a number of other pathways to becoming an acupuncturist. We tend to reserve the title to people who use acupuncture full time as a practice, but there are a number of healthcare professionals such as doctors and physiotherapists who use acupuncture principally as another tool in the toolbox within their existing scope of practice, and their training is shorter. It is also based on an entirely different concept of what acupuncture is and how it works.

There are a number of professional organisations as well as the BAcC. Some also have three year degree level entry training, and others two year diploma level training. We regard the accredited courses as the 'gold standard' for training, but the other practitioners are all safe and competent acupuncturists.

Acupuncture always works to a degree; the question is to what degree and how sustainable the change is. There is nothing which stops it working, but there are a number of factors which might impact on how much benefit someone can derive from treatment. A number of factors within a patient's control, like alcohol, large meals or over-strenuous exercise immediately after treatment, can limit the success of treatment, There are also factors such as essential drugs which impact on overall health which can make progress slower, and there are a number of progressive and deteriorating health conditions which acupuncture might help to slow down but could not be expected to reverse.

In general, however, there is usually progress, however slight, and the professional skill and judgement of the patient lies in ensuring that someone's progress is reviewed regularly to ensure that the time and investment in treatment continues to be worthwhile.

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.

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