Is the British Acupuncture Council against acupuncture?

Q: A couple of time I have read on your website that acupuncture treatments are almost good for nothing and that there is no evidence that it can successfully treat conditions as Trigeminal Neuralgia and many others. Are you against acupuncture? Your website seems to advocate against this science.

A: This is a very good question, for which we think there are some very good and, we hope, informative, answers.

The first and most important point to make is that since the Advertising Standards Authority's reach was extended to cover websites and internet marketing there are much stricter conditions about what people can claim in their advertising and marketing materials. In healthcare in particular any claims to cure, treat or help in the treatment of a problem now have to be backed up by evidence that this really is the case. By'evidence' the ASA has adopted a standard with which nearly every complementary therapy has disagreed and with which they have taken issue, the randomised double blind control trial. This really only works well for drug testing, not for therapies where the nature of the intervention develops as treatment progresses.

The BAcC, along with many other bodies, has been engaged in discussion with the ASA for the last five years about the unsuitability of this as a standard, and also about the choice of experts by the ASA to review evidence. The bottom line, though, according to this criterion is that only about four or five conditions meet the required standard, and a very uninteresting group they make too unless you happen to be looking for acupuncture treatment for dental pain. The vast majority of studies are not RCTs, nor would we want them to be; the acupuncture is often formulaic and restricted, and about as far removed from day to day practice as one can imagine.

However, these are the rules, and so when we are asked about named conditions we have to be very clear that the evidence from this perspective is not conclusive. We often use terms like 'encouraging' or 'promising' when the evidence is short of conclusive but fairly robust,  but as a regulatory body which has to require its members to comply with the law we cannot ourselves bend or break the rules. If there is no conclusive evidence in the ASA's terms then we cannot claim there is, even when we know that we have treated many cases of a problem successfully.

As far as named conditions themselves are concerned we have also been backed into a corner, partly because of the nature of our own marketing over the years. As we are at pains to say in nearly every response traditional acupuncture treats the person, not the condition. Although you will find an increasing number of books and internet articles about 'acupuncture for headaches' or 'acupuncture for stomach disorders' this is not how we view our work. To some extent it is possible to treat named conditions in themselves but from a traditional acupuncture perspective it is not as satisfying or ultimately as likely to succeed long term as treating the person, i.e. tailoring the treatment to the individual and their unique imbalances. In the circumstances it is with great caution that we would say 'acupuncture treats x or y or z';. There are going to be many prospective patients for whom this will not be the case because what seems like a simple problems sits atop a pattern of overall disorder which might take months or even years to sort out.

At the same time, as practitioners we have seen many thousands of patients over the years, and we have a fairly clear idea of the conditions which, whatever the state of an individual's health, do not seem to be too tractable to treatment. Some, like severe tinnitus, can endure through many courses of treatment of all kinds, as the magazines of the tinnitus support groups attest. It would be unhelpful and misleading for us to claim to treat such problems on the basis that acupuncture treats the person, not the condition, when we know that it is one of a number of problems which do not seem to respond well to any treatment.

We take the view that as a mature profession we should be honest in assessing those problems which are more likely to be helped and those which aren't, and letting the prospective patient know this. We remember earlier times when the fact that acupuncture treated the person more than the disease led to some patients getting the very wrong end of the stick; treating a patient with cancer is not the same as treating cancer, but people will hear what they want to hear unless someone is very careful with their choice of words.

As a final point, we would probably not want to lay claim to the word 'science' for what we do. There are all sorts of definitions of scientificity, and under many of them we could probably make a case for traditional acupuncture as a science. We also, though, recognise that there is an art to what we do, skills based on experience and observation which are unique to each practitioner and which provide an infinite number of perspectives on groups of patients. We had this brought home most clearly when we were discussing National Professional Standards with doctors. For them a diagnosis was an accumulating paper or computer file which could travel from doctor to doctor without any change or modification. For us, diagnosis was an active process which depended on the individual practitioner, and evolved over time. Until we ironed out this major semantic difference there was great confusion.

We hope that this explains why we take the approach we do, and why our answers and our website in general do not claim as much as we would like or, in fact, could do based on our clinical
experience. Our strategy has always been, however, to encourage people to visit our members to find out what acupuncture can do for them as unique individuals rather than offering generic answers to individual problems. Judging by the feedback we receive this approach seems to have gone down well with a large proportion of the 2500 people to whom we have replied through this facility.

This is a very good question, for which we think there are some very good and, we hope, informative, answers.

The first and most important point to make is that since the Advertising Standards Authority's reach was extended to cover websites and internet marketing there are much stricter conditions about what people can claim in their advertising and marketing materials. In healthcare in particular any claims to cure, treat or help in the treatment of a problem now have to be backed up by evidence that this really is the case. By'evidence' the ASA has adopted a standard with which nearly every complementary therapy has disagreed and with which they have taken issue, the randomised double blind control trial. This really only works well for drug testing, not for therapies where the nature of the intervention develops as treatment progresses.

The BAcC, along with many other bodies, has been engaged in discussion with the ASA for the last five years about the unsuitability of this as a standard, and also about the choice of experts by the ASA to review evidence. The bottom line, though, according to this criterion is that only about four or five conditions meet the required standard, and a very uninteresting group they make too unless you happen to be looking for acupuncture treatment for dental pain. The vast majority of studies are not RCTs, nor would we want them to be; the acupuncture is often formulaic and restricted, and about as far removed from day to day practice as one can imagine.

However, these are the rules, and so when we are asked about named conditions we have to be very clear that the evidence from this perspective is not conclusive. We often use terms like 'encouraging' or 'promising' when the evidence is short of conclusive but fairly robust,  but as a regulatory body which has to require its members to comply with the law we cannot ourselves bend or break the rules. If there is no conclusive evidence in the ASA's terms then we cannot claim there is, even when we know that we have treated many cases of a problem successfully.

As far as named conditions themselves are concerned we have also been backed into a corner, partly because of the nature of our own marketing over the years. As we are at pains to say in nearly every response traditional acupuncture treats the person, not the condition. Although you will find an increasing number of books and internet articles about 'acupuncture for headaches' or 'acupuncture for stomach disorders' this is not how we view our work. To some extent it is possible to treat named conditions in themselves but from a traditional acupuncture perspective it is not as satisfying or ultimately as likely to succeed long term as treating the person, i.e. tailoring the treatment to the individual and their unique imbalances. In the circumstances it is with great caution that we would say 'acupuncture treats x or y or z';. There are going to be many prospective patients for whom this will not be the case because what seems like a simple problems sits atop a pattern of overall disorder which might take months or even years to sort out.

At the same time, as practitioners we have seen many thousands of patients over the years, and we have a fairly clear idea of the conditions which, whatever the state of an individual's health, do not seem to be too tractable to treatment. Some, like severe tinnitus, can endure through many courses of treatment of all kinds, as the magazines of the tinnitus support groups attest. It would be unhelpful and misleading for us to claim to treat such problems on the basis that acupuncture treats the person, not the condition, when we know that it is one of a number of problems which do not seem to respond well to any treatment. 

We take the view that as a mature profession we should be honest in assessing those problems which are more likely to be helped and those which aren't, and letting the prospective patient know this. We remember earlier times when the fact that acupuncture treated the person more than the disease led to some patients getting the very wrong end of the stick; treating a patient with cancer is not the same as treating cancer, but people will hear what they want to hear unless someone is very careful with their choice of words.

As a final point, we would probably not want to lay claim to the word 'science' for what we do. There are all sorts of definitions of scientificity, and under many of them we could probably make a case for traditional acupuncture as a science. We also, though, recognise that there is an art to what we do, skills based on experience and observation which are unique to each practitioner and which provide an infinite number of perspectives on groups of patients. We had this brought home most clearly when we were discussing National Professional Standards with doctors. For them a diagnosis was an accumulating paper or computer file which could travel from doctor to doctor without any change or modification. For us, diagnosis was an active process which depended on the individual practitioner, and evolved over time. Until we ironed out this major semantic difference there was great confusion.

We hope that this explains why we take the approach we do, and why our answers and our website in general do not claim as much as we would like or, in fact, could do based on our clinical
experience. Our strategy has always been, however, to encourage people to visit our members to find out what acupuncture can do for them as unique individuals rather than offering generic answers to individual problems. Judging by the feedback we receive this approach seems to have gone down well with a large proportion of the 2500 people to whom we have replied through this facility.

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