No Brexit for acupuncture!

No Brexit for acupuncture!

By Katie Osborne

Last weekend, 700,000 people took to the streets of London to protest against Brexit, former UKIP leader Nigel Farage called for more support for his Leave means Leave campaign and a beleaguered UK prime minister issued a plea for time to deliver “the Brexit the people voted for.”

Meanwhile, in the beautiful, historic Italian city of Bologna, another international event was taking place where the atmosphere was decidedly more amicable.

In stark contrast to the deadlock between British and European politicians negotiating Brexit, the 2nd International Symposium on Research in Acupuncture was the perfect environment for open and productive dialogue between leading acupuncturists from around the world.

Hosted jointly by Bologna’s Association of Medical Acupuncturists and the city’s Italian – Chinese School of Acupuncture, the event showcased key research and explored some of the main issues currently affecting the profession.

Like European politics, the world of acupuncture has its fair share of divided opinion on a range of different issues, but, unlike the acrimonious Brexit negotiations, the overall tone of the symposium in Italy was one of friendship and collaboration.

It has been the cause of much frustration among the profession that policymakers and indeed members of the medical profession in many countries have steadfastly refused to embrace acupuncture as a legitimate healthcare choice. And there has been much debate about why many clinical trials have produced negative or inconclusive evidence, with perhaps the most compelling hypotheses being that sham acupuncture is not an effective placebo.

Speaking on the second day of the symposium, Hugh McPherson, professor of acupuncture research at the University of York in the UK, suggested, however, that most clinical trials are actually far too small and underpowered to demonstrate a positive effect and that this is one of the major reasons for negative or inconclusive results, especially when compared to sham.

Matt Bauer, president of the Acupuncture Now Foundation in California, argued that many clinical trials are not designed to allow enough time for ‘real’ acupuncture to demonstrate maximum therapeutic benefit.

It was interesting to hear the viewpoints of a group of French doctors who attended the event. In France, many doctors have embraced acupuncture simply ‘because they have seen that it works.’ French doctors who decide they would like to use acupuncture in their practice must undergo at least three years’ training and are then regulated by the French government.

Dr Henri Truong, president of the French College of Acupuncture, explained that he regards acupuncture in the same way he regards other ‘tools’ at his disposal when seeing patients. There might be occasions when he turned to acupuncture first to deal with a particular condition, but, equally, he may decide that a pharmacological intervention would be more effective. He is not concerned about the lack of positive scientific evidence, he says, because he has seen the results for himself.

In another lecture, Professor Claudia Witt, director of the Institute of Complementary and Integrative Medicine at University Hospital Zurich, explained that in Switzerland acupuncture was introduced into training programme for doctors, dentists and pharmacists thanks to a public vote in

2009 which saw complementary medicine become fully integrated into the country’s healthcare system.

But she acknowledged this was a unique case and that complicated cost evaluation processes often limit how much acupuncture is integrated into health systems around the world.

Dr Remy R. Coeytaux, Professor of Family Medicine at the Wake Forest School of Medicine in North Carolina, USA, spoke about how the opioid crisis in the States had led to a recognition that conventional medicines have not always been the most effective solution for pain, explaining that although acupuncture was not covered by many of the most important US healthcare insurance organisations, many were beginning to realise that incorporation of non-pharmalogical approaches into conventional medicine could make sense. He added that many healthcare providers, including those treating veterans and academic medical centres, were now offering acupuncture.

Perhaps the most compelling lecture was delivered by Dr Stephen Birch, associate professor at the Kristiana University in Oslo, who revealed that, following extensive research, his team had identified 4,463 positive recommendations for acupuncture in 2,175 different publications around the world. A total of 2,999 of those recommendations were for the use of acupuncture in 146 pain indications, while 1,464 were for the use of acupuncture in 152 non-pain indications, he said.

For more than 83% of these recommendations ‘positive or trend positive findings were found in reviews of literature’, suggesting the recommendations were generally evidence-based.

He highlighted that many mainstream governments, most notably Australia, had taken steps to fully integrate acupuncture into their national health systems but that, perhaps in another echo of Brexit, the UK was bucking the trend.

Dr Birch accused Britain’s National Institute of Health and Clinical Excellence (NICE) of bias following both its decision in 2014 to reject acupuncture for the treatment of osteoarthritis and a pending decision which looks set to also reject acupuncture for the treatment of depression. This, despite the evidence and the fact that the NHS Shared Decision-Making process does not agree and continues to recommend the treatment in these conditions.

Dr Birch used the conference to announce that he and his team had successfully applied for British Acupuncture Council funding to create an international registry of all the positive recommendations. He hopes the registry will enable acupuncturists and medical professionals to begin to change mindsets both in the UK and further afield.

It seems ironic does it not that, despite thousands of positive examples as highlighted by Dr Birch, it is so hard to convince policymakers of the positive benefits of acupuncture; yet two years ago it was so easy to convince 52% of the British electorate, on the back of very little evidence and much false promise, to vote for Brexit.

What is certain though is that delegates left the conference in Bologna safe in the knowledge that, whatever the outcome in the ongoing Brexit negotiations, British acupuncturists stand united with their European and international colleagues in a joint quest to raise awareness of acupuncture and its importance in the global healthcare arena.

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Katie Osborne

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