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NICE draft guidelines on depression ‘not fit for purpose’, say health bodies

NICE draft guidelines on depression ‘not fit for purpose’, say health bodies

The British Acupuncture Council is among dozens of leading health organisations who have signed a position statement (pdf) calling on the National Institute of Health and Care Excellence (NICE)  to conduct a ‘full and proper revision’ of its 2009 guidelines on the Recognition and Management of Depression in Adults.

The coalition of stakeholders, led by the Society for Psychotherapy Research, claims the latest draft guidelines are not fit for purpose and if published would seriously impede the care of millions of people in the UK suffering from depression, potentially even causing clinical harm.

NICE has agreed to meet representatives of the coalition on Friday 24 May 2019 to discuss its ‘additional work on the depression in adults guideline’.

The coalition argues that the overall methodological approach used in the current draft is not robust and will result in patients not being offered appropriate treatment, which in turn will result in long-term cost implications for the NHS.

NICE has agreed to an unprecedented third revision of the draft guideline as part of an ongoing review process which was originally launched in September 2014. The regulatory body has also announced that the publication date of the final guidance has been delayed until February 2020, with a consultation period set between 2 October and 13 November 2019.

Head of research at the British Acupuncture Council, Mark Bovey, said: ‘We feel very strongly that NICE has not taken proper account of evidence which shows that acupuncture is effective in the treatment of depression.

‘As the position statement says, the current draft guideline omits large amounts of data and relies on very short-term outcomes. The views of patients have been largely ignored and the methodological approach inherently favours medical and particular psychological treatments over other approaches. We believe the guideline should draw on a diverse range of evidence and provide a level playing field when this evidence is analysed and interpreted. Recommending acupuncture as a treatment option would enhance patient choice and benefit.’

A study carried out in 2013 by Hugh MacPherson, professor of acupuncture research at the University of York, showed that acupuncture and counselling produced significantly better depression scores than usual care.

The latest Cochrane review is also positive (Smith 2018), showing that acupuncture was moderately more effective than no treatment, slightly better than pharmaceutical treatment or sham acupuncture and similar to psychological therapies. As an add-on to medication it was found to be highly effective. The researchers cautioned, however, that more high-quality trials are needed to confirm these results.

Acupuncture was also calculated to be cost-effective when compared to either usual care or counselling (Spackman 2014) and has been found to help specific groups of people with depression including those with post-natal depression, cancer and those convalescing after a stroke (Yang 2016).

The position statement  calls on NICE to conduct a proper analysis of longer-term follow-up data, carry out a full systematic review of studies of service user experience, and reanalyse studies using outcomes more relevant to users.

The coalition has taken this latest action because it believes concerns raised in its response to the first draft, published in 2015, were not addressed in the revised version published in October 2017.

A second four-week consultation was opened in April 2018 after an early day motion was tabled in parliament and a number of MPs signed a cross-party letter to NICE asking it to respond to concerns raised in a joint letter by the coalition of stakeholders sent to NICE in November 2017.

In July 2018, 34 MPs and peers once again wrote to Sir Andrew Dillon, CEO of NICE, asking him to address the concerns. In October 2018 it was announced that a third revision of the guidelines would start in December 2018 with formal publication scheduled for December 2019.

Notes to editor

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About the BAcC

The British Acupuncture Council (BAcC) has a membership of nearly 3,000 professionally qualified acupuncturists. It is the UK's largest professional body for the practice of acupuncture. BAcC members practise a traditional, holistic style of acupuncture diagnosis and treatment based on a system developed and refined over 2,000 years. To achieve BAcC membership, practitioners must first undertake extensive training in traditional acupuncture (minimum three years full-time or part-time equivalent), which includes physiology, anatomy and other biomedical sciences appropriate to the practice of acupuncture.

Traditional acupuncture

Traditional acupuncture as practised by members of the BAcC is based on Chinese medicine principles that have been developed, researched and refined for over 2,500 years. Traditional acupuncture is holistic, not focused on isolated symptoms. It regards pain and illness, whether physical or mental, to be a sign the whole body is out of balance. Western or medical acupuncture is a more recent development practised predominantly by doctors and physiotherapists, who use acupuncture techniques within their existing scope of practice on the basis of a western medical diagnosis. There is a growing body of evidence showing how effective acupuncture is in a range of conditions:

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