This publication arises from a resolution passed at the 1998 Annual Representative Meeting of the BMA, which said that the Board of Science and Education should look into the scientific basis and efficacy of acupuncture and the quality of training and competence of its practitioners. The BMA is a professional organization representing the medical profession in the United Kingdom.
The report starts by establishing the fact that the term acupuncture may refer either to the traditional Chinese system (yin and yang, 'meridians', chi and so forth) or to a 'Western' version based on modern ideas of anatomy, physiology, and pathology. This is an important distinction that has not always been observed in previous accounts of acupuncture. The report also points out, correctly, that there is no good evidence to show that any particular way of practising acupuncture is better than others and that it is therefore not practical to try to distinguish among the training and techniques used in the different varieties.
The first question to be considered is clinical efficacy. Here the report makes the important point that scientific evidence of effectiveness is not necessarily the same as cost effectiveness; even if the value of a treatment can be partially or wholly ascribed to the placebo effect, it may still be useful in clinical practice and should not be ignored on that ground alone.
The report looks at several types of disorder that are often treated with acupuncture; the studies discussed are summarised in a number of useful tables. As one might expect, the recurrent theme is 'more research needed', though the difficulties of devising a suitable control procedure are acknowledged. The balance of evidence favours the use of acupuncture in back pain and neck pain. It seems to help in osteoarthritis, although whether this is a specific effect remains unclear. Recurrent headache probably also responds, though as usual the evidence is not conclusive.
The treatment of nausea and vomiting using the acupuncture point known as Pericardium 6 in the wrist has been researched quite extensively. The use of this point in pregnancy appears to be effective and safe, although whether it is necessary to be specific about the site of stimulation is unclear. Stimulation at this site to relieve nausea and vomiting after surgery is as effective as conventional anti-emetic drugs. There is uncertainty about the effectiveness of wrist bands to relieve motion sickness.
Acupuncture for smoking cessation and weight loss appears to be without value. Acupuncture to assist recovery from stroke has been tried; initial reports were encouraging but the effectiveness is probably non-specific. There is no evidence that acupuncture works for tinnitus or asthma. (I have seen dramatic results in a few patients with asthma; however, the numbers would be too small to show up in a clinical trial.) Acupuncture probably does relieve dental pain although the effect is small.
As well as benefits, acupuncture carries certain risks; these are discussed in terms of physical injuries, infections, and other adverse reactions. The conclusion is that the incidence of such things is relatively low. Naturally, training is important in relation to risks, and this topic is addressed in the report. There is no regulation of acupuncture in Britain at present and there is considerable variation in the training courses available. At least two universities in Britain offer degree courses in acupuncture. There are also several acupuncture organizations, which offer different types and durations of training. The report recommends the need for acceptance of a core curriculum, to include anatomy and physiology, research methodology, acupuncture techniques, fundamentals of orthodox diagnosis, and ethics.
Other chapters look at the role of acupuncture in primary care and possible future developments. The report concludes with three recommendations. First, the National Institute for Clinical Excellence should select key complementary therapies, including acupuncture, for its third review in 2001-2002. Second, the NHS Executive should maintain a list of all acupuncture practioners, both medically qualified and not. Third, consideration should be given for making acupuncture available to NHS patients for back pain, dental pain, migraine, and nausea and vomiting.
This is a comprehensive and fair report, which summarizes the present position of acupuncture in the United Kingdom in a balanced and constructive manner. It will have an important influence on the way acupuncture develops in Britain in coming years and will doubtless be read widely in other countries as well.