In the UK - Accupuncture on the NHS!

[don9999]

I recently discovered that accupuncture treatment is being given free on the NHS (ie. us taxpayers end up paying for this nonsense!)

I was so incensed that I wrote to my MP, and have now started several lines of communication with John Reid and his office (Secretary of State for Health), Jane Hutt (Welsh Minister for Health and Social Services) and Dr Livingstone at the British Medical Accupuncture Society.

I have informed Randi, and have promised to provide him with an update after a short while.

The first responses I received were nothing unexpected, but I will aim to publish the full correspondence at a later date. For now, I provide a few snippets from their letters, and invite your comments:

From John Hutton MP (John Reid's office):
He referred to a March 2004 BMJ publication on the findings of a randomised controlled trial of the use of acpuncture. I've found this article on the internet at http://bmj.bmjjournals.com/cgi/content/full/bmj;328/7442/744

On the face of it, I'm thinking:
placebo - randomly selected people KNEW they were receiving acupuncture treatment, and may have given biased results
ineffective control - those that received the acupuncture treatment were given it in ADDITION to standard care from general practitioners
However, the article's author notes these limitations himself in a section aptly called 'Limitations'. But he gives arguments as to why these are not relevant under this scenario. Unfortunately, I am no scientist and although I have strong doubts, I don't know whether what he says is correct or not

From Jane Hutt:
"Complementary and alternative medicines may be prescribed on the NHS provided hey have been proven to be clinically safe and effective."
I'm not SO concerned about the 'safety' of the treatment, but wonder if Jane understands that there is NO evidence that acupuncture is effective. I will be asking her...

From the BMAS
I found their replies most refreshing!
They freely admitted the lack of scientific evidence both on the clinical effectiveness of acupuncture, AND the existence of Chi. Though of course this does not halt their 'belief'.

An interesting paragraph from a recent communication:
"...... As I said in my earlier e-mail, there is now a significant body of evidence, based on animal studies, which is helping us to understand how acupuncture might work. We know, from animal
studies, that giving acupuncture treatment results in the release of many naturally occuring pain relieving chemicals, including natural endorphins (morphine like substances) and serotonin (mood elevating substance). It also results in the relase of other hormones in the body such as cortisol (boosts the body's immune system) and oxytocinon (promotes relaxation and well being). Acupuncture does this because the needles have a direct effect on the nervous system. Presumably, the nervous system believes it is 'under attack' from the needles, and sets about a series of changes designed to reduce pain and promote healing."

Hmmmm......

Anyway, please feel free to comment on the snippets I have provided above. I am continuing my communications with these people so if anyone has any pertinent points that I could include in my next replies, please forward them on.

Cheers,
Don

 

[Interesting Ian]

I recently discovered that accupuncture treatment is being given free on the NHS (ie. us taxpayers end up paying for this nonsense!)

Nonsense?? Are you claiming it doesn't work? I think it's wonderful news.

About time we declared war against the Skeptics.

 

[Prester John]

Re: Re: In the UK - Accupuncture on the NHS!

Nonsense?? Are you claiming it doesn't work? I think it's wonderful news.

About time we declared war against the Skeptics.

Nonsense? So are you claiming it does work!?

Whats wrong with evidence?

 

[Benguin]

"...... As I said in my earlier e-mail, there is now a significant body of evidence, based on animal studies, which is helping us to understand how acupuncture might work. We know, from animal
studies, that giving acupuncture treatment results in the release of many naturally occuring pain relieving chemicals, including natural endorphins (morphine like substances) and serotonin (mood elevating substance). It also results in the relase of other hormones in the body such as cortisol (boosts the body's immune system) and oxytocinon (promotes relaxation and well being). Acupuncture does this because the needles have a direct effect on the nervous system. Presumably, the nervous system believes it is 'under attack' from the needles, and sets about a series of changes designed to reduce pain and promote healing."

Well here's my comment ...

Isn't that all backwards? how can you do investigation on how something might work without proper blinded trials showing it does work? I mean, not only is it a wasted effort but yoiu lack a proper model of what has been shown to work and what has been shown not to.

The endorphin release etc, strongly suggests you could stick a needle in anywhere and get a pain relieving outcome. I don't dispute that might be true (I doubt it, but it might), however that isn't proving acupuncture it is finding sopmething interesting out on the back of truckloads of layered speculation.

 

[The Don]

Does this mean that "kick you in the nuts" therapy will also be offered. After all, if you want a release of pain reducing chemicals, that'll be the way to achieve it.

The trouble with CAM is that there is a body of vociferous support and many of the practitioners and supporters are on the fringe of Labour support. As a result, the government will not want to p155 them off especially after sticking to their guns (and, I believe, being damaged politically) during teh MMR fiasco.

Pouring a few tens of millions down the drain in order to gain the support of a group is nothing new after all, the farmers have been subsidised for years.

 

[Tom Morris]

That's terrible. Do take a look on PubMed, there is a pretty good study on how it is possible to do placebo-control studies of acupuncture (I've got the full reference sitting around if you have difficulty finding it).

Good that you are doing this. It would be extremely good if we started up a "Real Medicine" campaign group that would fight against the inclusion of woo-woo treatments on the NHS. I've been meaning to send my complaint about homeopathy off but haven't got round to doing it. Might do it this morning.

Why has "unproven ◊◊◊◊◊◊◊◊" become "alternative medicine"? It's not an alternative and it's certainly not medicine.

 

[Benguin]

That's terrible. Do take a look on PubMed, there is a pretty good study on how it is possible to do placebo-control studies of acupuncture (I've got the full reference sitting around if you have difficulty finding it).

Good that you are doing this. It would be extremely good if we started up a "Real Medicine" campaign group that would fight against the inclusion of woo-woo treatments on the NHS. I've been meaning to send my complaint about homeopathy off but haven't got round to doing it. Might do it this morning.

Why has "unproven bulls**t" become "alternative medicine"? It's not an alternative and it's certainly not medicine.

Well you could argue it's an alternative to medicine. In that medicine helps, and this doesn't. I am mightily unhappy about the NHS paying for it, also because if they are wasting money on this obvious fraud (and homeopathy) how much more are they pouring down the drain on other unproven (but more difficult to identify) treatment?

 

[don9999]

Not sure how to find PubMed, but am assuming that you are describing the control studies that involve a sham 'needle' which apparently looks and feels like a real needle to the patient, but in fact withdraws into its sheath rather than penetrating the skin. I had read of those tests. I need to read some more and go back to the BMAS explaining that control studies CAN be performed.

An earlier E-mail from them stated the following:

"One problem is, of course, that it is almost impossible to conduct a traditional placebo controlled trial for acupuncture treatments because there is no such thing as placebo acupuncture. The nearest we get to a placebo is 'sham' acupuncture where needles are place in areas of the body which are not traditionally recognised as acupuncture points. However, many of us medical acupuncturists believe there is no such thing as sham acupuncture. Any needling of any part of the body is a form of acupuncture."

I'm a little confused by their reply. Are they saying that sticking a needle in 'anywhere' will make the patient feel better (in which case why do practitioners ned to be taught where to stick them?). Or are they saying that sticking a needle in anywhere will have 'some' affect on the patient. I'm assuming the latter, in which cae I would say 'so what?'. If we are treating a bad back, and this requires needles to be put in a specific place, then we can perform a control test - by sticking needles in the wrong place too (the fact that this might be healing a headache 9according to the acupuncturist) rather than the bad back is immaterial to the test).

Anyway, once I've found more about the dummy needles, I'll put this to the Dr at the BMAS.

Cheers,
Don

 

[Tom Morris]

hubmed.org is a good way to search PubMed (it has RSS functionality, which means I get warnings in my headline reader when new studies come out on various woo-woo topics)

 

[don9999]

Just a quick reply to Benguin.

The BMAS told me:

"......I can reassure that the NHS does not spend millions of pounds on acupuncture. In fact, acupuncture treatment is very hard to obtain as an NHS patient and most acupuncture treatments in the UK are given in private practice. (Most of us who do provide acupuncture treatment within the NHS do
so pro bono.)"

I don't have any real figures yet, so can't dispute that - though I will be asking for these figures from the givernment shortly.

I also doubt the claim that 'treatment is very hard to obtain in the UK'. According to Jane Hutt, it is up to the GP whether or not to refer a patient for acupuncture treatment - there is no implication that the service is restricted in any way. But I will ask for further clarification.

Cheers,
Don

 

[Benguin]

I seem to remember Rolfe or Eos or someone finding a study on endorphine release that concluded, whilst there was some truth the needles would do this, a slap on the ass was an order of magnitude more effective.

I did suggest we open an assslapathy clinic, but no-one seemed interested.

 

[Rolfe]

I think this paper here, by a real veterinary-qualified acupuncturist (and raving woo-woo nutter), says quite a lot more than its author really meant to reveal about the alleged "effectiveness" of acupuncture on animals.

Rolfe.

(OK, that web page is down. Probably not permanently though.)

 

[iain]

There does appear to be a growing number of good studies suggesting that accupuncture is successful at delivering pain relief in certain situations.

New Scientist has a report of a study this week in which accupuncture was found to give as effective relief for post-operative nausea as standard drugs (See the "In brief" section of the New Scientist 31 July 2004).

 

[Benguin]

New Scientist.com

Can one of you medics get that journal?

It's an interesting report, but proving (if it has, indeed, done that) that one acu-point can help with one state is hardly proof of acupuncture.

I mean, post-operative surgery was hardly on the menu when all this chi theory was thought up!

 

[reprise]

Just a quick reply to Benguin.

The BMAS told me:

"......I can reassure that the NHS does not spend millions of pounds on acupuncture. In fact, acupuncture treatment is very hard to obtain as an NHS patient and most acupuncture treatments in the UK are given in private practice. (Most of us who do provide acupuncture treatment within the NHS do
so pro bono.)"

I don't have any real figures yet, so can't dispute that - though I will be asking for these figures from the givernment shortly.

I also doubt the claim that 'treatment is very hard to obtain in the UK'. According to Jane Hutt, it is up to the GP whether or not to refer a patient for acupuncture treatment - there is no implication that the service is restricted in any way. But I will ask for further clarification.

Cheers,
Don

Hmmm. I wonder if the situation is similar to what happens here, where when acupuncture is provided by a GP (a significant number of GPs offer it) it is booked as a separate appointment and billed to the NHS as a standard or long consultation (no mention being made in the billing of the consultation having been purely for the purpose of providing acupuncture). If that's the case, then it's hard to assess just how much the NHS is paying for acupuncture.

 

[Benguin]

Hmmm. I wonder if the situation is similar to what happens here, where when acupuncture is provided by a GP (a significant number of GPs offer it) it is booked as a separate appointment and billed to the NHS as a standard or long consultation (no mention being made in the billing of the consultation having been purely for the purpose of providing acupuncture). If that's the case, then it's hard to assess just how much the NHS is paying for acupuncture.

Yes, I've a paper somewhere Geni sent me which reports on the prevalence of CAM within the NHS GP clinics and whatever those other primary care centres are called.

The figures were quite high and being flung about with exaggerated abandon by olaf in one of her 100 000 medical doctors frenzies.

I'll dig it out tonight ... I recall the majority were not actually providing NHS-paid-for treatment, but some certainly were. I didn't see actual money figures though.

A quick hunt revealed this

 

[Benguin]

OK, this is more useful

University of york, NHS centre for reviews and dissemination

Effective Healthcare (Acupuncture), NOVEMBER 2001 VOLUME 7 NUMBER 2 ISSN: 0965-0288

It's a stonking great pdf though, I warn you.

From the summary;

[Acupuncture] is
widely used in both
private and NHS settings.
It has been estimated that
one million acupuncture
treatments are given on
the NHS and two million
in the private sector in
England each year.

Mmmm, a million treatments given on the NHS in england per year.

Whilst there
are many RCTs
evaluating the
effectiveness of
acupuncture, the
majority are of poor
quality, and provide
conflicting evidence.

Acupuncture appears to
be effective for
postoperative nausea and
vomiting in adults,
chemotherapy-related
nausea and vomiting and
for postoperative dental
pain.

Current evidence suggests
that acupuncture is
unlikely to be of benefit
for obesity, smoking
cessation and tinnitus.
For most other conditions,
the available evidence is
insufficient to guide
clinical decisions.

 

[Rolfe]

Acupuncture as practised by the Chinese wasn't about pain relief, it was about curing disease. However, in modern times the only thing it seems to be getting any credence for is pain relief.

I listened to a consultant with a special interest in pain control lecture about this (it was part of a lecture about how to assess published evidence critically, otherwise you'd end up believing things that ain't necessarily so). He essentially trashed the evidence by looking at the quality of the trials involved (see this page for example)

The question is whether this review provides evidence of lack of effect, or lack of evidence of effect. The inability of the four highest quality blinded trials to show a statistically significant short-term improvement must be worrying for those providing acupuncture services, and for the health services or individual who purchase acupuncture. A sceptical view seems to be most appropriate until trials of high quality prove that to be wrong.

Oh, I see this is about one of Professor Ernst's studies again - well, he doesn't seem to be very pro-acupncture either as far as this lot goes.

It seems that sticking needles in people can have a very profound psychological effect - they want to believe, they need to believe, and since pain is all in the mind then there is a tendency to report an improvement. However, there has never been a well-conducted study that demonstrates clearly that it matters one whit where you stick the bloody needle! (Or, I think, even whether you just succeeded in making the patients believe you'd stuck a needle in them.)

So is this really a useful contribution to pain management? Especially as it's not entirely safe.

This refreshing little review points out that the seemingly innocuous, if done improperly or without care, can result in serious harm. The numbers of patients harmed by acupuncture in this literature review is difficult to assess, but runs into the hundreds. Choosing acupuncture because it is deemed harmless may be a poor choice.

Oops, it's Professor Ernst again being quoted here. (Sorry, it's just that on another thread a poster said without any enquiry that he was "sure" that Professor Ernst believed that homoeopathy and acupuncture were effective. Come on guys, critical thinking here!)

Rolfe.

 

[asthmatic camel]

Rolfe, I'm truly disgusted that accupuncture is offered by the NHS. I'm even more astonished that so many NHS employees believe it has any value. Around here, alcoholics are routinely offered accupuncture by the alcohol abuse team. My friend attended a few sessions and reported that "It was relaxing but that was only because she (the "therapist") talked to us. He has since stuck one end of a hosepipe into the exhaust pipe of his car, the other end through the car window, turned on the engine and killed himself. Anecdotal, I know, but I sure wish he was still around and had been treated by professionals; he might have stood a chance. A psychiatrist I spoke to recently said that "I have a problem with homeopathy, I'm not sure about accupuncture. Accupuncture has been around for a long time." My response : "So has ◊◊◊◊◊◊◊◊ and fraud."

 

[Prester John]

New Scientist.com

Can one of you medics get that journal?

It's an interesting report, but proving (if it has, indeed, done that) that one acu-point can help with one state is hardly proof of acupuncture.

I mean, post-operative surgery was hardly on the menu when all this chi theory was thought up!

I got it, here is part of the summary:

Main Results
Twenty-six trials (n = 3347) were included, none of which reported adequate allocation concealment. There were significant reductions in the risks of nausea (RR 0.72, 95% CI 0.59 to 0.89), vomiting (RR 0.71, 95% CI 0.56 to 0.91) and the need for rescue antiemetics (RR 0.76, 95% CI 0.58 to 1.00) in the P6 acupoint stimulation group compared with the sham treatment, although many of the trials were heterogeneous. There was no evidence of difference in the risk of nausea and vomiting in the P6 acupoint stimulation group versus individual antiemetic groups. However, when different antiemetics were pooled, there was significant reduction in the risk of nausea but not vomiting in the P6 acupoint stimulation group compared with the antiemetic group (RR 0.70, 95% CI 0.50 to 0.98; RR 0.92, 95% CI 0.65 to 1.29 respectively). The side effects associated with P6 acupoint stimulation were minor. There was some evidence of asymmetry of the funnel plot.

The funnel plots for nausea and vomiting showed some evidence of bias, despite a thorough search and exclusion of trials with a 'no treatment' control group. Therefore, the summary estimates from this systematic review may be an over-estimate.

This systematic review has shown that P6 acupoint stimulation is effective in reducing the risk of PONV compared to sham treatment, although there is considerable heterogeneity among the trials examined.

There was no evidence that P6 acupoint stimulation reduced the risk of PONV compared to various types of prophylactic antiemetics. It is unclear whether there was 'no evidence of difference' or 'evidence of no difference', given that there was only a small number of trials, with a small number of participants, comparing P6 acupoint stimulation to various types of antiemetics.

My interpretation, its better than doing nothing, but not better than existing treatment. And the effects have likely been overestimated anyway. Its screaming placebo effect to me