The reported severity of some of the documented adverse effects
associated with acupuncture is alarming, although as noted in some of the
feedback, comparatively fewer than reported with the use of conventional
medicine. Yet, were the adverse effects of acupuncture exacerbated by a
compromised immune system, poor aseptic techniques, or poor educational
standards of the administrating practitioner, or was there a bias in the
sample of reported adverse effects?
Contributing to the underlying probability of adverse effects
occurring with acupuncture, is the qualification and educational standards
of the administrating practitioner. The standard of education for the
majority of general practitioners (GP)/ medical doctors (MD) who practice
acupuncture/TCM is at best no more than 250hours. (At least this is the
case in Australia- but its not to say that there are some highly qualified
acupuncturist/ GP). Alternatively acupuncturist/TCM practitioners have a
minimum 2500 hours (1500 of which is TCM/Acupuncture), covering both
traditional and non-traditional, or alternatively termed, medical
acupuncture approaches. Obviously the differences in standards of
education would contribute to the frequency of adverse effects occurring.
For this reason legislation for the registration practitioners who
practice acupuncture/TCM, currently in review in Australia, seeks to aim
at standardising educational standards in this field, irrespective of the
practitioners medical ie GP/MD status.
An interesting facet of the current discussion is its metamorphoses
from a discussion on the documented risks of acupuncture to the
'scientific' or lack of, basis of acupuncture. Such issues that have been
raised question the efficacy of the practice of acupuncture, its ‘archaic’
origins, and the apparent lack of statistical significance in a few noted
studies. As a qualified practitioner in acupuncture and TCM, having
completed a four year undergraduate degree at the University of
Technology, Sydney (UTS), and currently enrolled in a post-graduate
research degree (acupuncture) also at UTS, I find it confounding the
number of people who report to have expertise in this field, yet have no
formal TCM/acupuncture qualifications.
I am the first to agree that there is alot of poor research in the
area of acupuncture and TCM. But too often have researchers unqualified
in the practice of acupuncture or acupuncturists not trained in scientific
research methodology, undertaken and commenting upon research into this
field. This not only undermines the acupuncture profession but raises
ethical issues as to the use of money that would be better spent
elsewhere, discomfort to research subjects and time wastage, especially if
researchers continue to compromise the integrity of research methodology
when applied to acupuncture. (If a person really 'opens' their eyes, they
may just find some very good research as well).
I am sceptical when people present research to back up their opinions
of acupuncture without providing further details as to the research
design, aims, objectives, sample size, what was being measured, how it was
measured and the statistical test used. Too often have I read supposedly
good research from reputable journals only to observe gaping holes in the
research design, poor operational definitions and uncontrolled extraneous
variables. (This, unfortunately, is not just confined to the field of
acupuncture but is a problem that is endemic to all professions, but
interestingly highlighted when it comes to acupuncture).
Given this, problems that question the validity of research fall into
three basic categories. The first is the use of a control or sham
acupuncture to the active treatment. Alot of work into the area of
research design has questioned the validity of using sham acupuncture as a
control. (The size, location, location method, selection of sham points
(traditional theory, western approaches such as dermatome, differences
between traditional theories) are some of the problems in the use of sham
acupuncture. I refer you to the work of Bob Felt and Stephen Birch in
their book Understanding Acupuncture who explore the issues and problems
of research into the field of acupuncture and present ways of overcoming
these problems based on sound scientific research principles. Secondly is
the exclusion of TCM disease categorisation and diagnostic principles in
allocating people to treatment groups. This subsequently questions the
internal validity of the research in regards to the active treatment, and
in fact, to whether the researchers are observing acupuncture/TCM or
simply the benefits of a localised noxious stimulus. Third is the lack of
testing of inter-rater agreement between practitioners and inclusion of
untested assumptions into research design.
Traditional TCM/Japanese/Korean/ Vietnamese acupuncture utilise
concepts and theory that are to a degree different from that practice by
Western medicine. Yet people overlook the fact that the theory and
associated treatment approaches have developed and evolved to meet the
changing response of a population to health and disease. As extant
theories have failed to meet the changing demands of a population new
concepts of health evolved. As such, medical principles and treatment
approaches in this paradigm focus upon functional relationships as they
pertain to health and disease. People forget that a lot of theory
developed around clinical observation, practice and treatment effects; an
empirical process.
The words ‘arcane’ and ‘esoteric’ have been used to describe the
practice of TCM and acupuncture. I wonder if the people who use these
descriptive terms have made a study or under taken some accredited degree
program or whether they have picked up the term from their cursory reading
and applied it to the practice of TCM/ acupuncture because of their
ignorance. Too often have I read descriptions of acupuncture that focus
on one aspect, and usually a fringe aspect at that, to describe and
justify their perception of this medical paradigm. It is true that the
theory of acupuncture, its rational for diagnosis, its nomenclature, and
treatment approaches utilise concepts, descriptions and techniques that do
not immediately conform to the concept of health as understood by the
Western medical profession. However, there are similarities. In fact, if
practitioners would concentrate on the similarities instead of the
differences between these two great medical paradigms, perhaps a more
constructive partnership could be formed instead of the continuing sniping
at each other’s heels.
Sean Walsh.
Competing interests:
No competing interests
22 March 2000
Sean Walsh
Post-graduate student. Part time academic. Acupuncturist.
University of Technology, Sydney. Edgeware Family Practice.
Rapid Response:
An 'alternative's' response.
The reported severity of some of the documented adverse effects
associated with acupuncture is alarming, although as noted in some of the
feedback, comparatively fewer than reported with the use of conventional
medicine. Yet, were the adverse effects of acupuncture exacerbated by a
compromised immune system, poor aseptic techniques, or poor educational
standards of the administrating practitioner, or was there a bias in the
sample of reported adverse effects?
Contributing to the underlying probability of adverse effects
occurring with acupuncture, is the qualification and educational standards
of the administrating practitioner. The standard of education for the
majority of general practitioners (GP)/ medical doctors (MD) who practice
acupuncture/TCM is at best no more than 250hours. (At least this is the
case in Australia- but its not to say that there are some highly qualified
acupuncturist/ GP). Alternatively acupuncturist/TCM practitioners have a
minimum 2500 hours (1500 of which is TCM/Acupuncture), covering both
traditional and non-traditional, or alternatively termed, medical
acupuncture approaches. Obviously the differences in standards of
education would contribute to the frequency of adverse effects occurring.
For this reason legislation for the registration practitioners who
practice acupuncture/TCM, currently in review in Australia, seeks to aim
at standardising educational standards in this field, irrespective of the
practitioners medical ie GP/MD status.
An interesting facet of the current discussion is its metamorphoses
from a discussion on the documented risks of acupuncture to the
'scientific' or lack of, basis of acupuncture. Such issues that have been
raised question the efficacy of the practice of acupuncture, its ‘archaic’
origins, and the apparent lack of statistical significance in a few noted
studies. As a qualified practitioner in acupuncture and TCM, having
completed a four year undergraduate degree at the University of
Technology, Sydney (UTS), and currently enrolled in a post-graduate
research degree (acupuncture) also at UTS, I find it confounding the
number of people who report to have expertise in this field, yet have no
formal TCM/acupuncture qualifications.
I am the first to agree that there is alot of poor research in the
area of acupuncture and TCM. But too often have researchers unqualified
in the practice of acupuncture or acupuncturists not trained in scientific
research methodology, undertaken and commenting upon research into this
field. This not only undermines the acupuncture profession but raises
ethical issues as to the use of money that would be better spent
elsewhere, discomfort to research subjects and time wastage, especially if
researchers continue to compromise the integrity of research methodology
when applied to acupuncture. (If a person really 'opens' their eyes, they
may just find some very good research as well).
I am sceptical when people present research to back up their opinions
of acupuncture without providing further details as to the research
design, aims, objectives, sample size, what was being measured, how it was
measured and the statistical test used. Too often have I read supposedly
good research from reputable journals only to observe gaping holes in the
research design, poor operational definitions and uncontrolled extraneous
variables. (This, unfortunately, is not just confined to the field of
acupuncture but is a problem that is endemic to all professions, but
interestingly highlighted when it comes to acupuncture).
Given this, problems that question the validity of research fall into
three basic categories. The first is the use of a control or sham
acupuncture to the active treatment. Alot of work into the area of
research design has questioned the validity of using sham acupuncture as a
control. (The size, location, location method, selection of sham points
(traditional theory, western approaches such as dermatome, differences
between traditional theories) are some of the problems in the use of sham
acupuncture. I refer you to the work of Bob Felt and Stephen Birch in
their book Understanding Acupuncture who explore the issues and problems
of research into the field of acupuncture and present ways of overcoming
these problems based on sound scientific research principles. Secondly is
the exclusion of TCM disease categorisation and diagnostic principles in
allocating people to treatment groups. This subsequently questions the
internal validity of the research in regards to the active treatment, and
in fact, to whether the researchers are observing acupuncture/TCM or
simply the benefits of a localised noxious stimulus. Third is the lack of
testing of inter-rater agreement between practitioners and inclusion of
untested assumptions into research design.
Traditional TCM/Japanese/Korean/ Vietnamese acupuncture utilise
concepts and theory that are to a degree different from that practice by
Western medicine. Yet people overlook the fact that the theory and
associated treatment approaches have developed and evolved to meet the
changing response of a population to health and disease. As extant
theories have failed to meet the changing demands of a population new
concepts of health evolved. As such, medical principles and treatment
approaches in this paradigm focus upon functional relationships as they
pertain to health and disease. People forget that a lot of theory
developed around clinical observation, practice and treatment effects; an
empirical process.
The words ‘arcane’ and ‘esoteric’ have been used to describe the
practice of TCM and acupuncture. I wonder if the people who use these
descriptive terms have made a study or under taken some accredited degree
program or whether they have picked up the term from their cursory reading
and applied it to the practice of TCM/ acupuncture because of their
ignorance. Too often have I read descriptions of acupuncture that focus
on one aspect, and usually a fringe aspect at that, to describe and
justify their perception of this medical paradigm. It is true that the
theory of acupuncture, its rational for diagnosis, its nomenclature, and
treatment approaches utilise concepts, descriptions and techniques that do
not immediately conform to the concept of health as understood by the
Western medical profession. However, there are similarities. In fact, if
practitioners would concentrate on the similarities instead of the
differences between these two great medical paradigms, perhaps a more
constructive partnership could be formed instead of the continuing sniping
at each other’s heels.
Sean Walsh.
Competing interests: No competing interests