Rigorous accreditation schedule for acupuncture already exists

Editor—E Ernst and A White raise important points about the safe practice of acupuncture.1 Most people would agree that sticking needles into patients, however fine they are, has the potential for harm. What I find surprising, having chaired the British Acupuncture Accreditation Board since its beginnings in 1989, is that the authors seem to be calling for a solution that has been in place for nearly eight years; bylaws governing aspects of safe practice in acupuncture clinics have been in place considerably longer.2 The “system of self regulation” that the British Acupuncture Accreditation Board embodies is not “likely to gain support from … official bodies”: it has already gained it, as Ernst and White will see if they reread the BMA's 1993 report on complementary medicine3 or talk to people in the Department of Health. We set a rigorous accreditation schedule, which makes stern demands on the acupuncture training colleges and includes the issues of safety and familiarity with orthodox medicine (comprising a third of the syllabus) that the authors are rightly concerned about.

Ernst and White overlooked a development that is known to most of those working in complementary medicine. As with homoeopathy, historically one of the difficulties has been to get medical practitioners round the same table as their non-medical counterparts. This has shown itself recently in the field of regulation and accreditation, and one result of Ernst and White's editorial might be to spur both camps to come together for the benefit of the general public.

Incidentally, the authors may prove unduly pessimistic about statutory registration for acupuncturists. Osteopathy, with which they seek to contrast acupuncture, was not defined in legislation either.

Core curriculum is important

Editor—As representatives of a college with candidacy status with the British Acupuncture Accreditation Board, we agree with E Ernst and A White's plea for “basic medical knowledge and experience” to be included in acupuncture training programmes.1 The authors are concerned about the safety of acupuncture as practised in Britain, citing reports of complications resulting from acupuncture (most of which occurred outside Britain) and suggesting that these are consequences of inadequate training and naivete of practitioners. We are sorry that they did not mention that the British Acupuncture Accreditation Board has a core curriculum for students, which emphasises a grounding in anatomy, physiology, and pathology; a knowledge of presentations of disease requiring referral to a conventional practitioner; and sterile and safe needle technique.2

Acupuncture practised by graduates of accredited colleges entails the insertion of sterile needles into acupoints located with the aid of a thorough knowledge of surface anatomy. Needles are usually retained for no more than 30 minutes. Needles are either single use needles or sterilised; there is no risk of the transmission of diseases such as HIV or hepatitis between patients and a minimal risk of skin flora being introduced into subcutaneous tissues.

Guidelines from the Royal College of Physicians suggest that prophylaxis for infective endocarditis should be considered only when the skin has been breached for invasive gastrointestinal, urological, or cardiac surgery.3 This suggests that expert opinion is that acupuncture does not pose the risk that concerns Ernst and White. Surely there must be greater risk in the use of larger gauge needles for venepuncture and injections.

Students are trained in the anatomy of vital organs and how these are avoided during needling. Correct knowledge of the depth of thoracic acupoints reduces the risk of reaching a visceral organ. We believe that the risks of acupuncture are bound to increase in inverse relation to the training of the practitioner. We therefore disagree that a medically qualified acupuncturist is less likely to cause complications: most doctors seek only a cursory training in acupuncture.

We find the phrase “overoptimistic prognoses naively based on the theory of Chi” to be a derogatory and inappropriate way of describing a sensitive diagnostic system that has stood the test of time. We are perplexed that a professor of complementary medicine should apparently hold such a negative view of an approach that acupuncturists worldwide would consider the essence of their practice.

Guidelines on practice of acupuncture exist

Editor—E Ernst and A White provide outdated information about the safety of acupuncture and seem to ignore current standards of practice in Britain.1 There have undoubtedly been many instances of infection in over 3000 years of use of acupuncture as well as some adverse reactions, but this would also be true of other invasive techniques and the use of Western medicine. What matters most to British patients is what happens in Britain now. Ernst and White's references give a global picture, in some cases referring to the 1970s and 1980s and to acupuncture given by doctors.

In Britain all healthcare professionals and patients can be assured that guidelines that minimise the risk of infection have existed for some time. These guidelines, which have been adopted by the British Acupuncture Council and its 1600 members, were independently developed by Professor Norman Noah (of King's College, London). They cover the use of sterile acupuncture needles, the techniques of sterilisation, and the hygiene measures used to minimise any risk of infection due to insertion through “dirty skin.” Indeed, the National Blood Transfusion Service allows patients who have recently had acupuncture treatment by members of the British Acupuncture Council to give blood because it is happy with these guidelines.

The British Acupuncture Accreditation Board advocates strict guidelines for a core syllabus in traditional acupuncture, which includes Western medicine. These guidelines, together with strict codes of ethics, practice, and professional conduct, ensure that those people graduating from accredited or candidate colleges and those already on the register of the British Acupuncture Council, practise traditional acupuncture safely and competently—patients' safety being the overriding consideration. Even so, the council, its members, and colleges of traditional acupuncture that are either accredited or going through the accreditation process of the British Acupuncture Accreditation Board, are not complacent about any of these issues.

Many of the ideas and solutions suggested by Ernst and White are essentially in place. The British Acupuncture Council recognises that it represents only traditional acupuncture and that many doctors and physiotherapists also perform a more limited style of acupuncture. The council would happily enter into discussions with a view to the adoption of a British or even European set of regulations and standards.