The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturistsBMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7311.486 (Published 01 September 2001) Cite this as: BMJ 2001;323:486
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EDITOR - In a (hypothetical) paper titled, "The York surgery safety
study:a prospective survey of 34000 surgical treatments" one would expect
to find information concerning the nature of the surgical procedures
carried out. Just as one would expect to find information concerning the
nature of the acupuncture treatments carried out in a survey on the safety
of acupuncture. Lack of this information makes drawing conclusions
difficult if not impossible.
Let us for example look at the incidence of the most frequently
reported serious complication associated with acupuncture: pneumothorax. A
recent review of prospective surveys on the safety of acupuncture reported
two cases of pneumothorax in nearly 250000 treatments (1). In contrast, in
a retrospective study from Holland the same number of pneumothorax was
encountered in 10000 treatments (2). In the prospective studies by White
(3) and MacPherson (4) a total of 66000 acupuncture treatments were
analysed and not a single pneumothorax was reported. Can we therefore
conclude that the risk of developing a pneumothorax after acupuncture
treatment is negligible (or at least less than 1:66000)? The reason we can
not, is that the two studies provide no denominator information i.e. how
many of the 66000 acupuncture treatments were actually performed on the
thorax, a flaw they share with all previously performed acupuncture safety
Furthermore it would be of interest to know more about the techniques
used, as with chinese-style acupuncture for instance, the needles
penetrate deeper in the tissues than with japanese-style acupuncture.
While systematic surveys on the efficacy and safety of complementary
medicine are to be applauded, we believe that studies providing more
detailed information are required to reliably assess the safety of
Competing interests: none declared
1. Ernst E, White AR. Prospective studies of the safety of
acupuncture: a systematic review. The American Journal Of Medicine
2. Van Dijk PA. Complications of acupuncture. Ned Tijdschr
3. White A, Hayhoe S, Hart A, Ernst E. Adverse events
following acupuncture: prospective survey of 32000 consultations
with doctors and physiotherapists. BMJ 2001;323:485-486
4. MacPherson H, Thomas K, Walters S Fitter M. The York
acupuncture safety study: prospective survey of 34000 treatments by
traditional acupuncturists. BMJ 2001;486-487
Competing interests: No competing interests
Although acupuncture has the public reputation of being safe, several
scientific publications - mainly case reports - outlined serious adverse
effects. The most commonly reported severe complications are traumatic
ones because of inadequate training of the therapists (1). However, the
prospective studies published by MacPherson et al. (2a) and White et al.
(2b) in the 1st September issue of the BMJ represent an important
contribution concerning the question how safe acupuncture really is. It is
the merit of the authors to motivate a rather huge number of qualified
acupuncturists to participate in their studies.
An attempt was made to expand the SAFA-Study of White et al. to Germany
(3). The authors encountered serious reservations from the heads of the
professional acupuncture bodies as well as by the acupuncturists
themselves. The first criticised the project in general and stated that
members trained by the respective organisation only perform safe
treatments. The latter were worried about possible lack of anonymity and
legal prosecution in the case of professional blunder. The study was not
Both studies presented in the BMJ only reported minor adverse effects and
concluded a statistical event rate for serious complications of 0 – 1.1
per 10.000 treatments.
One can assume that pneumothorax, one example of severe traumatic
complications, happens extremely rarely. However, in 2001 Odsberg and
colleagues published a prospective study on adverse effects of acupuncture
(4). As in the two studies presented in the BMJ, the Swedish group found
no major complication in more than 9000 treatments. However, between
completion of the survey and publication date, three cases of pneumothorax
due to acupuncture were reported to the National Board of Health and
Welfare in Sweden.
In conclusion, both studies are a meaningful beginning and should be
continued urgently to assess the event rate for major complication, as
Informed consent has become an important part of medical practice. It
requires the communication of information about possible adverse effects
However, acupuncturists have expressed concern that increased provision of
risk information may make patients unduly anxious and change their
decisions about treatment (5). It has been our experience that provision
of detailed information about possible adverse consequences of treatment
can improve patients' understanding and satisfaction without inducing
increased anxiety. Meanwhile this has been proven by several studies (6).
A proposal has been made and will be published in the next issue of
Acupuncture in Medicine.
(1) Peuker ET, White A, Ernst E, Pera F, Filler TJ. Traumatic
complications of acupuncture - Therapists need to know human anatomy.
Arch Fam Med 1999;8:553-558.
(2a) MacPherson H, Thomas K, Walters S, Fitter M. The York
acupuncture safety study: prospective survey of 34 000 treatments by
traditional acupuncturists. BMJ 2001;323:486-487.
(2b) Adrian White, Simon Hayhoe, Anna Hart, and Edzard Ernst. Adverse
events following acupuncture: prospective survey of 32 000 consultations
with doctors and physiotherapists. BMJ 2001;323:485-486.
(3) Peuker ET, Diederich F, White AR, Ernst E, Hecker U, Filler TJ.
Internationale Studie zu Nebenwirkungen der Akupunktur. AKU 1999;27: 49-
(4) Odsberg A, Schill U, Haker E. Acupuncture treatment: side effects
and complications reported by Swedish physiotherapists. Complement Ther
(5) “The safe practice of acupuncture conference”. Organised jointly
by the Acupuncture Association of Chartered Physiotherapists, British
Acupuncture Council and the British Medical Acupuncture Society;
Discussion. London, 2001, June 19th
(6) Garrud P, Wood M, Stainsby L. Impact of risk information in a
patient education leaflet. Patient Educ Couns 2001;43:303-6.
Competing interests: No competing interests