Harm comes in many forms.
Vincent in his editorial  was right to point out that the two
studies on the safety of acupuncture are reassuring.[2,3] He also pointed
out that considering safety alone is unhelpful, a risk: benefit ratio
should be considered. However, harm comes not only from adverse events.
Another area of concern with "alternative" practitioners is the lack of
communication with "conventional" carers, and in particular primary care.
If one core element of primary care is co-ordination of care  then poor
communication between complimentary practitioner and primary care can only
serve the patient poorly. Indeed, harm may occur. Without full knowledge
of the patient, their condition and medications inadvisable treatments
might be advocated. Therefore there needs to be a clear link between
"alternative" or, better still, complementary practitioners and the
patients primary care provider.
To create a linkage between primary care provider and complementary
therapist does require a different approach. In our own practice we have
forged strong links with a chiropractic doctor (in the past, placing a
fund holding contract with one), offered accommodation to an acupuncturist
and have held evening meetings with complimentary therapists to discuss
the merits of their treatments. Two partners in the practice are trained
in the basics of complementary therapies (acupuncture and homoeopathy).
All this adds up to an open relationship between patient, their GP and
their complementary therapist. One area that we have not succeeded with is
in linking with herbalists. This is of some concern given the possible
interactions between herbal remedies and allopathic treatment  and the
potential problem of herbal toxicity that may not be recognised for what
it is .
Therefore safety studies of complementary therapy needs to look at
broader aspects of care and, in particular, communication and
organisational problems that might arise.
1 Vincent C. The safety of acupuncture. BMJ 2001; 323: 467-468.
2 White A, Hayhoe S, Hart A, Ernst E. Adverse events following
acupuncture: prospective survey of 32 000 consultations with doctors and
physiotherapists. BMJ 2001; 323: 485-486.
3 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.
4 Starfield B. Primary care: balancing health needs, services and
technology. Oxford: Oxford University Press, 1998.
5 Braun L. Herb-drug interaction guide. Aust Fam Physician 2001: 30(6):
6 Borins M. The dangers of using herbs. What your patients need to know.
Postgrad Med 1998; 104(1): 91-5, 99-100
Competing interests: No competing interests