This article reports on a prospective study, funded by the British Acupuncture Council, looking into the safety of acupuncture treatment. The study involved 1 in 3 members of the BAcC who between them recruited 9,400 patients as survey respondents. The characteristics of the acupuncture patients and their reason for seeking treatment are outlined. Short-term reactions to treatment are described, along with perceived adverse events reported in a 3-month follow-up questionnaire. The data presented belie alarmist claims that non-physician acupuncturists put patients at risk by delaying conventional diagnosis and treatment and/or advising changes in prescribed medication. The conclusion from this large-scale and rigorously conducted study strongly reinforces existing evidence that acupuncture, when practised by qualified acupuncture practitioners, is a safe intervention. It also provides compelling evidence that the standards promoted by the BAcC have led to qualified acupuncturists being safe in their broader role as healthcare professionals.
Introduction Acupuncture is safe in competent hands’ was the statement that summed up the results of the first study into acupuncture safety sponsored by the British Acupuncture Council (BAcC) in 2001. However it was soon apparent that this research was but a job half done. There were a few crucial limitations needed to be addressed by additional research. First our first data set was based on practitioner reports on safety, resulting in concern about the data that practitioners can only be expected to be selective in their reporting of adverse events.
Secondly, we had trouble addressing potential concerns that non physician practitioners might not be safe, as we had no data on perceived adverse consequences arising from delayed conventional diagnosis and treatment or from advice about conventional/prescribed medication. To address these concerns, the British Acupuncture Council funded a second safety study, which directly addressed these potential limitations. In this new study, which we report here, one in three members of the British Acupuncture Council (638) became involved, and helped us recruit 9,408 patients. Of these, 6,348 (67%) completed and returned follow-up questionnaires three months later. In this article, firstly we describe the characteristics of acupuncture patients and in particular their reason for seeking treatment. Secondly, we describe the mostly positive short-term reactions that were reported by the 9,408 patients at the time when they signed up for the study.
Thirdly we describe the reports of the 6,348 patients on the adverse events they experienced over the three months, including the perceived adverse consequences resulting from delayed or missed diagnosis, and advice to reduce or stop prescribed medication. The conclusion from this large-scale and rigorously conducted study strongly reinforces existing evidence that acupuncture is safe in competent hands. However, it is not just that acupuncture is safe, we also have compelling evidence that the standards promoted by the British Acupuncture Council have led to qualified acupuncturists being safe in their broader role as healthcare professionals.
The Need to Address Ill-informed and Alarmist Statements As members of the British Acupuncture Council, it is estimated that we provide two million acupuncture treatments in the UK each year (White E 2000). We are now at a point where we are treating so many patients that, as a profession, we can no longer ignore the issues of patient safety. Recognising this, the British Acupuncture Council has been actively supporting research into safety in a number of ways. Funding was provided for the Foundation for Traditional Chinese Medicine to conduct a practitioner survey of adverse events over a four week period in May 2001. Over 500 BAcC acupuncturists helped with this survey, and the results of this study were published in the British Medical Journal soon afterwards (MacPherson et al. 2001b). We also published two other versions of this research, one in Acupuncture in Medicine (MacPherson et al. 2001a) and one in the European Journal of Oriental Medicine (MacPherson H et al. 2002). The evidence from this survey can be combined with a parallel survey conducted by Adrian White, also published in the British Medical Journal (White et al. 2001) and Acupuncture in Medicine (White, Hayhoe, Hart, and Ernst 2001). Together these two surveys covered over 60,000 consulta-tions. In total, practitioners reported 86 significant non-serious adverse events, most commonly nausea, fainting and dizziness. These papers led Professor Charles Vincent, an expert on error and safety in conventional medicine (and in the past an acupuncturist trained at Leamington), to make the definitive assertion in a British Medical Journal editorial that ‘acupuncture is safe in competent hands’ (Vincent 2001).
Whenever research is published, there is a tendency among scientific and academ-ic communities to target the weaknesses of the study, criticising it wherever possible. There is perhaps a healthy aspect to this, in that if research can stand the test of critical appraisal, then its credibility will be bolstered. If, on the other hand, specific weaknesses are identified, then it can be a spur to further research. The criticism will be all the more inevitable when issues of professional territory are raised; for example, when there is a sub-text about which professional grouping is safest for patients. So, as one might have expected, after the above research was published, our research was subjected to criticism. First, it was implied that professional acupuncturists, especially those of us who depend on acupuncture as a livelihood, would be biased in reporting adverse events. The inference being that we would under-report negative reac-tions related to acupuncture, especially if they were serious. There may be some legitimacy to this concern, in that we already know that gross under-reporting of adverse events can occur among hos-pital doctors (Smith et al. 1996) and general practitioners (Moride et al. 1997). The second challenge to our profession has come mostly from doctors who are not so much concerned about the safety of acupuncture per se, but whether acupuncturists are safe. Few British Acupuncture Council members are trained as physicians, so the concern has been raised that our patients are poten-tially not safe because as practitioners we have not benefited from a full medical training. For example, one typical comment was that ‘since acupuncture is used by some practitioners as a complete system of medicine, it may constitute a risk of delayed conventional diagnosis (or treatment)’ (Ernst E 2001). This concern was elaborated, with the explanation that ‘a sinister underlying cause’ might be missed, thereby putting the patient at risk. The criticisms went further, suggesting that ‘practitioners have the unfortunate habit of (changing prescribed medication), which could be associated with important risks’ (Ernst E 2001).
Innuendos can only be stopped by hard evidence, so that anytime anyone says anything about ‘non-medical’ acupuncture practitioners missing a serious or malignant diagnosis in a patient, we need to be able to respond with a robust state-ment of the actual evidence. If the research is conducted at the highest lev- els of rigour, then it will be a fair assessment of the risks and provide powerful arguments to rebut ill-informed attacks. While an initial reaction to these somewhat alarmist points of view might have been defensive, the British Acupuncture Council took a progressive view and decided to pre-emptively tackle these challenges by supporting further research. Exploring the actual risks in these areas was seen as necessary because as long as there was no evi-dence, the critics could continue with their alarmist sound bites, taking the high ground by saying that as long as there is no evidence, you just do not know how serious the risks might be.
The imperative of conducting further research into the safety of acupuncture, backed by funding from the British Acupuncture Council, provided the Foundation for Traditional Chinese Medicine with the possibility of collecting some additional data, while ensuring that the main goals of the research were not compromised. We were interested in two other areas that we believe would be useful for the profession. Firstly, we were interested in the characteristics of patients who consult acupuncturists, the pathway that they took to acupuncture, what condition they were being treated for and whether they had had contact with their GP or hospital specialist beforehand. Secondly, we wanted to extend our previous interest in short-term reactions to acupuncture, which we expected to be largely positive, and might include temporary aggravations to existing symptoms that could be a prelude to an improvement. However, we did not lose sight of our primary aim in this research which was to establish prospectively the type and frequency of adverse events as reported independently by patients. Related to this assessment of safety, we also had as central aims the requirement that we identify the perceived adverse consequences associated with either advice about medication or delayed conventional diagnosis or treatment.
The challenge of collecting the necessary data from patients Recruitment of practitioners and patients: Over a six month period in 2002, we invited all 1,955 acupuncturists registered with the British Acupuncture Council (BAcC) to identify up to 60 consecutive patients (aged over 18) and give them a short questionnaire and consent form. Patients willing to participate returned their baseline questionnaires and consent forms direct to us at the Foundation for Traditional Chinese Medicine. Three months later we sent out by post a questionnaire where we asked about possible adverse events that they might have experienced, either caused directly by the acupuncture treatment, or caused indirectly from following the acupuncturist’s advice about medication, or from delayed conventional diagnosis or treatment. Where possible, we aimed to compare these data with our previous research in which practitioners reported adverse events experienced by their patients covering 30,000 consultations (MacPherson, Thomas, Walters, and Fitter 2001b). The Northern and Yorkshire Multi-centre Research Ethics Committee gave ethical approval for this study.
Data collection on adverse events We collected data on the profiles of the acupuncture patients, their immediate and short-term reactions to treatment at baseline, and details of perceived adverse events at three months. For the adverse events, we provided at checklist of possible negative reactions, and patients ticked the ones that were relevant. At three months, we also asked for details of adverse consequences resulting from both advice about medication and from delayed diagnosis or treatment. For patients who followed advice about medication, we sent a short additional questionnaire asking about the type of medication, whether the advice was to stop or reduce, and whether this advice had been discussed with their GP or specialist. With the patients’ permission, all serious events and all cases of delayed diagnosis and treatment were followed up with a short telephone interview, clarifying the details of the event with questions from a checklist.
Data analysis The baseline data provided us with information on practitioners and patients, as well as the patients’ short-term reactions to acupuncture. We tabulated the reported type and frequency of adverse events, calculating the absolute risk in terms of an adverse event rate per 1,000 patients over three months. We also explored practitioners and patient characteristics to see if there were any potential risk factors.
The Main Findings: What Our Patients Reported
About the acupuncturists In our study, 1,114 British Acupuncture Council acupuncturists responded to our initial letter (52%), and 638 (33%) agreed to help us recruit patients into the study. Acupuncturists who declined to participate reported to us that they were too busy (n=146), not in practice (45), seeing too few patients (35), retiring or moving away (28), on holiday (21), on a maternity break (18), disapproving of the survey (15) or other reasons (60). We present details of participating acupuncturists in Table 1.
Characteristics of the patients In Table 2 we present demographic data on sex and age and compare with data on who consults their GP from the General Household Survey (General Household Survey 2002), the national average (UK Census 2001), and a similar survey undertaken by Kate Thomas in 1989 (Thomas et al. 1991).
Patients reported their pathway to consulting an acupuncturist, whether they had previously consulted their GP or hospital specialist about their main problem or symptom, whether it was their first time receiving acupuncture, and whether the NHS had paid for their treatment (see Table 3). The most common pathways involved were self-referral (39%) or recommendation from a family member, friend or colleague (34%). A relatively small proportion (10%) of patients had been recommended to consult their acupuncturist by someone in the NHS: that is a GP, hospital specialist, physiotherapist, or nurse.
Main problem or symptom of patients The main problem or symptom reported by patients as their reason for consulting their acupuncturists we report in Table 4 using the categories of the International Classification Primary Care (Lamberts and Wood 1987). For patients who reported that they were consulting for treatment for ‘general wellbeing’, we coded an additional item. As might be expected, the largest category is that of musculo-skeletal conditions, accounting for 38% of all consultations. For the purposes of comparison, we also present the equivalent data from the Kate Thomas survey undertaken in 1988 (Thomas, Carr, Westlake, and Williams 1991). It is interesting to note that, compared to 1988, patients are now seeking treatment less for musculo-skeletal disorders and more for a range of other conditions. The breakdown of problems and symptoms as well as the association between these and other patient characteristics are presented more fully elsewhere (MacPherson H, Sinclair-Lian N, and Thomas K 2005).
Short-term reactions to acupuncture Of the 9,408 patients who returned baseline questionnaires, 8,904 (94.6 %) reported experiencing 15,745 short-term reactions associated with their acupuncture, an average of 1.8 reactions per patient. The breakdown of the type and frequency of these reactions are presented in Table 5 in three categories: a) 'positive', mostly relaxed and energised, b) tiredness and drowsiness (which could be interpreted as either positive or negative), and c) 'negative'. In this table we also present the data from the previous practitioner survey (MacPherson, Thomas, Walters, and Fitter 2001a). Compared to practitioners, we found that patients reported higher rates, with 79% of patients feeling relaxed and 33% feeling energised. In addition to these positive reactions, 24% of patients reported experiences of tiredness and drowsiness. A range of negative reactions were also reported (by 30% of patients), most commonly an experience of pain at the site where a needle was inserted. We also analysed the characteristics of patients who were more likely to report these different types of reactions, and have reported this elsewhere (MacPherson H and Thomas KJ 2005).
Patients were asked, “Given this experience, would you be willing to have acupuncture treatment again?” In Table 6, we present the numbers both willing and unwilling to have acupuncture treatment again. This data is presented in the same three categories, positive reactions, tiredness or drowsiness reactions, and negative reactions. The overall rate of unwillingness was only 1.4 patients per 1,000 consultations, surprisingly with no significant difference between positive and negative reactions. We also explored the characteristics of patients who were either willing or unwilling to have acupuncture again, reporting this data elsewhere (MacPherson H and Thomas KJ 2005).
Reports on perceived adverse events In the three month follow-up questionnaire, 682 patients (10.7%) reported a total of 1,044 adverse events caused directly by the acupuncture treatment. The most common event reported was ‘severe tiredness and exhaustion’ (3.6%) followed by prolonged or unacceptable pain at the site of needling (1.6%) (see Table 7). Patients also spontaneously mentioned a number of adverse events under the category ‘other’, most com-monly bruising at the needling site. We have classified 109 (10%) adverse events as potentially avoidable, most commonly: needles being left in at the end of treatment (n=55); moxibustion burns to the skin (28); perceived problems with electro-acupuncture (15), for example too strong a current; and being left alone too long (10). Three events were deemed to be ‘serious’, where we had predefined ‘serious’ as resulting in hospitalisation (reported by one patient), and perma-nently disabling (none reported) and potentially life threatening (reported by two patients). In Box 1, we present a summary of what these three patients said to us when we telephoned them afterwards.
At three months, only 40 patients said they would not be willing to have acupuncture again. In relation to the 30,196 consultations covered by this survey, the adverse event rate reported by the patients was 350 per 10,000 consultations. As a result of further analysis (MacPherson et al. 2004), we found that patients not funded by the NHS were less likely to report adverse events, as were those patients who had not had contact with their GP or hospital specialist prior to or during the three month period. However, patients were more likely to report adverse events if they had not had acupuncture before or if they were consulting a practitioner with less than two years experience.
Reports on advice about medication Over the three month period, 199 patients (3%) reported that at some point they were given advice from their acupuncturist to reduce or stop taking prescribed conventional medication. On sending out an additional questionnaire to this group, but only to those who had agreed to be contacted again (n=177), 99 responded. With additional information from four patients who we followed up by telephone, we were able to further analyse data on advice about medication for 103 patients. For 36 (35%) of the patients in this subgroup, the advice was to stop rather than reduce their medication. In addition, 60 (58%) patients also discussed this advice with their GP or hospital specialist. Six (0.1% of 6348) patients reported that they experienced adverse consequences as a result of the advice they received about their prescribed medication, none of the consequences being serious. The medication and the adverse event data for the 103 patients are presented in Table 8.
Reports of delayed diagnosis and treatment Over the three months, 660 patients (11%) reported receiving advice from their acupuncturist to consult a GP or hospital specialist. Of the remainder (5,688), two patients (0.04%) reported delayed conventional treatment as a result of consulting an acupuncturist. For one patient the adverse consequence was the cost of ineffective acupuncture for her jaw pain and for the other a prolonged urinary tract infection (see Box 2), neither of these consequences being serious.
Interpreting Our Results: What We Have Learned from the Data
Patient profiles With regard to the profiles of acupuncture patients, we found that on average patients consulted acupuncturists most commonly for musculo-skeletal problems (38.1%), followed by psychological (11.2%), general (9.1%), neurological (8.2%), and gynaecological/obstetric (7.6%) problems. We noted that the proportion consulting for musculo-skeletal problems has dropped significantly since 1988 when it stood at 47.3%. We suspect this is a consequence of a recent broadening out of the public perception of what acupuncture can treat successfully. Women still comprise a higher proportion of acupuncture patients than men do. Our survey found a larger proportion of women (74%) patients consulting acupuncturists, which can be explained in part by the fact that women tend to consult their GPs more often too (General Household Survey 2002). In our survey the average age was 51, with a range from 18 to 100 years, compared with a mean age of 44 for people who consult their GP, 39 for the general population and 49 for acupuncture patients in 1989. A relatively higher proportion of people between the ages of 35 and 74 tend to consult acupuncturists. Only to a small extent can this be explained by our exclusion of respondents under the age of 18.
The majority of people in this survey self-referred or were given a recommendation by a member of their family, a friend or a colleague. Healthcare practitioners from within the National Health Service referred only 9.8% of our survey respondents. The NHS paid for only 4.7% of our respondents’ treatment. This shows that acupuncture provided for this group of patients was primarily outside of the mainstream NHS system, and as an out-of-pocket expense must be considered by patients to have had some value. We know from acupuncture patients in the USA (Cassidy 1998a; Cassidy 1998b) that patients value a range of aspects, including: improvement of symptoms, improved quality of life, reduced use of prescription drugs and surgery, as well as improvements in physiological and psychosocial adaptivity, a close relationship with their practitioner, and feeling more able to guide their own lives and care for themselves.
Short-term reactions With regard to short-term reactions to acupuncture, our main result is that 95% of patients reported experiencing treatment reactions during or immediately afterwards, an average of 1.8 reactions per patient. This unexpectedly high rate was much higher than was reported by acupuncturists in our previous survey (MacPherson, Thomas, Walters, and Fitter 2001a). The most common reaction was feeling ‘relaxed’ (79%) followed by feeling ‘energised’ (33%). Patients also reported ‘tiredness’ and ‘drowsiness’ at a relatively high rate of 24%. Negative reactions, such as pain and bruising at the site of needling, were reported by 30% of patients. Interestingly, aggravations reported by our patients at 1.8% were lower than we expected, less than the 2.8% reported by practitioners in our other survey (MacPherson, Thomas, Walters, and Fitter 2001a; Yamashita et al. 2000). On average patients have reported short-term reactions at about five times the frequency than did their practitioners. Nevertheless, it is worth noting that in both our surveys, the most common three types of reactions are the same, namely feeling relaxed, energised and tired or drowsy. It is the last of these that is clearly the most worrying in terms of patent safety, and we are now thoroughly convinced that as acupuncturists it is essential that we do all we can to ensure that patients when they leave after treatment are able to drive home safely.
It is interesting to speculate what is happening at the physiological level to cause such marked short-term reactions. When needles are inserted, a range of biophysical reactions is set in train. While our knowledge of these processes is limited, we do know that acupuncture releases endorphins, the endogenous opioids that can bring relaxed happy feelings, oxytocin, the so-called ‘love drug’, and serotonin, where a deficiency is linked to depression (Andersson and Lundeberg 1995; Hsu 1996; Pomeranz 1996). These effects have been demonstrated to last up to 12 hours (Andersson and Lundeberg 1995), and have similarities with the physiological processes that result from vigorous physical exercise. However, acupuncture also sets off longer-term neurophysiological processes, and it has been speculated that these are fundamentally different from short-term ones (Bensoussan A 1991;Carlsson 2002), and may be responsible for longer-term outcomes reported in the literature (Kjendahl et al. 1997; Thomas KJ et al. 2005; Vincent 1989).
Adverse events The type and frequency of adverse events reported by patients as being associated with their acupuncture treatment at three months was the most important outcome of this study. Of the 6,348 patients participating, 682 (11%) patients reported at least one adverse event over three months. The most common events reported were severe tiredness and exhaustion, pain at the site of needling and headache. Interestingly, only 40 of our patients regarded their experience of adverse events to be so bothersome that it would deter them from trying acupuncture again in the future. Concerns about patients being at risk because they were consulting professional acupuncturists (rather than physicians) were not supported by the evidence from this study. We received reports of adverse consequences related to advice about conventional (prescribed) medication from only six patients and delayed conventional treatment from only two. None of these were serious. This survey has considerably strengthened the evidence on the safety of acupuncture in routine practice.
The data from this survey are different from that which what we found in our practitioner survey and arguably more robust. For example the adverse event rate reported by the patients in this study, 350 per 10,000 treatments is considerably higher than the 13 per 10,000 that practitioners reported in our first safety study (MacPherson, Thomas, Walters, and Fitter 2001a). While some of this disparity might be explained by different definitions of adverse events, other factors are likely to play a part. Practitioner under-reporting might have been due to being overly busy, losing interest in the research or worrying about criticism, and patient over-reporting might have been due to the use of checklists with tick boxes in the survey reported here.
This survey provides some valuable lessons for practitioners and educationalists, the most important three of which we discuss here. Firstly, we have found that at baseline 24% patients reported experiencing tiredness and drowsiness and, at three months, 3% reported ‘severe’ tiredness and exhaustion and 1% reported severe drowsiness such that it caused a potential hazard on the road. Clearly this reinforces concerns about car accidents on driving away afterwards (Brattberg 1986). Practitioners need to alert patients to this risk prior to treatment, and monitor levels of wooziness or light-headedness on leaving the treatment room and before driving home. Ironically, for the one patient in this survey who reported a car accident, the association with acupuncture is extremely unlikely as it occurred two days after treatment. Secondly, 5% of adverse events involved needles being left in by mistake, and so practitioners need to take extra care in counting needles in and out. Thirdly, with 3% of adverse events involving moxibustion burns, practitioners need to take extra care in this area, for example by adhering to current practice guidelines requiring acupuncturists to always remain in the treatment room while using moxibustion. All in all, 109, 10% of all adverse events, might be considered potentially avoidable.
As discussed above, there have been concerns raised about the safety of patients being treated by non-physician practitioners, especially if those practitioners provide acupuncture outside national healthcare institutions (Ernst E 2001; Norheim 1996). Based on the findings of this study, these concerns cannot be sustained, as adverse event rates reported by patients consulting outside the NHS were significantly lower than those reported by NHS patients, and rates reported by patients who had had no contact with their GP or hospital specialist before or during the course of treatment were significantly lower than among those patients who had had such contact.
From the data on advice about prescribed medication and delayed diagnosis and treatment, the fresh evidence that we present here does not support alarmist claims that patients are at risk simply because they are being treated by non-physician acupuncturists (Ernst E 2001). The advice about prescribed conventional medication was more often to reduce rather than stop; in more than half the cases the patient discussed this advice with their GP or specialist, and most commonly it involved antidepressants, corticosteroids, non-steroidal anti-inflammatories and hormonal drugs. The reported adverse consequences associated with advice about prescribed medication experienced by the six (0.1%) patients in this study were not serious.
A particular concern would be raised if patients were stopping their asthma medication; however, our evidence shows that none of the 11 patients who reported taking prednisolone or steroid inhalers were advised to discontinue. Reports of delayed treatment were also infrequent, involving only two patients (0.03%), both experiencing non-serious consequences.
Further research Further research could usefully explore why so few patients were unwilling to have acupuncture again, whether after experiencing short-term reactions or actual adverse events. From our data, only 13 (0.14%) patients were unwilling to have acupuncture again at baseline, and only 40 (0.6%) after three months of treatment. This is an exceptional low rate, given that not all reactions to treatment were positive. It would also be useful to explore the extent to which short-term reactions provide patients with a strong motivation to continue with acupuncture for a sufficient period for its effectiveness to become apparent. We know from previous research that it takes on average the first six or so treatments before substantial benefits of treatment are experienced (MacPherson H and Fitter M 1998). Is it possible then that without these short-term reactions, many more patients might believe that acupuncture is ineffective, and therefore not continue with it for a sufficient number of sessions? One can speculate that these ubiquitous and generally positive short-term reactions have played a crucial role in extending acupuncture’s impact in the West in recent years, in some way compensating for the low level of ‘gold standard’ evidence to support acupuncture’s reputation for effectiveness.
In addition, future research could usefully explore the extent to which acupuncturists interpret short-term reactions and modify their choice of points in response, thereby tailoring treatment more closely to the needs of the patient. Another useful line of enquiry involves exploring how patients weigh up the perceived cost of an adverse event with the perceived benefit of acupuncture, possibly using qualitative research methods and interviewing patients. Given that patients may also be interested in choosing between acupuncture and conventional treatment options, future research could also compare risk profiles between interventions for common conditions such as chronic pain. This would be particularly pertinent for chronic pain where it is estimated that nonsteroidal anti-inflammatories (such as Ibuprofen and Diclofenac) cause 2000 deaths a year from internal bleeding (Tramer et al. 2000).
Conclusions: Confirming Evidence on Acupuncture Safety With over 9,400 respondents, this survey is much larger than any previous survey of acupuncture patients, and consequently we have been able to provide rigorous evidence on short-term reactions that patients experience during or immediately after treatment, and on adverse events that patients report at three months. We have also been able to report on some of the characteristics of patients who consult acupuncturists, and in particularly their reasons for seeking care. Our findings are that people continue to come predominantly for treatment of musculo-skeletal complaints, followed by psychological problems.
We found that 95% of patients reported reactions to acupuncture during or immediately after their session, an unexpectedly high level. The most common short-term reactions were positive, namely feeling relaxed and feeling energised, followed by feelings of tiredness and drowsiness. At three months, we found that patient reports of serious adverse events associated with acupuncture were rare. Adverse events related to advice about medication and delayed conventional treatments were also infrequent. There was no evidence that patients consulting acupuncturists outside the NHS were at any greater risk. While acupuncture treatment is associated with a range of adverse effects, these are not sufficient to prevent most patients seeking further acupuncture. This prospective study provides strong confirming evidence that acupuncture, when practiced by qualified acupuncture practitioners, is a safe intervention, and supports the government’s position that the acupuncturists who are members of the British Acupuncture Council are currently ready to be centrally involved in the statutory self-regulation of the profession.
Acknowledgements Thanks are due to Julie Elrick and Tony Scullion for piloting and administering the survey, with Tony undertaking the day-to-day work of mailings, the lion’s share of inputting the data, and much data analysis; Kate Thomas and Stephen Walters for contributing to study design, data analysis and interpretation of results; Hannah Taylor for recoding the reasons for seeking care; David Torgerson who advised on the analysis and provided comments on an earlier draft of this manuscript; Richard Blackwell and Jennifer Dalewho contributed to the interpretation of the results; Trevor Sheldon for helping in the drafting parts of the manuscript; Alan Bensoussan, Stephen Birch, Alan Breen, Roy Carr-Hill, Mike Fitter, Charles Vincent and Adrian White for their help as external advisors; the British Acupuncture Council for providing a grant; and last but not least, the practitioners and patients who took part.
(Tables and References for this article are printed in the hard copy of The European Journal of Oriental Medicine Vol. 5 No. 1; 2007.)
Hugh MacPherson Hugh MacPherson trained in acupuncture and Chinese herbal medicine in the 1980s and currently practises in York. He founded the Northern College of Acupuncture and in 1995 steered the College towards the first acupuncture degree course in the UK, validated bu the University of Wales. With Ted Kaptchuk, he co-edited the book Acupuncture in Practice: Case History Insights from the West. Since 1997 as Research Director of the Foundation for Traditional Chinese Medicine, he has undertaken a series of research projects evaluating acupuncture's effectiveness and safety. more recently he has joined the Department of Health Sciences, University of York, as a Senior Research Fellow funded by the Department of Health.