Phase 1: A literature survey of adverse events following acupuncture 1998-2000.
The safety of acupuncture has come under scrutiny in the UK over the past five years. The Foundation has researched the original papers in the literature and published a series of review articles each one written for a different audience (MacPherson & Gould 1998, MacPherson 1998, MacPherson 1999a, MacPherson 1999c, MacPherson & Lewith 2001). These papers explore the evidence on safety, examine the quality of reporting and make proposals for prospective studies designed to evaluate risk and safety of acupuncture and acupuncturists.
Phase 1 - key publications:
MacPherson H, Gould A. "Grasping the nettle: a response to reports of adverse events from acupuncture." European Journal of Oriental Medicine, 1998; 2(5): 19-26.
MacPherson H. "How safe is acupuncture? Setting the record straight." Caduceus 1998; 42: 37-39.
MacPherson H. "Fatal and adverse events from acupuncture: allegation, evidence and the implications." Journal of Alternative & Complementary Medicine (USA) 1999a; 5(1):47-56.
MacPherson H. "How safe is acupuncture? Developing the evidence on risk." Journal of Alternative & Complementary Medicine (USA) 1999c; 5(3):223-224.
MacPherson H, Lewith GT. “On the reporting of adverse events following acupuncture.” Physiotherapy Journal 2001; 87(1):21-24.
Phase 2: A practitioner survey of adverse events associated with acupuncture 2001-2002.
The study involved contacting 1848 professional acupuncturists, all members of the British Acupuncture Council over a four-week period in 2000. A total of 574 practitioners participated, these practitioners reported on 34,407 treatments, recording details of adverse events and mild transient reactions following treatment using standardised self-report forms. They also provided information on themselves, including age, sex and length of training and years of practice.
Practitioners reported no serious adverse events and 43 significant minor adverse events, a rate of 1 per 1,000 treatments. A total of 10,920 mild transient reactions were reported in 5,136 treatments. In terms of local reactions at the site of needling, there were reports of mild bruising (1.7%), pain (1.2%) and bleeding (0.4%). Patients experienced an aggravation of existing symptoms after 2.8% of treatments, most of which (85%) were followed by an improvement, possibly indicating a positive “healing crisis”.
The short report has been published in the British Medical Journal (MacPherson et al 2001a) and a full report has been published in Acupuncture in Medicine (MacPhersonet al, 2001b). The results have also been presented to different audiences through publications in the European Journal of Oriental Medicine (MacPhersonet al, 2002a) and CAM (MacPherson et al 2002c).
Phase 2 - key publications:
MacPherson H, Thomas K, Walters S, Fitter M. "The York Safety Study: a prospective survey of 34,000 treatments by traditional acupuncturists". British Medical Journal. 2001a; 323(7311); 486-487.
MacPhersonH, Thomas K, Walters S, Fitter M. “A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists.” Acupuncture in Medicine. 2001b; 19(2):93-102.
MacPherson H, Thomas K, Walters S, Fitter M. Safety in numbers. "What practitioners reported about adverse events and treatment reactions following 34,000 acupuncture sessions." European Journal of Oriental Medicine 2002a; 3(6): 13-22.
MacPherson H, Thomas K, Walters S, Fitter M. "How safe is acupuncture?" CAM 2002c; 7: 14-22.
Phase 3: A patient survey of adverse events associated with acupuncture 2002-2004
As an extension of this work, the British Acupuncture Council funded a follow-up survey of adverse events as experienced by patients. One third of all BAcC members helped us recruit 9,408 patients, of whom 6,348 (67%) completed three-month questionnaires. At three months, 682 patients reported adverse events caused directly by the needling process. The most common was severe tiredness and exhaustion. Three events were serious defined as requiring hospitalisation, causing permanent disability or being life threatening. There was no evidence that patients not funded by the National Health Service or not in contact with their general practitioner or hospital specialist were at greater risk. Six patients reported a worsening of symptoms after taking advice on medication and two patients reported delayed conventional treatment. Our recently published results show that acupuncture is a relatively safe intervention when practised by qualified and regulated practitioners. In two sub-studies, we have reported on the profiles of these patients and on the short-term reactions to treatment experienced by the patients.
Phase 3 - key publications:
MacPherson H, Scullion T, Thomas K, Walters S. "Patient reports of adverse events associated with acupuncture: a large scale prospective survey." Quality & Safety in Health Care. 2004; 13: 349-355]
MacPherson H, Thomas KJ. Short-term reactions to acupuncture: a cross-sectional survey of patient reports. Acupuncture in Medicine. 2005; 23(3): 112-120.
MacPherson H. Strengthening the case that acupuncture is safe in competent hands. European Journal of Oriental Medicine. 2005; (1): 60-73.
MacPherson H, Sinclair-Lian N, Thomas K. "Profiles of acupuncture patients: a national survey." Complementary Therapies in Medicine, 2006; 14(1): 20-30.