Acupuncture (8) -safety
Safety
Because acupuncture needles penetrate the skin, many forms of acupuncture are invasive procedures, and therefore not without risk. Injuries are rare among patients treated by trained practitioners in some countries. Sometimes, needles are required by law to be sterile, disposable and used only once; in some places, needles may be reused if they are first resterilized, e.g. in an autoclave. When needles are contaminated, risk of bacterial or other blood-borne infection increases, as with re-use of any type of needle.
Adverse events
Serious adverse events are exceedingly rare鈥攐n the order of five in one million鈥攁nd are usually associated with poorly trained, unlicensed acupuncturists. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles.
The vast majority of adverse events from acupuncture are minor, and are estimated to occur in approximately 7% to 12% of treatments, both in adults and children. The ones most commonly reported occur at the site of needle insertion: minor bleeding (3%), hematoma (2-3%), and pain from needling (up to 3%). Dizziness is reported in about 1% of treatments.
Serious adverse events are frequently due to practitioner error, exceedingly rare, and diverse. The most common are infection due to unsterile needles and injury鈥攕uch as puncture of a major organ or nerve damage鈥攄ue to improper placement of needles. Most such reports are from Asia, possibly reflecting the large number of treatments performed there or else a relatively higher number of poorly-trained acupuncturists. A 2010 systematic review found that acupuncture has been associated with a possible total of up to 86 deaths over the years surveyed, most commonly due to pneumothorax. Infectious diseases reported since 1970 include bacterial infections (50 cases) and hepatitis B (more than 80 cases). Though very rare in practice, injury to any site in the body is possible by needling too deeply, including the brain, any nerve the kidneys, or heart. Many serious adverse events are not intrinsic to acupuncture but rather to bad practices (such as improper needling or unsterile needles), which may be why such complications have not been reported in surveys of adequately-trained acupuncturists.
Risk of foregoing conventional medical care
Receiving alternative medicine as a replacement for standard modern medical care could result in inadequate diagnosis or treatment of conditions for which modern medicine has a better treatment record.
As with other alternative medicines, unethical or na茂ve practitioners may also induce patients to exhaust financial resources by pursuing ineffective treatment. Profession ethical codes set by accrediting organizations such as the National Certification Commission for Acupuncture and Oriental Medicine require practitioners to make "timely referrals to other health care professionals as may be appropriate." In Canada, public health departments in the provinces of Ontario and British Columbia regulate acupuncture.
Legal and political status
Australia
Acupuncture became a health profession registered at the Australian Health Practitioner Regulation Agency (AHPRA) in July 2012. Before that, Victoria was the only State in Australia with an official government registration board for acupuncture. In 2012 the CMBV will become the Chinese Medicine Board of Australia, and is currently in the process of establishing accreditation arrangements for the profession in partnership with AHPRA.
Canada
In British Columbia, the practice of acupuncture and Chinese Medicine has been professionally regulated since 1996 by the CTCMA. In Ontario, the practice of acupuncture is now regulated by the Traditional Chinese Medicine Act, 2006, S.O. 2006, chapter 27. The government is in the process of establishing a college whose mandate will be to oversee the implementation of policies and regulations relating to the profession.
New Zealand
Traditional/lay acupuncture is not a regulated health profession. Osteopaths have a scope of practice for Western Medical Acupuncture and Related Needling Techniques. The state-owned Accident Compensation Corporation reimburses for acupuncture treatment by registered health care practitioners and some traditional/lay acupuncturists that belong to voluntary professional associations.
United Kingdom
Acupuncturists are not a regulated profession. The principal body for professional standards in traditional/lay acupuncture is the British Acupuncture Council, The British Medical Acupuncture Society is an inter-disciplinary professional body for regulated health professional using acupuncture as a modality and there is the Acupuncture Association of Chartered Physiotherapists.
United States
Acupuncturists in the United States are required to attend a four-year graduate level, accredited program to be licensed. Each state has its own licensure agencies and confers different titles ranging from the Acupuncture Physician in Florida to Licensed Acupuncturist in Oregon. The abbreviation "Dipl. Ac." stands for "Diplomate of Acupuncture" and signifies that the holder is board-certified by the NCCAOM. Twenty-three states require certification, according to that body.
A poll of American doctors in 2005 showed that 59% believe acupuncture was at least somewhat effective for treatment of pain. In 1996, the United States Food and Drug Administration changed the status of acupuncture needles from Class III to Class II medical devices, meaning that needles are regarded as safe and effective when used appropriately by licensed practitioners. As of 2004, nearly 50% of Americans who were enrolled in employer health insurance plans were covered for acupuncture treatments.
