Acupuncture Regulation

[gina c]

Dear All,
It seems that the regulation of acupuncture and herbal medicine is a bit of a hot topic at the moment, so I thought we ought to have a new discussion, since it really isn't anything to do with Five Element Acupuncture!

Below is a link to the Department of Health's draft regulations for State Regulation of the Acupuncture and Herbal medicine professions.

http://www.dh.gov.uk/Consultations/ClosedConsultations/ClosedConsultationsArticle/fs/en?CONTENT_ID=4083508&chk=9dE%2B/o

When this first came out I read it cover to cover and although at first, it seems fine, the devil is really in the detail.

These regulations have undergone many changes, and dozens of people are working really hard to get them into some sort of state that would be acceptable to the majority of acupuncturists and herbalists. It's a tricky job though, with dry-needlers having to come under the same set of rules as acupuncturists using a Chinese diagnosis, and acupuncturists and herblists all coming under the same regulations.

I think the lastest issue is that the powers-that-be are trying to make a common set of standards to which all acupuncturists must adhere. The danger with this, as I think one of you already mentined, is the possible dumbing down of acupuncture, as we move towards the lowest common denominator (dry-needlers) being the only standard which can apply across the board. We are in danger of being dragged down to the level of the dry-needlers, with nothing to distinguish between us and them.

(Not so different to the current situation then!)

Aragorn, I know you mentioned that the acupuncturists may end up shouldering the burden of the herbalists' regulation, but in fact, I think it may be that the herbalists are on a more successful track than the acupuncturists with regard to having a sensible set of regulatory guidelines to work to. Maybe acupuncturists ought to consider that herbalists (who work to a more traditional diagnosis) are better allies than doctors as they are also working to protect the traditional methods.

What are people feeling about this? How much does anyone know about it? What do the public know?

Bonny

 

[Candice Pierce]

Hi Bonny
Good to have you back!

First off I would take issue with you saying "being dragged down to the level of dry-needlers". With respect, this is a pretty derogatory way to refer to a large group of therapists who use needling techniques to bring about valuable pain relief to thousands of patients.

I have no understanding at all why dry-needling therapy is called acupuncture, or why the misnomer continues to be perpetuated. Dry-needling is, as far as I am aware, almost always used in conjunction with a primary therapy, and the combination can be very effective. A dry-needler is not an acupuncturist just because s/he uses acupuncture needles, any more than I could claim to be a GP just because I use a sphymomanomter. This essential distinction is wholly missing from the DoH proposal, and so the whole thing is a bit of a farce to me.

Let's give respect to what dry-needlers do, distinguish it as a therapy in its own right, preserve the traditions of acupuncture, and ultimately give the public the best possible information about what they are getting when they seek acupuncture treatment. Imagine the confusion if, when booking to see an osteopath, the public didn't know whether they were getting a member of the General Osteopathic Council or someone that's done a weekend course in back-rubbing! Why does acupuncture deserve any less?

As for herbalsits - why not just have their own General Council just as Osteopaths and Chiropractors do? - Well, because there just aren't enough of them to justify the administration costs. Better to "team up" with acupuncturists, using the common philosophy of the medicine as a reason, whilst in practice the regulation would be incomparable. I, as an acupuncturist, don't want to pay the costs of proving the safety and efficiacy of thousands of herbs to the MCA (Medicines Control Agency). It is wholly irrelevant to acupuncturists.

Best wishes
Aragorn

 

[Jolene L]

Dear Aragorn,

There are quite a few herbalists currently in practice in the UK if you take in all the different associations, also there are many TCM practitioners who currently do not belong to any association and then if we count the western herbalists, tibetan herbalists and practitioners of ayurveda then it adds up to quite a significant number. The reason that many herbalists do not want a seperate council is that most practitioners of Chinese Herbal Medicine are also acupuncturists and so do not want to have to be registered to more than one body.

Currently the subscription to the RCHM is considerably lower than the BAcC sub (approximately £500 per year) although the RCHM only has about one quarter of the BAcC membership, and the ATCM subscription is even lower.

With regard to safety and efficacy of herbal medicine and the MCA (Now renamed the MHRA), It is only safety and quality that needs to be shown and not efficacy and the safety and quality requirements need to be demonstrated by the herbal suppliers and not practitioners so it is the herbal suppliers who will need to bear the costs.

Best wishes, Tony

 

[Liberal Nemesis]

so what is the difference between dry needling (sounds horrible) and acupuncture as you are describing? are they wet needling?

 

[Micha]

Dear Tony
Thanks for the extra info on herbalists. I was under the impression that the costs of dealing with the MHRA would be borne by the new body.
As for herbalists wanting a joint council because many of them are acupuncturists - I understand that, but most of the members of the new body will be only acupuncturists. If there are cost implications of being joined with the herbalists, it makes no sense for the majority of the membership to pay the costs for the convenience of the few. The proposed regulations do not allow for dual membership anyway - hence the subcatagory of "TCM practitioners" for herbalsits who are also acupuncturists - a glorious misnomer implying that all practitioners of TCM are also herbalists!
Besides this, acupuncture as defined in the DoH document has nothing to do with herbal medicine. Why would they be combined, any more than the dentists and osteopaths would have a joint council?
I have yet to hear a convincing argument for having a body that lumps dry-needlers and tibetian herbalists into one administration.

Best wishes
Aragorn

 

[HeksaiseTip]

Dear Rosie
When I use the term acupuncture, I am refering to the practice of oriental medicine predominatley using needles amongst other techniques to implement the treatment of an oriental medical diagnosis. I would point out that there is a wealth of diversity in this definition alone!

Dry-needlers are osteopaths, physiotherapists, nurses and GPs that use acupuncture needles as an adjunct to their primary treatment, using needles based on a diagnosis borne out of their own field of medicine, with no reference to oriental medicine.

At the moment, "dry-needling" is usually called "acupuncture", and a "dry-needler" may call themselves an "acupuncturists". If the public are not aware of the distinction, they may be referred to "acupuncture" (e.g. from a forum such as this, other websites, magazines and so on) but may not necessarily understand that there are different types, and that they are not at all the same!

The significance is that the strength of acupuncture (oriental medicine) is in the diagnosis - needles are merely one way to treat the patient based on that diagnosis. If you take away the oriental diagnosis, IMO you are no longer using acupuncture.

Why this matters to me? I so often hear the phrase "I tried acupuncture, and it didn't work." I then say, "Who did you see for acupuncture?" "Oh, it was my GP." To me this means they've never tried acupuncture! Yet they are under the impression it can't help them. What a shame! There must be so many people who believe they have "given acupuncture a go" and weren't helped, when, if treated with oriental acupuncture, they may be.

Dry-needlers do good work, but it is not acupuncture.

At the moment, as far as I know, the only way to guarantee getting an acupuncturist who is properly trained in oriental medicine is to find one who is a member of the British Acupuncture Council. Other groups exists, such as the British Medical Acupuncture Society, which sounds grand, but can be joined by a GP who has done a weekends training in needling! Somewhat different to the four years I trained in chinese medicine!

Best wishes
Aragorn

 

[SamJenkins]

thanks for that, aragorn.

i totally understand what you are saying and can also see why you feel there is a distinction.

in other bodywork, it can be seen as a sort of snobbery <g>, and i am a great one for that! its a bit like people going to their beauty therapist, who has a beauty diploma, having a facial, wax and reflexology... i dont think reflexology can be taught completely as an add on to beauty... but the public dont know that <sigh>.

 

[Richard F]

Hi, does anyone know if people that perform acupuncture have to have hepatitis a,b or c vaccinations? Or even TB vaccination?
Thanks.

 

[Matthew Cream]

Hi pdavis
We are not obliged to have any vaccinations (I'm certain there would be an outcry if we were!).
Professionally trained acupuncturists use a safe needling technique, where there is no danger to the practitioner or patient.

Why do you ask?

Aragorn

 

[Pompal 09.]

Hi and thanks. I asked because a pysio friend of mine did an acupuncture course a little while ago and the students needled each other. He said none of them were required to have any vaccinations. I thought this was strange.

 

[alex995bikerboy]

Hi
Well there's no contact with body fluids, so no disease can be transmitted this way.
Acupuncture treatment is very safe.

Aragorn

 

[babiigail]

Thank you. I often bleed when i have it, are they doing it wrong? If i bleed isn't there a slight chance of an exchange of fluids?

 

[ugehhuzsiwhitsefs]

I am not an acupuncturist, but as far as I know you should not bleed when a needle is inserted. Unless the needle is inserted to deep or at the wrong angle or wrong place. What does our expert acupuncturist say?

Artemis

 

[jgevdustidwiikepo]

It's more when it is taken out, not inserted. Fairly often there's a small spot of blood, but even if a patient doesn't bleed, the needle is going in to soft tissue and must come into contact with body fluid, and there must be a risk of the acupuncturist accidently pricking him/herself with that needle. It's probably a tiny chance, but handling and inserting 100/200 needles a day, all day every day for 10/20 years, there's definatly a chance. And if a used needle isn't at risk of being contaminated then why dispose of them in a sharps box, they may as well be kept and used on the next patient.
This wasn't so much my question though, because it could be argued that a trained professional will not make a mistake, but my origonal point of unqualified students using needles on each other without being required to have vaccinations against hepatitis-b etc suprised me. Isn't it advisable that all acupuncturists have a vaccination?

 

[forgetful]

Hi PD

My apologises - I think my post was misleading. Of course there is a risk of infection if an acupuncturist stuck a used needle into themselves after taking it out of a patient. The point I was trying to make was that, using a safe needling technique, there will not be any chance of that happening. We use sterile cotton wool as a barrier between the needle shaft and our skin. A used needle is immediately disposed of in a sharps bin. They are an infection hazard as things like Hep B can live outside the body for some considerable time. It's not easy to accidently stick an acupuncture needle into yourself! They are as thin as a hair.

When students are training, they are following careful instruction and being supervised. The procedure varies from college to college, but where I trained, we did not practice needling into each other until after a year of training - so there is a sense of responsibility here; we're not just talking about any old person off the street sticking needles in each other!

The idea of compulsory vaccinations is a real problem - there is a lot of dissent about the effectiveness of vaccination anyway which is way too big a topic to go into here. It's not as if we are conventional medical practitioners! Personally, I would prefer to treat the immunizable diseases with acupuncture should I catch them, rather than have a load of poison introduced into my bloodstream.

Regarding the bleeding - there are a few explanations:
Very occasionally a point will release a drop or two of blood when the needle is removed. There are instances when this is actually intended and required. Some practitioners use a "stronger" needle technique so this may happen more often.
Some patient's tend to bleed more than others regardless of the gentleness or depth of needling.
Some "dry-needlers" (practitioners of other therapies that use acupuncture needle techniques, e.g. physios, osteopaths, GPs etc) do not have the same kind of consideration toward needling as traditional acupuncturists. I have seen them needling very aggressively and deeply in a way that bears no relation to acupuncture. It is no wonder their patients bleed a lot more.
Whatever the reason though, the blood is immediately wiped away with cotton wool and disposed of in the clinical waste. There is no contact with the practitioner.
I do not have any statistics regarding body fluid hazard for traditional acupuncturists at hand, but I have never come across a case or know another practitioner that has.

HTH
Best wishes
Aragorn

 

[RandomChick62]

Thanks,
I would say something as thin as a hair would be easier to stick into yourself by accident than something as thin as a broom handle. You explained it very well though thanks, and i can tell basically there are some good acupuncturists and some not so good. It seems the problem is it isn't regulated very well.
It seems the type of acupuncture i have had was what you are calling "dry needle". It was by a very popular and busy physiotheropy practice around here. The same needles and guides were used a few times, there was no cotton wool used and any tissue used to clean up the blood spots went into the normal trash. When not boing used the needles were balanced in their packaging on top of an ultrasound machine, but none of this is wrong in the eyes of the law?
Also from what i understand the course some of the people using needles lasted 2 weekends. Do you know if the patient getting needled has to be told how qualified the theropist is?
I believe that alot of these types of people get de-sensertised to what is actually happening. Needles are going into peoples flesh, this needs to be regulated and enforced better in my opinion.
I understand probably none of this is relavent to what you do and how you practice it, so please don't take it as a personal insult. In my opinion only these people should have to be vaccinated against Hepatitis-b, hopsital staff have to be so why not dry and wet needlers?

 

[?noog??? ?oog??? ?]

Hello,

The practionner does not have to legally tell you his qualifications, but nothing prevents you from asking!


Artemis

 

[stallliont]

Hi PB
As you say, it's not regulated. Yet. Any one can set up an acupuncture clinic and start practicing without even a weekend's training! It is not a criminal offence to call yourself an acupuncturist if you are not trained, as it is to call yourself a doctor or an osteopath, for example.
The story of your acupuncture experience just sounds shocking to me. I think it is such a shame that this kind of thing is allowed to happen, but it won't be for much longer. The government regulation of acupuncture in some shape or form is just around the corner now. Whilst many of us have serious grievences about the proposed regulations, whatever is enforced will hopefully protect the public from unsafe needling techniques and unscrupulous practitioners.
In answer to your first point - I think the problem is not so much in the regulation, but in the information and knowledge of the public. If everyone that wanted acupuncture went through the professional body that governs us, there would be fewer instances like your own! Not easy to get that information out there, though they are trying hard. With regulation comes information, as the media jumps on it and suddenly everyone is being referred to acupuncture! I think this is all coming into effect in 2 years or so.

Best wishes
Aragorn

BTW - no offence taken by me! I wish more people had your concerns.

 

[ChristopherUS]

Thanks very much Aragorn. YOu have been very helpfull.
I would like to talk to some of the dry needlers to be honist. As i have thought more and read your replies I have become a little passionate about this subject, and it's not even a small part of my life really. I occasionally had acupuncture for a tight I.T band in my leg and to be fair it worked well. It would cause knee pain and after some treatments i was pain free when an hour before i found stairs very painfull to walk down/up.
I started thinking when i was talking to a theropist who seemed so matter of fact about needles, and mensioned the course. I am very suprised how low the minimum standards are. It's almost like the law will let anyone get on with it until they make a mistake and then they will take a look at what's going on in that indicidual case. Which seems very poor.
I would guess the insurance companies are governing acupuncure more than anyone else? I presume it's not legal to practice without insurance? And i would presume also that it's impossible to get insurance unless you have a qualification? What's a worry is what is deemd to be a qualification. I have looked at a few sites that offer an accupuncture course. None of them even advise any vaccinations.

Phil.

 

[Mz. Lovely Maddie]

Dear all,

Just a few comments to add.

Even after regulation has taken place most acupuncturists will probably opt for not having vaccinations because of the low risk compared to the relatively unpleasant and sometimes dangerous side-effects that these vaccinations have. Hep B used to be compulsory in the NHS but now due to bad reactions and the risk of litigation from the employee about having invasive procedures forced on them (I think there have already been some court cases after adverse reaction) the situation now, i believe, is that it is voluntary.

It isn't illegal to practice acupuncture without insurance and people can obtain insurance with the most dubious of qualifications, whether a claim will be paid is an entirely different matter. Some Insurance companies have a habit of taking the premium and then looking into the qualifications only after a claim is made.

If you were concerned about your treatment (as I would be), there are a couple of things you can do. You can complain to the local environmental health department, most clinics need to be registered and be maintaining agreed levels of hygiene and safe practice.

You can also complain to the governing body, which for physios is the AACP, the problem with physios is that at the moment its not a protected title so unless you check first that they are chartered physios you could be seeing anyone.


Best wishes, Tony