According to the Acupuncture Regulatory Working Group, which was formed to investigate the process of statutory regulation, "The last three decades have witnessed considerable growth and development in the use of complementary and alternative medicine (CAM) in the UK. Acupuncture has been at the forefront of this development and is among the most widely used CAM therapies."

In the UK today, practitioners of acupuncture fall into three main categories. At one end of the scale are practitioners who are of Chinese origin, who have completed six years training and have settled in the UK either permanently or for periods of up to three years. This group is becoming increasingly visible as they set up Chinese medicine centres across the country, but although their knowledge of Chinese medicine may be excellent they may have a more limited understanding of the English language and local culture.

At the other end of the scale are the doctors, physiotherapists and nurses who undertake short courses in acupuncture to use as an adjunct to their existing practice. Many do not accept the traditional theories underlying Chinese medicine and explain the effects of needling in scientific terms of stimulating the nervous system and the release of chemicals such as endorphins. They term their style of treatment as "medical acupuncture" or "trigger point acupuncture".

In the centre ground are a growing number of practitioners who have undertaken three to four year courses in the UK. These courses offer a foundation in allopathic medicine together with their focus on traditional Chinese medicine and culture. Eight are regulated by the British Acupuncture Accreditation Board, which was formed in 1993 and is now connected with the British Acupuncture Council. According to the House of Lords Report on Science and Technology, "Establishing an independent accreditation board along the lines of the BAAB is a positive move, other therapies with fragmented professional representation may wish to use this as a model." Some courses have also been validated by universities, which now offer BSc and MSc programmes in acupuncture and Chinese herbal medicine. Many practitioners using acupuncture will combine it with the traditional techniques of moxibustion and cupping and in addition may be qualified in herbal medicine and massage, they call themselves professional or traditional acupuncturists.

The problem for both the general public and the NHS is knowing which practitioner to use. At present the profession is not regulated by the government and has no protection of title or standardised form of training or qualification. Over the past few years, the process towards statutory self-regulation for all the CAM professions has begun, but with such a range of views and practices just amongst the acupuncturists this is proving to be a complicated and lengthy process. The majority of NHS treatment is undertaken by medical acupuncturists, though this situation is changing and there are some notable exceptions in specialist areas.

Two such exceptions are the Gateway Centre in South London, which started by providing treatment for HIV and drug rehabilitation, but now works with local GPs and hospitals treating a wide range of conditions, and the maternity service provided by the Derrisford Hospital in Plymouth. Both provide traditional acupuncture and have won the Award for Good Practice in Integrated Health Care from The Prince of Wales Foundation for Integrated Health.

The World Health Organisation has reported that at present "acupuncture is being used in at least 78 countries. Although there is some clinical evidence that it does work, there is no definitive explanation for how it works." It is this lack of a substantial evidence base which is one of the major concerns for the profession. It is one thing to know that growing numbers of patients are interested in acupuncture, but quite another to persuade GP practices or hospital trusts to fund its use.

In response to the situation there have been a substantial number of projects initiated across the world to investigate its efficacy for a wide range of conditions, including back pain, neck pain, knee pain, menstrual problems, gynaecological conditions, anxiety and depression, addiction and substance abuse, migraine and stroke to name but a few. In many studies the effect of acupuncture is found to be positive in both the short and the long term and in some cases to demonstrate significant financial benefits.

For example in Sweden, in 1993 Johansson carried out a study on the treatment of stroke patients with acupuncture which showed both ‘lasting benefits’ in neurological function and also a saving of

In the UK today, practitioners of acupuncture fall into three main categories. At one end of the scale are practitioners who are of Chinese origin, who have completed six years training and have settled in the UK either permanently or for periods of up to three years. This group is becoming increasingly visible as they set up Chinese medicine centres across the country, but although their knowledge of Chinese medicine may be excellent they may have a more limited understanding of the English language and local culture.

At the other end of the scale are the doctors, physiotherapists and nurses who undertake short courses in acupuncture to use as an adjunct to their existing practice. Many do not accept the traditional theories underlying Chinese medicine and explain the effects of needling in scientific terms of stimulating the nervous system and the release of chemicals such as endorphins. They term their style of treatment as "medical acupuncture" or "trigger point acupuncture".

In the centre ground are a growing number of practitioners who have undertaken three to four year courses in the UK. These courses offer a foundation in allopathic medicine together with their focus on traditional Chinese medicine and culture. Eight are regulated by the British Acupuncture Accreditation Board, which was formed in 1993 and is now connected with the British Acupuncture Council. According to the House of Lords Report on Science and Technology, "Establishing an independent accreditation board along the lines of the BAAB is a positive move, other therapies with fragmented professional representation may wish to use this as a model." Some courses have also been validated by universities, which now offer BSc and MSc programmes in acupuncture and Chinese herbal medicine. Many practitioners using acupuncture will combine it with the traditional techniques of moxibustion and cupping and in addition may be qualified in herbal medicine and massage, they call themselves professional or traditional acupuncturists.

The problem for both the general public and the NHS is knowing which practitioner to use. At present the profession is not regulated by the government and has no protection of title or standardised form of training or qualification. Over the past few years, the process towards statutory self-regulation for all the CAM professions has begun, but with such a range of views and practices just amongst the acupuncturists this is proving to be a complicated and lengthy process. The majority of NHS treatment is undertaken by medical acupuncturists, though this situation is changing and there are some notable exceptions in specialist areas.

Two such exceptions are the Gateway Centre in South London, which started by providing treatment for HIV and drug rehabilitation, but now works with local GPs and hospitals treating a wide range of conditions, and the maternity service provided by the Derrisford Hospital in Plymouth. Both provide traditional acupuncture and have won the Award for Good Practice in Integrated Health Care from The Prince of Wales Foundation for Integrated Health.

The World Health Organisation has reported that at present "acupuncture is being used in at least 78 countries. Although there is some clinical evidence that it does work, there is no definitive explanation for how it works." It is this lack of a substantial evidence base which is one of the major concerns for the profession. It is one thing to know that growing numbers of patients are interested in acupuncture, but quite another to persuade GP practices or hospital trusts to fund its use.

In response to the situation there have been a substantial number of projects initiated across the world to investigate its efficacy for a wide range of conditions, including back pain, neck pain, knee pain, menstrual problems, gynaecological conditions, anxiety and depression, addiction and substance abuse, migraine and stroke to name but a few. In many studies the effect of acupuncture is found to be positive in both the short and the long term and in some cases to demonstrate significant financial benefits.

For example in Sweden, in 1993 Johansson carried out a study on the treatment of stroke patients with acupuncture which showed both ‘lasting benefits’ in neurological function and also a saving of $26,000 per patient.

However, as The Acupuncture Research Resource Centre has pointed out, many of the surveys undertaken are "small and encounter problems of finding a suitable control," and many other reviewers complain of poor methodology or lack of funding. This situation will have to change as acupuncture moves more into the mainstream and the process of regulation advances.

Echoing the demands of the scientific community as a whole, the House of Lords Report on Science and Technology, which examined CAM therapies and regulation, has called for research to take a high priority recommending "that CAM practitioners and researchers should attempt to build up an evidence base with the same rigour as is required of conventional medicine, using both randomised controlled trials (RCTs) and when appropriate other research designs." However, the use of RCTs as the ‘gold standard’ methodology is not a straightforward issue for many CAM therapies.

For acupuncture this approach is possible, but restrictive. For the majority of acupuncturists the therapy requires skilled practitioners, who diagnose patients as individuals, rather than diseases, and then involve the patient as much as possible in the treatment. There is no problem with randomly selecting patients and a ‘blind’ control is possible, though very strange to most practitioners, with the use of sham points or ‘placebo acupuncture’, but the need for skilled practitioners precludes the use of ‘double blind’.

In the same House of Lords Report Dr David Peters, a GP and osteopath "suggested that although RCTs and meta-analysis of RCTs are valuable, in that they provide certainty about the efficacy of a medication for a particular condition, real-life primary care does not mirror the way illness and treatment are defined in such research… Thus, the simple definitions of clinical problem and treatment that good RCTs require do not always mirror the complexity of CAM practice."

Although there is undoubtedly a need for well-funded, large-scale studies, they must include a wide range of imaginative methodologies, both quantitative and qualitative, which are relevant to the holistic approach of acupuncture in practice.

6,000 per patient.

However, as The Acupuncture Research Resource Centre has pointed out, many of the surveys undertaken are "small and encounter problems of finding a suitable control," and many other reviewers complain of poor methodology or lack of funding. This situation will have to change as acupuncture moves more into the mainstream and the process of regulation advances.

Echoing the demands of the scientific community as a whole, the House of Lords Report on Science and Technology, which examined CAM therapies and regulation, has called for research to take a high priority recommending "that CAM practitioners and researchers should attempt to build up an evidence base with the same rigour as is required of conventional medicine, using both randomised controlled trials (RCTs) and when appropriate other research designs." However, the use of RCTs as the ‘gold standard’ methodology is not a straightforward issue for many CAM therapies.

For acupuncture this approach is possible, but restrictive. For the majority of acupuncturists the therapy requires skilled practitioners, who diagnose patients as individuals, rather than diseases, and then involve the patient as much as possible in the treatment. There is no problem with randomly selecting patients and a ‘blind’ control is possible, though very strange to most practitioners, with the use of sham points or ‘placebo acupuncture’, but the need for skilled practitioners precludes the use of ‘double blind’.

In the same House of Lords Report Dr David Peters, a GP and osteopath "suggested that although RCTs and meta-analysis of RCTs are valuable, in that they provide certainty about the efficacy of a medication for a particular condition, real-life primary care does not mirror the way illness and treatment are defined in such research… Thus, the simple definitions of clinical problem and treatment that good RCTs require do not always mirror the complexity of CAM practice."

Although there is undoubtedly a need for well-funded, large-scale studies, they must include a wide range of imaginative methodologies, both quantitative and qualitative, which are relevant to the holistic approach of acupuncture in practice.

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Content last updated: 11/08/2005

About our expert

Rosey Grandage is course leader of the Diploma in Qi Gong Tuina at the University of Westminster and also lectures on the BSc in Acupuncture. As well as a degree in International History and Politics, she obtained a qualification in acupuncture and tuina massage in Beijing in 1992.
In 2003, she set up Prospect Seminars which organises workshops for practitioners of Chinese medicine. She has worked as an acupuncturist at the Pain Clinic at St Thomas’ Hospital, London; sat on the executive committee of the British Acupuncture Council; chaired their committee for the Survey on Adverse Events and continues to be a member of their Professional Conduct Committee. Rosey practices as a physiotherapist, acupuncturist and tuina practitioner in West London.

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