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Clean Needles for Acupuncture Safety

First Published in Acupuncture Today June, 2010, Vol. 11, Issue 06

By Michael Jabbour, MS, LAc, William Morris, DAOM, PhD, LAc and Steven Schram, PhD, DC, LAc

A recent article in the British Medical Journal by Woo et al. argues that infection from acupuncture needles is a serious problem.¹ Pointing at 50 cases worldwide since 1970, the author implies that acupuncture is dangerous because the risk of infection is high and that acupuncturists are not using sufficient care to prevent infections.

Both assertions are patently false, the risks greatly exaggerated and, if anything, has clarified for the public how safe trained practitioners of acupuncture are. Every medical treatment from aspirin to brain surgery carries some risk and acupuncture is no exception. According to one study, "Although the incidence of minor adverse events associated with acupuncture may be considerable, serious adverse events are rare."2

Consider the facts in context. There are currently 30,000 acupuncturists and 8,000 acupuncture students in the U.S. Each sees an average of 50 patients per week. This equates to roughly 1.5 million treatments per week and 78 million acupuncture treatments per year. This does not include the multitude of acupuncturists in Europe, Australia or the Far East, where acupuncture is routinely practiced and, in main cases, fully integrated into mainstream medicine and government-reimbursed health care. The claim of 50 disparate infections worldwide over a 40-year period comes to approximately one infection per year globally. If anything, this article highlights the extraordinary safety of acupuncture treatments, not that acupuncture presents a danger to the public. Given the billions of acupuncture treatments administered worldwide, it is clear that there is an extremely low risk of infection from acupuncture needle insertion.

If these same low levels of adverse events were reported for any treatment method in conventional medical practice, that treatment would rightly and routinely be touted as a huge success. With regard to mainstream medical practice, an average of 195,000 people in the U.S. died due to potentially preventable, in-hospital medical errors from 2000 to 2002, according to a new study of 37 million patient records that was released by HealthGrades, the health care quality company.³ In addition to the deaths, 1.14 million patients also suffered a "safety incident," which represents one in four Medicare patients admitted from 2000 to 2002.⁴

Another risk gauge for infection or other side effects in acupuncture is the cost of malpractice insurance. A $1 million to $3 million policy for an acupuncturist in the U.S. is less than $800/year. If there was an infection risk of any magnitude, the premiums would be significantly higher.
According to Adrian White, clinical research fellow at the Peninsula Medical School, and Mike Cummings, both editors of Acupuncture in Medicine, the risks associated with acupuncture can be considered negligible in the hands of competent practitioners.^5-7 In fact, White and Cummings go further to say that the currently published opinion of medical experts is that routine disinfection of skin prior to needle insertion is actually unnecessary in healthy patients, even though it is regularly practiced in acupuncture clinics in the U.S.^8,9

Woo's second claim that acupuncturists are not using sufficient care to prevent infections is also not factual. Without current best acupuncture practices, Woo states that the cause of most outbreaks was from "improperly sterilized reusable acupuncture needles." But he fails to mention the fact that qualified acupuncturists in the U.S., Canada, the U.K., and many other countries must adhere to strict clean-needle guidelines and, by law, may only use sterile, single-use disposable needles.¹⁰ In fact, the article fails to cite research published in the same journal showing acupuncture to be extremely safe when practiced by a trained acupuncturist.⁶

The Woo article errs on two counts. It sensationalizes negligible risk and omits current best practices that mitigate what little risk is, in fact, there. Additionally, Woo's analysis undermines the scientific and regulatory integrity of the profession, clearly pointing to academic bias. What would be more appropriate and useful to health care providers and the public is recent data taken from prospective studies of the incidence of infection from acupuncture.^11,12 This would place the risk associated with acupuncture treatment delivered in the U.S., U.K., and Europe in true perspective.

It is perplexing to the academic community how this irrelevant and misleading editorial was allowed through the BMJ's rigorous editorial process. The publication of inaccurate and alarmist data that does not consider current safety precautions is ill-conceived and irresponsible on the part of the author and the publisher. The article created the impression that acupuncture may be dangerous, while in fact, the readily available data shows extraordinary safety compared to many other medical interventions. The subsequent dissemination of this editorial via the BBC Web site and other news outlets raises disproportionate concern and fear mongering regarding one of the safest of the medical practices.

The reach of this inaccurate article continues worldwide. It is being republished on the BBC, Reuters, FOX News, and a growing number of other news organizations. This misinformation could lead to unnecessary panic and people choosing not to use this safe and effective treatment modality. An immediate public statement of clarification by the BMJ is warranted to preserve its reputation and give a balanced, accurate representation of factual medical information.

All authors of this article are members of the American Association of Acupuncture and Oriental Medicine (AAAOM) and active contributors to the community through academic, research, professional, legislative and regulatory work. One of the primary purposes of the AAAOM is to promote adherence to high ethical, safety, and professional standards on part of the practitioner. The AAAOM works with a wide range of national and international standards-setting and research organizations, legislative and regulatory bodies, and institutions that oversee, govern, and advance the practice of acupuncture and Oriental medicine. The AAAOM takes patient risks associated with acupuncture seriously and works to advance the practice of acupuncture and Oriental medicine in the safest ways possible.

References

1. Woo PCY, Lin AWC, Lau SKP, Yuen KY. Acupuncture transmitted infections. BMJ 2010;340:c1268.
2. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med 2001;110:481-5.
3. www.medicalnewstoday.com/articles/11856.php.
4. www.whale.to/a/iatrogenic_q.html.
5. White A, Hayhoe S, Hart A, et al. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 2001;323(7311):485-6.
6. MacPherson H, Thomas K, Walters S, et al. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 2001;323(7311):486-7.
7. Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed 2009;16(2):91-7.
8. Walsh B. Control of infection in acupuncture. Acupunct Med 2001;19(2):109-11
9. Hoffman P. Skin disinfection and acupuncture. Acupunct Med 2001;19(2):112-6.
10. www.ccaom.org/cntprogram.asp.
11. White A. The safety of acupuncture; evidence from the UK. Acupunct Med 2006;24(Suppl):S53-7.
12. Witt CM, et al. Efficacy, effectiveness, safety and costs of acupuncture for chronic pain; results of a large research initiative. Acupunct Med 2006;24(suppl):S33-9.

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Michael Jabbour speaks on technology, medicine and politics pertaining to traditional Chinese medicine. He is one of the founding directors of the New York State Acupuncture Coalition and the current president of the Acupuncture Society of New York, and chairs the AAAOM Medical Integration committee. He maintains a private acupuncture and herbology practice in midtown Manhattan.

Click here for more information about William Morris, DAOM, PhD, LAc.

Dr. Steven Schram has been a licensed acupuncturist since 1996. He is the past president of the Acupuncture Society of New York, and is the current president of the Manhattan District of the NY State Chiropractic Association. In addition, he serves on the Insurance Committee of the AAAOM, remains a member in the States President's Council of the AAAOM, and has maintained a private practice in Manhattan since 1984.