Acupuncture safety: what patients report Hugh MacPherson

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Acupuncture safety what patients report Hugh
MacPherson

• Senior Research Fellow
• Department of Health Sciences
• University of York
• hm18_at_york.ac.uk

Research Director Foundation for
Traditional Chinese Medicine York
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In 2001 two safety surveys

• Adrian White, Simon Hayhoe, Anna Hart, and Edzard
  Ernst. Adverse events following acupuncture
  prospective survey of 32,000 consultations with
  doctors and physiotherapists.BMJ, 2001 323 485
  - 486.
• Hugh MacPherson, Kate Thomas, Stephen Walters,
  and Mike Fitter. The York acupuncture safety
  study prospective survey of 34,000 treatments by
  traditional acupuncturists.BMJ, 2001 323 486 -
  487

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Results of the two surveys

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Accompanying BMJ editorial

• Acupuncture is safe in the hands of competent
  practitioners
• Charles Vincent BMJ 2001323467-8

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Further concerns for patients..

• Since acupuncture is used as a complete medical
  system, . a sinister underlying cause. (may be)
  missed
• With depressing regularity we hear of.delayed
  access to potentially life-saving conventional
  treatment.
• (Practitioners) . have the unfortunate habit of
  (changing prescribed medication).
• Ernst E. 2001 Desktop Guide to Complementary
  Alternative Medicine

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What do patients say?

• .the one source of experience that remains
  largely ignored .
• Patients have a key role to play in
  identifying adverse events ..

Vincent Coulter QSHC 2002 11 76-80
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Aims of new survey to..

• Find out from patients their experiences of
  adverse events
• Identify adverse events associated with
• Delayed conventional diagnosis or treatment
• Advice from acupuncturists about prescribed
  medication

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What we planned a prospective patient survey

• All 1955 practitioners of the British
• Acupuncture Council invited
• Identify up to 60 consecutive patients each
• Patients sign consent forms
• Three month questionnaires sent direct to
  patients from research centre
• Target of 30,000 consultations

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Patient consent form

• Demographic data (age, sex)
• First time acupuncture?
• Treatment self-funded?
• Contact with General Practitioner?
• Experience of practitioner
• Any short-term reactions?

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Three month questionnaire

• Checklist of significant adverse events
  (derived from previous surveys)
• Details about nature, severity, duration and
  outcome
• Was the adverse event serious?
• Hospitalisation?
• Life-threatening?
• Permanent disability?

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Survey results

• 638 BAcC practitioners participated (33)
• 9,408 patients consented
• 6,348 three-month questionnaires received (67)
• Reports covered 30,196 treatments

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About the patients

• 76 female
• 52 years average age
• 4 of acupuncture paid by NHS
• 11 not had acupuncture before

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Main conditions being treated
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Pathway to acupuncture
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Serious adverse events over three months

• Three events occurred
• Hospital admission 1
• patient, with advanced breast and secondary
  cancer, severe pain (8244)
• Life threatening 2
• patient became severely ill, experience was
  cathartic (3265)
• patient, two days after treatment, fell asleep at
  the wheel and crashed her car (5721)
• Permanent disability 0

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Commonest significant events
Patients n 6348 No. events 1044
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Did your acupuncturist advise you to reduce or
stop taking medication prescribed by your doctor?

• 196 (3) patients reported yes -

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Acupuncturist advice regarding prescribed
medication
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Did your acupuncturist advise you to reduce or
stop taking medication prescribed by your doctor?

• Of the 196 (3) patients who reported yes, 6
  patients reported adverse consequences
• - hydrocortisone skin cream (4704)
• - antidepressant Seroxat (7122)
• - antidepressant Seroxat (7248)
• - antidepressant Setraline (8851)
• - hormone replacement therapy (8995)
• - medication unknown (9355)

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Did your acupuncturist advise you to consult
your GP or a hospital specialist?

• 660 (10) reported yes
• 5527 (87) patients reported no, of whom 2
  patients report adverse consequences
• - 1 patient cost of ineffective
  acupuncture for jaw pain, subsequent tooth
  extraction (3611)
• - 1 patient prolonged urinary tract
  infection, subsequent antibiotics (6348)

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Relative risk

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Given this experience, would you be willing to
have acupuncture again?

• 40 (6) of the 672 patients
• who had an adverse event,
• would not want to experience it again

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Patients short-term reactions to acupuncture
(n9408)
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Comparison of the two BAcC surveys

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Comparison of serious events

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Comparison of numbers of significant adverse
events

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Comparison of frequency of short-term reactions

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Limitations of the survey

• Not all practitioners participated
• Self-reporting by patients
• Sample too small for rare events
• No assessment of risk-benefit

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Conclusions

• Serious adverse event rate is very low
• Indirectly caused adverse events are infrequent
• Patients outside NHS not at higher risk
• Despite adverse events, most willing to continue
  with acupuncture

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Acknowledgements

•  
• 9,408 Patients
• 638 Practitioners

• Research Team
•  
• Hugh MacPherson
• Tony Scullion
• Kate Thomas
• Stephen Walters