A pair of papers published recently in the Journal of Alternative and Complementary Medicine challenge the United Kingdom's NICE (National Institute for Health and Care Excellence) clinical practice guidelines for osteoarthritis of the knee, specifically the guideline's recommendation against the use of acupuncture as a treatment option for knee OA.
According to the abstract from the first paper,1 authored by Stephen Birch, PhD, of Kristiania University College in Norway, and colleagues, "[I]t is argued that this NICE guideline has limitations that lead to several potential biases in its evaluation of acupuncture, which were not addressed correctly … If the same criteria and methods that have been applied to acupuncture were applied to other NICE-recommended therapies for knee OA, including patient centeredness, patient education, self-management and weight loss, nonsteroidal anti-inflammatory drug (NSAIDs), and cyclooxygenase-2 inhibitor (COX-2 inhibitors), these too would no longer be recommended and opiates would become the first line of drug prescription."
The title of the second paper, a commentary authored by Hugh MacPherson, PhD, Department of Health Sciences, University of York (U.K.), makes the author's issue with the NICE guideline abundantly clear: "NICE for Some Interventions, But Not So NICE for Others: Questionable Guidance on Acupuncture for Osteoarthritis and Low-Back Pain." Dr. MacPherson's commentary appears in the same issue as the Birch, et al., review.
Both papers are available online (for a fee) through the journal's publisher, Mary Ann Liebert, Inc.; John Weeks, editor-in-chief of the journal and editor / publisher of the Integrator Blog, also has an interesting piece on the topic (including the papers' mention in Popular Science) in Integrative Practitioner.2
References
Birch S, et al. The U.K. NICE 2014 guidelines for osteoarthritis of the knee: lessons learned in a narrative review addressing inadvertent limitations and bias. J Alt Comp Med, April 2017;23 (4).
Weeks J. "Marching for the Science of Acupuncture: Article Featured in Popular Science." Integrative Practitioner, May 16, 2017.
A student stands over a patient, needle poised. They have a “perfect” prescription: a textbook combination of points harvested from a lecture slide on chronic lower back pain. But as the needle meets the skin, the student hesitates - the symptom of a quiet habit that has taken hold of our profession. We routinely say we “prescribe” points. It sounds efficient. It echoes the authority of biomedical culture and fits neatly into the insurance field. But vocabulary is never neutral; repeated long enough, it dictates behavior.
Acupuncture can be highly effective in cases of nasal congestion so common in allergy presentations; so much so that I often treat such issues using acupuncture protocols alone. In cases of seasonal allergies with highly predictable causes such as obvious elevations of environmental allergens, I use a skeleton acupuncture prescription that can easily be fleshed out to target potential underlying patterns and effectively customized to the patient.
The field of acupuncture in the U.S. continues to grow in visibility, patient demand and clinical effectiveness. Yet behind the curtain, many acupuncturists are quietly struggling to keep their doors open. While the profession is rooted in centuries of healing tradition, modern economic pressures – particularly those driven by insurance limitations, low reimbursement rates and job-market saturation – are making it increasingly difficult for licensed acupuncturists to thrive.
