EDITORMoore et al and Kovacs and Gil del Real criticise the BMA's report on acupuncture. 1 2 Our review of the evidence base of acupuncture rested heavily on the comprehensive work of Ernst and White, which summarised the clinical evidence for and against the effectiveness of acupuncture.3

The conclusion of this work is that acupuncture seems to be more effective than sham acupuncture or other control interventions for some conditions, including nausea and vomiting, back pain, dental pain, and migraine. However, for smoking cessation, weight loss, and a range of other conditions the present evidence is unclear. We discussed the problems introduced in basing conclusions on poor quality studies or reports.

Our survey of general practice throughout the United Kingdom showed that acupuncture is the complementary therapy most used by general practitioners, with most patients being referred for pain relief and musculoskeletal disorders. Acupuncture is now reported to be used routinely ahead of physiotherapy and drug delivery systems in 86% of chronic pain services.4

The thrust of our recommendations seems to have been missed. The BMA calls for substantial research funding, the production of guidelines, and a formal appraisal of acupuncture. Kovacs and Gil del Real should note that our recommendation about availability of acupuncture in the NHS was subject firstly to having policies, guidelines, and mechanisms for making this treatment generally availablehence the need for appraisal by the National Institute for Clinical Excellence (NICE). Improvements in training and regulation of non-medical practitioners are required, and doctors need to know the basics of complementary and alternative medicine so that they are better able to advise patients. Our detailed review of safety and adverse reactions to acupuncture should reassure Moore et al that the treatment is comparatively safethe more important risk is likely to arise through misdiagnosis and the withholding of orthodox treatment.

There are more than 5500 acupuncturists in the United Kingdom, of whom over 3500 are statutory health professionals, an increase of 51% in two years.5 Acupuncture treatment has flourished despite a lack of widespread knowledge of its efficacy, and without comprehensive guidelines for either general practitioners or patients. Recommendations clarifying whether acupuncture should be used in the NHS are urgently needed.

William Asscher, chairman.
　　Board of Science and Education, BMA, London WC1H 9JP

　　From BMJ.com