The Oregon Medical Board Newsletter arrived today and in it was the announcement of a public hearing on proposed rules for acupuncture. The hearing is tomorrow at noon and they will accept written comments until noon tomorrow (12/5/15) to Nicole.Krishnaswami@state.or.us.
A modified version of what follows was submitted to the OMB.
OAR 847–070–0021 has two parts. It
- requires Oregon-licensed acupuncturists to follow clean needle technique standards and
- use only disposable, single-use acupuncture needles.
Using disposable, single-use needles is imminently reasonable. There have been outbreaks from Hepatitis B to MRSA to Mycobacterium tuberculosis associated with acupuncture. How many of the outbreaks are due to needle reuse or poor technique is variable and uncertain. But with the potential risk for the inadvertent spread of infectious diseases from reusing needles, there is no good reason not to require disposable, single-use acupuncture needles.
The other rule, to require acupuncturists to follow clean needle technique standards is more problematic.
As head of Infection Control for 25 years and an Infectious Disease physician, if you watch the practice of acupuncture it will make your skin crawl. Watch any video on the web demonstrating acupuncture and, if watched with the critical eye of infection control, you will be appalled. Technique is always deficient and it is fortunate that it is difficult to cause complications and infections from acupuncture.
The practice of acupuncture is often horribly deficient when compared to modern medical practice.
The Clean Needle Technique is an interesting document. Published by the Council of Colleges of Acupuncture and Oriental Medicine, it is offered as a web course. The YouTube video, from the viewpoint of infection control, demonstrates technique that is a major improvement over the usual techniques used for acupuncture
I would prefer wearing gloves and avoiding the palpation of the skin with the bare hand after the alcohol cleaning to totally minimize risk from the procedure. They compare acupuncture to a subcutaneous or intramuscular infection, but given the number of needle used and how long the needles are left in I am not certain that is a fair comparison. Infection control has the most benefit when it considers unusual events, not the usual.
The more philosophical consideration concerns risk/benefit of acupuncture. The authors of the clean needle approach are unduly optimistic about the effectiveness of the interventions discussed in their guidelines. Acupuncture with its dozens of variations, cupping, moxibustion, gua sha and the rest of traditional Chinese medicine have never demonstrated efficacy in the treatment of any illness.
And they should have no efficacy since they are not based on a modern understanding of anatomy and physiology, but are based on the pre-scientific fictions of qi and meridians.
Extensive evaluations, beyond the scope of this discussion, on the lack efficacy of acupuncture and traditional Chinese medicine can be found at Science-Based Medicine, the Society for Science-Based Medicine and Oregonians for Science-Based Medicine, where I am, respectively, an editor and President.
Medicine is about risk vrs benefit. If the benefit is zero, as it is for the interventions in the Clean Needles manual, then any risk is unwarranted and unacceptable.
It is an interesting ethical question as to the appropriateness of improving the safety of interventions that are not based in reality and do not and cannot have any efficacy. It is perhaps not unlike mandating all cigarettes have filters.
Some of the suggestions in the Clean Needles manual are odd to the medical ear. For fainting, one intervention suggested is
Acupuncturists may use a finger to press Du 26 (Renzhong) to help revive the patient; calling for medical help may be necessary in some cases.
It is inevitable that patients will continue to use a wide variety of pseudo-medicines. There is a long history of pseudo-medical providers resisting changes to improve patient safety. To my knowledge, there has never been a pseudo-medical intervention that has published the results of a quality initiative that improved patient safely.
The issues with the Clean Needles manual aside, the Clean Needle guidelines are an important step forward in patient safety. They need to be implemented.