Challenges for clinical practice guidelines in traditional medicines: The example of acupuncture

Birch, Stephen; Alræk, Terje; Lee, Myeong Soo

doi:10.1016/j.eujim.2016.07.032

Cited by 12 publications

(9 citation statements)

References 29 publications

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“…When a therapy has evidence of effectiveness and safety it starts to be considered as a treatment option by Clinical Practice Guideline (CPG) development groups 83 . A recent publication based on an extensive search through August 2017 for publications that recommend acupuncture has found acupuncture to be more extensively recommended by CPG and expert groups than was previously thought 5 .…”

Section: Resultsmentioning

confidence: 99%

“…The Society for Integrative Oncology has been tracking evidence for the use of integrative therapies like acupuncture 105 and has published guidelines promoting their use in oncology practice 106 . Previous publications have discussed problems of implementation of published guidelines and how the many recommendations to use acupuncture have been under-utilized 11, 83. The acupuncture field needs to work with oncologists and public health officials to develop more effective implementation strategies if the growing recommendations to use acupuncture in cancer care are to be followed.…”

Section: Resultsmentioning

confidence: 99%

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Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review

Birch

Lee

Alræk

2019

Integrative Medicine Research

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Background Recently research on acupuncture for cancer related symptoms has significantly increased. To what extent have medical professionals recommended to use acupuncture in light of that evidence? Methods Evidence of effectiveness and safety was found by searching Pubmed for reviews to identify for what conditions and general results. Publications that recommend acupuncture in oncology were searched in the database of an ongoing general search for publications that recommend acupuncture. This database was developed by searching google for publications that recommend the use of acupuncture with the terms ‘name of symptom’ and ‘clinical practice guideline’ or ‘treatment guideline’. Results Acupuncture is moderately or weakly effective for 19 symptoms in patients with cancer and cancer survivors. Acupuncture is a safe therapy in cancer care if administered by trained acupuncturists. Acupuncture is targeted to improve symptoms associated with the cancer and different cancer treatments, not to treat the cancer itself. More than 350 publications by clinical practice guideline groups and expert groups, including public health statements made by national and government agencies recommended the use of acupuncture for 61 cancer related symptoms many with positive evidence of effectiveness. Conclusion The strength of evidence is weak for many indications, however the evidence for many standard therapies is either not very strong or if stronger, the incidence of adverse events is more, which makes acupuncture a treatment option despite the weak evidence. We have found evidence that many oncologists around the world have started to incorporate acupuncture into the treatment of various cancer related symptoms.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review

Birch

Lee

Alræk

2019

Integrative Medicine Research

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“…We found that the use of peer reviewed research was the least used source of knowledge and not a major agent of change for acupuncture practitioners, which explains why very few changed their practice due to research alone, despite a substantial increase in the number of clinical trials and improvements in reporting quality of acupuncture publications over time [28][29][30]. Birch and colleagues [31] found a total of 1311 publications between 1991-2017 with recommendations for the use of acupuncture, especially in North America, Europe, and Australasia, made by government health institutions, national guideline, and medical specialty groups [31] but noted that that not all these recommendations are known within the acupuncture or the mainstream medical communities [31,32] and identi ed the need to address the lack of presentations focusing on research and implementation at international symposia [32]. A recent analysis supports this lack of awareness, with a recent analysis on Australian guidelines in pregnancy showing signi cant inconsistences in the recommendation, or in some cases prohibition, of acupuncture for various conditions including nausea and vomiting, and pelvic pain [33].…”

Section: Discussionmentioning

confidence: 99%

The Changing Clinical Landscape in Acupuncture for Women’s Health: A Cross-Sectional Online Survey in New Zealand and Australia

Graca

Betts

Smith

et al. 2021

Preprint

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Background Acupuncture is growing in popularity as a treatment option for women’s health worldwide with reported increasing usage in the last ten years. A significant number of clinical trials and meta-analysis are now published on aspects of women’s health treatment with acupuncture. The aim of this survey was to explore if, how and why, aspects of acupuncture practice has changed since our last survey in 2013. Method An online cross-sectional survey of registered acupuncturists and Chinese Medicine practitioners in Australia and New Zealand. Questions covered the practitioner demographics and training, women’s health conditions commonly treated, modalities used, sources of information and continuing education (CE) (e.g. webinars), changes in clinical practice, and referral networks. Results One hundred and seventy registered practitioners responded to this survey, with 93% reporting treating women’s health in the last 12 months. The majority of respondents were from Australia (60%), held a bachelors level qualification (60%), and used a traditional Chinese medicine framework (86%). Most practitioners incorporated other modalities in addition to acupuncture. Most practitioners’ referral networks were predominantly based on word of mouth for menstrual, fertility and pregnancy related conditions, with referrals from medical practitioners being much less common. More than half (57%) reported having changed their women’s health practice in the past 12 months; just over a quarter of those who changed treatment (27%) reported it was due to research findings. The most commonly used sources of information/CE used to inform treatment were webinars and conferences, while peer-reviewed journal articles were the least commonly used source. Conclusion Acupuncture practitioners in Australia and New Zealand commonly treat women’s health conditions, but this is usually the result of women seeking them out, rather than being referred from a medical practitioner. The majority of practitioners did report changing their women’s health practice, but peer reviewed academic articles alone are not an ideal medium to convey this information since practitioners favour knowledge obtained from webinars and conferences. Academics and other clinician researchers should consider alternative means of disseminating knowledge beyond traditional academic publications and conferences, special interest groups may assist in this and also help improve research literacy.

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“…NICE, a Non-Departmental Public Body responsible for providing evidence-based guidance on health and social care, has been increasingly monitoring and changing its guidance on the use of acupuncture since 2008, when three reports were published, until today, when approximately 10 reports are published annually, addressing the use of acupuncture in relation to more than 30 conditions. 32 Perhaps unsurprisingly, given the breadth and focus of NICE's activities, the presence of acupuncture is marginal in NICE documents. Acupuncture is mentioned principally as a non-supported practice for a number of conditions in which other biomedical treatments are provided and funded, such as mental health conditions.…”

Section: The Multiple Regulation Of Acupuncturementioning

confidence: 99%

The regulation of acupuncture in France and the UK: Shifts and fragmentation in contrasting healthcare systems

Cloatre

Ramas

2019

Medical Law International

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This article explores the regulation of acupuncture in the UK and France. It focuses on the dilemmas such regulation has raised, and the effects of two contrasting approaches to the regulatory organisation of acupuncture within healthcare systems on practices and care. Although the question of how acupuncture, like other complementary, alternative or traditional therapies, should be regulated has often been reduced to a question of scientific knowledge, it is also dependent on the intricacies of national health system governance, state rationales and professional identities. France and the UK provide exemplary instances of contrasting systems, in which each of these factors has come to shape the regulation of the highly heterodox practice that is acupuncture. Overall, exploring the challenges of regulating acupuncture provides useful perspectives on how the make-up of legitimate therapies is constituted in particular healthcare contexts.

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Challenges for clinical practice guidelines in traditional medicines: The example of acupuncture

Cited by 12 publications

References 29 publications

Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review

Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review

The Changing Clinical Landscape in Acupuncture for Women’s Health: A Cross-Sectional Online Survey in New Zealand and Australia

The regulation of acupuncture in France and the UK: Shifts and fragmentation in contrasting healthcare systems

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