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State of research, recognition and advertising


The World Health Organisation's (WHO) "ACUPUNCTURE: REVIEW AND ANALYSIS OF REPORTS ON CONTROLLED CLINICAL TRIALS" (2003) in conjunction with the "Advertising: Strategy, legislation and guidelines" from the Australian Health Practitioner Regulation Agency (AHPRA) makes for an interesting morning's reading.

The WHO has endorsed acupuncture for the treatment of a wide array of diseases, while being open to the collection of more evidence in the treatment of further diseases, symptoms or conditions.

The following list comes from the WHO report cited above (essentially meaning that we can advertise treatments for these cases):

"...Diseases and disorders that can be treated with acupuncture

The diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials reported in the recent literature can be classified into four categories as shown below.

1. Diseases, symptoms or conditions for which acupuncture has been proved—through controlled trials—to be an effective treatment:

Adverse reactions to radiotherapy and/or chemotherapy

Allergic rhinitis (including hay fever)

Biliary colic

Depression (including depressive neurosis and depression following stroke)

Dysentery, acute bacillary

Dysmenorrhoea, primary

Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)

Facial pain (including craniomandibular disorders)

Headache Hypertension, essential Hypotension, primary

Induction of labour Knee pain Leukopenia Low back pain Malposition of fetus, correction of

Morning sickness

Nausea and vomiting

Neck pain

Pain in dentistry (including dental pain and temporomandibular dysfunction)

Periarthritis of shoulder

Postoperative pain

Renal colic

Rheumatoid arthritis

Sciatica

Sprain

Stroke

Tennis elbow

2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:

Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)

Acne vulgaris Alcohol dependence and detoxification Bell’s palsy Bronchial asthma Cancer pain Cardiac neurosis Cholecystitis, chronic, with acute exacerbation

Cholelithiasis Competition stress syndrome Craniocerebral injury, closed Diabetes mellitus, non-insulin-dependent Earache Epidemic haemorrhagic fever Epistaxis, simple (without generalized or local disease)

Eye pain due to subconjunctival injection Female infertility Facial spasm Female urethral syndrome

Fibromyalgia and fasciitis Gastrokinetic disturbance Gouty arthritis Hepatitis B virus carrier status Herpes zoster (human (alpha) herpesvirus 3)

Hyperlipaemia

Hypo-ovarianism Insomnia Labour pain Lactation, deficiency Male sexual dysfunction, non-organic

Ménière disease

Neuralgia, post-herpetic

Neurodermatitis Obesity Opium, cocaine and heroin dependence

Osteoarthritis

Pain due to endoscopic examination Pain in thromboangiitis obliterans Polycystic ovary syndrome (Stein–Leventhal syndrome)

Postextubation in children Postoperative convalescence Premenstrual syndrome Prostatitis, chronic Pruritus Radicular and pseudoradicular pain syndrome

Raynaud syndrome, primary Recurrent lower urinary-tract infection Reflex sympathetic dystrophy Retention of urine, traumatic Schizophrenia Sialism, drug-induced Sjögren syndrome Sore throat (including tonsillitis)

Spine pain, acute Stiff neck Temporomandibular joint dysfunction

Tietze syndrome Tobacco dependence Tourette syndrome Ulcerative colitis, chronic Urolithiasis Vascular dementia Whooping cough (pertussis)

3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult:

Chloasma Choroidopathy, central serous Colour blindness Deafness Hypophrenia Irritable colon syndrome Neuropathic bladder in spinal cord injury

Pulmonary heart disease, chronic Small airway obstruction

4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment:

Breathlessness in chronic obstructive pulmonary disease

Coma Convulsions in infants Coronary heart disease (angina pectoris)

Diarrhoea in infants and young children

Encephalitis, viral, in children, late stage

Paralysis, progressive bulbar and pseudobulbar..."

AHPRA's Summary of advertising obligations makes it clear that an acupuncturist in Australia cannot advertise being able to treat any condition or disease where the current research and meta-analyses of current and past research using double-blind randomised controlled trials (DBRCTs) does not support the use of acupuncture to treat said condition or disease. This means that no amount of case study evidence, gathered over any number of years in practice, constitutes an acceptable level of evidence for advertising purposes.

It also states that we cannot use patient testimonials for our advertising, or probably even allow patients to write testimonials on our social media or business pages (or review our services if their review includes any therapeutic outcomes). A patient could maybe, for example, say "the treatment was lovely and relaxing" but can't include "my back no longer hurts" or "after a course of treatments, I no longer have a thyroid disease"even if their condition is on the WHO list above; and their testimonials cannot be used in any form of advertising.

What I find interesting about this is that a) I have successfully treated many of the above diseases, symptoms or conditions and b) I have also treated a significant range of things that are not on this list, but I can't advertise that fact. Note, for example, that Tennis Elbow (Lateral Epicondylitis) is on the list of conditions with good research to justify advertising, but Golfer's Elbow (Medial Epicondylitis - where the pain and dysfunction is on the inside instead of the outside of the elbow) is not. Does it seem likely that acupuncture can treat a disease on one side of a joint but not the other?

Another aspect of this is that there is almost no English-language research available into using Japanese or other non-Traditional Chinese Medicine (TCM) acupuncture systems for any kind of treatment, which makes the burden of proof quite a heavy one for non-TCM-style acupuncturists especially. Even heavier considering most acupuncture research is predicated on the idea that there's no effect of acupuncture without a needle sensation, which is rarely used in Japanese-style acupuncture, which is known for its gentle approach and concern for patient comfort.

Even my use of the above list of conditions could be interpreted as contravening my advertising obligations, because I have not specifically included the multiple pages of text in the original document explaining which trials, analyses, meta-analyses and what decision-making processes were used as evidence during the WHO review that led to the creation of the report.

If you've been wondering why I haven't been advertising my services, now you know - this is why. It's become very difficult to come up with advertising copy about what I do, how I do it and what I can treat without falling foul of these new advertising rules, especially given that many of my clinical areas of interest are not well-researched and I therefore can't advertise any of the work I've been doing for over a decade with autoimmune or endocrine disorders, with menopause, with paediatrics and gerontology, with chronic lung diseases, or with sports or other injury rehabilitation - at least until the research catches up with the clinical reality.

If you have any questions about what I do, or how I do it, or what makes my style of acupuncture and bodywork different - or if you'd like help with any of the conditions listed above, please feel free to contact me, all my details are on my website: www.timclearyclinic.com


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Marrickville