MD, PhD, FMedSci, FSB, FRCP, FRCPEd

I happen to be convinced that safety issues related to alternative medicine are important – very important, in fact. Therefore I will continue to report on recent publications addressing them – even at the risk of irritating a few of my readers. And here is such a recent publication:

This review, a sequel to one published 10 years ago, is an evaluation of the number and the severity of adverse events (AEs) reported after acupuncture, moxibustion, and cupping between 2000 and 2011. Relevant English-language reports in 6 databases were identified and assessed by two reviewers; no Asian databases were searched and no articles were included which were in languages other than English. 117 reports of 308 AEs from 25 countries and regions were associated with acupuncture (294 cases), moxibustion (4 cases), or cupping (10 cases). Three patients died after receiving acupuncture.

A total of 239 of infections associated with acupuncture were reported in 17 countries and regions. Korea reported 162 cases, Canada 33, Hong Kong 7, Australia 8, Japan 5, Taiwan 5, UK 4, USA 6, Spain 1, Ireland 1, France 1, Malaysia 1, Croatia 1, Scotland 1, Venezuela 1, Brazil 1, and Thailand 1. Of 38 organ or tissue injuries, 13 were pneumothoraxes; 9 were central nerve system injuries; 4 were peripheral nerve injuries; 5 were heart injuries; 7 were other injuries. These cases originated from 10 countries: 10 from South Korea, 6 from the USA, 6 from Taiwan, 5 from Japan, 3 from the UK, 2 from Germany, 2 from Hong Kong, 1 from Austria, 1 from Iran, 1 from Singapore, and 1 from New Zealand.

The authors concluded “although serious AEs associated with acupuncture are rare, acupuncture practice is not risk-free. Adequate regulation can even further minimize any risk. We recommend that not only adequate training in biomedical knowledge, such as anatomy and microbiology, but also safe and clean practice guidelines are necessary requirements and should continue to be enforced in countries such as the United States where they exist, and that countries without such guidelines should consider developing them in order to minimize acupuncture AEs.”

When I last wrote about the risks of acupuncture, I discussed a Chinese paper reporting 1038 cases of serious adverse events, including 35 fatalities. I was keen to point out that, due to under-reporting, this might just be the tip of a much bigger iceberg. Subsequently, my inbox was full with hate-mail, and comments such as this one appeared on the blog: “This is tiresome old stuff, and we have to wonder what’s wrong with Ernst that he still peddles his dubious arguments.”

I suspect that I will see similar reactions to this post. It probably does not avert the anger to point out that the authors of the new article are, in fact, proponents of acupuncture. Neither will it cool the temper of acupuncture-fans to stress that the new paper completely ignored the Chinese literature as well as articles not published in English; this means that the 1038 Chinese cases (and an unknown amount published in other languages; after all, there might be a lot of published material in Japanese, Korean or other Asian languages) would need adding to the published 308 cases summarised in the new article; and this, in turn, means that the numbers provided here are not even nearly complete. And finally, my re-publishing the conclusions from my previous post is unlikely to apease many acupuncture-enthusiasts either:

True, these are almost certainly rare events – but we have no good idea how rare they are. There is no adverse event reporting scheme in acupuncture, and the published cases are surely only the tip of the ice-berg. True, most other medical treatments carry much greater risks! And true, we need to have the right perspective in all of this!

So let’s put this in a reasonable perspective: with most other treatments, we know how effective they are. We can thus estimate whether the risks outweigh the benefit, and if we find that they do, we should (and usually do) stop using them. I am not at all sure that we can perform similar assessments in the case of acupuncture.

32 Responses to More on the dangers of acupuncture

  • I’m interested in getting acupuncture done, but infections has been one of my main concerns. Thanks for enlightening me on the dangers of the treatment with this post.

    • The danger of acupuncture treatment is far less severe than a medical doctor wrong treatment. I am sure you agree with me. 2 of my uncles were killed by medical doctors while doing a simple surgery. I wonder if you know any patient got killed by an acupuncturist? Nobody reuses the acupuncture needles (other than China but there the doctors sterile the needles before reusing them). All the needles are one time usage. They come in a sealed, sterilized plastic bag and once used, they are disposed. Acupuncture for treating muscular pain is by far the best treatment you can ever have. I practice acupuncture and I know what I am talking. Give it a try and you will never regret this option of treatment.

      • I am afraid you do not seem to know what you are talking about at all!

      • Wong Chew Onn

        This tragic case made the news a few days ago – would you like to comment on it?

        Canadian Olympian’s ‘nightmare’ after acupuncture needle collapses her lung

        How about this: A Trilogy of (Acupuncture) Terror « Science-Based Medicine.

        Here’s a few more: What’s the Harm?.

        Not all these cases resulted in death after acupuncture, but, given that there is scant evidence of any benefit for acupuncture (despite your beliefs), do you consider such a risk worth taking?

        • Interesting comments Alan given that in the UK acupuncture is now recommended by NICE as a treatment option for both low back pain and headaches and is used extensively within NHS pain clinics by physiotherapists and medical doctors.

          • andy said:

            “Interesting comments Alan given that in the UK acupuncture is now recommended by NICE as a treatment option for both low back pain and headaches and is used extensively within NHS pain clinics by physiotherapists and medical doctors.”

            I’m sure you’ll be aware that the 2009 NICE guidelines have been heavily criticised as being biased and not representative of the robust evidence. Additionally, the prevalance of its use does not improve the paucity of good evidence for it.

            But do you believe acupuncture is useful for anything else?

        • Unfortunately Kim Ribble-Orr was done by an unqualified acupuncturist. It is not enough just to attend some weekend courses and starts sticking needles. Acupuncturist went through thousands hours of classes and practical training. One of the most important training is to identify the danger zone such as the thoracic region which may lead to pneumothoraces and this we are all aware. But in real life the malpractices by medical doctor in treating patients are far more than malpractices in acupuncture. Don’t believe that every medication you take is the right medication. Most of the time it is under-dosage or over-dosage and most of the time it is wrong medication.

  • I’ve done TCM on and off since childhood and very comfortable with alternative and modern medicine. Recently I had acupuncture and the Dr. put the needle in my upper groin area too deep and two days later I had an infection. He put in more needle and gave me some Chinese pills and said it should be OK. I ended up in the hospital with a mango sized abscess under the skin and an internal infection. I had to have an operation and am still packing my open would with gauze everyday. This was an unlucky instance but it can happen. I have some friends that are using an electro-stimulation device to the same effect without stabbing the skin to stimulate meridians to good success. I may do acupuncture again but this was a very unpleasant experience that happened to me as a result of sloppy work, done by a 20 year Chinese veteran in Asia.

  • I had acupuncture for my back pain. He used disposable needles a new one for each point. Two sessions later the pain is so much more reduced.
    I worry about taking pills , how many died from the reaction to drugs the doc gives them . I bet that is bad.

  • please can you help me can electroacupuncture cause tears under the skin to the muscles.
    if the current is too high and the treatment is too long.
    by an unqualified acupuncturist.

    • Susan

      It’s clear that acupuncture can cause harm in several ways but it sounds like you need to see your GP and a lawyer. As for electroacupuncture, the machines used are generally limited to being able to provide a low current that is unlikely to cause any more than a slight tingling sensation, but of course, there is no way of telling what the machine your acupuncturist used was capable of.

  • Mr Henness,
    Thank you for your help , why did you mention seeing a lawyer my Dr is trying to help me , do Chinese Acupuncturists use a different technique do they go in deeper, if the machine was faulty can it do damage to the soft tissues.
    I have read that damage from electroacupuncture can cause damage .
    is this true.

  • have you ever heard of electroacupuncture causing damage to the soft tissues the muscles, ligaments ,

  • Mr Henness,
    Do you have an email address I can let you know the full extent of the damage he has done , I have got a solicitor involved , and my Doctor is trying to help me , I have been left housebound because of the treatment , he did a very hard acupressure treatment down my back where he had just taken the needles out.
    He put needles into my head and both sides of my spine.

  • Thank you for your help , who is capable of checking his machine , who would know its faulty or the wrong machine.

  • Susan

    I’m sure your solicitor is best placed to advise you.

  • Who is there to help you when something has gone seriously wrong with a treatment , a solicitor would not know anything about machines an acupuncturist uses, there must be someone who regulates the use of the machines to see they are in working order , would there be someone in this country that could test his machine.

    • Susan

      Solicitors know little about a lot of things, but that does not mean they can’t find out or know who to talk to. However, I assume that the acupuncturist isn’t about to hand the machine used over to you to test. That would take the courts and your solicitor is still best placed to advise.

      There are rules on such equipment. I am sure it would be classed as a medical device (even though there is no good evidence of medical effect) and, as such, it need to be CE marked according to the Medical Devices Directive. There is no regulator of these devices as such, but the MHRA is the statutory body (in the UK) whose remit covers medical devices. They have a page Reporting adverse incidents involving medical devices that might be of interest.

  • I have been told by people who sell these machines in this country that they don’t have any Chinese customers as they get them from China.
    I don’t know if that makes any difference .

    All I want to know is can they cause tissue damage,
    Thank you for your on going help.

    • Susan

      I cannot advise you on whether these machines can cause tissue damage, but your lawyer will be able to find out.

      It is illegal to place a medical device that falls within the remit of the MDD on the market without it having the CE marking properly applied – and there are rules about this. The MHRA might be worth asking as they enforce them in the UK, but your solicitor will know this.

      I don’t think I can help you any more on this.

    • “All I want to know is can they cause tissue damage”

      Not unless someone actually uses the machine. This might sound like a facetious reply, but it isn’t. The question is not “Can the machine cause tissue damage?” because you cannot sue a non-sentient machine. The question is “Can a practitioner, who uses one of these machines, produce tissue damage?” to which the only logical answer is: Yes.

      This is why you need to present the full details of your case to a lawyer rather than keep asking questions here.

  • I do understand all I wanted to know in the first place can serious damage occur to the muscles, tendons , ligaments all the soft tissues by a practitioner using the machine incorrectly can this happen.
    And how is the damage caused, the wrong machine, a faulty machine , someone must know. or is it all down to the practitioner not knowing what he is doing, my Doctor wants to know.

  • This is my last email Mr Henness, I am desperate for an answer please can you tell me if an acupuncturist can cause serious damage to the muscles all the soft tissues , by incorrectly using the electro stimulator Electroacupuncture.

  • I have got in touch with a solicitor she has been to see me , she can see I am in a really serious condition I have shown her this site she wants to know what your position is , are you an acupuncturist yourself .

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