MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

An analysis of the 2012 National Health Interview Survey Data examined the associations between self-reported use of various forms of complementary and alternative medicine (CAM) therapies (dietary supplements, mind-body practices) and the number of days missed from job or business in the past 12 months due to illness or injury. Multivariable Poisson regression was used to determine the association between CAM use and absence from work among individuals with one or more chronic disease (n = 10,196).

Over half (54 %) of the study population reported having one chronic disease, while 19 % had three or more conditions. The three most common chronic diseases were high cholesterol (48 %), arthritis (35 %) and hypertension (31 %). More participants used dietary supplements (72 %) while fewer individuals reported using mind-body practices (17 %) in the past twelve months. Over half of individuals reported missing any number of days from job or business due to illness or injury (53 %). Of those who had missed any days from work, 42 % missed one or two days, 36 % missed three to five days, and 23 % missed six days or more.

In multivariable Poisson regression adjusting for demographic variables (race, age, gender, income, education) and potential confounders (BMI, general health, and use of CAM to improve energy), the rate of missing days from job or business in the past 12 months among those who used mind-body therapy was significantly greater than those who did not use these practices (IRR = 1.55, 95 % CI: 1.09, 2.21) (Table 4). Similar association was observed for dietary supplements use (IRR = 1.13, 95 % CI: 0.85, 1.51) (Table 4), although the result was not significant.

The authors concluded: Although nearly all individuals who practiced mind-body therapies reported being in good to excellent health, these individuals had a higher rate of absenteeism compared to non-users. Previous studies have shown that many individuals with chronic illness use CAM with the intent of alleviating the symptoms associated with chronic illness but this body of evidence is limited. Further studies are needed to examine the potential effects of these self-managed CAM therapies on the symptoms associated with chronic disease. Additionally, future studies should explore how managing these symptoms through the integration CAM therapies chronic disease management and employee programs could have a positive effect on absence from work, school, and other responsibilities.

How can these finding be interpreted?

The authors offer two possible explanations: Self-administered CAM practices may be more accessible to individuals with chronic disease regardless of socioeconomic status and other demographic factors. Alternatively, CAM use without the advisement of a practitioner may be harmful due to lack of knowledge on proper technique or dosage.

I am sure there are other ways to make sense of these data. How about this interpretation, for instance: CAM-use and absenteeism have in common that they are the things that the ‘worried well’ tend to do. Thus the two phenomena correlate because they are a characteristic of a certain type of consumer.

Yes, I am just guessing, because the data certainly does not give us anything like a conclusive explanation.

Nonetheless, one thing seems to be fairly clear: CAM-use in this population is not a thing that motivates consumers to go to work.

97 Responses to Use of alternative medicine is associated with absenteeism

  • Correlation does not imply causation.
    But where two dimensions are associated, it might just be that one has caused the other!
    So, “Using CAMs causes folks to be absent from work”.
    Well I never!

    IMHO, Edzard’s suggestion more reasonably reflects what is going on: folks of a certain personality type and inclination have the tendency to (a) use CAMs (camistry); (b) be absent from work.

    Never mind “managing the symptoms through integration (of?) CAM therapies, chronic disease management and employee programmes” (as the authors suggest), the real question that needs answering is “what type of person is a camee (who uses CAMs) and what type an absentee – and can they be usefully distinguished?”

    We need a holistic approach and not one focusing on symptoms!

  • Personally I find the dismissive use of the phrase ‘worried well’ to be one of the more distasteful mantras of the sceptic community. It seems to betray an assumption that someone can only justifiably seek help if they have a full-blow disease with a medical label, and brushes aside the fact that chronic stress (for example) is integral to the pathogenisis of many serious conditions. You’re quite right to say correlation doesn’t mean causation, and all you do here is display your own bias.

    As you know, there are a number of studies that show a reduction in days absent from work as a result of CAM (acupuncture at least), for example the one sited here:

    ‘…patients suffering with chronic headache (80% with migraine) were given 12 sessions of acupuncture over 3 months. This resulted in 34% fewer headache days, 15% less medication, 15% fewer days off work and 25% fewer GP visits after one year. The cost-effectiveness, expressed per ‘quality-adjusted life year’ (QALY), the recommended measure, was £9000 per QALY, well under the threshold of £20-30 000 per QALY) required by the National Institute of Clinical Effectiveness (NICE). These results have been repeated in Europe.’

    https://www.migrainetrust.org/living-with-migraine/treatments/acupuncture/

    • “Personally I find the dismissive use of the phrase ‘worried well’ to be one of the more distasteful mantras of the sceptic community.” the term does not originate from the ‘sceptic community’; it comes from GPs, as far as I know.

      • Who cares where it comes from? It is commonly used dismissively by the sceptic community.

        • you certainly don’t seem to care whether your statements are correct or invented!

        • @Tom Kennedy
          If you have an disease, chronic or acute, you are unwell. If you don’t have a disease, you are well. If you are well but persist in seeking medical or pseudo-medical attention you are a hypochondriac. “Worried well” is a gentle, polite description to avoid saying ‘hypochondriac’. (‘Hypochondriasis’, like ‘ignorance’ has gained unnecessarily negative connotations, even though the word is purely descriptive in origin.)

          Sorry, Pete Attkins has already said the same thing but his comment didn’t appear as a response.

          • @Frank you’re entitled to your opinion, but I think it’s a grossly simplistic one. Diseases don’t always just appear, they develop, often over the course of many years. Thankfully the NHS is beginning to acknowledge this by offering stress management etc. but not enough recognition is given to the damaging effects of stress and diet/lifestyle problems.

            @Edzard, I won’t bother doing it, but I’m pretty sure this blog and the comment threads will contain many, many uses of the term.

          • …as long as you are pretty sure!!!

          • “…not enough recognition is given to the damaging effects of stress and diet/lifestyle problems.” LOL! Scarcely a day goes by without some news item on the broadcast media and in the dead tree press about the damaging effects of diet/lifestyle. You’d have to be deaf or blind not to have seen a piece expressing concern about growing levels of obesity and its relation to type 2 diabetes, about excessive alcohol consumption and its deleterious effect on health. For cigarette smoking, you’d have to be positively stupid not to appreciate the majority of people in the UK think it’s an unacceptable practice.

            GPs have been aware for years of diet and lifestyle problems. They consistently advise patients about the damaging effects of their smoking/drinking/eating habits. But we are all highly accomplished at deceiving ourselves so the advice is rarely taken.

            Stress management is slightly different. Stress often arises from (e.g.) social and financial problems: the associated clinical conditions can’t be managed solely by physicians. But any doctor who doesn’t appreciate the impact of stress on a patient and attempt to help is below par on a competence scale.

        • I think it’s true that the term is used by the sceptic community, but not so sure that “dismissive” is the best characterization of its use. Rather, its a shorthand for people who have somewhat vague complaints that don’t easily fit a medical diagnosis or who aren’t satisfied with the advice that they should lose weight or change a behavior/get counseling to alleviate the problem. They are unsatisfied with the brevity of the doctor’s advice and insulted if counseling/psychiatry is recommended, so they move on to the woo community where they are very likely to get a full hearing and lots of hands on attention. This isn’t “dismissive”, it’s just the way some people are and doctors are truly very busy people.

          • Spot on!

          • One might argue that the term “the worried well” is not only valid and acceptable but even essential to the discussion as it delineates a critical element in the problems we are discussing on this blog.
            It is a concise, comprehensible and relevant term consisting of only two words that together brilliantly describe and delineate the problem.
            I have used it repeatedly myself in comments here and hitherto considered it neither dismissive nor derogatory. Not any more than saying “the obese patients” for example. I certainly do not consider myself as one who takes such things lightly.

            Many physicians have a lot of contact with outpatient clientele that is not suffering from somatic or psychiatric disease but simply unduly affected and worried about (minor) symptoms and signs that are in effect ‘existential’ in nature and caused by the stress-inducing pressure of modern life, a life for which all too many are not properly prepared.
            It takes a lot of patience, time, diplomacy and even courage to handle such cases and this is not consistent with the capacity of most clinics. Many patients leave the doctors office unfulfilled and sometimes dissatisfied. This is especially the case when the doctor has suggested the patient has a responsibility of his own and suggests a change in lifestyle and increased personal efforts.

            I can appreciate Tom’s concern about the term. If I am not mistaken, his livelihood largely consists of tending to “the worried well” who did not get the help they think they need from the doctor – so why should he not be protective of his main source of income?

            “The worried well” usually do not get much more help from the genuine healthcare system than a pat on the back at most. Those for whom this is not enough tend to seek alternative ways of getting confirmation and care for their worries. Going to an alternative practitioner is almost a guarantee for a diagnosis (albeit usually wrong) and some kind of positive action ranging from hand-waving through needles in strange places to overt poisoning and harm. The more theatrically impressive, the more effective it seems.
            “The worried well” are also mostly the one’s who are easiest to soothe and satisfy, at least temporarily. They seek another kind of TLC, tender loving care than a GP or a busy surgeon is usually able to provide and when they on top of that get confirmation that something is indeed the matter and something can be done about it, they are (literally) “sold”.

    • “The expression ‘worried well’ in fact dates back to 1970, and was coined by the late Sidney Garfield MD in an article published in Scientific American.”
      http://www.macmillandictionary.com/buzzword/entries/worried-well.html

      The worried well: People who are unnecessarily anxious about their physical or mental health. — Oxford Dictionaries.

      See also: hypochondriasis.
      https://en.wikipedia.org/wiki/Hypochondriasis

      • ty @Pete Attkins. your reply is actually more accurate than mine was. i guess when i started nursing in 1981 what i was seeing was a popularization of the term in a particular demographic, not the actual coining of the term. 🙂

      • Well, to be fair to Mr Kennedy, (and I am afraid I have to take issue with Ernst here), Mr. K never said anything about the ORIGIN of the term, but rather noted that it is often used in the sceptic community, which I think is true. The real argument Mr Kennedy is making is that sceptics use this term disparagingly. For the very first time, I find Prof Ernst to have responded unnecessarily tersely to a commenter. I also think that the use of the term by sceptics is often used at least somewhat disparagingly, but I would also defend it as a useful catchall term.

      • The term ‘worried well’ doesn’t have to be used dismissively. Worries are real, stress is real, and there is a limit to what doctors can do about either. Most types of CAM will not hurt these people, and may make them feel better. Most people in these circumstances won’t spend more on CAM than they can afford. Calling them ‘worried well’ distinguishes them from people who are really ill. If these people use CAM instead of real medecine the consequences can be lethal, and people who have been told their cancer cannot be cured may spend far more than they or their dependants can afford on bogus treatments.

        I’m not at all in favour of anyone using CAM, well or unwell – I’m just pointing out why the distinction is there.

    • ‘worried well’ originated decades before there was a skeptic movement when alt med first got fashionable, in the early days of the AIDS epidemic. it referred to gay and bisexual men who weren’t symptomatic in any way but were so scared to death that they couldn’t enjoy their lack of symptoms (and was used for asymptomatic men with HIV as well as men without it and those who didn’t know their status). then as now the worried well are extremely vulnerable to the woo pushers and it’s why the wooish actually invent all kinds of diseases and supposed need for preventive and/or maintenance care for things that don’t actually exist. it wasn’t a term of derision then or now and it still doesn’t mean what you think it does.

    • There is a differential diagnosis for the “worried well” that requires a careful history, physical and possibly some tests. It is dismissive to blame it mostly on “chronic stress.” Reassurance and close follow up often manage the issue. Occasionally a medical problem is identified. Unfortunately, many patients are not reassured and end up with numerous costly tests and referrals. When the diagnosis is psychiatric patients often are angered at that possibility and refuse to accept treatment. They doctor shop with additional symptoms that often cannot be explained otherwise. They become the worried well. It is not a simple issue and unless you deal with these patients on a regular basis it is presumptuous to suggest it is so simple to manage. Reassurance and counseling often are not accepted by Hysterical Personalities or Hypochondriacs. They can respond partially to repeat visits but part of the pathology is to always have unexplained symptoms that demand acknowledgement without resolution. These are time and resource consuming individuals. They tend to be upper class with unreasonable expectations and demands.

  • @Edzard yes, I’m ‘pretty sure’, just like you’re ‘just guessing’ with the point you’re making in this post.

    • the difference is, when I am guessing, I say so, and when you are guessing, you say;’I am pretty sure’

      • But you’re ‘fairly clear’ that CAM-use in this population is not a thing that motivates consumers to go to work. Similar to me being ‘pretty sure’ isn’t it? And I’ve presented some contrary evidence, which you’ve chosen to ignore.

        • “‘fairly clear’ that CAM-use in this population is not a thing that motivates consumers to go to work”…because that’s what the data show.

          • Well, Google says there about 40 uses of the phrase ‘worried well’ on this site. so now I’m sure rather than pretty sure. But you’re still guessing with your statements.

      • Sometimes you use “fair to assume”, like when you completely guessed how students might have answered a survey question:

        “These results speak for themselves and leave me (almost) speechless. The response rate was truly dismal, and it is fair to assume that the non-responding students held even more offensive views on vaccination than their responding colleagues.”

        • do you have a point?

          • You said “the difference is, when I am guessing, I say so, and when you are guessing, you say;’I am pretty sure’”.

            Tom’s not guessing – he’s actually seen the phrase used many times on this blog. It’s based on reality. Your guess in the example I used is based on unreturned surveys. The answers literally don’t exist. That’s a total guess, based on fantasy. That’s the difference.

          • thank you so much for this remarkable insight.

    • Tom Kennedy,

      I am ‘pretty sure’ that you are ‘pretty sure’ that sticking needles into your clients into locations that you are ‘pretty sure’ will alleviate diseases — diseases which we are all ‘pretty sure’ that you are neither licenced to diagnose nor licenced to cure — will somehow end up being medically efficacious to your clients.

      If you think that you are providing proper health care then you are dangerously deluded.

      • Pete Atkins – yes, if you are alluding to acupuncture, carefully placed needles are medically efficacious. If I inadvertently prick myself with a needle whilst sewing, for example, there is a momentary “ouch” and is so far removed from the experience of acupuncture’s effect, that the experience/feeling/result/ cannot be compared to a pin prick. However, in your inimitable fashion, those that benefit (and from many other CAM modalities) are delusional or worse. What’s new? In the meantime Planet Reality continues, and those that benefit will continue to do so. I am no expert – I leave that to commenters like Mel – but I do know my own experience. So it is and I fear always will be that the sceptics in their unique style will denigrate and much worse all things CAM……..in the meantime, onwards and upwards…..

        • A said:

          carefully placed needles are medically efficacious.

          Yet you provide not a jot of good evidence… Why is that?

        • “I do know my own experience.” That’s fine, then. Perfect evidence for something. As with people who say the same for fortune telling, psychic readings and belief in a god.

        • “However, in your inimitable fashion, those that benefit (and from many other CAM modalities) are delusional or worse.”

          It is the CAM practitioners, including Tom Kennedy, who are “delusional or worse”.

          My “inimitable fashion” is based not on being a skeptic, it is based on having spent a small fortune over the decades on trying to cure my incurable disease by visiting a plethora of camists. I’ve even tried branches of quackery that very few camists have ever heard of. None of it was effective: my health slowly declined; and it continues to do so.

          Not one of those dozens of camists ever asked me for feedback after I eventually stopped making further appointments with them. Why? Because camists rely on positive testimonials and they have no mandatory mechanism in place to also record and report their failures.

          In total contrast, the NHS provides me with accurate information because it is mandated to record and review all outcomes, not just the positive outcomes.

          I am not a sceptic of CAM. I have in-depth first-hand experience of the trickery that is deployed within the CAM empire. I have attended many training courses in CAM and I have certificates that qualify me to be a multimodal CAM practitioner. NB: I have never been, and will never be, a CAM practitioner for ethical reasons.

          For the readers who wish to learn more, I thoroughly recommend reading the book “Trick or Treatment? Alternative Medicine on Trial” by Simon Singh and Edzard Ernst.
          https://en.wikipedia.org/wiki/Trick_or_Treatment

          • Pete

            Sorry to hear about your health – you’re quite fortunate to have the NHS. Hopefully the US will follow suit sooner than later. In the last 30+ years, we’ve never had a doc ask for feedback or follow-up after treatment (even after a couple surgeries). I empathize. Our vet, on the other hand always follows up a day or 2 later. I think the US med system will find it’s a great system.

            “I have attended many training courses in CAM and I have certificates that qualify me to be a multimodal CAM practitioner.” In what areas? I should have asked this long ago, as it may make finding common terminology easier.

          • Jm, I’m far too embarrassed to publicly state my fields of certified incompetence! Had I not read the book Trick or Treatment, then changed my beliefs, it’s very likely that I’d be eligible for an entry in Prof. Ernst’s ‘ALT MED HALL OF FAME’.

            In my opinion, the UK NHS is superb, and we are very fortunate indeed to have this system of health care. We are also very fortunate indeed to have this superb service:
            “Emergency air ambulances are generally helicopter based, and used to respond to medical emergencies in support of local ambulance services. In England and Wales, all of these services are charitably funded, and operated under contract with a private provider. The ambulance staff crewing these flights are generally seconded from the local NHS ambulance service.”
            https://en.wikipedia.org/wiki/Air_ambulances_in_the_United_Kingdom

            We also have charitably-funded organisations that provide end-of-life care services to those who are suffering from a terminal disease; and charitably-funded organisations that provide essential services to those who are suffering from an incurable chronic disease. These charities not only provide care services, they also constantly review the medical literature in order to provide the very best up-to-date advice and health care.

            Lastly, but I think most importantly, we are extremely fortunate to have our health care services advised by the truly remarkable expertise of the Chief Medical Officer for England: Dame Sally Davies, DBE, FMedSci, FRS.
            https://en.wikipedia.org/wiki/Sally_Davies_(doctor)

      • @Pete Certainty is impossible in this world (one of the teachings of Chinese Medicine in fact). But I stay within the boundaries of my license, and I use all available evidence to guide the way I present my services.

        • “But I stay within the boundaries of my license”

          If you actually held a licence within the UK then I think it would clearly state that it is a “licence”, rather than a “license”. If you have received a “license” to practise medicine within the UK then I suggest that you have been conned, and that you are conning your clients.
          https://en.wikipedia.org/wiki/Medical_license#UK

          • licence
            noun
            1.
            a permit from an authority to own or use something, do a particular thing, or carry on a trade (especially in alcoholic drink).

            I am a member of the British Acupuncture Council (registered with the Professional Standards Authority). This is one type of licence, as it allows me to apply for licensing from local governments (another type). I also hold medical malpractice insurance. So I have more than one permit from different authorities which allow me to do a particular thing.

          • Tom Kennedy said:

            licence
            noun
            1.
            a permit from an authority to own or use something, do a particular thing, or carry on a trade (especially in alcoholic drink).

            I am a member of the British Acupuncture Council (registered with the Professional Standards Authority).

            The BAcC isn’t a licensing authority – they are a trade body with no statutory powers. The PSA isn’t one either.

            As I understand it, the Local Government (Miscellaneous Provisions) Act 1982 mandates registration of the premises and/or the person performing acupuncture purely for hygiene purposes (and strictly, this is a certificate and not a licence). It says nothing about the qualification or training of the person.

            I also hold medical malpractice insurance.

            Irrelevant.

  • @Bjorn ‘When you say “migraine”, are you sure we are talking about real migraine or just another worried-well career seeker with stress-induced tension headaches that are easily relieved by whatever care and consideration you throw at the customer that helps temporarily with the stress?’

    This was a comment of yours on another page, and to me at least it comes across as both dismissive and derogatory, not just to me but to these types of patient. I agree that most conventional medical clinics are not equipped to deal with these people properly, which is one reason CAM serves an important purpose. Yes, I see a lot of people in this category, and I see my role as helping them avoid the disastrous long-term effects of stress and other lifestyle triggers in the hope that they will avoid developing ‘real’ diseases down the line. I also see many people with more serious conditions who have sadly given up on mainstream healthcare, although I don’t claim to be able to ‘cure’ them of anything.

    • Tom Kennedy
      You said:

      I don’t claim to be able to ‘cure’ them of anything.

      From your website:

      “WHAT CAN ACUPUNCTURE TREAT?

      Unfortunately, due to new ASA regulations, acupuncturists and other healthcare providers are no longer allowed to discuss the benefits of their therapies in terms of specific conditons not deemed to be proven scientifically. Nor are they allowed to display information provided by patients who have found relief from specific conditions. Please refer to the Research and Conditions pages for a further discussion of these issues, and educational information regarding various conditions.”

      Perhaps the final line of your comment would better be revised as follows: “I don’t claim to be able to ‘cure’ them of anything, for purely legal reasons (but see my website for hints).”

      • @Frank here’s a link (to an educational site for children) that helps explain the difference between ‘treating’ and ‘curing’ something. Yes, they talk about doctors not acupuncturists, but the principle is the same.

        http://m.kidshealth.org/en/teens/curable.html?WT.ac=

      • Frank

        In the UK, is there a differentiation between ‘treat’ and ‘cure’? How does modern medical industry use those terms – interchangeably, or is there a difference?

        • Tom, jm

          Point taken. My mistake. Of course if altmed could ever cure any condition you’d lose income from repeat customers.

          • Frank

            It would be wonderful if all healthcare practitioners were unemployed because they weren’t needed.

          • jm

            It would indeed be wonderful if all practitioners qualified and trained to offer effective healthcare were unemployed because they weren’t needed. The same does not apply to pseudo-medics who think they’re providing healthcare when the evidence very clearly says otherwise.

          • Well, what can you do? If only we ruled the world, eh?

            Actually, does it really bother you that there are ne’er-do-wells like Tom out there, helping people without evidence? If so, how much? I’ve always been curious if commenters just like to complain on a blog…or if they are trying to change things. Either way is fine, of course – but it would be interesting to hear what’s actually being done (or at least attempted).

    • You have revealed, yet again, that you do not begin to understand medical terminology. The medical term “migraine” is not a specific illness (that is either diagnosable or treatable by camists — despite their many claims), it is a category that encompasses all of the identified subtypes.

      Camists, including yourself, rely heavily on wilful obscurantism plus the fallacy of composition, the fallacy of division, and all other fallacies that serve the core tenet of the CAM business model, which is exploitation via misdirection.
      https://en.wikipedia.org/wiki/Fallacy_of_composition
      https://en.wikipedia.org/wiki/Fallacy_of_division

      I hope your wife is now rejoicing over the fact that you have decided to ignore her previous words of wisdom.

      • Migraine is a common health condition, with subtypes – what have I said that contradicts that? I don’t claim to make medical diagnoses – people usually come to me with diagnoses from their doctors, who have been unable to help them (which isn’t to suggest doctors don’t often help people a great deal).

  • @Alan this seems like a rather pointless semantic debate, but I am allowed to carry out the practice of acupuncture by my local authority because of the training I have completed. If I hadn’t completed said training, I would not have been granted permission. So my membership of the BAcC acts as my licence. Here’s what the NHS says:

    ‘There are a number of acupuncture organisations in the UK practitioners can join if they hold certain qualifications and agree to work according to certain codes of practice.
    The British Acupuncture Council holds a register of practitioners that has been vetted and approved by the Professional Standards Authority. If you decide to have traditional Chinese medicine acupuncture, you can visit this website to find a qualified acupuncturist near you.’

    • Whoosh! There go the goalposts.

      • The goalposts were shifted after my very first comment, when I introduced some evidence to counter the premise of the original post. Amazing how often folks here cry ‘where’s your evidence’, and yet it gets ignored when it’s presented. Instead, there is an obvious preference for trying to trip people up on trivial or simply invented matters. Exactly what happened the last time I tried to make a contribution here.

        • Wrong.

          You continue to conflate an LA certificate of registration for hygiene with a ‘licence to practice acupuncture’ and qualifications in acupuncture with membership of a trade body.

          You do realise that PSA accreditation of the BAcC register says nothing about the efficacy of acupuncture and that they don’t check or vet educational requirements, don’t you?

          • And what does that have to do with the evidence countering the premise of the original post?

          • Good grief.

            Tom is the one who raised the issue of his ‘licence’. I showed he was wrong.

          • Jm, It’s a pity that you didn’t bother to evaluate “the evidence countering the premise of the original post”.

            The ‘evidence’ that Tom Kennedy quoted starts with an initial ellipsis […], which was used to omit:

            In so-called ‘pragmatic’ studies, the real-world effectiveness of acupuncture has been assessed when given in addition to. Patients are randomized to ‘acupuncture’ or ‘no additional treatment (standard GP management) without the use of a placebo. In one such study,

            In other words, it was an A + B versus B study design — a study design that cannot possibly produce a negative result. Therefore, this does NOT constitute “evidence countering the premise of the original post”!

            See also: Acupuncture for depression? The quality of the research is enough to make me depressed!
            http://edzardernst.com/2013/10/acupuncture-for-depression-the-quality-of-the-research-is-enough-to-make-me-depressed/

          • Pete

            No pity at all. I have no interest in evaluating the evidence countering the original post – I had faith that scads of others would. I didn’t think it would take over 50 comments to get there, though.

            Instead, the focus seemed to be on defending the use of “worried well”, the correct spelling of license, and Alan’s trivial obsession with licensing details.

            That seemed kind of odd, since I thought folks would be more interested in:

            – “A Cochrane systematic review first published in 2001 analysed 16 studies involving 1151 patients and concluded that ‘the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches’, but called for further large-scale studies. Large, randomised controlled clinical trials involving several thousand patients have now been conducted, funded by German health insurance companies. These studies have compared acupuncture with standard treatment (drugs and advice given by physicians) and demonstrate persistent and clinically relevant benefits under real-life conditions and equivalence to specialist drug management.”

            – And the NICE guideline recommendations for migraine “If neither topiramate nor propranolol are suitable or work well, you may be offered a course of up to 10 sessions of acupuncture.”

          • @Alan please see here for the PSA Standards for Accredited Registers, especially standard 9 which deals with education:

            http://www.professionalstandards.org.uk/docs/default-source/accredited-registers/ars-policies-and-procedures/standards-for-accredited-registers.pdf?sfvrsn=4

            I didn’t mean to imply that I held a ‘medical licence’, but membership of the BAcC does require degree-level training, without which I would not be allowed by my LA to do what I do. To me, that constitutes a licence, but I’m happy to call it a permit, a membership or whatever else. The fact is it does give various important reassurances to the public.

          • Tom Kennedy said:

            please see here for the PSA Standards for Accredited Registers, especially standard 9 which deals with education

            I’m well aware of what the PSA say. Standard 9 simply says a register must have some sort of educational/training standards. It is silent on whether what they are taught is based in science and evidence – all it requires is that it’s trainees are taught something or other. As I said, the PSA make it clear that accreditation says nothing about the efficacy of any treatment a member of a register provides.

            It’s also a mystery how Standard 6 was deemed to have been met.

            I didn’t mean to imply that I held a ‘medical licence’

            I’m glad we’ve finally sorted that out.

            but membership of the BAcC does require degree-level training

            That seems to count for little these days. It’s not that long ago British universities were handing out BSc degrees to homeopaths.

            without which I would not be allowed by my LA to do what I do.

            As I’ve already pointed out, the Act does not require any qualifications in acupuncture: it is concerned only with hygiene.

            To me, that constitutes a licence, but I’m happy to call it a permit, a membership or whatever else.

            Membership of an Accredited Register and a certificate of registration with the LA for hygiene.

            The fact is it does give various important reassurances to the public.

            Assurances that you follow good hygiene practices, have insurance, etc, but not that there is a jot of good evidence for acupuncture. I wonder how many members of an Accredited Register make that clear to their customers?

  • The only ‘evidence’ in the points “jm” is trolling, is that things go slow in the world of science and fact finding. Evidence is fast accumulating against acupuncture. NICE still has more work to do in cleaning out vague and wishful recommendations to woo. They recently cleaned out acupuncture from their back pain recommendations. I guess the migraine prophylaxis chapter (which “jm” misquotes 🙁 ) will be revised sooner or later to reflect accumulating evidence that needling is nonsense in any field of medicine.
    Cochrane is not the infallible oracle some want it to be, but a huge collaboration of volunteers struggling to keep out the inevitable elements of irrational enthusiasm and overt idiocy. The muddle about acupuncture for migraine is a fine example of woo-lly brains trying to peer through their brainfog and interpret the hazy outlines to fit their fantasies.

    • Bjorn

      I’m quoting (copy/paste) migraine trust, linked to from the page Tom was referencing.
      https://www.migrainetrust.org/living-with-migraine/treatments/evidence-based-guidance/nice-guideline/

      Looks like they are in fact paraphrasing NICE:

      “1.3.20 If both topiramate and propranolol[12] are unsuitable or ineffective, consider a course of up to 10 sessions of acupuncture over 5–8 weeks according to the person’s preference, comorbidities and risk of adverse events. [2012, amended 2015]”

      So you might want to let them know they’re misparaphrasing. You could also let them know about the speed of science, and the inevitable elements of irrational enthusiasm and overt idiocy inherent in Cochrane. I’m sure they will appreciate you help. Especially if you work in the phrase “woo-lily brains” – I think that’s a new one for you :).

      • Jm, I repeat: It’s a pity that you didn’t bother to evaluate “the evidence countering the premise of the original post”.

        FFS, stop blaming others for your incompetence, your ineptitude, and your ongoing wilful ignorance.

      • Pete,

        NICE recommends acupuncture. Did they not evaluate the evidence? Maybe they are incompetent, inept, and wilfully ignorant?

        • “NICE recommends acupuncture.” No, NICE does not recommend acupuncture. I recommend that you learn to read and to properly understand a whole document before you cherry-pick from it.

          All you are doing is providing further evidence, not that any was needed, to support Björn’s comment above:
          http://edzardernst.com/2016/08/use-of-alternative-medicine-is-associated-with-absenteeism/#comment-80432

        • Pete,

          Rather than spending your time with the attempted insults and referencing Bjorn’s slow world of science, NICE still has more work to do, “will be revised sooner or later”, woo-lily brains etc, why don’t you just explain. This is currently from NICE:
          ____________________________
          “We have updated or added new recommendations on the prophylactic treatment of headaches (section 1.3).”

          Recommendation in 2015 guideline
          1.3.20 If both topiramate and propranolol[12] are unsuitable or ineffective, consider a course of up to 10 sessions of acupuncture over 5–8 weeks according to the person’s preference, comorbidities and risk of adverse events. [2012, amended 2015]

          Reason for change
          The updated evidence review did not look at acupuncture so this part of the recommendation is unchanged and the use of gabapentin has been removed.
          ____________________________

          So since you feel that I need to learn how to read – why don’t you teach me. Explain to me how this is “No, NICE does not recommend acupuncture.” From the incompetent, inept, wilfully ignorant layman point of view, it reads pretty straightforward. They seem to literally spell it out in black and white.

          • Now “jm” has got it wrong twice. It is ‘Woo-lly’ from ‘Woo’ meaning of quackery and ‘Wool’ as hair from sheep, nothing to do with lillies.
            Guess (s)he needs new spectacles?

            NICE didn’t have a look at acupuncture when revising its guideline on headaches and migraines last time over. So!? That is no argument for needless needling. More likely they have some woo-lly brained blockhead(s) obstructing progress in the headaches department.
            Let’s wait and see what happens when they really have a look at the totality of evidence without interpreting the data through wish-it-works-goggles.

            Last time over however, they had a look at acupuncture for LBP. And now they are about to throw that dud out despite the findings of several eminent acupuncturists that recipients of needles have reported feeling better in their backs How come? Of course because they look at the totality of evidence, not only wishful writings like this, that found effect in some[sic] patients.

            Let’s wait see what happens when NICE really reviews acupuncture for headache and migraine. Progress is slow, business is fast.

          • Jm wrote: “From the incompetent, inept, wilfully ignorant layman point of view, it reads pretty straightforward. They seem to literally spell it out in black and white.”

            That’s because neither you nor Tom Kennedy have the first effing clue about 21st Century medicine due to your obvious inability and unwillingness to acquire a sufficient level of education in medicine to even begin to understand it, its nomenclature, and the nomenclature used in science. You have chosen instead to tread the very easy and lucrative path of learning, advocating, and practising quackery along with its multiple forms of misdirection. Practising medicine without a licence is a criminal offence in many jurisdictions across the globe, whereas quackery is, very sadly, still more-or-less covered by “caveat lector” and “caveat emptor”.

            The overwhelming volume of evidence clearly shows that acupuncture is nothing other than a theatrical placebo. An excellent resource for learning about this is the books and the website written by Professor Edzard Ernst: I’ll supply you and Tom with links if you are unable to find these resources by yourselves.

            You previously asked me what I think. I told you exactly what I think. You didn’t like it. Tough! I thoroughly detest people, such as you and Tom, who take advantage of vulnerable members of society.

            Jm, you are so hopelessly incompetent, inept, and wilfully ignorant that you still haven’t managed to figure out why the “contrary evidence” presented in the comments does *not* constitute contrary evidence to the subject and the contents of Prof. Ernst’s article: Use of alternative medicine is associated with absenteeism.

            You and Tom are clutching at straws and constructing, pathetic, straw man arguments. Your ships are sinking. I hope you will both soon learn to do the only honourable thing: go down with the ships, *after* you have freed from your clutches as many of your paying passengers as is humanly and humanely possible.

          • Pete

            You still haven’t told me how “No, NICE does not recommend acupuncture.” fits with reality. Maybe as Bjorn suggests, they will look at the overwhelming volume of evidence and remove the recommendation in the future. But in the current reality, the recommendation is there.

            You wrote several paragraphs of insult, book recommendations, some weird assumed opinions, and various other diversions – but none of that changes the current NICE recommendations. “No, NICE does not recommend acupuncture.” is just fantasy, or possibly a mystical vision of the future, gleaned with dowsing rods from Amazon.com.

          • Jm,

            “If both topiramate and propranolol1 are unsuitable or ineffective, consider a course of up to 10 sessions of acupuncture over 5–8 weeks according to the person’s preference, comorbidities and risk of adverse events.” — NICE, Management of migraine (with or without aura), Prophylactic treatment (2015).

            consider [verb]: think carefully about (something), typically before making a decision.

            Medical facts: Acupuncture is a theatrical placebo; it isn’t even a particularly effective placebo therefore it isn’t a cost-effective placebo; it carries the risk of serious adverse events therefore the risks far outweigh the benefits.

            A GP will take the above medical facts into consideration. Hence, none of the GPs at my local surgery recommend acupuncture for anything. My GPs follow NICE guidelines and they do not recommend acupuncture because NICE does not recommend acupuncture.

            I repeat: NICE does not recommend acupuncture.

            You cherry-picked the very specific case[1] of a person with migraine that has not responded to medical treatment (including lifestyle advice). NICE has not yet removed the mention of acupuncture as a last resort because, as Björn stated, “NICE didn’t have a look at acupuncture when revising its guideline on headaches and migraines last time over.”

            [1] It just so happens that this very specific case applies to me so I’m far better qualified to discuss it than are camists. You are the one who’s living a fantasy, and you are indeed clutching at straws.

          • Pete

            Medical facts, effective placebo, cost effectiveness, GP decisions (they are guidelines and recommendations after all, not mandates), your local surgery, etc. – none of that changes the current NICE guidelines. Maybe all of those factors will change future guidelines.

            “You cherry-picked…” I cherry-picked the part where NICE recommends acupuncture.

          • I repeat: NICE does not recommend acupuncture.

          • Pete

            “I repeat: NICE does not recommend acupuncture.” You repeat that a lot. And yet, this is what NICE currently has to say:

            ____________________________
            “We have updated or added new recommendations on the prophylactic treatment of headaches (section 1.3).”

            Recommendation in 2015 guideline
            1.3.20 If both topiramate and propranolol[12] are unsuitable or ineffective, consider a course of up to 10 sessions of acupuncture over 5–8 weeks according to the person’s preference, comorbidities and risk of adverse events. [2012, amended 2015]
            ____________________________

            Maybe their website got hacked by the Russians or something.

          • Jm, All you’ve done is to highlight the vital difference between physicians and camists: the former are competent to practise medicine, the latter are not.

            Had you bothered to learn how and why acupuncture got mentioned in NICE guidelines then you would know who ‘hacked the website’.

            You still haven’t learnt the difference between “recommend acupuncture” and “consider a course of up to 10 sessions of acupuncture over 5–8 weeks according to the person’s preference, comorbidities and risk of adverse events”.

            NICE does not recommend acupuncture.

          • “consider a course of up to 10 sessions of acupuncture over 5–8 weeks according to the person’s preference, comorbidities and risk of adverse events” is recommended by NICE.

          • For which very specific health condition [rhetorical question].

  • @Alan A few points I response to your last post:

    1) ‘Standard 9 simply says a register must have some sort of educational/training standards’. No, it clearly goes well beyond that – anyone can read the full standards and judge for themselves.

    2) ‘It is silent on whether what they are taught is based in science and evidence’. That is a separate issue and not one I made any claims about here. My training entailed a mixture of Western science and traditional concepts – entirely appropriate for a rounded understanding of acupuncture in my opinion (and that of the PSA board).

    3) ‘the PSA make it clear that accreditation says nothing about the efficacy of any treatment a member of a register provides’. Again, I never said it did.

    4) ‘I’m glad we’ve finally sorted that out’. It’s totally disingenuous to imply some kind of victory here – I NEVER CLAIMED I held a medical licence.

    5) (degree-level training) ‘seems to count for little these days’. You’re welcome to your opinion of course, but I’m very proud of the three hard years of effort I put in to my degree.

    6) ‘the Act does not require any qualifications in acupuncture’. The Act may not specifically require this, but local authorities (including mine) often do. Please see the following link, which not only clearly defines what I hold as a ‘licence’, but also states the requirement to provide qualifications certificates: https://www.gov.uk/apply-for-a-licence/tattooists-piercing-and-electrolysis-licence/bristol/apply-1

    Your comments on this thread come across as pedantic and supercilious (as well as largely incorrect) – par for the course I suppose.

  • @Alan Presumably you meant ‘Oh dear I got it wrong about the licence thing and I’ve produced a very boring thread’? Well, we all make mistakes, don’t worry too much about it 😉

    • You did and I demonstrated just how and why you were wrong.

      • …and then I showed you were clearly wrong with this link (unless you claim to be a greater authority than the UK government?):

        https://www.gov.uk/apply-for-a-licence/tattooists-piercing-and-electrolysis-licence/bristol/apply-1

        I suggest you contact me via my website if you really want to carry this on further in case we bore anyone to death.

        • I suggest that it was incumbent on you to properly understand why Alan is correct and you are wrong *before* you applied for registration:
          https://www.bristol.gov.uk/documents/20182/33303/Byelaws.pdf

          See also Section 14 Acupuncture of the Local Government (Miscellaneous Provisions) Act 1982:
          http://www.legislation.gov.uk/ukpga/1982/30

        • LOL!

          You said:

          @Pete Certainty is impossible in this world (one of the teachings of Chinese Medicine in fact). But I stay within the boundaries of my license [sic], and I use all available evidence to guide the way I present my services.

          And:

          licence
          noun
          1.
          a permit from an authority to own or use something, do a particular thing, or carry on a trade (especially in alcoholic drink).
          I am a member of the British Acupuncture Council (registered with the Professional Standards Authority).

          It may well be that you believe that a licence can be issued by any Tom, Dick or Harry and not just the Government, but the BAcC is not an authority and they do not issue licences or permits; they are just a trade body.

          Also, being a member of a trade body gives you no ‘permit’ or ‘license’ regardless of whether it is accredited by the PSA, who, as I also pointed out, are careful to say that their accreditation gives no legitimacy to any treatment carried out by a member of an Accredited Register – and therefore no boundaries.

          I showed you that what you actually had was a certificate of registration for hygiene from your Local Authority. Having one is certainly a legal requirement, but there is no requirement to have any training in acupuncture.

          Although not required by s.14 of the Local Government (Miscellaneous Provisions) Act 1982, your LA asks about your qualifications. The Act, however, does not give the LA any powers whatsoever to reject an application on the grounds of inadequate or non-existent qualifications however they might judge that: it is purely an administrative requirement by the LA. Membership of the BAcC or any other register accredited by the PSA is not a requirement.

          The fact remains that the certificate of registration only demonstrates that you and your premises have adequate hygiene facilities and standards not expertise, training nor competence in acupuncture; it sets no boundaries on your practice of acupuncture.

          In your first quote, you certainly appeared to me to be using what you deemed to be your official ‘licence’ to gain credibility for what you do, particularly given that you claimed this licence of yours imposed boundaries. The only boundaries your certificate of registration for hygiene imposes are limits on, well, hygiene.

          • I hope it’s clear to anyone who might stumble on this thread that when I made the comment ‘I stay within the boundaries of my licence’, I was simply defending myself from Pete’s suggestion that I was ‘dangerously deluded’ in the way I carried out my business. In other words, it was shorthand for saying ‘I stay within the bounds of the law, and within the bounds of safe and ethical practice as defined in the various codes and regulations I have signed up to as a member of the British Acupuncture Council and as an acupuncturist sanctioned by my local authority’. Because I hold a licence to carry out acupuncture from my local authority, which carried with it a check on the aforementioned membership, it seemed an entirely appropriate and succinct statement. In no way was I trying to ‘gain credibility’ beyond that which any properly trained and accredited acupuncturist should expect (none around here, obviously). You may be technically correct in your forensic examination, but that doesn’t change the obvious essence of what I was saying, so what was the point? The flurry of bluster that my simple statement caused just goes to show the deep seated desire in this community to undermine anyone with an opposing point of view, rather than engage in meaningful debate.

          • Tom Kennedy said:

            In other words, it was shorthand for saying ‘I stay within the bounds of the law, and within the bounds of safe and ethical practice as defined in the various codes and regulations I have signed up to as a member of the British Acupuncture Council and as an acupuncturist sanctioned by my local authority’. Because I hold a licence to carry out acupuncture from my local authority, which carried with it a check on the aforementioned membership, it seemed an entirely appropriate and succinct statement.

            Well, about this licence… I have already pointed out that the law is silent on any acupuncture training requirements or membership of any trade body, experience, etc for your hygiene registration certificate. The Bristol City Council form does ask for qualifications, etc but as I’ve already pointed out, the law does not permit the Council to reject an application on the grounds of inadequate or non-existent qualifications. You seem to want to continue to believe that your hygiene registration certificate is more than what it is: a certificate that you are registered with the Council for the purposes of hygiene. This registration says nothing about your qualificatins, acupuncture or your ability to treat anyone.

            However, just in case I was wrong, I thought it would be worthwhile asking Bristol City Council for some clarification, so I emailed them. I got a reply today.

            I asked:

            In your application for a licence to carry out acupuncture, you ask for:

            * Details of all relevant qualifications, training and experience (including where undertaken, dates, awarding body, etc)
            * Membership of any professional organisation

            Can you tell me what qualifications, etc and membership you require before you will grant a licence?

            Their reply (from a Senior Enforcement Officer in their Food Hygiene department):

            There are no specific qualifications required before we issue a acupuncture registration.

            Just to clarify, I then asked:

            So are you saying that no qualifications or affiliations are required at all for registration?

            Their answer:

            Yes that is correct, we concentrate on the hygiene requirements

            I’m glad we’ve finally got that sorted out.

        • Tom Kennedy,

          In addition to Alan’s reply to you on Friday 12 August 2016 at 16:16, I feel it incumbent on me to make you adequately aware of your previous claim: “I also hold medical malpractice insurance.”

          “Medical malpractice insurance” is a meaningless term, and it is most definitely NOT the type of insurance that you are legally mandated to possess in order to meet the terms and conditions of your trade and of your workplace(s).

          • I’m not sure why you consider it a meaningless term – it’s simply what Royal Sun Alliance call it, and it’s one of a comprehensive package of insurances BAcC members hold as part of being responsible practitioners.

  • @Alan Your detective work has produced some interesting information that wasn’t clear to me, so thanks for that. I was under the impression (due to the application process) that my local council required practitioners to be adequately trained before granting them a licence – I think you’ll admit this is a reasonable assumption, considering you felt the need to contact the council directly for clarification. I find it worrying that anyone with a hygiene certificate can apparently open an acupuncture business – perhaps even some common ground there? Hopefully statutory regulation will eventually solve the problem (I doubt you’ll agree with that part).

    The central point I was making (in response to being called ‘delusional or worse’) still remains – ‘I stay within the bounds of the law, and within the bounds of safe and ethical practice as defined in the various codes and regulations I have signed up to as a member of the British Acupuncture Council and as an acupuncturist sanctioned by my local authority’. That statement alludes to 3,600 hours of initial training, consequent CPD, professional and ethical conduct, appropriate insurance, and safety (yes, including hygiene). I stand by my response on August 15th.

    • Tom Kennedy said:

      @Alan Your detective work has produced some interesting information that wasn’t clear to me, so thanks for that.

      It wasn’t detective work: I simply asked a couple of rather obvious and pertinent questions.

      I was under the impression (due to the application process) that my local council required practitioners to be adequately trained before granting them a licence – I think you’ll admit this is a reasonable assumption, considering you felt the need to contact the council directly for clarification.

      No. I do not think it was at a reasonable assumption to make considering you are well aware that there is no statutory regulation of acupuncturists. It was entirely clear to me from the Local Government (Miscellaneous Provisions) Act 1982; I only contacted the Council because you seemed to be having difficulty understanding it and wanted to make things clear and simple.

      I find it worrying that anyone with a hygiene certificate can apparently open an acupuncture business – perhaps even some common ground there?

      No, no common ground: I find it worrying that anyone practices acupuncture.

      Hopefully statutory regulation will eventually solve the problem (I doubt you’ll agree with that part).

      Correct: as we’ve seen with chiros and osteos, all that statutory regulation does is give a veneer or respectability not warranted by the best evidence.

      The central point I was making (in response to being called ‘delusional or worse’) still remains – ‘I stay within the bounds of the law

      I’m sure we all strive to stay within the bounds of the law: it would be bizarre if you were to claim otherwise.

      and within the bounds of safe and ethical practice as defined in the various codes and regulations I have signed up to as a member of the British Acupuncture Council

      As the dear professor has clearly demonstrated – and as you have failed to refute – there is no comprehensive AE reporting system and the evidence for benefit is scant at best. It is therefore a moot point whether any acupuncturist can claim to practice safely and ethically.

      and as an acupuncturist sanctioned by my local authority’.

      Good grief.

      That statement alludes to 3,600 hours of initial training, consequent CPD, professional and ethical conduct, appropriate insurance, and safety (yes, including hygiene).

      Theology has been taught at the University of Edinburgh since 1583 and I have little doubt the Bachelor of Divinity course is a long and arduous one. That, however, does not give a jot of credence to anything that is taught.

      • @Alan ‘just in case I was wrong, I thought it would be worthwhile asking Bristol City Council for some clarification’ suggested to me there was doubt in your mind, but obviously not – in fact you seem enviably sure of most things you say.

        No common ground then – I’ll just have to live with that.

    • “I was under the impression…”

      deluded [adjective]:
      believing things that are not real or true (Cambridge Dictionary);
      believing in something that is false (Collins Free Online Dictionary).

      Your ‘impression’ of the legal documents and the application process is irrelevant: you are required, by law, to properly understand what the documents are for, and their terms and conditions. Ignorance of the law is NOT a justifiable excuse for anyone who is an employer, which includes those who are self-employed.

      I find it horrendous that you — in your occupation as an acupuncturist in Bristol, UK — delight in flaunting your ignorance and your delusions on Professor Ernst’s website. I strongly recommend that you request an appointment with your local Trading Standards authority for two purposes: rectifying your delusions; and to check that you have the types of insurance demanded by law, rather than the type(s) recommended by the British Acupuncture Council.

      Tom Kennedy, thank you for continuing to provide further insights into the acupuncturists’ mind-set:
      http://edzardernst.com/2016/06/an-invitation-resulting-in-a-rare-insight-into-the-acupuncturists-mind-set/

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