Regulation of acupuncture in the UK - there are competing proposals

September 7, 2003

Dear Colleagues,

I hope you won't mind my taking up discussion about the regulation of

acupuncture in the UK - I realise that for people outside the UK, some of these

details may be pretty boring.

At present, the modality for state registration of acupuncture in the UK hasn't

been decided. A number of acupuncture organisations, including the British

Acupuncture Council, which represents oriental-style acupuncturists, and the

British Medical Acupuncture Society, which represents medical doctors who use

acupuncture, possibly not employing oriental medical theory, have met under the

auspices of UK government, and have developed a proposal for the state

registration of acupuncture that will be published shortly. I presume that this

is the proposal Godfrey Bartlett is referring to when he says 'As always, they

[the doctors' organisation] hold most of the power so negotiations are about

what is realistically achievable in the interests of promoting traditional

practice, not about what we would all like to see in an ideal world.'

However, the BAcC-BMAS etc. proposal is only one of two of the formal proposals

that has emerged from government-appointed bodies considering state registration

of complementary medicine. The body considering the state registration of herbal

medicine has developed an alternative proposal, that promotes the regulation of

acupuncture amongst other forms of complementary medicine modalities, in an

umbrella organisation called something like the Council for Complementary and

Alternative Medicine (CCAM).

One of the issues in the UK has been that there are a large number of ethnic

Chinese practitioners of TCM. These individuals consider, rightly in my opinion,

that it is artificial and wrong to regulate the two primary modalities of TCM,

acupuncture and herbal medicine, separately. In response, the body considering

state regulation of herbal medicine has come up with the CCAM solution, which

would enable forms of complementary medicine to be registered as systems of

medicine, and not as techniques. Thus, in the CCAM proposal, TCM could be

registered as an entity in its own right, as could Japanese-style acupuncture.

An advantage of the CCAM proposal is that a great many expenses could be shared,

so that CCAM state registration could be cheaper than having separate bodies to

regulate acupuncture and Chinese herbal medicine. Apparently, there are

influential people in the UK Department of Health who are disinclined to having

many separate state registration bodies for a myriad of CAM modalities.

Proponents of the CCAM consider that, as an explicitly CAM body, it will promote

the interests of CAM collectively, and enhance the standing of CAM in the UK,

while enabling discrete systems of medicine to be registered in their own right.

A gross limitation of the BAcC-BMAS proposal, as I understand it without having

read the proposal (because it hasn't yet been published), is that it will not

specifically allow different modalities of acupuncture, such as TCM acupuncture

or Japanese-style acupuncture, to be regulated in a manner tailored to their

specific needs and requirements.

I look forward to the publication of the proposals for state registration, but I

encourage UK acupuncturists to ensure that both state registration proposals are

considered properly, as the CCAM proposal may be superior to the one developed

by the BAcC.

Best wishes,

Wainwright Churchill

September 7, 2003

Thank you Wainwright for your enlightening message.

The other associations in these government led discussions are the

ATCM (Association of TCM) and the BSCM (British Society of CM). The

ATCM is run by Dr WU whilst the BSCM is led by Dr Ke, both are

lecturers at Middlesex University and Dr Ke was one of the original

lecturers to Maciocia.

I sincerely hope that herbal medicine is not categorised in the CAM

camp as CM needs to move away from this umbrella grouping as it does

no favours for CM.

I've heard from various people that a person with a diploma will be

called an acupuncturist. A doctor or nurse cannot be called an

acupuncturist but can still practice acupuncture and a person with

my qualification, BSc (TCM) can be called a consultant. Well, big

bloody deal. The fact that doctors and nurses will still be able to

practice acupuncture in a closed healthcare system is seriously bad

to TCM in the UK.

I understand that doctors are already taught and licensed to insert

needles into people but this simply isn't acupuncture. The cookbook

approach simply doesn't work in CM or even in WM for that matter.

I hope the report will be published soon. And I wonder how many

members of the BAC know that their organisation is selling them out.

BTW, the house of lords report is available via the links section of

the group. I've read it and contra to other people's views, found it

very balanced.

Attilio

Chinese Medicine , " Wainwright

Churchill " <WChurchill@b...> wrote:

> Dear Colleagues,

>

> I hope you won't mind my taking up discussion about the regulation

of acupuncture in the UK - I realise that for people outside the UK,

some of these details may be pretty boring.

>

> At present, the modality for state registration of acupuncture in

the UK hasn't been decided. A number of acupuncture organisations,

including the British Acupuncture Council, which represents oriental-

style acupuncturists, and the British Medical Acupuncture Society,

which represents medical doctors who use acupuncture, possibly not

employing oriental medical theory, have met under the auspices of UK

government, and have developed a proposal for the state registration

of acupuncture that will be published shortly. I presume that this

is the proposal Godfrey Bartlett is referring to when he says 'As

always, they [the doctors' organisation] hold most of the power so

negotiations are about what is realistically achievable in the

interests of promoting traditional practice, not about what we would

all like to see in an ideal world.'

>

> However, the BAcC-BMAS etc. proposal is only one of two of the

formal proposals that has emerged from government-appointed bodies

considering state registration of complementary medicine. The body

considering the state registration of herbal medicine has developed

an alternative proposal, that promotes the regulation of acupuncture

amongst other forms of complementary medicine modalities, in an

umbrella organisation called something like the Council for

Complementary and Alternative Medicine (CCAM).

>

> One of the issues in the UK has been that there are a large number

of ethnic Chinese practitioners of TCM. These individuals consider,

rightly in my opinion, that it is artificial and wrong to regulate

the two primary modalities of TCM, acupuncture and herbal medicine,

separately. In response, the body considering state regulation of

herbal medicine has come up with the CCAM solution, which would

enable forms of complementary medicine to be registered as systems

of medicine, and not as techniques. Thus, in the CCAM proposal, TCM

could be registered as an entity in its own right, as could Japanese-

style acupuncture. An advantage of the CCAM proposal is that a great

many expenses could be shared, so that CCAM state registration could

be cheaper than having separate bodies to regulate acupuncture and

Chinese herbal medicine. Apparently, there are influential people in

the UK Department of Health who are disinclined to having many

separate state registration bodies for a myriad of CAM modalities.

Proponents of the CCAM consider that, as an explicitly CAM body, it

will promote the interests of CAM collectively, and enhance the

standing of CAM in the UK, while enabling discrete systems of

medicine to be registered in their own right. A gross limitation of

the BAcC-BMAS proposal, as I understand it without having read the

proposal (because it hasn't yet been published), is that it will not

specifically allow different modalities of acupuncture, such as TCM

acupuncture or Japanese-style acupuncture, to be regulated in a

manner tailored to their specific needs and requirements.

>

> I look forward to the publication of the proposals for state

registration, but I encourage UK acupuncturists to ensure that both

state registration proposals are considered properly, as the CCAM

proposal may be superior to the one developed by the BAcC.

>

> Best wishes,

>

> Wainwright Churchill

September 7, 2003

Hi all,

Thanks for the info Wainwright. There are minutes of the Acupuncture

and Herbal Regulatory working groups posted at:

http://www.doh.gov.uk/acupuncturerwg/meetings.htm

As a member of the BAcC, I'm still not clear why you think they are

selling us out, Attilio. Care to elaborate?

Godfrey.

> I understand that doctors are already taught and licensed to insert

> needles into people but this simply isn't acupuncture. The cookbook

> approach simply doesn't work in CM or even in WM for that matter.

>

> I hope the report will be published soon. And I wonder how many

> members of the BAC know that their organisation is selling them out.

>

September 7, 2003

Hi Godfrey.

Below is the message i posted on the 11th August 2003. Thanks for

the wonderful link, i've added it to the links section for future

use.

11th August 2003 message starts here:

I posted last week a email i received from the British Acupuncture

Council on regulation in the UK. I replied as follows:

Atti: Thank you for your email. I take it then that doctors and

nurses who have been on weekend courses will still be allowed to

practice acupuncture in their associated hospitals?

The British Acupuncture Council replied today stating:

The short answer to that question is yes, but the background is

rather more complex

The Acupuncture Regulatory Working Group decided early in its

discussions that it would be impossible to aim for protection of

function as well as protection of title - dentists, for example,

have

both; no-one can even practice dentistry in any form unless they are

properly qualified and regsitered. Too many people use acupuncture

in

valid and important ways (drug detox, etc whose practice no

legislator would want to outlaw) for protection of function to be

sustainable. Protection of title is another matter and this is what

is being discussed for acupuncturists.

With protection of title, the title 'acupuncturist' will only be

able to be used by practitioners who have achieved high educational

standards, whether these be traditional acupuncturists, medical

acupuncturists or physiotherapists. Anyone else who uses acupuncture

will be subject to the rules of the regulating body under which they

fall, but will not be able to call themselves acupuncturists. The

standards which they will have to attain will be monitored by the

regulatory body in conjunction with the new Acupuncture Council.

The experience of the osteopaths has been that the advent of

statutory regulation has meant that people have more often than not

chosen to go to a registered professional than someone who uses it

as

an adjunctive technique.

Many BAcC practitioners feel uncomfortable with the fact that in the

short term there will be many people offering acupuncture as an

adjunct whose standards fall short of a professional acupuncturist,

but the BAcC's preferred strategy is to emphasise its members

strengths rather than attack other people's weaknesses, especially

since many BAcC members aspire to working alongside orthodox health

professionals in the NHS.

Atti: i fear the worst for TCM in the UK. As you may know, the vast

majority of healthcare is available free on the National Health

Service (NHS). If doctors and nurses are allowed to continue giving

acupuncture to patients after attending a weekend course, this could

signal the dead nail for TCM in the UK. Why go and see a

acupuncturist in your local high street when you can get it for free

on the NHS. Even now, hospital pain clinics are administered

by 'real' qualified acupuncturist but don't get paid!

These are worrying times.

Attilio

Chinese Medicine , " acu_qichina "

<acu@q...> wrote:

> Hi all,

> Thanks for the info Wainwright. There are minutes of the

Acupuncture

> and Herbal Regulatory working groups posted at:

> http://www.doh.gov.uk/acupuncturerwg/meetings.htm

>

> As a member of the BAcC, I'm still not clear why you think they are

> selling us out, Attilio. Care to elaborate?

>

> Godfrey.

>

> > I understand that doctors are already taught and licensed to

insert

> > needles into people but this simply isn't acupuncture. The

cookbook

> > approach simply doesn't work in CM or even in WM for that

matter.

> >

> > I hope the report will be published soon. And I wonder how many

> > members of the BAC know that their organisation is selling them

out.

> >

September 7, 2003

Dear Attilio, [my spell checker suggested your name should be spelled as

'Attila'!!!]

Thanks for your reply, and in fact, thanks very much for hosting such an

interesting and productive discussion group!

I'd like to respond briefly to some of your points in your message below. I'd

like to mention that I have been involved with political and regulation issues

in the UK over the years at an official level, but I haven't been involved in

the crucial negotiations that have been taking place in the past two years,

leading to the acupuncturists' and herbalists' official recommendations. I have

discussed these issues with colleagues in the know, but anything I say is not

definitive, and we will have to await the publication of the recommendations.

What is interesting and significant is that two separate proposals have arisen

from the acupuncturists' and herbal regulation working groups that both outline

a procedure for regulating acupuncture. It may be that the government itself

will have a preference for one of the recommendations, but hopefully the

acupuncture profession will democratically signal its choice, in full awareness

of the two options that exist and after considered debate.

You mention:

I sincerely hope that herbal medicine is not categorised in the CAM

camp as CM needs to move away from this umbrella grouping as it does

no favours for CM.

I do know that the many herbal groups that have considered regulation carefully

don't share your concerns, and are very anxious that the Council for

Complementary Medicine umbrella group is established, including acupuncture as

one of the modalities it covers. This is for several reasons, including

a.. Cost

b.. The possibility of disciplines being regulated as systems of medicine,

such as 'TCM', and not as abstract technical modalities, such as 'herbal

medicine' or 'acupuncture'.

It is the second of these reasons that merits closest consideration. Herbal

medicine comprises very developed systems of medicine, including Ayurveda and

TCM. Ethnic practitioners in both these modalities objected strongly to being

regulated in an abstract category such as 'herbal medicine', feeling that their

practices couldn't be reduced to such a narrow description. They were insistent

that their disciplines be regulated under the banner of their system of

medicine, such as 'TCM' , which would include both acupuncture and herbal

medicine as therapeutic modalities. The UK government has been unwilling to

allow the state regulation of TCM or Ayurveda in isolation, and this impasse was

a notable obstacle to state registration of any form of herbal medicine.

However, the herbalists have achieved what they believe is a good solution in

the CCAM, as this does allow systems of medicine, such as Ayurveda and TCM, to

be regulated as discrete entities within the CCAM umbrella. The CCAM proposal

also allows the possibility of other systems being regulated individually, so

one could have explicit regulation of different styles of acupuncture. I'm sure

that people will readily appreciate that there are great differences between

Japanese and TCM acupuncture, and in Japan, people take courses of several years

duration without covering TCM. I personally think it takes several years of

study to adequately practice TCM acupuncture, and the same must be true for

styles of Japanese acupuncture. It is arguable that a Japanese acupuncturist

should not have to study TCM (which is after all a modern, state-supported

interpretation and version of a much larger tradition of Chinese medicine) to a

level of professional competence, just to be state registered as an

'acupuncturist'. What is important is that one has mastered the style of

acupuncture which one practises, and that this style is of sufficient depth to

merit official validation by being state registered.

BTW, I don't think Dr. Ke was one of Giovanni Maciocia's teachers, but he was

certainly a colleague teacher in a Chinese Herbal Medicine School in the late

80s and early 90s run by Giovanni and Michael McIntyre. I also disagree with you

about the Lord's Report - it is, in my opinion, strongly biased in the direction

of biomedicine and against systems of medicine such as TCM.

Best wishes,

Wainwright

-

" " <attiliodalberto

Sunday, September 07, 2003 11:00 AM

Re: Regulation of acupuncture in the UK - there are competing

proposals