Acupuncture Transmitted Infections Are Underdiagnosed, Experts Call For Infection Control Guidelines

[HuckleB]

http://www.bmj.com/cgi/content/full/340/mar18_1/c1268

"Acupuncture, which is based on the theory that inserting and manipulating fine needles at specific acupuncture points located in a network of meridians will promote the harmonious flow of "Qi," is one of the most widely practised modalities of alternative medicine. Because needles are inserted up to several centimetres beneath the skin, acupuncture may pose risks to patients. One of the most important complications is transmission of pathogenic micro-organisms, from environment to patient or from one patient to another.

In the 1970s and 1980s most infections associated with acupuncture were sporadic cases involving pyogenic bacteria.1 So far, more than 50 cases have been described globally. In most cases, pyogenic bacteria were transmitted from the patient’s skin flora or the environment because of inadequate skin disinfection before acupuncture. In localised infections, meridian specific and acupuncture point specific lesions were typical. About 70% of patients had musculoskeletal or skin infections, usually in the form of abscesses or septic arthritis, corresponding to the site of insertion of the acupuncture needles.1 2 A minority had infective endocarditis, meningitis, endophthalmitis, cervical spondylitis, retroperitoneal abscess, intra-abdominal abscess, or thoracic empyema.3 4

As in other musculoskeletal or skin infections, Staphylococcus aureus was the most common bacterium responsible, accounting for more than half of the reported cases.1 2 Although most patients recovered, 5-10% died of the infections and at least another 10% had serious consequences such as joint destruction, paraplegia, necrotising fasciitis, and multiorgan failure.1 2

Apart from pyogenic bacterial infections, five outbreaks of hepatitis B virus infection associated with acupuncture, which affected more than 80 patients, have been described globally since the 1970s.5 6 In most outbreaks the sources were infected patients, and the virus was transmitted from one patient to another through improperly sterilised or unsterilised reusable acupuncture needles, but in one outbreak an acupuncturist who was positive for hepatitis B surface antigen and hepatitis B e antigen was thought to be the source.5 6

..."

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For additional coverage of this issue...

Growing Number Of Acupuncture-Transmitted Diseases: Experts Call For Infection Control Guidelines
http://www.medicalnewstoday.com/articles/182822.php


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I'm actually a little surprised by this.

[leftofcool]

1. Breaking News: FDA bans acupuncture

Vitimin C next!

[HuckleB]

2. Umm.

:shrug:

[MineralMan]

4. Seems unlikely. They might just issue some guidelines on sterile

procedures, though. That seems to make sense, doesn't it?

If the procedures are causing infections, then something needs to change.

[MineralMan]

3. Interesting. I would suppose that technique and proper use of

new, sterile needles would make a difference. Personally, I've never been tempted to have accupuncture. I've seen no evidence that any thing that might be termed "Qi" exists or has any effect on anything.

[HuckleB]

5. Yeah, "Qi" falls under the realm of lacking plausibility.

For a long time, I'd kept hope that the act itself had some benefit, but research is proving that hope to have been in vain.

As for the infection issue, the acupuncturists I've known use pre-sterilized throw-away needles, and they're actually quite obsessive about keeping a sterile field, which is why this information caught me a bit by surprise.

[MineralMan]

7. Apparently, there are those who do not follow those

procedures. There was a moronic "wellness" practitioner in my town in California who did acupuncture, along with every other sort of "healing" he could take a course in.

Knowing him personally, I cannot imagine that he would be careful about sterility of anything. I suspect there are a lot of people who are doing acupuncture who are similar in their lack of knowledge and laxity of technique.

The whole field of naturopathy and alternative "health" practitioners is full of people who just keep taking short courses somewhere and adding new things to their armamentarium. Lousy regulation and licensing encourages such shoddy practices.

[HuckleB]

8. Indeed.

I think I've avoided those types of practitioners at every turn. The acupuncturists I know, while still believing in Qi, went to a multi-year school, and they're able to talk about health and the body at least on the level of a BS trained RN.

[Sanity Claws]

9. short courses somewhere?

Acupuncturists are licensed by the State. To practice, they must past a licensing exam, not take a short course in something.
I am familiar with acupuncture training at two well-known institutions, Bastyr University and the Pacific College of Oriental Medicine. Both require clinical work under supervision where technique is drilled into the students.

Naturopaths also require much more than just a short course somewhere.

I really would like to know what kind of short courses you are talking about that would enable someone to pass the licensing requirements for acupuncture and naturopathy.

[EvolveOrConvolve]

10. Something like this

http://www.canyoncollege.edu/d~naturopathy.htm

They allow "life credits" - nuf said.

[Sanity Claws]

11. huh?

Where does that say that a person is licensed to practice acupuncture or naturopathy after a few short courses?
Sure, one can take some classes there. But that doesn't mean that one is licensed in anything after a few short courses.
If you are acquainted with someone who is practicing acupuncture or naturopathy without meeting licensing requirements, you should report him to the state licensing board.

[HuckleB]

12. Have you ever been to Wyoming?

[EvolveOrConvolve]

14. No, but it gives people who take a few short courses a "Doctorate"

This is the text from the website:

"Join the exciting health care profession as a naturopathic physician and learn the art of alternative medicine. Holistic medicine has become an ever growing need in today's health care system. You can now earn a Doctorates degree in naturopathic medicine entirely online and in the convenience of your home or office without campus attendance. The Doctor of Naturopathy degree program is designed as a semi self paced, guided and mentored independent study program."

Does that sound like something that is aboveboard?

Much of the "licensing" that takes place is based on some of these bullshit degrees. In my state, this is what the relevant statute says about practicing naturopathy:

Insofar as naturopathy is not taught within the educational requirements for those licensed to practice medicine in Idaho, it cannot come within the all-inclusive field of medicine and surgery, and thus, those practicing naturopathy are not required to hold a license to practice medicine and surgery.

http://www.legislature.idaho.gov/legislation/2005/S1158.html

If you read through the statute, a Naturopathic Formulary Board is setup to regulate the practice in the state. This board is made up of naturopaths, who are free to set whatever guidelines they see fit. And, since the state doesn't have a formalized method for identifying naturopaths, anyone who simply claims to be a naturopath can be considered as such.

Fox, meet hen house.

[Sanity Claws]

20. States vary

Washington state has pretty rigorous requirements. See http://www.doh.wa.gov/hsqa/professions/naturopathy/licensure.htm

Idaho apparently no longer licenses naturopaths, see http://www.spokesman.com/blogs/boise/2009/jan/27/naturopath-repeal-clears-committee/
This means that persons with that label cannot do things that are limited to persons with medical licenses, such as write prescriptions, do surgery, or do injections.

[EvolveOrConvolve]

25. No, but anyone is free to use that label in Idaho

Including acupuncturists.

So, someone could take a short course, print out a certificate and consider themselves an acupuncturist, naturopath, etc. That's the context this sub-thread is addressing.

[Sanity Claws]

26. Labels

It seems that you are selecting one state that does not license or regulate the profession to degrade the entire profession. As I pointed out specifically, some states have rigorous requirements before one may become licensed and perform the duties of an acupuncturist or naturopath. In addition to the Washington state licensing requirement, see http://www.dca.ca.gov/publications/press_releases/2005/0203.shtml regarding California's requirements.

In addition to various states regulating and licensing acupuncturists, there is also national certification available for acupuncturists, see http://www.nccaom.org/ This should provide some assurance of quality and education to those who live in states that do not yet license acupuncturists.

As for those states that do not license the profession, there are still regulations that prohibit people who claim these titles from performing the usual duties of the profession.
For example, states generally regulate who may do injections, write prescriptions, etc. A naturopath who is in a state that does not license the profession would not be able to do such things. So while a person may call himself a naturopath in those states, they would not be able to do all the usual things a naturopath could do and it is a useless label.

A person who lives in a state that licenses naturopaths and acupuncturists should feel safe that he is working with a medical professional with an adequate course of study, not a few short courses, as someone derisively put it.
For those who live in a state that do not license these professions, they can check to see the credentials of the person who is claiming the label. I would also urge people in those states that they push their state to provide licensing requirements.

[MineralMan]

17. State laws on this vary.

See these links:

Acupuncture
http://www.nccaom.org/applicants/State_Contacts/State%20Licensure%20Information%2001-13-2010.htm

Naturopathy
http://www.anma.org/stlaws2.html

[Sanity Claws]

6. They don't reuse needles

The problem appears to be inadequate swabbing of the area where the needle is to inserted.
I always wondered why the acupuncturist swabbed the area; now I know it is to prevent bacteria on the skin from entering the body.

[HuckleB]

13. Who's "they?"

[Sanity Claws]

16. Acupuncturists

The opening post is about acupuncture

[HuckleB]

18. So you think all acupuncturists use throw away needles?

[Sanity Claws]

19. yes, at least the ones in North America

I also think all MDs in North America do.
There may be exceptions in both categories but such doctors and acupuncturists are rare and subject to revocation of license, if they fail to dispose of needles after a single use.

[HuckleB]

21. What makes you think that?

[Sanity Claws]

22. experience

I have had acupuncture in two major cities and all of the acupuncturists used disposable needles. There's no way I'd allow reusable needles to be used on my body.

[HuckleB]

23. So two major cities, two (maybe a few more than two) acupuncturists...

...and you think you can generalize to the whole of North America from that?

:shrug:

[Sanity Claws]

24. Everyone knows that reused needles can spread disease

It is not a secret.
Acupuncturists do take health care seriously.

[xchrom]

15. Recommend