Two papers challenge exclusion of acupuncture in government guidelines

Even as news in the United States recently highlighted the growing inclusion of acupuncture and other complementary and integrative medicine therapies in guidelines for multiple pain conditions, the exclusion of acupuncture in two British governmental guidelines is challenged in a paper and a commentary that are presently available free on The Journal of Alternative and Complementary Medicine (JACM) website until May 29, 2017.

In "The U.K. NICE 2014 Guidelines for Osteoarthritis of the Knee: Lessons Learned in a Narrative Review Addressing Inadvertent Limitations and Bias," an international team of co-authors led by Netherlands researcher Stephen Birth, PhD challenge the UK's National Institute for Healthcare Excellence (NICE) for holding acupuncture to a higher evidentiary standard than other modalities. The authors also challenge the panel's decision to focus on clinical trials with sham acupuncture, given that the sham methods are known to not be inert, thus diminishing the "effect size" of acupuncture.

In an invited JACM commentary on this guideline and another on low-back pain and sciatica that also excluded acupuncture, United Kingdom acupuncture researcher Hugh MacPherson, PhD, MBAcC also takes the NICE panel to task for also being "compromised by inconsistent application of criteria between interventions for different modalities." The commentary is entitled "NICE for Some Interventions, But Not So NICE for Others: Questionable Guidance on Acupuncture for Osteoarthritis and Low-Back Pain."

"While the authors fall short of accusing the NICE panel of intentional bias, it is dumbfounding and deeply unfortunate in a time of advancing awareness of the public harm from over-reliance on pharmaceuticals in pain treatment that NICE should choose to stack the deck against the significant evidence for acupuncture as another tool," says The Journal of Alternative and Complementary Medicine Editor-in-Chief John Weeks, Seattle, WA.