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In this issue
  1. David John Carr1,2
  1. 1Institute for Medical and Biomedical Education, St George's University of London, London, UK
  2. 2Royal London Hospital for Integrated Medicine, University College London Hospitals NHS Trust, London, UK
  1. Correspondence to Dr David Carr, Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK; davidcarr{at}doctors.org.uk

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To round off 2015, this December issue of Acupuncture in Medicine first looks at the potential role of acupuncture in the treatment of osteoporosis. Regular readers may have noticed several preclinical articles on this topic over recent years, mainly in animal models of osteoporosis induced by surgical removal of the ovaries. In an editorial, Jenson Mak (University of Sydney) neatly summarises the progress in this field, introduces new research by Wang et al., featured in this issue, and concludes that, although the mechanistic research is encouraging, high-quality trials with clinically relevant endpoints are required to clarify the effect of acupuncture on bone mineral density, and ultimately risk of fractures, in patients.

This issue's editor's choice article is by Zhou et al., who describe the current dispute between physiotherapists and traditional acupuncture (TA) practitioners (physicians and non-physicians) over what may be considered ‘professional ownership’ of acupuncture and related techniques. In particular, ‘dry needling’ (DN) practice has attracted controversy. Whilst readers in the UK may be unaware of the issue, it has been a hot topic in the USA since 1992, when the New York Board of Education ruled that physiotherapists should not be allowed to practice DN. While New York has not changed position and has been joined by several other states (including Washington, Idaho, Kansas, South Dakota and Hawaii), elsewhere >25 individual states have issued statements affirming that DN is indeed within scope of practice for physiotherapists.1

This is strongly contended by the American Association for Medical Acupuncture and National Certification Commission for Acupuncture and Oriental Medicine, which mandates that TA practitioners log a minimum of 1905 hours of study (including 660 clinical hours) as a prerequisite for state licensure.2 DN training is naturally much shorter, but the American Physical Therapy Association (APTA) argue that DN, like Western medical acupuncture in its broader sense, is based on anatomy/physiology (in which physiotherapists are well versed) not traditional ideology. Many TA practitioners argue that acupuncture and DN overlap, citing a 1977 study by Melzack et al. reporting 71% correlation between myofascial trigger points and classical acupuncture points.3 However this assertion has been challenged. As there are >350 classical acupuncture points on the body, it would arguably be difficult to find an anatomical location that is distant from any traditional point. Moreover, Birch showed that 60% of the acupuncture points included in the 1977 study are not classically indicated for pain at all, and most points selected for analgesia in TA practice are distant not local, suggesting more generalised mechanisms of action.4

The counter-argument that physiotherapists are ideally placed to deliver acupuncture/DN is presented in an accompanying editorial by Vivienne Dascanio, immediate past chairman of the Acupuncture Association of Chartered Physiotherapists, which is currently the largest acupuncture organisation in the UK. However, it should be acknowledged that the UK is far from typical in its promotion of acupuncture provision by a range of non-physician allied healthcare professionals and the predominantly non-traditional approach adopted by its practitioners. Indeed, the British Medical Acupuncture Society is relatively unique among European medical acupuncture associations in having embraced non-doctors since a constitutional change in 2002. Zhou et al. are ultimately calling for greater collaboration between TA practitioners and physiotherapists, a potential positive step forward that may be welcomed considering that 2015 has seen lawsuits to try and ban DN by physiotherapists and APTA “antitrust” counter-suits being filed in North Carolina.

Finally, whatever their own personal style of acupuncture, I would like to take this opportunity to wish each and every reader a Merry Christmas and Happy New Year and I look forward to bringing you lots more exciting content in 2016.

References

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Footnotes

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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