The random thoughts of a sceptical activist

My local NHS Trust and AltMed

Ever anxious to ensure the taxpayer isn’t paying for bogus therapies, I though it was about time I asked my local NHS trust.

I duly sent a Freedom of Information Act request to the North West London Hospitals NHS Trust. I wanted to get a comprehensive understanding of what AltMed therapies they indulged in. Their responses are in italics:

Please provide the following information under the Freedom of Information Act:

1. What therapies you consider to be ‘alternative’ or ‘complementary’ or included under the heading of ‘integrated’.

The Trust offers acupuncture as part of a programme of integrated care for musculoskeletal patients with pain.

2. What the Trust’s policy is on each of the therapies identified at 1.

The Physiotherapy department offers acupuncture as part of a modality to manage patient’s pain contributed by musculoskeletal problems only.

Staff who provide this therapy are trained to practice within the guidelines set by the Acupuncture Association of Chartered Physiotherapists.

3. Copies of any guidance or memorandums the Trust has issued to GPs, staff, patients or others regarding each of the therapies identified at 1.

Staff who provide this therapy are trained to practice within the guidelines set by the Acupuncture Association of Chartered Physiotherapists.

Acupuncture is offered to the patient if indicated and an information leaflet is provided (This is currently under review and is subject to a S22 restriction – information intended for future publication). The patient will be given time to think about the therapy intervention (acupuncture) and or discuss the use of acupuncture with the referring doctor should the patient choose to do so. Should patients choose to practice other alternative therapy then they are free to do so as long as the therapist is aware of the patient’s choice.

Please see the guidance for staff on interface with private/independent practitioners/alternative therapies attached

4. How much the Trust spent in each of the past five years commissioning or otherwise providing or supporting each of the therapies identified at 1.

Cost of training each member of staff is approximately £500 depending on the provider but the provider has to be approved by the Acupuncture Association of Chartered Physiotherapists. Depending on individual PDP, training will be supported. In the last 5 years we have trained 46 physiotherapists to practice acupuncture. The cost of training in the last 5 years has been £23291 having trained to date a total of 59 staff some who have moved on to other employers.

Currently needle cost £956.80 per year and this supply has been ordered to meet the demand. Currently 25 staff trained are able to practice acupuncture.

5. The number of referrals made to practitioners of each of the therapies identified at 1.

The Trust does not receive referrals for acupuncture treatment. The trust receives around 16000 referrals per year for MSK problems.

If acupuncture is indicated and in line with evidence to support use of acupuncture then this will be offered to patients.

6. Details of any internal memos, minutes, reports, etc concerning any of the therapies identified at 1.

The Trust does not hold this information.

7. Details of any discussion or communication with any patient representative organisations about any of the therapies identified at 1

The Trust does not hold this information.

8. Details of any discussion or communication with any group, trade body, regulator or other organisation representing any of the therapies identified at 1.

The Trust does not hold this information.

9. Details of any proposed policy that concerns the commissioning or otherwise providing or supporting each of the therapies identified at 1.

The Trust does not hold this information.

There are a few things there that need chased up, particularly their new information leaflet on acupuncture.

Training

I find it interesting that it costs just £500 to train a physiotherapist in the ancient and mysterious ways of acupuncture. I can just imagine someone who already has a good grounding in human anatomy being told of the Ch’i ‘life force’ surging through never-been-seen meridians and how a needle knows to unblock that flow, rather than hinder it.

Anyway, £500 gets you just one day’s training. Maybe they don’t want to tell the physiotherapists too much about yin and yang. But this is odd, given that the AACP website says:

The Acupuncture Association of Chartered Physiotherapists requires a minimum of 80 hours training for Physiotherapists to become Accredited members; thereafter 10 hours CPD is required for each two years of membership to remain an accredited member.

The British Acupuncture Council says:

Most BAAB [British Acupuncture Accreditation Board] accredited courses award either BSc (Hons) or BA (Hons) degrees involving at least 3,600 hours study. All courses require you to attend university or college for lectures, tutorials, seminars and practical work. They include a considerable amount of home study as well as clinical hours working with patients in a teaching clinic. Full-time study lasts at least three years. Part-time study will take longer.

I have to wonder how it takes three years to get a ‘BSc’ in acupuncture and if all the physiotherapists are being taught is how to insert needles safely — while enhancing the placebo effect, of course — particularly since it’s been shown that it doesn’t seem to matter where the needles are inserted. Or even if toothpicks are used instead of needles.

Yep. A day or so of training sounds about right. But I’ll be asking the Trust for clarification.

The Trust spent £24,000 on that training over five years and a further £1,000 a year on needles. An expensive placebo.

Evidence

As part of their rheumatology service (cached), they say they only offer acupuncture if it:

…is indicated and in line with evidence to support use of acupuncture then this will be offered to patients.

Since the evidence for acupuncture for any condition is neither consistent nor convincing, I’ll be asking them what evidence they are referring to and what the indications are.

Homeopathy

After David Tredinnick‘s utterly ridiculous Early Day Motions in support of homeopathy and Julian Huppert‘s correction of them and the release of the Government’s response to the House of Commons Science and Technology Committee Evidence Check 2: Homeopathy report, I wanted to find out if the Trust would change any of their policies.

I note the Government Response to the Science and Technology Committee report ‘Evidence Check 2: Homeopathy‘ was published earlier today.

I note that it concludes that the Government will leave the decision whether to provide any homeopathic services to Trusts/PCTs/clinicians.

I appreciate you have told me that you do not currently provide any homeopathic services, but can you tell me if this report will change your position?

I got a response:

The Trust would like to confirm the position on alternative and complimentary [sic] therapies. The Trust does not offer any services of this nature other than the acupuncture previously mentioned. If a consultant wished to introduce a service like this it would be subject to developing a business case for consideration by the Executives as with any other service development. In addition the choice of medicines used would go through our normal process of consideration by the Drugs and Therapeutics Committee which has representatives from Primary Care. The medicines are only approved where there is strong evidence of cost effectiveness.

It’s good that they’re currently not wasting valuable resources on homeopathy. It’s wrong, of course, to call homeopathy a ‘medicine’, and I have to wonder what a ‘business case’ for homeopathy would look like, but it’s good that they would consult their Drugs and Therapeutics Committee before deciding if it was cost effective.

It’s clear from the evidence that homeopathy just does not work any better than placebo, so any calculation of cost effectiveness would come out negative.

More questions and answers

Although much of this is good news, there are still some unanswered questions. I’ll update this post when I get those answers.

29 Responses to My local NHS Trust and AltMed

  • Hey! That’s the kind of FOI request that ought to be sent to every NHS Trust in the country.

    I wonder how many there are?

  • I agree with Sceptical Letter Writer – I shall point @MrMMarsh of the MSS/1023 might be interested in seeing your FOI to get pointers for a template to be sent out across the land…

  • @SLW

    :-)

    There are 66 of them in England and Wales and 14 NHS Scotland Health Boards in Scotland.

  • Only 66? Gosh, I could rattle that lot of in a single afternoon!

    Do you fancy updating your FOI request to defend against the half-answers your local PCT used?

  • I have done a 2 day course in “Western Medical acupuncture”

    we did spend about 30 minutes on the historical roots of chinese acupuncture and the rest of the time was spent learning about safety etc.

    if you are interested in the content of the course it is on this chaps website.

    http://www.acupuncturecourse.org.uk/

    it is perfectly possible to learn the basics of the western acupuncture approach in a couple of days. so what the trust is spending seems about right to this quack…

  • As a chiropractor I have done post-graduate training in acupuncture, although we tend to refer to it as “dry needling” to differentiate it from the Traditional Chinese Medicine paradigm.

    The courses I have done have been delivered by medics. They have commented that the benefits of training chiropractors, GPs, osteopaths and physiotherapists in this skill is that they already know the anatomy and physiology. This means that the necessary training is essentially learning the technique of inserting the needles and the relevant points, together with understanding the do’s and don’t’s.

    It is a useful adjunct to the work that we do with its biggest value, in my experience, being its effectiveness in deactivating mysofascial trigger points. “Sceptics” will cry “placebo”, but my experience suggests that there is more to it than that.

    However, even if it were only a placebo effect, it is effective. The cost of training a qualified physio or other healthcare professional is relatively small and do remember that this will have formed part of the physios CPD requirement, which means that if they hadn’t been paying for them to learn this, they would have been paying for some other training anyway.

    To suggest that spending £956.80 on needles in a year represents expensive placebo seems extraordinary. Given a referral rate of 16,000 patients for musculoskeletal problems, that means potentially a cost of less than 6.25 pence per patient. Of course not every patient will have had acupuncture, but all the same, this is actually very inexpensive.

  • It would be interesting to see what the trust spent on other physiotherapy modalities like Ultrasound/indeferential during that period. But as it is not considered alt med bloggers are less intrested in its evidential base and use in musculoskeletal healthcare.

  • Hmm! One also wonders what the cost of responding to this FOI request was? There’s no doubt that it will have been a burden on resources that otherwise could be directed at patient care.

  • Acupuncture has been around for thousands of years and billions of people have experienced the benefits. If that isn’t enough evidence, then nothing will ever satisfy the author. Calling it a placebo only demonstrates the ignorance of the author and discredits his statements. To limit yourself to the results of biased and methodically flawed double blind studies is to limit your understanding that this model is in itself invalid and that it would take eons and infinite funds to prove everything that already is known to be effective through billions of testimonials.

  • As you know little about me, please don’t try to tell me what evidence would or would satisfy me. And it is also irrelevant whether or not you think I am ignorant.

    The history of acupuncture is disputed, but the age of it is irrelevant, as is whether or not you think billions of anecdotes constitute proof.

    If you think any particular study is methodologically flawed and/or biased, please feel free to try to explain why you think so.

  • ‘Dr’ K, that comment just had to be tongue-in-cheek, didn’t it?

  • Dr K -totally agree with your comments.

  • Zeno – Can I ask a question? Supposing you get all these therapies taken off the NHS, what on earth are you going to do to fill in your time?

  • Joe Bloggs

    I don’t suppose you have any details on what Dr K was talking about when he/she mentioned methodological flaws?

  • Joe Bloggs

    What concern is of yours how I might spend my time?

  • Can I ask if you have a job or do you just spend your time making these people’s life miserable?

  • Joe Bloggs

    No. It’s irrelevant.

  • Or the answer may simply be ‘no’ I don’t have a job

  • Joe Bloggs

    As I’ve said, my employment status is irrelevant and none of your business!

  • Zeno – or will you not rest until you have all NHS chiropractors out of a job?

  • Joe Bloggs

    What NHS chiropractors? The NHS does not employ chiros.

  • No, I do know that. I wondered if you actually knew that.

    I am a patient who has had acupuncture and have been helped tremendously and people like you are trying to stop these things being allowed on the NHS. That is my only problem with you. It is nothing personal

  • Joe Bloggs

    Nice try.

    ‘It is nothing personal’ LOL!

  • @ Joe Bloggs

    What do you mean by “these things” exactly? It seems a rather dismissive way to talk about serious health disciplines.

  • I think that you are unable to see anyone else’s side apart from a skeptics belief. There is really no point in explaining how much I have been helped as I am just shot down in flames every time I try.

  • @Joe Bloggs

    In all seriousness, why let one person’s point of view affect you so much? If you have been helped by such treatments, well that is good for you, but Zeno has his argument and this is supported by facts and evidence. You should simply respect the fact that other people do not agree with you and do something that gives you joy. I myself am sceptical of alternative medicine, but I do not tend to go onto the sites of those that do believe and post comments on there – it is reasonably considered to be ‘trolling’ and is never welcomed.

  • “…unable to see anyone else’s side apart from a skeptics belief”

    Skeptics do not rely on ‘belief’, that is the whole point of bothering to gather evidence and support it’s effect on Quackery and nonsense. Belief is unreliable as it can be changed though rarely does in the light of proof, evidence and fact. Evidence is reliable because it stands as being true until new evidence proves otherwise.

    If you are unable to comprehend the difference between reason and nonsense, that would be a good place to start.

  • Late to this debate. However, it worries me greatly that so many physiotherapists (including the Acupuncture Association of Chartered Physiotherapists) dabble in TCM acupuncture.

    Firstly because TCM is animistic/non-scentific. Secondly, even if TCM acupuncture obeyed the fundamental laws of physics, there is no way that physiotherapists are going to learn TCM in 80 hours (or does the BCA course involve 3,520 hours in anatomy?).

    80 hours learning westernised acupuncture (largely based theories related to on neurohormonal and autonomic effects) would at least fall within the sphere of science, albeit these biological mechanism are not supported by a convincing number of clinical trials.

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