Could Bioethics Recommend Acupuncture for Public Health Programmes?

Abstract

Acupuncture is intent on not being classified as an alternative medicine and in fact it seems to have had a favourable reception both by the public and the medical profession. Its scientific status remains unclear and will be hard to establish as long as the criteria of evidence-based medicine are required to prove therapeutic effectiveness. The most consistent therapeutic effects have been shown by patients suffering from pain or nausea. Diseases based on structural disorders have disclosed unconvincing results. Bioethics should be expectant in case acupuncture does confirm its place in medical therapeutics, for developing world countries would develop a keen interest in an effective procedure that may be less expensive than pharmacological agents. A five-point programme is suggested in order to eventually substantiate the incorporation of acupuncture in national health policies: (a) select disorders with high probability of successful response; (b) concentrate on diseases that do not have adequate therapies; (c) research using appropriate strategies, preferring crossover, historical or active control group methods instead of placebo controls; (d) standardise the therapeutic technique; (e) professionalise practitioners. Should acupuncture solidly confirm its usefulness, it would be ethically improper to withhold it especially from those patients who have not been helped by current therapies or do not have access to them. Alternative medicines have been gaining momentum in Western cultures for a variety of reasons, including: high medical costs with insufficient insurance coverage; increasing presence of managed medical services; and loss of confidence in practitioners and pharmaceutical companies. Acupuncture is the one alternative therapeutic procedure that has profited most from this shift in patients’ orientation, to the point where there is no agreement as to whether it belongs to the bulk of alternative medicines or is to be classified as a “therapy within a modern health service”.1 It has been plausibly …