Unregulated acupuncture clinics | A disaster waiting to happen

By Sarah Hannan

Over the last decade, the number of acupuncture clinics seems to have mushroomed across the island, and the number of people opting to receive such treatment has turned into a topic of debate as there have been several incidents where following treatment, many have visited general physicians complaining about side effects.

The practice itself was introduced to the country by Dr. Anton Jayasuriya, a medical doctor who introduced the practice to internal doctors at the Kalubowila Hospital, after which he went on to train individuals interested in the practice.

However, these teachings or the persons that completed the training were never registered with the Sri Lanka Medical Council (SLMC) or the Ayurvedic Medical Council.

Colombo South Teaching Hospital (Kalubowila Hospital) Director Dr. Asela Gunawardena said that there was no authorised acupuncture clinic in operation at the hospital at present and that whoever is running the practice, claiming to be affiliated to the hospital, is an imposter and is not a trained acupuncture practitioner.

Meanwhile, Government Registered Homoeopathic Practitioners’ Association Vice President Dr. S. Ramesh noted that the illegally appointed Homoeopathic Interim Committee approved 49 persons (non-academic persons) fraudulently to register people practising modern acupuncture medicine and criminal abortions by manipulating the patients and relevant authorities to earn money through such unregulated medical practices.

“This Homoeopathic Council has not been active for over a decade, with the ministry attempting to appoint fraudulently registered people to the Homoeopathic Council Board. Furthermore, there are Supreme Court and Court of Appeal verdicts that clearly order the cancellation of the illegal appointment of the fraudulent registrations. However, the Ministry of Health and Indigenous Medical Services is yet to implement the court order,” Dr. Ramesh added.

Acupuncture practice unrecognised

The Sunday Morning contacted Ayurveda Union President Dr. Nimal Karunasiri to understand the reason behind the Chinese acupuncture practice not being regulated in Sri Lanka and to find out whether it is not recognised as an alternative medical practice.

“We do not have a medical council for the Chinese acupuncture practitioners in Sri Lanka as well as on an international level, or even in the country of its origin – China – leaving the practice without any regulatory ordinance. Therefore, even the Sri Lanka Medical Council or the Ayurvedic Medical Council of Sri Lanka are not able to recognise them as safe practices and are unable to implement regulations over such clinics,” Dr. Karunasiri explained.

Adding that today, even some of the Ayurveda practitioners use acupuncture in their practice, and there is no way that the medical council can put a stop to it.

“If they are trained to practice acupuncture and the people who come for treatment require them to administer needles, and if the practitioner is willing to provide the treatment, we cannot object to it. It is their basic right as patients, and it is the right of the practitioner to offer all possible treatments to the patients. However, the practice itself is not recognised under the Medical Ordinance, which makes it impossible to define the profession and to recognise it as a regulated practice in Sri Lanka,” Dr. Karunasiri elaborated.

Adverse effects

The World Health Organisation (WHO), in their systematic review of the Chinese literature on acupuncture-related adverse events, stated that several adverse events were identified through a review of case reports from 1980 to 2009, but very few were found in surveys or prospective observational studies.

This suggests that serious acupuncture-related adverse events are rare. Bleeding and pain during needling are reported less often in Chinese literature than in English literature, perhaps because practitioners in China consider such events too trivial to report them.

Infections (primarily hepatitis) after acupuncture are reported frequently in English literature, but relatively rarely in Chinese literature, even though non-disposable acupuncture needles are still used in China. It is possible that in China, acupuncture-related infections are underreported.

Various types of acupuncture-related adverse events have been reported in China. Similar events have been reported by other countries, usually as a result of inappropriate techniques. Acupuncture can be considered inherently safe in the hands of well-trained practitioners. However, there is a need to find effective ways to improve the practice of acupuncture and to monitor and minimise the health risks involved, the WHO review pointed out.

The Sunday Morning contacted SLMC member Dr. Upul Gunasekara to clarify about the acupuncture practice and whether there were any measures to give it recognition as a Sri Lanka Medical Association-approved medical profession.

“The Sri Lanka Medical Council only governs the western medical practices, and acupuncture is known to be a complimentary medical treatment that is used in eastern medical practices. Therefore, it should ideally be regulated by the Ayurvedic Medical Council.”

He added that there are concerns raised by the medical fraternity about such practices and there is an ongoing discourse about regulating all medical practices that will be governed by one umbrella under the Medical Act, which are to branch out as western and eastern indigenous medicine.

Deaths reported after acupuncture

About 90 deaths after acupuncture have been anecdotally documented in medical literature, Journal of The Royal Society of Medicine (JRSM).

The practice has been associated with more deaths than most other “alternative” therapies, except herbal medicine.

In the article “Acupuncture – a treatment to die for?” by Edzard Ernts, published in 2010 in the JRSM, it is noted that the fatalities are usually due to an acupuncture needle penetrating a vital organ, causing pneumothorax cardiac tamponade or major haemorrhage.

Illustrating two instances, Ernts revealed that a 44-year-old Chinese woman with a history of diabetes and hypertension had consulted an unlicensed acupuncturist in a rural setting. When an acupuncture needle penetrated her heart, the patient instantly complained of severe and alarming symptoms. Instead of taking urgent action, the acupuncturist inserted a further needle into her chest wall. The patient then died almost immediately. At autopsy, two punctures of the right ventricle were found.

The second patient was a 26-year-old Chinese woman who consulted an acupuncturist for an unnamed reason. A needle penetrated her lung and the patient died of tension pneumothorax.

The first case exemplifies the importance of adequate training and technique. As with all invasive interventions, complications after acupuncture can occur, but when they do, they must be recognised and promptly treated. Hallmarks of poorly trained alternative therapists, one might argue, are poor technique and a tendency to overestimate the potential of their own interventions. Instead of initiating life-saving measures, the acupuncturist tragically sought to treat his patient’s symptoms with more acupuncture.

The second case report is also typical, but portrays an entirely different respect. It is devoid of detail to the point of being almost meaningless.