A number of questions relating to the provision of complementary and alter-
native medicine were asked in the survey. The response rate was 56%. The
most popular therapy arranged for patients was acupuncture (47% of
respondents). In almost half these cases the service was provided within an
orthodox setting such as the GP’s own surgery. Pain relief and musculo-
skeletal disorders were the most frequently cited conditions treated; other
applications included smoking cessation, stress and morning sickness.
When asked whom they thought should provide acupuncture, the GPs
replied strongly in favour of registered medical practitioners, followed by
physiotherapists and dentists. Less than half the respondents thought that
TCM practitioners should be involved.
Reasons for not offering acupuncture were lack of demand (63%), lack
of knowledge of the services available (63%) and lack of guidelines on how
to assess the competence of practitioners.
The percentage of physicians who practise acupuncture in the UK has
varied widely over the last 20 years, with estimates of 1% in Scotland,^123
from 3%^124 to 21%^125 in England, and from 4%^126 to 5%^127 in the country
as a whole. This compares with the USA (1%)^128 and New Zealand
(Wellington 18%^129 and Auckland 21%^130 ). In Australia the use of acupunc-
ture by doctors has increased greatly since the 1984 introduction of a
Medicare rebate for acupuncture. In 1996, 15.1% of Australian doctors
claimed for acupuncture, with almost one million insurance claims being
made.^131
In the UK the practice of acupuncture is not legally restricted to medically
qualified doctors as it is in many other European countries (e.g. France,
Hungary, Italy, Poland and Portugal), so the market may be partially satis-
fied by professional or non-medically qualified practitioners (NMQPs).
There are more than 5500 acupuncturists in the UK, of whom 3500 are
statutorily registered health professionals.
There are 3000 traditional acupuncturists in British Acupuncture
Council, 5000 physiotherapists, 2500 GPs and about 3000 in other
associations.
Cost-effectiveness studies of acupuncture
Cost-effectiveness studies of acupuncture have been mainly restricted to the
treatment of pain. Wonderling et al. evaluated the cost-effectiveness of
acupuncture in the management of chronic headache.^132 The main outcome
measure was incremental cost per quality-adjusted life-year (QALY) gained.
Total costs during the 1-year period of the study were on average higher for
the acupuncture group £403 (€460, US$663) than for controls £217 (€248,
US$357) because of the acupuncture practitioners’ costs. The mean health
gain from acupuncture during the 1-year trial was 0.021 QALYs, leading to
a base case estimate of £9180 (€10,500, US$15,240) per QALY gained. This
148 | Traditional medicine