Letters

Acupuncture may be associated with serious adverse events

EDITORIn their review of acupuncture, Vickers and Zollman¹ state that systemic infection seems to be uncommon. When it occurs, however, it can be devastating, and the single reported fatality from acupuncture last year was due to streptococcal toxic shock-like syndrome.² A 41 year old man who received acupuncture for shoulder pain collapsed three days later with rapidly spreading erythematous and necrotic change in the skin of the shoulder. Despite immediate extensive debridement and high doses of antibiotics, he died one day later.

Acupuncture is associated with life threatening complications, although these may well be rare. ^{3 4} We recently searched the literature available on Medline, Embase, and the Cochrane Library for all reports of serious adverse events associated with acupuncture which were published during 1998. Eleven case reports were found and are summarised in the table (a complete list of references is available on the BMJ's website).

There were several other cases of infection that ran a severe, prolonged clinical course and required intensive treatment. Accurate diagnosis was often delayed because patients were reluctant to tell their doctors that they had received acupuncture. Angina during electroacupuncture was reported in two patients, an event that has not previously been reported; both cases were confirmed by recurrence of the symptoms on re-exposure.

In addition to these case reports, we found three relevant surveys. A cross sectional survey of seropositivity for hepatitis C in Japan found an increased risk of hepatitis C associated with acupuncture (odds ratio 2.46 in male patients, 1.81 in female patients). A prospective survey of Japanese acupuncture practitioners recorded adverse events during 55 000 treatments. Only 64 adverse events were recorded, the most common being forgotten needles and faintness. A questionnaire survey of 121 consecutive patients given acupuncture in Germany found that 29% reported at least one event during the course of treatment, and adverse events occurred during 9% of treatments, the most common being needle pain (4%).

We conclude that acupuncture continues to be associated with occasional, serious adverse events and fatalities. These events have no geographical limits. Most of these events are due to negligence. Everyone concerned with setting standards, delivering training, and maintaining competence in acupuncture should familiarise themselves with the lessons to be learnt from these untoward events.

E Ernst, director. 
e.ernst{at}ex.ac.uk

A R White, research fellow. 
Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter EX2 4NT