As incredible as it sounds, the Department of Veterans Affairs offers acupuncture services in 88% of their 1,920 facilities nationwide, and the top five hospitals in the United States, ranked by US News and World Report all offer acupuncture to their patients.
The World Health Organization (WHO) updated their International Statistical Classification of Diseases and Related Health Problems (ICD) in June 2018 to include traditional Chinese medicine (TCM) diagnoses. The ICD-11 will be implemented on January 1st, 2022. Insurers base reimbursement on ICD codes. Public health organizations use the collected data for allocation of health resources. ICD codes also provide a common language for health professions to share health information globally.
The inclusion of TCM diagnoses is welcome news in 183 countries and regions worldwide, in addition to the WHO having 103 member states that routinely use TCM. Traditional Chinese medicine includes acupuncture, moxibustion and herbal medicine as well as Tai Chi and Qigong, and is being taught worldwide. For example, all 37 medical schools in Germany offer elective courses in acupuncture.1 There are 60 nationally accredited acupuncture and Oriental medicine schools in the United States and more than 38,000 licensed acupuncturists practicing across the U.S. Approximately 10,000 physicians and allied health professionals in the U.S. and 80,000 physicians in Europe practice acupuncture.2 Twelve European Union Member States consider acupuncture a distinct therapeutic system. Scientific interest in the practice of acupuncture is on the rise as well, with more than 28,000 studies at the National Institutes of Health National Library of Medicine “PubMed” database.
Acupuncture has a strong safety record in the United States, with no fatal adverse events reported to the CDC in the past 50 years of practice. Minor adverse events include pain/bleeding at the insertion site, and subcutaneous hematomas (bruising), and less often but more serious, pneumothorax (puncture of the lung pleura).3 Moxibustion, a common technique in TCM has caused localized burns, which have led to malpractice suits. There have been a small number of fatalities reported in other countries. This calls attention to the importance of proper training and following standards of practice to avoid adverse events. Non-credentialed, poorly trained practitioners have caused these deaths, in the majority of cases. Examples include needles that have broken off and migrated into organs, very rare brain stem punctures and other anomalies.4 In a study of 34,000 acupuncture treatments, the authors concluded that, “When compared with medication routinely prescribed in primary care, the results suggest that acupuncture is a relatively safe treatment modality.”5
Herbal Medicine vs. Pharmaceutical Medications
Traditional Chinese herbal medicine has been practiced for millennia and adverse events have been documented in China through their Food and Drug Administration since 1999. There were 230,069 (16.6 per 100,000) reported adverse events due to Chinese herbal medicine in 2017 in China, in contrast to 1,183,212 (85.2 per 100,000) drug adverse events. The United States had 1.3 million (399.1 per 100,000) emergency room visits by adults due to adverse drug events, and an additional 200,000 (61.4) by children under 18 in 2017; the total of which was 1.5 million events (460.5 per 100,000). Based on these figures, an American has an incredible 28 times greater chance of harm due to pharmaceutical drugs than from Chinese herbal medicine. It’s important to understand that Chinese herbal medicine can be purchased over the counter in China without the supervision of a trained TCM practitioner, presumably increasing the possibility of adverse events, while herbal medicine is only offered by a subset of herb-trained acupuncturists in the U.S.
Implications of ICD-11
In 2018, Licensed Acupuncturists received a unique occupational code from the Bureau of Labor Statistics, allowing the profession to be tracked in terms of number, distribution and wages. Diseases and health conditions diagnosed in TCM diagnostic terminology will also be tracked by ICD-11 after 2022. A simple example is anemia, diagnosed by a TCM practitioner as a “Heart Blood deficiency.” The new ICD codes will allow the WHO to track how many patients suffering from anemia visit licensed acupuncturists for treatment.
With the addition of Traditional Medicine codes to ICD-11, acupuncture and herbal medicine are poised to improve outcomes for patients and reduce expenditures of overburdened health management systems globally. As the world reduces infectious disease rates through improved sanitation, water and hygiene, chronic disease management will become the primary challenge to healthcare. When delivered by well trained practitioners, acupuncture and herbal medicine’s high track record of safety and ability to address chronic disease makes it well suited to be included in healthcare systems. This recognition is unprecedented and constitutes a major step toward international recognition and acceptance of traditional Chinese medicine.
Bill Reddy, L.Ac., Dipl.Ac. is a Nationally Board Certified Licensed Acupuncturist (NCCAOM), Director of Integrative Health Policy Consortium and Principal Consultant of Integrative Health Associates, LLC.
Nick Jacobs, FACHE, is a Principal of Sunstone Management Resources.
1. Jocham, A, et al. “Supplementary Material for: Why Do Students Engage in Elective Courses on Acupuncture and Homeopathy at Medical School A Survey.” 2017 Karger Publishers. Dataset.
3. Zhao, L, et al. “Adverse Events Associated with Acupuncture: Three Multicentre Randomized Controlled Trials of 1968 Cases in China.” Trials 12 2011: 87. PMC. Web. 20 Oct. 2018.
4. Xu S, et al. “Adverse events of acupuncture: a systematic review of case reports.” Evid Based Complement Alternat Med. 2013;2013:581203.
5. MacPherson, H, et al. “A Prospective Survey of Adverse Events and Treatment Reactions following 34,000 Consultations with Professional Acupuncturists.” Acupuncture in Medicine 2001;19(2):93-102)