Funding of the acupuncture

| February 8, 2010 | 0 Comments | 403 views

The provision of acupuncture treatment has flourished despite lack of widespread knowledge of its efficacy, lack of comprehensive guidelines for either GPs or patients, and without national regulatory and safety standards being in place for the practitioners themselves. One fundamental issue concerns funding, both for research and for service provision. In a primary care-led NHS, 86% of all health problems are managed entirely within primary care (DoH, 1999). The Government's current primary care research and development (R & D) strategy is summarised in R & D in Primary Care National Working Group Report (DoH, 1997), and was accompanied by a ministerial commitment to increase R & D spending on primary care research to £ 50 million by 2002-3. Figures show that only 0.08% of the NHS R & D funds were used in complementary medicine in 1996 (Ernst, 1996). Funding for service provision in the NHS based on evidence-based medicine depends on the availability of evidence of efficacy of the treatment. Large-scale trials are the best way to obtain this data, but are expensive to undertake. Research funds are urgently needed.

Sources of funding could include the NHS, Medical Research Council (MRC), via independent or joint initiatives, the Wellcome Trust, King's Fund, or perhaps The National Lottery. In fact, in February this year, the King's Fund awarded the Foundation for Integrated Medicine a substantial grant of £ 1 million to support their work on regulation. The European Commission's analysis of unconventional medicine (EC, 1998) recommended that those agencies, whether governmental or voluntary, who currently make funds available for research should be encouraged to allow for submissions from those working in unconventional medicine. Equally, CAM practitioners should ensure that their methodologies are in accordance with standards of good quality research. In the last five years the MRC has received six applications for grant support from researchers of CAM therapies, for relaxation techniques, herbal medicine, chiropractic, acupuncture, homoeopathy and hypnosis. All but one (a trial of chiropractic treatment for back pain in primary care) has failed to reach the competitive standard required for funding. Support is given to potential applicants in the form of advice on developing successful applications, which may include guidance from the Clinical Trials Manager on trial design, or in some cases, practical statistical help. The MRC have been involved in meetings with the Foundation for Integrated Medicine and also have a place on the Homoeopathic Trust Research Committee. The MRC and DoH have a joint initiative for research in primary care.

The NHS research and development budget for 2000-2001 will be over £ 448 million. There are no dedicated funds for research into CAM. Two grants have recently been awarded to researchers of acupuncture in the NHS Health Technology Assessment Programme (HTA). Both studies are pragmatic RCTs which also examine cost-effectiveness; one will evaluate the offer of acupuncture to patients

with low back pain assessed as suitable for primary care management (mentioned in chapter 2), the other will evaluate acupuncture delivered by physiotherapists to patients with chronic migraine. The HTA programme aims to identify the most important gaps in the current knowledge that the NHS has about health technologies by soundings from key people and organisations, extracting research recommendations from high quality systematic reviews of research evidence, and using the Horizon Scanning center in the University of Birmingham. Criteria used in assessing research priorities include: what the benefits are from research in terms of reduced uncertainty, how long it might be before any benefits could be realised, and whether the assessment would be likely to offer value for money.
A separate NHS R & D programme, the Service Delivery and Organisation Programme, aims to "produce and promote the use of research evidence about how organisation and delivery of services can be improved to increase the quality of patient care, ensure better strategic outcomes and contribute to improved health "(DoH, May 2000). Such a programme could possibly provide funding for suitable research into the provision of acupuncture in primary care.
Further sources of funding for research include medical charities which spent 0.05% of their total research budget on CAM in 1999 (Ernst, 1999), and institutions which provide funding solely for CAM-the Blackie Foundation Trust, The Homoeopathic Trust, and the Foundation for Integrated Medicine. The 1993 BMA report suggested that many CAM therapists and organisations may not have the resources to develop adequate research infrastructure, and so funding from grant awarding medical research organisations appears essential to enable this  development; as such funding has not been substantive in recent years the prospect of monies dedicated to encouraging and supporting high quality research should be considered. This would ensure funds are directed appropriately and would assist targeting and measurement of funding levels.

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