Letters to the Editor

Statement About Risks of Acupuncture Is Misleading


Am Fam Physician. 2003 Nov 1;68(9):1713-1714.

to the editor: I am troubled by the following comment that was made by Dr. Morelli and colleagues: “Although acupuncture has been promoted as a safe therapy, significant infections have occurred, including human immunodeficiency virus and hepatitis, as a result of the use of unsterilized needles.”1 This is a poorly researched comment that inaccurately states the level of risk in acupuncture.

Practitioners of acupuncture in the United States take courses on clean needling technique. Acupuncture needles are gas sterilized to over 300°F and are individually packaged for single use. Both the National Acupuncture Certification Board and state regulatory boards oversee safety issues.

Although there have been a few case reports of human immunodeficiency virus and hepatitis infection, a review2 of nine prospective studies of the safety of acupuncture found no reported cases of disease transmission.2 According to the same reference that Dr. Morelli and colleagues1 cite, the 1997 National Institutes of Health Consensus Statement3 on acupuncture notes that the documented occurrence of adverse events with acupuncture is extremely low.

The comment by the authors1 is made without stating the specific risk level and exaggerates the risk involved in acupuncture. In reality, acupuncture probably helps relieve pain more than the other modalities discussed.


1. Morelli V, Naquin C, Weaver V. Alternative therapies for traditional disease states: osteoarthritis. Am Fam Physician. 2003;67:339–44.

2. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 2001;110:481–5.

3. Berman BM, Swyers JP, Ezzo J. The evidence for acupuncture as a treatment for rheumatologic conditions. Rheum Dis Clin North Am. 2000;26:103–15.

in reply: We agree with Dr. Levy's concerns. As he mentioned, the risks of acupuncture are extremely low. The intention in our article1 was only to point out that there have been case reports of transmission of human immunodeficiency virus (HIV) and hepatitis from acupuncture needles. We decided to mention HIV because of the severity of the disease and to mention hepatitis because acupuncture was cited in the late 1980s to have been the cause of at least two office-source outbreaks.2,3 We chose not to mention the much rarer cases of cardiac tamponade,4 pneumothorax, and endocarditis.5

Again, it is never our intention to present slanted or biased information or to steer patients away from therapies that could be helpful in treating debilitating symptoms. However, acupuncture, like other therapies mentioned in the article, has not been shown to alter the natural course of the disease in any way. And, at the same time, it would be irresponsible not to point out potential risks to patients.


show all references

1. Morelli V, Naquin C, Weaver V. Alternative therapies for traditional disease states: osteoarthritis. Am Fam Physician. 2003;67:339–44....

2. Kent GP, Brondum J, Keenlyside RA, LaFazia LM, Scott HD. A large outbreak of acupuncture-associated hepatitis B. Am J Epidemiol. 1988;127:591–8.

3. Slater PE, Ben-Ishai P, Leventhal A, Zahger D, Bashary A, Moses A, et al. An acupuncture-associated outbreak of hepatitis B in Jerusalem. Eur J Epidemiol. 1988;4:322–5.

4. Kirchgatterer A, Schwarz CD, Holler E, Punzengruber C, Hartl P, Eber B. Cardiac tamponade following acupuncture. Chest. 2000;117:1510–1.

5. Norheim AJ. Adverse effects of acupuncture: a study of the literature for the years 1981–1994. J Altern Complement Med. 1996;2:291–7.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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