Why does health insurance cover acupuncture, not clinical psychology?

Under the Microscope/Prof William Reville: Acupuncture is an ancient Chinese medical practice used to treat many illnesses and…

Under the Microscope/Prof William Reville: Acupuncture is an ancient Chinese medical practice used to treat many illnesses and to relieve pain in rheumatic conditions and during surgery.

Needles used in acupuncture in China as long as 4,000 years ago have been found. Today, needles are made of steel, but the first needles used were made of stone. Acupuncture involves the insertion and manipulation of needles at 365 main points in the human body. Acupuncture is used in most hospitals in China and is also practised now in a great many countries worldwide. The scientific basis for its effectiveness is unclear.

Traditional Chinese medicine (TCM) believes that a life energy called Qi (pronounced "chee") flows along meridians in the body and each of the 12 major meridians represents a major organ system. Three hundred and sixty five main acupuncture points are located on these 12 meridians. In TCM the body is viewed as a delicate balance of two opposing and inseparable forces called yin and yang. Yin is the cold, slow, passive principle and yang is the hot, excited, active principle. Health is achieved by maintaining the body in a balanced state and disease is caused by an imbalance of yin and yang.

When yin energy and yang energy are out of balance, Qi can become blocked, resulting in illness. Chinese medicine believes that sticking needles into blocked points can restore normal energy flow and stimulate healing and good health.

The main use of acupuncture in China is the relief of pain in surgery (surgical analgesia). Chinese surgeons claim that 30 per cent of patients receive adequate analgesia by acupuncture alone and that analgesia produced by acupuncture is superior to traditional Western drug-induced analgesia because normal body physiology is maintained and the patient is much less vulnerable to shock. US surgeons have confirmed that acupuncture works with some patients, but put the figure at 10 per cent.

Science has been unable to find Qi and remains uncertain as to how acupuncture works. It is suggested that the analgesic effects of acupuncture may result from the release of natural pain inhibiting chemicals in the system such as enkephalins and endorphins. Studies have shown that placing acupuncture needles in certain parts of the brains of dogs caused the level of endorphins to rise in spinal fluid.

The Journal of the American Medical Association published a new study in May 2005 by Klaus Linde and others at the University of Technology in Munich. They studied 362 people who suffered from migraine headache. They were divided into three groups. One group received standard acupuncture treatment. A second group received "sham" acupuncture, ie the needles were inserted at non-acupuncture points. The third group received no acupuncture. The subjects kept headache diaries. The subjects did not know what group they were in and the evaluators did not know whose diary they were reading.

The results were striking. Patients who reported a reduction in headache days by at least 50 per cent were called "responders". The proportion of responders in the acupuncture group was 51 per cent, 53 per cent in the sham-acupuncture group and 15 per cent in the "waiting list group". The conclusion drawn by the authors is that "the effect may be due to non-specific physiological effects of needling, to a powerful placebo effect, or to both".

There have been many studies on the potential usefulness of acupuncture but often clear-cut results have not been forthcoming because of difficulties with study design, size and the use of placebos. However, the consensus seems to be that the treatment gives promising results in a number of areas such as postoperative and chemotherapy vomiting and nausea and in postoperative dental pain. It also provides pain relief for people with osteo-arthritis of the knee. Other conditions often treated with acupuncture include ulcers, high blood pressure, asthma and appendicitis.

Acupuncture is gaining increasing acceptance in Ireland, and UCD now offers a higher diploma to doctors and physiotherapists who wish to use acupuncture as an adjunct to other therapies for sports and soft-tissue injuries.

At present, complementary therapists in Ireland are not regulated by the Government and, in effect, anyone can call themselves an acupuncturist. If you are contemplating undergoing acupuncture you would be well advised to inquire as to the acupuncturist's qualifications, training and experience and to check that they are medically insured for malpractice and public liability. Also check if they belong to a recognised register of practitioners with formal codes of ethics and practice.

Both VHI and Bupa health insurance cover acupuncture treatment. Bupa also covers homeopathy and reflexology. However, neither VHI or Bupa cover clinical or counselling psychological services. Psychiatry is covered, but not psychology. Clinical psychology is a well-established health profession, works on a scientific basis and is of proven effectiveness. How is it that homeopathy, a form of alternative medicine whose basis contradicts scientific principles, and acupuncture whose scientific basis is unknown, can be covered under health insurance while clinical psychology, a mainline science-based discipline of proven effectiveness, is not covered?