Inadequate response to acupuncture and chiropractor OIA

Kevin McCready made this Official Information request to Accident Compensation Corporation

The request was partially successful.

From: Kevin McCready

Dear Accident Compensation Corporation,

Thank you for your response of 10Jul2014 to my OIA request of 16Jun2104 on your continued funding of acupuncture and chiropractic "modalities". Unfortunately your response was inadeqate and incomplete and I ask for this information and further information.

1. Re which acupuncture and Chiropractic "modalities" are funded, you said the information was available on your website under the heading "ACC payment for services". An advanced search on your website for this exact phrase gets 200 hits. Would you be so kind as to provide me with the link to which you refer.

2. I asked who the experts were and you failed to tell me. Will you please provide me with the names and qualifications of your research team which did the 2011 literature review of acupuncture. Please provide me with a copy of their report, any recommendations they made and any material which will help me understand their decision. Were members of your research team unanimous on each recommendation and if not so, please provide dissenting conclusions and reasons.

3. A) Other than for musculoskeletal pain, do you fund acupuncture for treatment of any other conditions? B) Do you limit payments for musculoskeletal pain to chronic neck and chronic shoulder pain? C) Do you fund acupunture for non-chronic pain? If the answers to any of these three questions is yes, please provide the scientific reasons for your decision to continue to do so.

4. You have failed to address my questions in regard to chiropractic. Will you please do so as restated here: upon what scientific evidence do you continue to fund some chiropractic "modalities" and exclude other chiropractic "modalities". What are the names and qualifications of the experts on whom you rely for such decisions. Please provide me with a copy of any report, any recommendations and any material which will help me understand your decision to continue funding chiropractic "modalities". Were your experts assessing chiropractic unanimous on each recommendation and if not so, please provide dissenting conclusions and reasons.

As I offered previously, I am happy to be guided by you to consider modifying this request if necessary.

Yours faithfully,

Kevin McCready

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From: Lisa White
Accident Compensation Corporation


Attachment ack.pdf
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See please see attached a letter regarding your Official Information Act
request of 10 July 2014.

 

Kind regards,

 

 
       
Lisa White,
  Senior Advisor
  Government Services
  Justice Centre - Level 7
PO Box 242 / Wellington 6011 / New Zealand / [1]www.acc.co.nz
 
    ACC cares about the environment – please don’t print this email
unless it is really necessary. Thank you.

 

 

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From: Lisa White
Accident Compensation Corporation


Attachment SCORMFD008014080114290.pdf
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Please find attached a letter regarding an Official Information Act
request from Mr McCready of 10 July 2014.

 

Kind regards,

 

 
       
Lisa White,
  Senior Advisor, Government Services
  Justice Centre - Level 7 PO Box 242 / Wellington 6011
  [1]www.acc.co.nz

  ACC cares about the environment – please don’t print this email
    unless it is really necessary. Thank you.

 

 

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Kevin McCready left an annotation ()

Holding response saying they need another 20 days and saying this is allowed under law, thus taking it to 4 Sept.

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From: Lisa White
Accident Compensation Corporation


Attachment response McCready.pdf
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Attachment ACC1523 Specified treatment providers costs.pdf
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Attachment 2 0 120113AcupunctureFinal extrev Redacted.pdf
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Please find attached the response to your 10 July 2014 Official
Information Act request.

 

Kind regards,

 

 
       
Lisa White,
  Senior Advisor, Government Services
  Justice Centre - Level 7 PO Box 242 / Wellington 6011
  [1]www.acc.co.nz

  ACC cares about the environment – please don’t print this email
    unless it is really necessary. Thank you.

 

 

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information.
If you believe you have received this email in error, please advise us
immediately by
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attachments.
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Kevin McCready left an annotation ()

The ACC response of 25Aug2104 shows it does not adhere to any science whatsoever in spending $24m for acupuncture in the last financial year. In particular it does not adhere to its own Review of the science.

The response says "ACC funds acupuncture for conditions where prescribed by the client's medical profressional. This includes conditions other than musculoskeletal pain, and for non-chronic pain."

So the statement ACC has previously made that it limits payments for certain conditions and to certain "modalities" is shown to be false.

In addition, the thin veneer of science it pretends to consult for acupuncture funding has now been released in redacted form. This internal ACC Review is entitled: "Pragmatic Evidence Based Review - The efficacy of acupuncture in the management of musculoskeletal pain" (Aug2011). I say 'veneer' because the Review does not say why it prefers one study over a Cochrane study which contradicts the internal Review conclusion.

The internal ACC Review makes two major claims (the second of which is backed up by no evidence whatsover):

1. "the effectiveness of acupuncture is most convincing for the treatment of chronic neck and shoulder pain. In terms of other injuries, the evidence is either inconclusive or insufficient."

2. "The state of the evidence on the effectiveness of acupuncture is not dissimilar to other physical therapies such as physiotherapy, chiropractic and osteopathy."

Chronic Neck Pain claim
On the first claim re chronic neck pain the Review claims "There is good evidence that acupuncture is effective for short term pain relief in the treatment of chronic neck pain." Short-term is not defined. The Review relies on the source in their Footnote 23 to make this claim: Fu L, Li, J., Wu, W.,. Randomized controlled trials of acupuncture for neck pain: systematic review and meta-analysis. Journal of Alternative & Complementary Medicine 2009;15(2):133-45.
http://www.ncbi.nlm.nih.gov/pubmed/19216...

The Review notes: "the effectiveness of acupuncture for treating disability and long term pain in the neck remains unproven."

So we have the Review saying acupuncture for short term pain relief works but not long term pain. However the Review does not say why this may not be a placebo effect. Indeed, the Review says, for example in relation to lower back pain, "Studies comparing effective conservative treatments (including simple analgesics, physical therapy, exercise, heat & cold therapy) for (sub) acute and chronic non- specific low back pain (LBP) have been largely inconclusive."

Chronic Shoulder Pain claim
The Review claims "There is good evidence from one pragmatic trial that acupuncture improves pain and mobility in chronic shoulder pain." However the Review then claims "With respect to shoulder pain, the best evidence comes from two RCTs 30 31 . One, a well-conducted pragmatic, multi-centre RCT 30 showed that that acupuncture improved pain and mobility compared to sham acupuncture or conventional therapy for up to three months post-intervention and the other 31 that reported that acupuncture improved pain in a mixed population significantly more than ‘sham’ acupuncture. This is contrasted with the finding
from a Cochrane review 29 of nine RCTs that there is “little evidence to support or refute the
use of acupuncture for shoulder pain although there may be short-term benefit with respect
to pain and function.” [numbers are Footnotes in the Review]

Unfortunately the Review appears to have mixed up its footnote numbers so it is impossible to assess which studies it is referring to. For example footnote 30 is: Santha CC. Acupuncture treatment for bilateral heel pain caused by plantar fascitis. Journal of the Acupuncture Association of Chartered Physiotherapists:67-74.

This is clearly an elementary mistake in the Review.

Footnote 29 which the Review says is a Cochrane Review is: Knight RR. Integration of manual therapy, rehabilitation and acupuncture in the treatment of a 17-year-old male professional football player with chronic medial tibial stress syndrome. Journal of the Acupuncture Association of Chartered
Physiotherapists:81-87.

This is clearly another mistake in the Review.

Other conditions
Despite the ACC admission that it relies on the "medical professional" and not the science to decide on what treatments the ACC funds, its own Review says: "There is no evidence to recommend the use of acupuncture for injury-related knee pain" and "There is no evidence to recommend the use of acupuncture for ankle pain." and "There is a paucity of research for the optimal dosage of acupuncture treatment for
treating shoulder, knee, neck and lower back pain."

The link the OIA response provides in response to my request on which "modalities" of acupuncture or chiropractic it funds is:
http://www.acc.co.nz/for-providers/invoi...
This link provides no information whatsoever about modalities. Instead the page contains another link which to a pdf which provides a scale of hourly rates for various "treatments", including $65.27 for acupuncture the chiropractic etc.

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Further references

J Altern Complement Med. 2010 Sep;16(9):937. doi: 10.1089/acm.2010.0384.
Concern with meta-analysis of acupuncture for neck pain.
Trinh KV, Sy A.
http://www.ncbi.nlm.nih.gov/pubmed/20738...

http://online.liebertpub.com/doi/abs/10....
Li-Min Fu, Ju-Tzu Li, and Wen-Shuo Wu. The Journal of Alternative and Complementary Medicine. February 2009, 15(2): 133-145. doi:10.1089/acm.2008.0135.
Objectives: The objectives of this study were to assess the effectiveness and efficacy of acupuncture in the treatment of neck pain.
Data sources: The following computerized databases were searched from their inception to January 2008: MEDLINE (PubMed), ALT HEALTH WATCH (EBSCO), CINAHL, and Cochrane Central.
Review methods: Systematic review and meta-analysis were conducted on randomized controlled trials of acupuncture for neck pain. Two (2) reviewers independently extracted data concerning study characteristics, methods, and outcomes, as well as performed quality assessment based on the adapted criteria of Jadad.
Results: Fourteen (14) studies were included in this review. Meta-analysis was performed only in the absence of statistically significant heterogeneity among studies that were selected for testing a specific clinical hypothesis. While only a single meta-analysis was done in previous reviews, this review performed nine meta-analyses addressing different clinical issues. Seven out of nine meta-analyses yielded positive results. In particular, the meta-analysis based on the primary outcome of short-term pain reduction found that acupuncture was more effective than the control in the treatment of neck pain, with a pooled standardized mean difference (SMD) of −0.45 (95% confidence interval [CI], −0.69 to −0.22). Moreover, the meta-analysis with a pooled SMD of −0.53 (95% CI, −0.94 to −0.11) showed that acupuncture was significantly more effective than sham acupuncture for pain relief. However, there was limited evidence based on the qualitative analysis of the trial data to support the above conclusions. We provided a detailed analysis on the issue of heterogeneity of the studies involved in meta-analysis and examined the consistencies and inconsistencies among the present review and two other reviews conducted previously.
Conclusions: The quantitative meta-analysis conducted in this review confirmed the short-term effectiveness and efficacy of acupuncture in the treatment of neck pain. Further studies that address the long-term efficacy of acupuncture for neck pain are warranted.

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