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Funding Electroacupuncture Research through the NHS - A Way Forward?

by David Mayor

Background

In May 2007, Elsevier published a textbook on electroacupuncture (EA) on which I worked as editor and author for nearly eleven years. With the book comes a CD which includes not only a greatly expanded version of the text, but also a fully searchable database compiled from more than 8,000 clinical studies on electroacupuncture and associated modalities (TENS, laser acupuncture, etc). These were originally published between 1959 and 2003 in English, Chinese, Russian, Ukrainian and other mainly Western European languages. Pertinent data were translated and entered by 23 different individuals, including acupuncture practitioners, researchers and students. The resulting innovative database is unique in that study entries include details of the acupoints and treatment parameters used, as well as information on study type, numbers and subgroups of subjects, endpoint measures used, and outcome. As far as possible, material was gathered without bias in respect of acupuncture philosophy, practice and language of publication.

In May 2008, Elsevier launched www.electroacupunctureknowledge.com, an open-access website built around the clinical studies database (although currently only viewable, the web version will soon be searchable as well). This means that the database is now available to all acupuncture practitioners, students and researchers, free of charge.

Benefits

Until now, there has been no single location where the data even from studies published in English can be consulted.

This innovative database,

  • Allows rapid identification of appropriate treatments and so can improve clinical practice, leading to more effective treatment
  • Enables researchers to decide rapidly which studies merit further investigation, and which do not
  • Speeds up literature reviews
  • Prevents duplication of effort
  • Will act as a springboard for further research
  • Increases awareness of diversity and creativity in the world of acupuncture

The project will benefit practising acupuncturists and their patients, acupuncture schools and other institutions, as well as policy makers and health management staff.

The need for funding

To retain its usefulness in this age of instant obsolescence (and as a basis for the next edition of the EA textbook), the database urgently requires updating. This process could also involve broadening its language base to include studies in Korean, Japanese, Vietnamese, Portuguese and Spanish, for example. This will require significant funding.

I started by discussing funding possibilities with various UK government and independent organisations (such as the Big Lottery Fund, King’s Fund, Medical Research Council and Wellcome Trust). None of these felt that my project meets their remit, despite considerable support for it from many prominent acupuncture researchers and practitioners, both in the UK and abroad, and from across the traditional-to-medical acupuncture spectrum. In the end, guided by advice from friends and colleagues in the research field and from government agencies, I decided to apply to the UK National Institute for Health Research (NIHR) for a research grant under the ‘RISC’ programme (Research for Innovation Speculation and Creativity). This provides ‘small’ grants for ‘new speculative and radical health research proposals that could lead to a step change in the care and management of patients’, and is open to researchers based in the NHS in England.

The grant application

The RISC grant application was completed in consultation with a number of experts in different fields. It involved my appointment not only as a Research Associate in the Physiotherapy Department at the University of Hertfordshire, but also as an Acupuncture Researcher for the West Hertfordshire Hospitals NHS Trust (WHHT), a truly convoluted procedure for a non-NHS practitioner! Co-applicants for the project included Mark Bovey (Acupuncture Research Resource Centre, Thames Valley University), Tim Watson (Professor of Physiotherapy, University of Hertfordshire – my academic supervisor), Hugh MacPherson (University of York) and Adam Young (Associate Medical Director, Clinical Governance, WHHT – my NHS supervisor).

The title of the grant application was Change in quality of clinical studies on electroacupuncture and related modalities (1997-2002-2007). Is there now sufficient evidence for their use in NHS practice? Update of an innovative database. The total grant applied for was £98,935 over 18 months.

The main submission deadline was 16:00 hrs on 29 April 2008, and the requisite forms were duly completed and submitted electronically. The NHS ‘Declarations and Signatures’ form was completed and faxed to the NIHR on 6 May, the deadline for this final part of the application.

Whatever happened to the submission?

To cut a long, nail-biting and frustrating saga short, although a NIHR staff member confirmed verbally that everything had arrived ‘on time’, and despite the fact that results of the RISC competition were due to be announced on 14 July, I finally heard only on 25 September that the application had been rejected, simply because ‘the signatures and declarations form arrived late’ (by 1 hr 1 min!).

After all the work put into the application by so many people, this was a really disappointing outcome. While the NIHR was free to change the date when results of this competition were announced by many weeks, without proper notification, a difference of a single hour was sufficient to discount a complete application. It would certainly have been helpful to know this result immediately, when memories of conversations were fresh, not nearly five months later. It is even possible that the problem could have been resolved there and then and the application put forward to the panel for proper adjudication. Appeals from the manager of the WHHT R&D Consortium and myself to the NIHR have been rejected.

Apparently, the NIHR has received several complaints about this particular RISC competition. It is little consolation to be told that procedures will be improved in the next RISC call for applications, or that, of the 38 applications discussed by the panel this time, none were recommended for funding – although seven were invited to address specific deficiencies with a view to possible funding (and so will presumably re-submit for the next RISC competition, with the advantage of this feedback).

What next?

Following this fiasco, we were kindly invited to tender a bid for funding by the German medical society for acupuncture (DÄGfA) – the central European equivalent to the British Medical Acupuncture Society (BMAS). The application has been updated to include studies from 2008, together with a slightly amended systematic review on study quality. The total amount applied for is £204,166 over two years, and we are currently waiting to hear how much of this DÄGfA may be able to provide. However, I understand that there is no way that the total amount sought will be covered. Therefore the RISC application already prepared will be revised and re-submitted (notification of the next RISC competition is expected in May). In addition, I am considering another NIHR bid, to the ‘RfPB’ (Research for Patient Benefit) programme, although the RfPB protocol is even more demanding than RISC's. Alternatively, a patchwork approach to medical research charities and other international professional acupuncture organisations may be needed (the AACP, BAcC and BMAS cannot offer further financial support). Whatever the way forward, it is not going to be easy, particularly in the present economic climate.

Can you help?

If you have any suggestions on potential sources of funding for this venture or would be prepared to collaborate on it in other ways, I would be very interested to hear from you.
David Mayor
MA, BAc, MBAcC, Hon Member AACP
davidmayor@welwynacupuncture.co.uk.

For those interested, details of NIHR funding competitions can be found at: www.nihr-ccf.org.uk/site/callsproposals/default.cfm

Notes

1. Population figure extrapolated from the 2001 census and 2006 ward population estimates provided by Hertfordshire County Council.

Biography

David Mayor is a research supervisor at the London College of Traditional Acupuncture (LCTA, and has recently become a member of the BAcC research team. He has been an acupuncture practitioner since 1982, and has taught electroacupuncture since 1996, lecturing at AACP, BAcC and BMAS events as well as to students on the MSc course at Coventry University and at some of the acupuncture colleges. In addition to editing the Electroacupuncture textbook, CD and associated website, he has edited two further books on acupuncture and written a number of articles on electroacupuncture and other topics. He is currently starting work on a new book for Elsevier, Energy Medicine East and West, which he is editing with Marc Micozzi.

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