Acupuncture out, dogma in: The UK National Institute for Health and Care Excellence guideline for osteoarthritis 2022

Introduction: The recently published National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis (NG226) does not recommend acupuncture. However, high-quality evidence exists that indicates acupuncture is effective for osteoarthritis and not simply a placebo. NICE clinical guidelines, such as NG226, provide recommendations for the National Health Service (NHS) in the U.K. In this opinion article the author examines the rationale and evidence set out in the guideline NG226 and the supporting documentation. Discussion: Two interrelated issues are identified: problems of interpretation and problems of definition. The problems of interpretation have been discussed in relation to previous NICE guidelines, these include: the evidence review erroneously analyses sham acupuncture as inert; the minimal important difference criterion for efficacy trials is not applied consistently; insufficient weight is given to pragmatic comparative effectiveness evidence. The problems of definition have not been discussed to the same degree. The evidence review employs no operational definitions of acupuncture or sham acupuncture. As a result, highly similar procedures are classified as sham in one trial but verum in another. This is illogical and unscientific. Conclusion: The guideline rationale fails to engage with the scientific debate regarding acupuncture research and repeats the mistakes of earlier guidelines. The interpretation of the evidence is erroneous as it is based on the dogma that sham acupuncture is inert. This is compounded by a failure to have clear definitions for acupuncture or sham acupuncture. The committee's interpretation of the acupuncture evidence will have negative consequences for patients in practice and for those enrolled in future clinical trials.