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In October 2000, the Federal Committee of Physicians and Health Insurers decided that acupunctural treatment may not be reimbursed by statutory health insurance companies except within the framework of experimental field studies.<ref name="GemeinsamerBundesausschuss" /><ref>{{cite journal |doi=10.1136/aim.2008.000281 |title=Modellvorhaben Akupunktur - a summary of the ART, ARC and GERAC trials |year=2009 |last1=Cummings |first1=M. |journal=Acupuncture in Medicine |volume=27 |pages=26–30 |pmid=19369191 |issue=1}}</ref><ref name="da1">{{cite journal |last1=Endres |first1=Heinz G. |last2=Diener |first2=Hans-Christoph |last3=Maier |first3=Christoph |last4=Böwing |first4=Gabriele |last5=Trampisch |first5=Hans-Joachim |last6=Zenz |first6=Michael |displayauthors= 4 |title=Akupunktur bei chronischen Kopfschmerzen |trans_title=Acupuncture for chronic headache |journal=] |year=2007 |volume=104 |issue=3 |pages=A-114, B-105, C-101 |url=http://www.aerzteblatt.de/archiv/54176/ |language=de}}</ref> In 2001 the GERAC were set up at ]<ref name="GemeinsamerBundesausschuss" /> as a field study on behalf of six ].<ref name="spiegelacupuncture"/><ref name="da1"/> In October 2000, the Federal Committee of Physicians and Health Insurers decided that acupunctural treatment may not be reimbursed by statutory health insurance companies except within the framework of experimental field studies.<ref name="GemeinsamerBundesausschuss" /><ref>{{cite journal |doi=10.1136/aim.2008.000281 |title=Modellvorhaben Akupunktur - a summary of the ART, ARC and GERAC trials |year=2009 |last1=Cummings |first1=M. |journal=Acupuncture in Medicine |volume=27 |pages=26–30 |pmid=19369191 |issue=1}}</ref><ref name="da1">{{cite journal |last1=Endres |first1=Heinz G. |last2=Diener |first2=Hans-Christoph |last3=Maier |first3=Christoph |last4=Böwing |first4=Gabriele |last5=Trampisch |first5=Hans-Joachim |last6=Zenz |first6=Michael |displayauthors= 4 |title=Akupunktur bei chronischen Kopfschmerzen |trans_title=Acupuncture for chronic headache |journal=] |year=2007 |volume=104 |issue=3 |pages=A-114, B-105, C-101 |url=http://www.aerzteblatt.de/archiv/54176/ |language=de}}</ref> In 2001 the GERAC were set up at ]<ref name="GemeinsamerBundesausschuss" /> as a field study on behalf of six ].<ref name="spiegelacupuncture"/><ref name="da1"/>


== Overview == ==Trial set-up==
⚫ ]]]


Beginning in 2001, the trials were carried out by ], the ], the ] and the ].
⚫ The RCTs were designed as three-armed trials, with the three parallel groups in each trial receiving either verum (real) acupuncture treatment, sham acupuncture treatment, or guideline-based conventional treatment.<ref name="spiegelacupuncture">{{cite web|last=Veronika Hackenbroch|title=Die eingebildete Heilung|url=http://www.spiegel.de/spiegel/print/d-32565481.html|publisher='']''|language=de|date=2004-10-25|quote=Zu diesem Zweck wurden die Kranken nach dem Zufallsprinzip drei Gruppen zugeteilt: Die Schmerzpatienten der ersten Gruppe wurden nach einem chinesischen Originalverfahren gestochen, auf das sich Akupunkteure bundesweit geeinigt hatten; die Patienten der Kontrollgruppe hingegen erhielten - ohne davon zu wissen - nur die Scheinakupunktur. Eine weitere Kontrollgruppe wiederum bestand aus Patienten, die nach der schulmedizinischen Standardtherapie behandelt wurden.}}</ref> The number of patients randomized was one of the largest ever for acupuncture trials.<ref name="spiegelacupuncture"/><ref name="da1"/> The trials were conducted using sham acupuncture.<ref name="da1"/>


⚫ There were separate trials for four indications: ],<ref name="shenker">{{cite journal |title= Demystifying acupuncture |year= 2008 |last1= Pyne|first1=D. |last2= Shenker |first2= N. G. |journal= Rheumatology |volume= 47 |issue= 8 |pages= 1132–6 |pmid= 18460551 |doi= 10.1093/rheumatology/ken161|url=http://rheumatology.oxfordjournals.org/content/47/8/1132.full}}</ref><ref name="GemeinsamerBundesausschuss" /> ],<ref name="GemeinsamerBundesausschuss" /><ref name="Scharf et al. 2006">{{cite journal |doi= 10.7326/0003-4819-145-1-200607040-00005 |last1= Scharf |first1= Hanns-Peter |last2= Mansmann |first2= Ulrich |last3= Streitberger |first3= Konrad |last4= Witte |first4= Steffen |last5= Krämer |first5= Jürgen |last6= Maier |first6= Christoph |last7= Trampisch |first7= Hans-Joachim |last8= Victor |first8= Norbert |displayauthors= 4 |title= Acupuncture and knee osteoarthritis: A three-armed randomized trial |journal= Annals of Internal Medicine |volume= 145 |issue= 1 |pages= 12–20 |year= 2006 |pmid= 16818924}}</ref> ] prophylaxis,<ref name="GemeinsamerBundesausschuss" /> and ].<ref name="GemeinsamerBundesausschuss">{{cite book |url=http://www.g-ba.de/downloads/40-268-487/2007-09-27-Abschluss-Akupunktur.pdf |title=Zusammenfassender Bericht des Unterausschusses 'Ärztliche Behandlung' des Gemeinsamen Bundesausschusses über die Bewertung gemäß §135 Abs.1 SGB V der Körperakupunktur mit Nadeln ohne elektrische Stimulation bei chronischen Kopfschmerzen, chronischen LWS-Schmerzen, chronischen Schmerzen bei Osteoarthritis |trans_title=Summary report of the subcommittee 'Medical treatment' of the Federal Joint Committee on the assessment pursuant to § 135 SGB V, Section 1 of the body acupuncture with needles without electrical stimulation for chronic headache, chronic lumbar pain, chronic pain associated with osteoarthritis |author=Gemeinsamer Bundesausschuss |date=2007-09-27 |accessdate=2013-11-30 |language=de|pages=1–527}}</ref> Apart from that, an observational study on ] of acupuncture was started.
⚫ ]]]


⚫ All RCTs were designed as three-armed trials, with the three parallel groups in each trial receiving either verum (real) acupuncture treatment, sham acupuncture treatment, or guideline-based conventional treatment.<ref>{{cite news|url=http://www.nbcnews.com/id/20959624/#.UtH849qS35o |publisher=NBC News |title=Acupuncture - real or fake - best for back pain|date=24 September 2007|accessdate=12 January 2014}}</ref><ref name="spiegelacupuncture">{{cite web|last=Veronika Hackenbroch|title=Die eingebildete Heilung|url=http://www.spiegel.de/spiegel/print/d-32565481.html|publisher='']''|language=de|date=2004-10-25|quote=Zu diesem Zweck wurden die Kranken nach dem Zufallsprinzip drei Gruppen zugeteilt: Die Schmerzpatienten der ersten Gruppe wurden nach einem chinesischen Originalverfahren gestochen, auf das sich Akupunkteure bundesweit geeinigt hatten; die Patienten der Kontrollgruppe hingegen erhielten - ohne davon zu wissen - nur die Scheinakupunktur. Eine weitere Kontrollgruppe wiederum bestand aus Patienten, die nach der schulmedizinischen Standardtherapie behandelt wurden.}}</ref> The involved acupuncturists were all medical doctors with a both a formal qualification and at least two years experience in acupuncture.<ref>{{cite web|url=http://www.healthcentre.org.uk/acupuncture/what-is-gerac.html |title=What is GERAC? |publisher=UK HealthCentre |accessdate=12 January 2014}}</ref>
⚫ Beginning in 2001, the trials were carried out by ], the ], the ] and the ] for ],<ref name="shenker">{{cite journal |title= Demystifying acupuncture |year= 2008 |last1= Pyne|first1=D. |last2= Shenker |first2= N. G. |journal= Rheumatology |volume= 47 |issue= 8 |pages= 1132–6 |pmid= 18460551 |doi= 10.1093/rheumatology/ken161|url=http://rheumatology.oxfordjournals.org/content/47/8/1132.full}}</ref><ref name="GemeinsamerBundesausschuss" /> ],<ref name="GemeinsamerBundesausschuss" /><ref name="Scharf et al. 2006">{{cite journal |doi= 10.7326/0003-4819-145-1-200607040-00005 |last1= Scharf |first1= Hanns-Peter |last2= Mansmann |first2= Ulrich |last3= Streitberger |first3= Konrad |last4= Witte |first4= Steffen |last5= Krämer |first5= Jürgen |last6= Maier |first6= Christoph |last7= Trampisch |first7= Hans-Joachim |last8= Victor |first8= Norbert |displayauthors= 4 |title= Acupuncture and knee osteoarthritis: A three-armed randomized trial |journal= Annals of Internal Medicine |volume= 145 |issue= 1 |pages= 12–20 |year= 2006 |pmid= 16818924}}</ref> ] prophylaxis,<ref name="GemeinsamerBundesausschuss" /> and ].<ref name="GemeinsamerBundesausschuss">{{cite book |url=http://www.g-ba.de/downloads/40-268-487/2007-09-27-Abschluss-Akupunktur.pdf |title=Zusammenfassender Bericht des Unterausschusses 'Ärztliche Behandlung' des Gemeinsamen Bundesausschusses über die Bewertung gemäß §135 Abs.1 SGB V der Körperakupunktur mit Nadeln ohne elektrische Stimulation bei chronischen Kopfschmerzen, chronischen LWS-Schmerzen, chronischen Schmerzen bei Osteoarthritis |trans_title=Summary report of the subcommittee 'Medical treatment' of the Federal Joint Committee on the assessment pursuant to § 135 SGB V, Section 1 of the body acupuncture with needles without electrical stimulation for chronic headache, chronic lumbar pain, chronic pain associated with osteoarthritis |author=Gemeinsamer Bundesausschuss |date=2007-09-27 |accessdate=2013-11-30 |language=de|pages=1–527}}</ref> In the observational study, 12,617 physicians reported on ] during or after acupuncture therapies they performed between 2001 and 2005,<ref name="da1"/> resulting in data on roughly 2.6 million patients, out of which a random sample of 190,924 was reviewed in terms of frequency of adverse events and serious adverse events.<ref name="da1"/>


Conventional treatment included pain killers, injections, and ].<ref>{{cite news|url=http://www.nbcnews.com/id/20959624/#.UtH849qS35o |publisher=NBC News |title=Acupuncture - real or fake - best for back pain|date=24 September 2007|accessdate=12 January 2014}}</ref>

In the real acupuncture group, a semi-standardized acupuncture approach was used, i.e. part of the acupuncture points were predetermined and part of them could be freely selected by the acupuncturist.<ref>{{cite book|title=Thieme Almanac 2007: Acupuncture and Chinese Medicine |publisher=Georg Thieme |url=http://books.google.de/books?id=-3iWiK-uIXEC&pg=PA30&lpg=PA30&dq=GERAC+standard+therapie&source=bl&ots=D9yh-bF1pN&sig=pr-4nmc4O18YyCuwSJxpzdMq9io&hl=zh-CN&sa=X&ei=nwDSUoKlAubyiAeXt4Bg&ved=0CGEQ6AEwBw#v=onepage&q=GERAC%20standard%20therapie&f=false |year=2007 |page=30}}</ref> In regards of the technique, deep needling with stimulation and activation of ] sensation was stipulated.<ref>{{cite journal |url=http://www.paradigm-pubs.com/sites/www.paradigm-pubs.com/files/files/Birch-german-studies.pdf |journal=Journal of Chinese Medicine |title=Reflections on the German Acupuncture studies |author=Birch, S. |issue=83 |year=2007 |pages=12-17 }}</ref>

In the sham control group, random points instead of acupuncture points were chosen. Needles were only superficially inserted and there was no subsequent stimulation or de-qi activation.<ref>{{cite book|title=Thieme Almanac 2007: Acupuncture and Chinese Medicine |publisher=Georg Thieme |url=http://books.google.de/books?id=-3iWiK-uIXEC&pg=PA30&lpg=PA30&dq=GERAC+standard+therapie&source=bl&ots=D9yh-bF1pN&sig=pr-4nmc4O18YyCuwSJxpzdMq9io&hl=zh-CN&sa=X&ei=nwDSUoKlAubyiAeXt4Bg&ved=0CGEQ6AEwBw#v=onepage&q=GERAC%20standard%20therapie&f=false |year=2007 |page=30}}</ref><ref>{{cite journal |url=http://www.paradigm-pubs.com/sites/www.paradigm-pubs.com/files/files/Birch-german-studies.pdf |journal=Journal of Chinese Medicine |title=Reflections on the German Acupuncture studies |author=Birch, S. |issue=83 |year=2007 |pages=12-17 }}</ref>
The number of patients randomized was one of the largest ever for acupuncture trials.<ref name="spiegelacupuncture"/><ref name="da1"/> For each indication, around 1000 test subjects were included.<ref>{{cite book|title=Thieme Almanac 2007: Acupuncture and Chinese Medicine |publisher=Georg Thieme |url=http://books.google.de/books?id=-3iWiK-uIXEC&pg=PA30&lpg=PA30&dq=GERAC+standard+therapie&source=bl&ots=D9yh-bF1pN&sig=pr-4nmc4O18YyCuwSJxpzdMq9io&hl=zh-CN&sa=X&ei=nwDSUoKlAubyiAeXt4Bg&ved=0CGEQ6AEwBw#v=onepage&q=GERAC%20standard%20therapie&f=false |year=2007 |page=30}}</ref><ref>{{cite journal|url=http://www.gwup.org/infos/themen-nach-gebiet/769-die-gerac-akupunkturstudien?catid=77%3Akomplementaer-und-alternativmedizin-cam |title=Die Gerac-Akupunkturstudien |author=Hessel, W. |journal=Skeptiker |issue=1 |year=2005}}</ref>

In the observational study, 12,617 physicians reported on ] during or after acupuncture therapies they performed between 2001 and 2005,<ref name="da1"/> resulting in data on roughly 2.6 million patients, out of which a random sample of 190,924 was reviewed in terms of frequency of adverse events and serious adverse events.<ref name="da1"/>

== Overview ==
In September 2007, ] commented on the news surrounding the study and said that "this trial seems to support the role of acupuncture as an effective alternative therapy for chronic lower back pain" but that "it will be important to try to tease apart the real treatment effects from those that occur through the placebo effect".<ref name="nhsa">{{cite web |title= Acupuncture may ease back pain |url= http://www.nhs.uk/news/2007/September/Pages/Acupuncturemaybeeffectiveforbackpain.aspx |publisher= ] |date= 2007-09-26 |accessdate= November 2013}}</ref> {{asof|2012}} The guidance within the UK ] is that "there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used", and its use is only supported for lower back pain.<ref name=nice>{{cite web |url= http://www.nhs.uk/Conditions/Acupuncture/Pages/Introduction.aspx?url=Pages%2fWhat-is-it.aspx |title= Acupuncture |publisher= NHS Choices |date= 2012-05-22 |accessdate= November 2013}}</ref> In September 2007, ] commented on the news surrounding the study and said that "this trial seems to support the role of acupuncture as an effective alternative therapy for chronic lower back pain" but that "it will be important to try to tease apart the real treatment effects from those that occur through the placebo effect".<ref name="nhsa">{{cite web |title= Acupuncture may ease back pain |url= http://www.nhs.uk/news/2007/September/Pages/Acupuncturemaybeeffectiveforbackpain.aspx |publisher= ] |date= 2007-09-26 |accessdate= November 2013}}</ref> {{asof|2012}} The guidance within the UK ] is that "there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used", and its use is only supported for lower back pain.<ref name=nice>{{cite web |url= http://www.nhs.uk/Conditions/Acupuncture/Pages/Introduction.aspx?url=Pages%2fWhat-is-it.aspx |title= Acupuncture |publisher= NHS Choices |date= 2012-05-22 |accessdate= November 2013}}</ref>


Revision as of 02:23, 14 January 2014

Needles being inserted into a patient's forearm.

The German acupuncture trials (Template:Lang-de) were a series of nationwide acupuncture trials set up in 2001 and published in 2006 on behalf of several German statutory health insurance companies. They consisted of one observational study on acupuncture side effects, and four randomized controlled trials (RCTs) investigating acupuncture treatment for low back pain, knee osteoarthritis, migraine prophylaxis, and tension-type headache. The trials are considered to be one of the largest clinical studies in the field of acupuncture.

No significant differences between acupuncture and sham acupuncture were found in any trial. A 2011 assessment of the trials judged that since the sham acupuncture was not a well-designed placebo, they were unlikely to have emitted clinically significant findings.

As a result of the GERAC trials, the German Federal Joint Committee ruled in April 2006 that the costs of acupunctural treatment for chronic back pain and knee osteoarthritis would be covered by public health insurers in Germany. Because of the trial's conclusions, some insurance corporations in Germany no longer reimbursed acupuncture.

According to Schweizer Fernsehen, the total cost of the trials amounted to 7.5 million Euros. Several years after the Committee's decision to incorporate acupunctural treatment into the healthcare of Germany was passed into law, the number of regular users of acupuncture in the country surpassed one million.

History

In the late 1990s, German healthcare regulators began to voice their doubts over the therapeutical usage of acupuncture, mostly due to the lack of reliable evidence regarding its therapeutic efficacy. This resulted in a heated debate, which led to Paul Rheinberger, Director of the Federal Committee of Physicians and Health Insurers, saying: "The higher the quality of clinical studies performed on acupuncture, the lesser the amount of evidence supporting its efficacy."

In October 2000, the Federal Committee of Physicians and Health Insurers decided that acupunctural treatment may not be reimbursed by statutory health insurance companies except within the framework of experimental field studies. In 2001 the GERAC were set up at Bochum University as a field study on behalf of six German statutory health insurance organizations.

Trial set-up

The Ruhr University Bochum

Beginning in 2001, the trials were carried out by Heidelberg University, the University of Marburg, the University of Mainz and the Ruhr University Bochum.

There were separate trials for four indications: low back pain, knee osteoarthritis, migraine prophylaxis, and tension-type headache. Apart from that, an observational study on adverse events of acupuncture was started.

All RCTs were designed as three-armed trials, with the three parallel groups in each trial receiving either verum (real) acupuncture treatment, sham acupuncture treatment, or guideline-based conventional treatment. The involved acupuncturists were all medical doctors with a both a formal qualification and at least two years experience in acupuncture.

Conventional treatment included pain killers, injections, and physical therapy.

In the real acupuncture group, a semi-standardized acupuncture approach was used, i.e. part of the acupuncture points were predetermined and part of them could be freely selected by the acupuncturist. In regards of the technique, deep needling with stimulation and activation of de-qi sensation was stipulated.

In the sham control group, random points instead of acupuncture points were chosen. Needles were only superficially inserted and there was no subsequent stimulation or de-qi activation.

The number of patients randomized was one of the largest ever for acupuncture trials. For each indication, around 1000 test subjects were included.

In the observational study, 12,617 physicians reported on adverse events during or after acupuncture therapies they performed between 2001 and 2005, resulting in data on roughly 2.6 million patients, out of which a random sample of 190,924 was reviewed in terms of frequency of adverse events and serious adverse events.

Overview

In September 2007, NHS Choices commented on the news surrounding the study and said that "this trial seems to support the role of acupuncture as an effective alternative therapy for chronic lower back pain" but that "it will be important to try to tease apart the real treatment effects from those that occur through the placebo effect". As of 2012 The guidance within the UK National Health Service is that "there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used", and its use is only supported for lower back pain.

No significant differences between acupuncture and sham acupuncture were found in any trial. A 2013 Chinese review stated that the results of controlled clinical trials of sham acupuncture in Germany had an adverse impact on acupuncture in the international community. The same review found there was "not enough evidence to support the statements that 'acupuncture and sham acupuncture have no difference in treatment effect' and 'acupuncture is just a placebo effect'". The review said that the "sham acupuncture used in Germany may not be standardized and may not be suitable for acupuncture clinical trial research". In 2005, the Deutsche Medizinische Wochenschrift (German Medical Weekly) published an article which criticized the trials for "not meeting scientific criteria". In 2006, Edzard Ernst, a professor of complementary medicine at the University of Exeter, noted that the studies had attracted criticism for not taking into account the risk of patient de-blinding, and that they " to conclusively answer the question whether acupuncture helps patients through a specific or a nonspecific effect".

Domestic consequences

As a result of the GERAC trials, the German Federal Joint Committee (Gemeinsamer Bundesausschuss) recognized acupunctural treatment as a therepautical option to be reimbursed by public health insurance in Germany, specifically for the treatment of low back pain and knee pain. On April 18, 2006, the Committee explained their decision was based on the acceptance of the results of the trials as the deciding factor. During the 16th legislative session of the Bundestag in July 2006, the German federal government announced that it would not object to the committee's decision. On July 3, 2006, The German Health Minister Ulla Schmidt confirmed the inclusion of acupunctural treatment for specific conditions as part of healthcare in Germany. Since no difference in efficacy of verum and sham acupuncture was found in the trials, some insurance corporations in Germany chose to stop reimbursement of acupuncture.

After the committee's decision to incorporate acupuncture into the healthcare of Germany was passed into law, health insurers reported that the number of users of acupuncture in the country increased, finding favour especially among women; in 2012 there were around one million estimated users.

Reception

The trials resulted in increased coverage of acupuncture in the German media. According to the news broadcaster Deutschlandfunk, the GERAC trials were considered to be the world's largest set of clinical studies on acupuncture. An article in Die Welt said that the results of the studies were "promising". Der Spiegel said that the results of GERAC couldn't be brushed aside by the Federal Joint Committee.

ABC News reported that the study "highlights the superiority of acupuncture", but also introduces uncertainty about the specific mechanisms of treatment. Heinz Endres, one of the authors of the study, told the Canadian Broadcasting Corporation that "acupuncture has not yet been recommended as a routine therapy", but "we think this will change with our study". The BBC stated that the study "echoes the findings of two studies published last year in the British Medical Journal, which found a short course of acupuncture could benefit patients with low back pain". Nigel Hawkes, health editor of The Times, wrote that the trials "suggest that both acupuncture and sham acupuncture act as powerful versions of the placebo effect."

See also

References

  1. ^ Hackenbroch, Veronika (2004-10-25). "Die eingebildete Heilung". Der Spiegel (in German). {{cite news}}: Unknown parameter |trans_title= ignored (|trans-title= suggested) (help) Cite error: The named reference "spiegelacupuncture" was defined multiple times with different content (see the help page).
  2. ^ Howick, Jeremy H. (2011). The Philosophy of Evidence-based Medicine. John Wiley & Sons. pp. 92–4. ISBN 9781444342666.
  3. ^ He, W.; Tong, Y.; Zhao, Y.; Zhang, L.; Ben, H.; Qin, Q.; Huang, F.; Rong, P. (2013). "Review of controlled clinical trials on acupuncture versus sham acupuncture in Germany". Journal of traditional Chinese medicine. 33 (3): 403–7. PMID 24024341. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help)
  4. ^ Hertzer, Karin (2009-08-12). "Akupunktur ist wirksam". Focus (in German). {{cite news}}: Unknown parameter |trans_title= ignored (|trans-title= suggested) (help)
  5. "Akupunktur". Schweizer Fernsehen. 2003-03-10. {{cite web}}: Unknown parameter |trans_title= ignored (|trans-title= suggested) (help)
  6. ^ "Frauen häufiger mit Akupunktur behandelt". Rheinische Post (in German). 2012-08-30. Retrieved 2013-05-23. {{cite news}}: Unknown parameter |trans_title= ignored (|trans-title= suggested) (help)
  7. Singh, Simon; Ernst, Edzard (2008). Trick Or Treatment: The Undeniable Facts about Alternative Medicine (1st American ed.). New York: W.W. Norton. pp. 81–2. ISBN 9780393066616.
  8. Korzilius, Heike (2000). "Bundesausschuss: Streit um Akupunktur" (PDF). Deutsches Ärzteblatt (in German). 97 (30): A-2013–4. Retrieved 2013-11-26.
  9. Suess, Jochen; Scharl, Anton (2004). "Lässt sich die Wirksamkeit der Akupunktur naturwissenschaftlich erklären?". Die Hebamme. 17 (4): 214–7. doi:10.1055/s-2004-860883.
  10. ^ Gemeinsamer Bundesausschuss (2007-09-27). Zusammenfassender Bericht des Unterausschusses 'Ärztliche Behandlung' des Gemeinsamen Bundesausschusses über die Bewertung gemäß §135 Abs.1 SGB V der Körperakupunktur mit Nadeln ohne elektrische Stimulation bei chronischen Kopfschmerzen, chronischen LWS-Schmerzen, chronischen Schmerzen bei Osteoarthritis (PDF) (in German). pp. 1–527. Retrieved 2013-11-30. {{cite book}}: Unknown parameter |trans_title= ignored (|trans-title= suggested) (help)
  11. Cummings, M. (2009). "Modellvorhaben Akupunktur - a summary of the ART, ARC and GERAC trials". Acupuncture in Medicine. 27 (1): 26–30. doi:10.1136/aim.2008.000281. PMID 19369191.
  12. ^ Endres, Heinz G.; Diener, Hans-Christoph; Maier, Christoph; Böwing, Gabriele; Trampisch, Hans-Joachim; Zenz, Michael (2007). "Akupunktur bei chronischen Kopfschmerzen". Deutsches Ärzteblatt (in German). 104 (3): A-114, B-105, C-101. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help); Unknown parameter |trans_title= ignored (|trans-title= suggested) (help)
  13. Pyne, D.; Shenker, N. G. (2008). "Demystifying acupuncture". Rheumatology. 47 (8): 1132–6. doi:10.1093/rheumatology/ken161. PMID 18460551.
  14. Scharf, Hanns-Peter; Mansmann, Ulrich; Streitberger, Konrad; Witte, Steffen; Krämer, Jürgen; Maier, Christoph; Trampisch, Hans-Joachim; Victor, Norbert (2006). "Acupuncture and knee osteoarthritis: A three-armed randomized trial". Annals of Internal Medicine. 145 (1): 12–20. doi:10.7326/0003-4819-145-1-200607040-00005. PMID 16818924. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help)
  15. "Acupuncture - real or fake - best for back pain". NBC News. 24 September 2007. Retrieved 12 January 2014.
  16. "What is GERAC?". UK HealthCentre. Retrieved 12 January 2014.
  17. "Acupuncture - real or fake - best for back pain". NBC News. 24 September 2007. Retrieved 12 January 2014.
  18. Thieme Almanac 2007: Acupuncture and Chinese Medicine. Georg Thieme. 2007. p. 30.
  19. Birch, S. (2007). "Reflections on the German Acupuncture studies" (PDF). Journal of Chinese Medicine (83): 12–17.
  20. Thieme Almanac 2007: Acupuncture and Chinese Medicine. Georg Thieme. 2007. p. 30.
  21. Birch, S. (2007). "Reflections on the German Acupuncture studies" (PDF). Journal of Chinese Medicine (83): 12–17.
  22. Thieme Almanac 2007: Acupuncture and Chinese Medicine. Georg Thieme. 2007. p. 30.
  23. Hessel, W. (2005). "Die Gerac-Akupunkturstudien". Skeptiker (1).
  24. "Acupuncture may ease back pain". NHS Choices. 2007-09-26. Retrieved November 2013. {{cite web}}: Check date values in: |accessdate= (help)
  25. "Acupuncture". NHS Choices. 2012-05-22. Retrieved November 2013. {{cite web}}: Check date values in: |accessdate= (help)
  26. Cite error: The named reference dmw1 was invoked but never defined (see the help page).
  27. Ernst, E. (2006). "Acupuncture - a critical analysis". Journal of Internal Medicine. 259 (2): 125–37. doi:10.1111/j.1365-2796.2005.01584.x. PMID 16420542.
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  29. "Akupunktur wird Leistung der gesetzlichen Krankenkassen". Federal Ministry of Health (Germany). 2006-07-03.
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  33. Williams, Carla (2007-09-24). "Fake or not, acupuncture helps back pain". ABC News. Retrieved 2013-11-25.
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  36. Hawkes, Nigel (2007-09-25). "Sticking needles in a bad back 'eases pain better than drugs'". The Times. Retrieved 2013-11-25. {{cite web}}: Italic or bold markup not allowed in: |publisher= (help)

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