to the editor: I am troubled by the following comment that was made by Dr. Morelli and colleagues: “Although acupuncture has been promoted as a safe therapy, significant infections have occurred, including human immunodeficiency virus and hepatitis, as a result of the use of unsterilized needles.”¹ This is a poorly researched comment that inaccurately states the level of risk in acupuncture.

Practitioners of acupuncture in the United States take courses on clean needling technique. Acupuncture needles are gas sterilized to over 300°F and are individually packaged for single use. Both the National Acupuncture Certification Board and state regulatory boards oversee safety issues.

Although there have been a few case reports of human immunodeficiency virus and hepatitis infection, a review² of nine prospective studies of the safety of acupuncture found no reported cases of disease transmission.² According to the same reference that Dr. Morelli and colleagues¹ cite, the 1997 National Institutes of Health Consensus Statement³ on acupuncture notes that the documented occurrence of adverse events with acupuncture is extremely low.

The comment by the authors¹ is made without stating the specific risk level and exaggerates the risk involved in acupuncture. In reality, acupuncture probably helps relieve pain more than the other modalities discussed.

in reply: We agree with Dr. Levy's concerns. As he mentioned, the risks of acupuncture are extremely low. The intention in our article¹ was only to point out that there have been case reports of transmission of human immunodeficiency virus (HIV) and hepatitis from acupuncture needles. We decided to mention HIV because of the severity of the disease and to mention hepatitis because acupuncture was cited in the late 1980s to have been the cause of at least two office-source outbreaks.^2,3 We chose not to mention the much rarer cases of cardiac tamponade,⁴ pneumothorax, and endocarditis.⁵

Again, it is never our intention to present slanted or biased information or to steer patients away from therapies that could be helpful in treating debilitating symptoms. However, acupuncture, like other therapies mentioned in the article, has not been shown to alter the natural course of the disease in any way. And, at the same time, it would be irresponsible not to point out potential risks to patients.