Acupuncture can be considered to be one of the safer treatments in medicine, conclude a team of authors from China and Germany.  Their systematic review included data from 21 studies covering 12.9 million acupuncture treatments.  Meta-analyses suggested that at least one adverse effect (AE) occurs in 9.31% of patients undergoing a series of acupuncture treatments, and in 7.57% of treatments.  Serious adverse effects (SAEs) were rare judged to be rare, with estimates of 1.01 per 10,000 patients and 7.98 per million treatments. AEs requiring medical treatments were uncommon, occurring in 1.14 per 1000 patients.  On average, 9.4 AEs occurred per 100 treatments.  Half of the AEs reported involved bleeding, pain or inflammation at the needle site that could be argued to represent intended acupuncture reaction.  AE definitions and assessments varied significantly in literature.  (Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies. BMJ Open. 2021 Sep 6;11(9):e045961).