on scientific principles. in 1971, new york times reporter james reston published an article on his acupuncture experiences in china, which led to more investigation of and support for acupuncture. the us president richard nixon visited china in 1972. during one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia. later it was found that the patients selected for the surgery had both a high pain tolerance and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving morphine surreptitiously through an intravenous drip that observers were told contained only fluids and nutrients. one patient receiving open heart surgery while awake was ultimately found to have received a combination of three powerful sedatives as well as large injections of a local anesthetic into the wound. after the national institute of health expressed support for acupuncture for a limited number of conditions, adoption in the us grew further. in 1972 the first legal acupuncture center in the us was established in washington dc and in 1973 the american internal revenue service allowed acupuncture to be deducted as a medical expense. in 2006, a bbc documentary alternative medicine filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anesthesia. it was later revealed that the patient had been given a cocktail of anesthetics. in 2010, unesco inscribed "acupuncture and moxibustion of traditional chinese medicine" on the unesco intangible cultural heritage list following china's nomination. adoption acupuncture is most heavily practiced in china and is popular in the us, australia, and europe. in switzerland, acupuncture has become the most frequently used alternative medicine since 2004. in the united kingdom, a total of 4 million acupuncture treatments were administered in 2009. acupuncture is used in most pain clinics and hospices in the uk. an estimated 1 in 10 adults in australia used acupuncture in 2004. in japan, it is estimated that 25 percent of the population will try acupuncture at some point, though in most cases it is not covered by public health insurance. users of acupuncture in japan are more likely to be elderly and to have a limited education. approximately half of users surveyed indicated a likelihood to seek such remedies in the future, while 37% did not. less than one percent of the us population reported having used acupuncture in the early 1990s. by the early 2010s, more than 14 million americans reported having used acupuncture as part of their health care. in the us, acupuncture is increasingly (as of 2014) used at academic medical centers, and is usually offered through cam centers or anesthesia and pain management services. examples include those at harvard university, stanford university, johns hopkins university, and ucla. cdc clinical practice guidelines from 2022 list acupuncture among the types of complementary and alternative medicines physicians should consider in preference to opioid prescription for certain kinds of pain. the use of acupuncture in germany increased by 20% in 2007, after the german acupuncture trials supported its efficacy for certain uses. in 2011, there were more than one million users, and insurance companies have estimated that two-thirds of german users are women. as a result of the trials, german public health insurers began to cover acupuncture for chronic low back pain and osteoarthritis of the knee, but not tension headache or migraine. this decision was based in part on socio-political reasons. some insurers in germany chose to stop reimbursement of acupuncture because of the trials. for other conditions, insurers in germany were not convinced that acupuncture had adequate benefits over usual care or sham treatments. highlighting the results of the placebo group, researchers refused to accept a placebo therapy as efficient. regulation there are various government and trade association regulatory bodies for acupuncture in the united kingdom, the united states, saudi arabia, australia, new zealand, japan, canada, and in european countries and elsewhere. the world health organization recommends that before being licensed or certified, an acupuncturist receive 200 hours of specialized training if they are a physician and 2,500 hours for non-physicians; many governments have adopted similar standards. in hong kong, the practice of acupuncture is regulated by the chinese medicine council that was formed in 1999 by the legislative council. it includes a licensing exam and registration, as well as degree courses approved by the board. canada has acupuncture licensing programs in the provinces of british columbia, ontario, alberta and quebec; standards set by the chinese medicine and acupuncture association of canada are used in provinces without government regulation. regulation in the us began in the 1970s in california, which was eventually followed by every state but wyoming and idaho. licensing requirements vary greatly from state to state. the needles used in acupuncture are regulated in the us by the food and drug administration. in some states acupuncture is regulated by a board of medical examiners, while in others by the board of licensing, health or education. in japan, acupuncturists are licensed by the minister of health, labour and welfare after passing an examination and graduating from a technical school or university. in australia, the chinese medicine board of australia regulates acupuncture, among other chinese medical traditions, and restricts the use of titles like 'acupuncturist' to registered practitioners only. the practice of acupuncture in new zealand in 1990 acupuncture was included into the governmental accident compensation corporation (acc) act. this inclusion granted qualified and professionally registered acupuncturists to provide subsidised care and treatment to citizens, residents, and temporary visitors for work or sports related injuries that occurred within the country of new zealand.the two bodies for the regulation of acupuncture and attainment of acc treatment provider status in new zealand are acupuncture nz, and the new zealand acupuncture standards authority. at least 28 countries in europe have professional associations for acupuncturists. in france, the académie nationale de médecine (national academy of medicine) has regulated acupuncture since 1955.