The Big Question: What is complementary medicine, and should the NHS be funding it?

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Why the fuss?

Thirteen eminent British doctors, including a Nobel prize-winner and six fellows of the Royal Society, have written to every NHS trust in the country, urging them to stop paying for complementary medicine and spend the money instead on conventional medicine "based on solid evidence". They say public funding of "unproven or disproved treatments" such as homeopathy and reflexology is unacceptable when the NHS is facing huge deficits and having to sack nurses and close wards. Only evidence-based therapies should be provided free to patients on the NHS.

Sounds fair enough?

It would do, if this marked the divide. But much orthodox medicine is not evidence based. Most antibiotics have never been tested in randomised controlled trials, for example. Orthodox medicine is often held up as a model of how things work but it is actually far from perfect science. John Bell, professor of clinical medicine at the John Radcliffe Hospital, Oxford, observed almost a decade ago that many drugs were discovered by accident, not design, and much treatment was based on anecdotal evidence, not systematic review. The role of social and psychological factors was little understood. "We need to know what kind of patient has the disease rather than what kind of disease the patient has," he said.

Why the growth of interest in complementary medicine?

Increasing disillusion with conventional medicine, which has proved ineffective against many of the chronic illnesses of modern times, such as back pain and stress. Complementary medicine has done orthodox medicine a service by reminding doctors of the power of care. The consultations are lengthy, detailed and personal. What matters to patients are results, not scientific explanations. Magic is acceptable if it accomplishes what is promised.

Is it widely used on the NHS?

Yes. At least half of all GPs refer some patients for treatment by complementary practitioners paid for by the NHS, according to the Smallwood report published by the Prince of Wales Foundation for Integrated Medicine in 2005. For many conditions - stress, for example - conventional medicine has little to offer. GPs argue that treatments such as autogenic relaxation training are cheap and simple remedies that do not require medical intervention, put patients in the driving seat and are popular. Even if they don't help the patients, they help the GPs. They say they are simply being pragmatic.

What do its critics say?

"You can call it pragmatism, but I call it bad science," said Edzard Ernst, professor of complementary medicine at the Peninsula Medical School, Exeter, and a signatory of the letter to NHS trusts. Providing therapies just because patients want them is not what doctors were trained to do. Professor Ernst's mission is to bring scientific rigour to the study of complementary medicine so that doctors and patients can distinguish what works from what does not. "Two wrongs don't make a right," is his answer to the charge that many orthodox medicines have never been tested. Without rigorous assessment, complementary medicine will never win mainstream acceptance, he says.

Is that true?

Many claim it has already been accepted in the mainstream. Professor Liam Donaldson, the Government's chief medical officer, told The Lancet back in 1997 that he saw an increasing role for complementary medicine "because it is what people want and people definitely benefit from it". The same year the Prince of Wales embarked on his campaign to forge closer links between orthodox and complementary medicine, which he took to the World Health Assembly in Geneva yesterday. "The proper mix of proven complementary, traditional and modern remedies can help to create a powerful healing force in the world," he said.

Does it work?

It depends. There is good evidence that acupuncture helps to relieve pain and nausea following surgery and in the treatment of musculo-skeletal conditions such as painful joints. Oddly, it does not seem to matter where the needles are inserted, along the body's meridians as dictated by Chinese theory or randomly - both seem equally effective.

Herbal medicine is effective in some cases - St John's wort is a proven treatment for depression - but dangerous in others. Kava kava, a tranquilliser, was banned in Britain after reports of liver damage.

Spinal manipulation - osteopathy and chiropractic - can help back pain but are not superior to conventional treatment with painkillers and physiotherapy.

Homeopathy arouses most doubts. A review of 110 trials published in The Lancet suggested it worked through the placebo effect.

Should doctors say what is available on the NHS?

Many people think not. Respondents to the BBC's website yesterday pointed out that as patients pay for the NHS through their taxes, they should have a say in what is provided. This principle should not extend to the wilder shores of complementary medicine, but the main therapies should be offered, they said.

Won't this reduce the funds available for proven drugs?

This is a different argument about the prioritisation of treatments. Even if homeopathy were proven to be effective, the question of whether we should pay for it is a separate one. Should we pay for fertility treatment on the NHS if we cannot afford to give patients cancer drugs?

What should doctors learn from the demand?

That there is a huge unfulfilled need out there. People are crying out for help, but the doctors supplying the medicine have to leave the empathy to be supplied by someone else. That is an important lesson for medicine.

Should alternative medicine be available on the NHS?

Yes...

* It is widely used on the NHS by more than half of all GPS - and is popular with patients

* For many conditions - stress and back pain, for example - conventional medicine has little to offer

* It is complementary to, not instead of, conventional medicine, and can help patients with diseases such as cancer to cope better

No...

* The NHS should only fund tried and tested treatments, especially when cash is tight

* To offer unproven remedies on the NHS is tantamount to substituting superstition for science

* There cannot be two kinds of medicine. There is only medicine that has been adequately tested and medicine that has not

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