Parl MAGAZINE Spring 06

COMPLEMENTARY & ALTERNATIVE MEDICINE: SHOULD IT BE PROVIDED ON THE NHS? MEETING OF THE PARLIAMENTARY AND SCIENTIFIC COMMITTEE ON MONDAY 17TH OCTOBER 2005 Some 40 per cent of GPs recommend CAM therapies to their patients – indeed, 20 per cent offer them on their premises. Although many doctors accept that CAM has much to offer their patients, others are not so sympathetic. Nevertheless CAM is increasing in popularity with many patients who claim to have benefited. Is the evidence base for the efficacy of any of the twenty-five recognised CAM therapies good enough to justify the taxpayer paying for this treatment as part of the NHS? Complementary and Alternative Medicine – should it be provided on the NHS? Lord Walton of Detchant or ten years I served as a conventional medical practitioners. question as to whether it should be Member of the House of Lords We broadly accepted the definition provided by the NHS. FSelect Committee on Science provided by the Cochrane It soon became clear that the uptake and Technology, and chaired three Collaboration as “A broad domain of CAM in the UK had increased Sub-Committee Enquiries, of healing resources that steadily. More than 15% of people producing Reports which were encompasses all health systems, in the UK had consulted CAM accepted by the parent Committee modalities and practices and their practitioners and more than 30% and eventually debated in the accompanying theories and beliefs, had bought over-the-counter House. The last enquiry which I other than those intrinsic to the remedies used in CAM, with a total chaired was into Complementary politically dominant health systems annual expenditure approximating and Alternative Medicine (CAM). of a particular society or culture in a to £1.6 billion. In the USA To assist the enquiry, two specialist given historical period.” expenditure was estimated at some advisors were nominated, namely Having issued a public call for US$27 billion. Professor Stephen Holgate, who will evidence, we received 185 written Eventually, we classified the CAM speak later, and Professor Simon submissions, and held 21 oral Mills, Director of the Centre for professions and disciplines into hearings, interviewing 44 three groups. In the first group Complementary Health Studies at representatives of many the University of Exeter. were those known as “the big five”, organisations in the conventional namely osteopathy, chiropractic, Our first task was to try to achieve a medical field, in science and in herbal medicine, acupuncture and definition of terms. We concluded CAM. Several individuals also gave homeopathy. The professions of that alternative medicine normally oral evidence. One witness was Dr osteopathy and chiropractic are refers to a number of professions or Stephen Straus, Director of the individually regulated by Acts of disciplines which claim to offer Office of Complementary and Parlament. Herbal practitioners in systems of diagnosis, prognosis or Alternative Medicine in the USA, an the UK are also to some extent a management using approaches organisation funded by the National cohesive group, who have different from those employed in Institutes of Health in order to developed a powerful method of conventional Western medicine. undertake research in CAM. In our voluntary self-regulation and who Complementary medicine we enquiry we were not primarily subscribe to scientific principles. accepted as embracing a number of concerned with efficacy, but were Very many powerful drugs in other professions or disciplines required to consider evidence, common used in Western medicine which do not usually offer regulation, training and education, are of herbal origin. We also diagnostic information, but which research and development, learned that, through the British are more often used to complement information availability and the Acupuncture Registration Board, the treatment offered by delivery of CAM, including the practitioners using acupuncture, 8 Science in Parliament Vol 63 No 1 Spring 2006 some of whom are doctors and including crystal therapy, radionics, which many of their patients may nurses but many of whom hold no dousing and kinesiology. consult. We also recommended other professional qualification, had While much evidence we received simple familiarisation courses for begun to develop a mechanism of stressed, very properly, the role of undergraduate medical students. self-regulation. There is good the therapist and of the placebo We also discussed the crucial physiological evidence to show that response, which has been shown, in importance of randomised acupuncture can induce an conventional medicine, to have controlled trials, sequential trials increased output of endorphins (the profound effects upon many bodily and many other research techniques body’s own analgesics) from the organs and especially upon the designed to collect evidence on the central nervous system. We also body’s immune system, we did validity and efficacy of the various included homeopathy, a long- receive evidence to indicate that CAM disciplines, with particular established method of diagnosis and several of the CAM disciplines, reference to being able to treatment used in the UK by many especially those in our group 1, do demonstrate which had effects medical practitioners, but also by have specific effects which could superior to placebo. We also non-medical homeopaths, in not be wholly accounted for by the recommended the establishment of Category 1. placebo response. We also noted Centres of Excellence in UK In our Category 2 we included that many alternative and universities, where CAM disciplines such as aromatherapy, complementary practitioners were practitioners could undertake massage, counselling, reflexology, able to offer much more time for research programmes in shiatsu, hypnotherapy, meditation consultations than can busy collaboration with scientists, and different varieties of healing. doctors. The Cochrane doctors and others already well We found that these disciplines Collaboration reviewed 154 trials, versed in research techniques. We were complementary in being used, 40% of which revealed some were pleased to note that the NHS generally, but not invariably, to benefit. The recent Smallwood R&D organisation has now complement conventional medical Report felt that CAM in the NHS supported several such research treatment. would be cost-effective, a point projects in the CAM field. We also Category 3 gave us the greatest disputed by Ernst and his considered mechanisms by which difficulty. In Category 3a we colleagues in a recent paper in the high quality information about included ancient Chinese medicine British Medical Journal. CAM could be made available, not and Ayurvedic medicine; we were Accepting that the practice of only to the public, but also to concerned by some principles osteopathy and chiropractic is healthcare professionals, and employed in Chinese acupuncture controlled by Acts of Parlament, we recommended that NHS Direct and Chinese herbal medicine, not recommended that herbal medicine might be a useful source of least because the large combinations and acupuncture should seek for information. We also recommended of herbs, widely used in both statutory regulation under the that health authorities should work ancient Chinese medicine and, to a Health Act 1999, alongside other with representatives of the well- lesser extent, in Ayurvedic healthcare professions; we took the regulated CAM professions to medicine, have sometimes included view that this might become produce information about well- harmful components such as possible for homeopathy, once qualified CAM practitioners in their aristolochia, which can cause differences of opinions and practice, respective areas and regions. serious renal damage, while some as between medically qualified Finally, in relation to the provision of preparations also contain homeopaths and those without CAM in the NHS, we recommended combinations of heavy metals which medical qualifications, are resolved. that primary care groups and trusts may be deleterious. We also feel We also recommended that the should be willing, in appropriate that many of the concepts upon many organisations representing the circumstances, to fund consultations which these disciplines rely (the disciplines in Category 2 should and treatment using well-established, elements, ying and yang and the seek to develop a system of rigorous well-regulated and well-founded five doshas, for example) which voluntary self-regulation for each , CAM methods, but that all such date from antiquity, are totally with a view perhaps ultimately to consultations paid for by public outdated. We therefore classified becoming registered by Statute. funds (ie through the NHS) should them in Category 3a, implying that, In relation to education and be by referral from doctors or other when practised according to training, we recommended that healthcare professionals, working in traditional concepts, they seemed to each profession should define a core primary, secondary or tertiary care. us to lack validity. Nevertheless, we curriculum including elements of Our Report was accepted without discovered later that some anatomy, physiology and clinical significant modification by the practitioners of ancient Chinese medicine, as well as statistics and parent Committee, and was debated medicine and many of Ayurvedic the accumulation and analysis of in the House of Lords early in 2001. Medicine take part in scientifically evidence. We felt it imporrtant that Our

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