TOPIC GUIDE: Complementary Medicine
"Complementary and alternative medicine should not be provided on the NHS"
PUBLISHED: 01 Jan 2008
AUTHOR: James Gledhill
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In May 2006 a group of scientists and doctors led by Professor Michael Baum wrote a letter calling on the NHS to stop providing complementary and alternative medicine (CAM) [Ref: Times Online]. A further letter a year later restated their case [Ref: Times Online]. Their campaign provoked an outcry from complementary medicine groups, and the Prince of Wales joined those who hit back [Ref: Times Online]. Accusations of state-funded ‘witchcraft’ were met by criticism of the arrogant superiority of doctors. Both sides agree that because the NHS is funded by taxpayers, and the treatments it provides are generally free at the point of delivery, the NHS should be accountable for the way it spends its money. But while CAM’s supporters see its provision as a question of health freedom and fairness, ensuring it’s not just available to those who can pay for it privately, its detractors say it’s a scandal that public money is being wasted on untested and unproven treatments. The NHS provides around 10 per cent of complementary services in the UK [Ref: BBC Health], and a survey of local primary care trusts in England found around two-thirds offered complementary medicine services. One reason that CAM might be attractive to the NHS is that it is claimed to be cheaper than conventional treatments. CAM is also popular, and in a system in which patients are increasingly seen as consumers with a right to choose their treatments it might seem only right that they should be able to choose CAM. In response to a petition asking for CAM to be provided alongside conventional medicine, the government has said this is up to primary care trusts, but that in providing local services trusts could explore this opportunity as part of patient choice [Ref: Number 10]. Would increased provision of CAM on the NHS be something to be welcomed or would it represent a betrayal of scientific medicine that must stop?
DEBATE IN CONTEXT
This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.
What is complementary and alternative medicine (CAM)?
This umbrella term refers to treatments that differ from conventional medicine – medicine based on scientific testing that is taught to medical professionals. However, while alternative medicine is used in place of conventional medicine, complementary medicine is used alongside it. There has been a shift towards seeing CAM as a complement rather than an alternative. The term integrated (or integrative) medicine is used by its advocates to describe use of CAM for which there is ‘some high-quality evidence of safety and effectiveness’ combined with conventional medicine. Leading examples of CAM include homeopathy, osteopathy, acupuncture, hypnotherapy, nutritional therapy, massage and reflexology. CAM is often practised as part of a holistic approach to medicine, a central part of which is the ‘human effect’ of individual treatment [Ref: Guardian].
Should all treatments be subject to the same standard of proof?
Critics of CAM argue the NHS should only provide treatments that are scientifically proven, principally by meeting the gold standard of randomised controlled trials. Put bluntly, ‘there is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine’ [Ref: Journal of the American Medical Association]. CAM’s supporters say it suffers from a lack of research into how it works – pharmaceutical companies ignore it because they can’t make money from it. More fundamentally, they say, it would be unfair to expect all treatments to meet the same standard of proof. It would result in a ‘medical apartheid’ where treatments that cannot be explained by the standard bio-medical model are excluded by the NHS, despite all the evidence from patients that they work [Ref: BBC News]. Critics do not deny that treatments may make people feel better, but where they are effective, as may be the case with therapeutic massage, they say this can be measured by orthodox science [Ref: RCGP], whereas treatments like homeopathy just have a placebo effect. CAM’s supporters say the placebo effect is a legitimate treatment, but also want to leave open the possibility of alternative explanations for efficacy that current science might fail to identify. But critics say that prescribing placebos is unethical and that advocates of CAM are intellectually dishonest to go on believing in a treatment when it lacks evidence.
Homeopathy: ‘worse than witchcraft’ or of proven benefit to patients?
Homeopathy is a particular focus of criticism: doctors expressed alarm at a new system for its licensing and the NHS has cut back on treatments. Because it involves diluting an active ingredient in water to such an extent that not one drop of it may remain, there seems to be no scientific explanation of how it could work. But supporters point to its popularity. They say the evidence is not conclusive and because homeopathy relies on individualised treatments it’s not suited to assessment through narrow conventional scientific trials.
If CAM is unlikely to cause harm to patients, then what’s the harm of providing it on the NHS?
Supporters say treatments like St John’s Wort can be not only more effective and cheaper than conventional treatments like antidepressants, but also have fewer side-effects. Baum, though, argues in the case of homeopathy that the safety argument is like ‘licensing a witches’ brew as a medicine so long as the bat wings are sterile’; money spent on homeopathy would be better spent on cancer drugs. But is this, as some suggest, simply a patronising and old-fashioned attitude that shows a lack of respect for patients?
It is crucial for debaters to have read the articles in this section, which provide essential information and arguments for and against the debate motion. Students will be expected to have additional evidence and examples derived from independent research, but they can expect to be criticised if they lack a basic familiarity with the issues raised in the essential reading.
Daily Mail May 2006
Michael Baum vs Peter Fisher BBC News May 2006
Polly Toynbee Guardian January 2008
Stuart Derbyshire Spiked November 2007
Michael Baum Daily Mail 01 May 2007 May 2007
Barbara Rowlands interviews Edzard Ernst Daily Mail December 2006
Robert Verkerk Alliance for Natural Health December 2006
Nicola Sturzaker Guardian Society September 2006
Complementary Medical Association May 2006
Michael Dixon Observer July 2001
Michael Baum vs George Lewith The New Generalist 4(3) October 2006
Christopher Smallwood FreshMinds pp. 8-18 October 2005
Bríd Hehir Spiked March 2001
Definitions of key concepts that are crucial for understanding the topic. Students should be familiar with these terms and the different ways in which they are used and interpreted and should be prepared to explain their significance.
Useful websites and materials that provide a good starting point for research.
Michael Baum Breast Cancer Research December 2007
Battle of Ideas debate
Michael Baum Spiked October 2007
Gustav Born Times Online May 2007
BMC Complementary and Alternative Medicine May 2007
IvyRose Holistic March 2007
Melanie Oxley Primary Care Today July/August 2006
NHS Networks May 2006
Anjana Ahuja The Times May 2006
BBC News May 2006
BBC Breakfast May 2006
Times Online Debate May 2006
BBC News Have Your May 2006
Guardian Unlimited May 2006
Telegraph Speakers’ Corner May 2006
Michael Baum et al Times Online May 2006
The Prince of Wales May 2006
BBC Radio 4 September – October 2004
House of Lords Science and Technology Committee Sixth Report November 2000
4 Health from Channel 4
Links to organisations, campaign groups and official bodies who are referenced within the Topic Guide or which will be of use in providing additional research information.
IN THE NEWS
Relevant recent news stories from a variety of sources, which ensure students have an up to date awareness of the state of the debate.
The Times May 2007
Guardian May 2007
BBC News February 2007
BBC News November 2006
Guardian September 2006
Daily Telegraph May 2006
Guardian May 2006
Times Online May 2006
Guardian May 2006
BBC News May 2006
The Times May 2006
BBC News November 2005
The Times October 2005
The Times October 2005
Times Online October 2005
BBC News 5 October 2005
BBC News August 2005
BBC News November 2004
BBC News October 2004
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