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http://news.independent.co.uk/uk/health_medical/article570906.eceThe Big Question: What is complementary medicine, and should the NHS befunding it?By Jeremy Laurance, Health EditorPublished: 24 May 2006Why the fuss?Thirteen eminent British doctors, including a Nobel prize-winner and sixfellows of the Royal Society, have written to every NHS trust in thecountry, urging them to stop paying for complementary medicine and spend themoney instead on conventional medicine "based on solid evidence". They saypublic funding of "unproven or disproved treatments" such as homeopathy andreflexology is unacceptable when the NHS is facing huge deficits and havingto sack nurses and close wards. Only evidence-based therapies should beprovided free to patients on the

NHS.Sounds fair enough?It would do, if this marked the divide. But much orthodox medicine is notevidence based. Most antibiotics have never been tested in randomisedcontrolled trials, for example. Orthodox medicine is often held up as amodel of how things work but it is actually far from perfect science. JohnBell, 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, notsystematic review. The role of social and psychological factors was littleunderstood. "We need to know what kind of patient has the disease ratherthan what kind of disease the patient has," he said.Why the growth of interest in complementary medicine?Increasing disillusion with conventional medicine, which has provedineffective against many of the chronic

illnesses of modern times, such asback pain and stress. Complementary medicine has done orthodox medicine aservice by reminding doctors of the power of care. The consultations arelengthy, detailed and personal. What matters to patients are results, notscientific explanations. Magic is acceptable if it accomplishes what ispromised.Is it widely used on the NHS?Yes. At least half of all GPs refer some patients for treatment bycomplementary practitioners paid for by the NHS, according to the Smallwoodreport published by the Prince of Wales Foundation for Integrated Medicinein 2005. For many conditions - stress, for example - conventional medicinehas little to offer. GPs argue that treatments such as autogenic relaxationtraining are cheap and simple remedies that do not require medicalintervention, put patients in the driving seat and are popular. Even if theydon't help the

patients, they help the GPs. They say they are simply beingpragmatic.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 justbecause patients want them is not what doctors were trained to do. ProfessorErnst's mission is to bring scientific rigour to the study of complementarymedicine so that doctors and patients can distinguish what works from whatdoes not. "Two wrongs don't make a right," is his answer to the charge thatmany 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 LiamDonaldson, the Government's

chief medical officer, told The Lancet back in1997 that he saw an increasing role for complementary medicine "because itis what people want and people definitely benefit from it". The same yearthe Prince of Wales embarked on his campaign to forge closer links betweenorthodox and complementary medicine, which he took to the World HealthAssembly in Geneva yesterday. "The proper mix of proven complementary,traditional and modern remedies can help to create a powerful healing forcein the world," he said.Does it work?It depends. There is good evidence that acupuncture helps to relieve painand nausea following surgery and in the treatment of musculo-skeletalconditions such as painful joints. Oddly, it does not seem to matter wherethe needles are inserted, along the body's meridians as dictated by Chinesetheory or randomly - both seem equally effective.Herbal medicine is

effective in some cases - St John's wort is a proventreatment for depression - but dangerous in others. Kava kava, atranquilliser, was banned in Britain after reports of liver damage.Spinal manipulation - osteopathy and chiropractic - can help back pain butare not superior to conventional treatment with painkillers andphysiotherapy.Homeopathy arouses most doubts. A review of 110 trials published in TheLancet 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 pointedout that as patients pay for the NHS through their taxes, they should have asay in what is provided. This principle should not extend to the wildershores 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 ifhomeopathy were proven to be effective, the question of whether we shouldpay for it is a separate one. Should we pay for fertility treatment on theNHS 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 forhelp, but the doctors supplying the medicine have to leave the empathy to besupplied 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 popularwith patients* For many conditions - stress and back pain, for example - conventionalmedicine has little to offer* It is complementary to, not instead of, conventional medicine, and

canhelp patients with diseases such as cancer to cope betterNo...* The NHS should only fund tried and tested treatments, especially when cashis tight* To offer unproven remedies on the NHS is tantamount to substitutingsuperstition for science* There cannot be two kinds of medicine. There is only medicine that hasbeen adequately tested and medicine that has not "Our ideal is not the spirituality that withdraws from life but the conquest of life by the power of the spirit." - Aurobindo.

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