CONTROVERSY over NHS-funding for Alternative Medicines

1. Britain once had such an outstanding health service that it attracted patients from all over the world.   Alas, the Utopian ideal of a universal health service, free at the point of service, may have to be abandoned as an unsustainable pipe dream.  Already there is much discussion over cut backs in funding and over who should pay for treatment (e.g. of cancer).
    

2. It is well known that  parts of the National Health Service are becoming dysfunctional.  The near collapse of dental provision within the NHS has made many realise that a state-funded health service cannot be taken for granted.  It is getting increasingly difficult to get even a timely appointment with the GP and despite the reassurances given by The Prime Minister on BBC Question Time prior to the last election, the appointment system for seeing a GP remains a frustrating talking point.  Those in post-operative wards and their visitors run the risk of catching MRSA and other nasty bugs like Clostridium difficile (eg outbreaks at Stoke Mandeville and Maidstone Hospitals).
    

3. Health and medicine have long been profitable businesses within a fast-growing and highly competitive global health market.  The British too have begun shopping (with NHS-funding where possible) for health services abroad.  Those who can are now contemplating retirement in countries where their pensions can be stretched to buy a better standard of health care and domestic help for a longer period; some have already bought second homes in their chosen health-care haven.  But what about those who cannot afford this luxury? 
    

4. People expect politicians and their advisors to foresee emerging trends and to take pre-emptive action to ensure that the NHS, a very large employer, is revitalised for the nation's benefit.  But many fear (perhaps unjustifiably) that the NHS is being sabotaged so that government will be forced to sell off its vast assets at a cut-rate price to the ever-growing, potentially very lucrative, private health sector.  These fears have have been compounded by recent reports of now withdrawn UK advertisements inviting private sector companies to manage NHS healthcare services. 
    

5. The current controversy over the effectiveness of Complementary Medicines must be judged against these and other trends in health provision in the UK and elsewhere.  In 1999, the BBC (http://news.bbc.co.uk/1/hi/health/426005.stm) considered why there was a growing tendency to supplement conventional medicine (based on reductionism in biochemistry and physics) with a range of Alternative Medicines.  Prince Charles, like the rest of us, applauds the achievements of science-based medicine.  However, he established his Foundation for Integrated Health to promote conjoint use of modern and complementary therapies.  The terms conventional, orthodox and traditional medicines are confusing and I will refer to modern conventional medicine as science-based medicine in contrast to Complementary/Alternative Medicines.  In his address to the World Health Assembly (http://www.fih.org.uk/NR/rdonlyres/95E771A9-8A8E-4F2B-99ED-C069454B0ED6/0/WHASpeechFinalVersion2.pdf)  he recommended that all nations should take positive action towards providing integrated health within the next five years, starting with some pilot schemes.  A group of 13 leading scientists led by Emeritus Professor Michael Baum are not so convinced and argue in a letter that NHS support for Alternative Therapies is a waste of scarce NHS funds.  The thread of the controversy can be picked up through links at:

http://news.surfwax.com/findhealthnews/files/Complementary_Medicine.html

 

Here are just a few of the objections and my thoughts on them.

1.  'We share the concerns that some treatments labelled as complementary and alternative medicines have not been properly tested and are known to cause adverse effects, while others have no demonstrable benefits.'  (http://www.timesonline.co.uk/article/0,,8125-2194523,00.html)
   
   This is a charge that can be held against science-based medicine as well. The public have not forgotten Thalidomyde, Opren, Prozac ... and have followed the well-publicised Phase I trial of drug TGN1412 at Northwick Park Hospital where 4 of the 6 volunteers who were administered the drug became very ill.  These albeit extreme examples show that science-based medicine also has to rely ultimately on a suck-and-see approach using people as guinea pigs to note their reactions in Phase I and to obtain subjective feedback in subsequent Phases.  (see http://www.leighday.co.uk/doc.asp?doc=797&cat=852 for information on drug trials). 
   
   Without having sight of examples cited of specific adverse effects in the Baum-group led letter, it is difficult to counter this charge.  However, many Alternative Therapies believe that aggravating symptoms can be evidence of the process of healing and may actually seek to induce them.  This does not rule out the possibility of unknown and/or unintended adverse effects.
    

2. "How a patient does or does not respond to complementary medicine depends entirely on the individual and cannot be predicted." (http://living.scotsman.com/index.cfm?id=767192006)
   
   Even within science-based medicine prediction is largely in terms of probabilities, which vary across areas of medicine.  Even the success of bone transplants are not entirely predictable and are not 100% successful because of individual conditions.  It is much more difficult to predict outcomes in some other diseases, such as cancer.  The above statement by Baum and his associates is misleading.   Alternative Therapies also use generalisations as convenient constructs even if they hold that nature is wonderfully complex and varied, and that organisms can be unpredictably unique in their reactions.  Despite this, many ancient systems such as Indian and Chinese medicines and homeopathy operate with classifications of diseases and of people based on syndromes of mental and physical symptoms.  Their classifications and remedies are also based on years of experiments by volunteers 'proving' the cures and continued observations in 'the field'.  For example, books on Chinese medicine cite case studies from treatments, for example those tried out on prisoners.
   
   When the classificatory system does not deliver the predicted outcome, Alternative Therapies too have to resort to a suck-and-see approach (also adopted by many GPs) to find an effective cure for the individual.  Proven alternative therapies seem to work because it is person- and not just disease-centred.  Even science does not deny that thumb and genetic fingerprints and some other human features are unique.  So, why is the (albeit time-consuming) treatment of a unique individual and the practice of finding the best cure for him/her so unacceptably charlatan?  If we accept that therapies suit some types of people and not others (this is the case even in science-based medicine, e.g. with penicillin and treatments for cancer) we also need to accept that experiments with Petri-dish, mice and even monkeys, may be irrelevant as in the case of TGN1412.  Equally, the subtle effects which natural therapies have on people may not occur or be detected in these experiments. 
    

3. "Complementary medicines cannot be measured in the same way as orthodox medicines, or compared to them, as they do not go through the same scientific tests for efficacy as clinical drugs." (http://living.scotsman.com/index.cfm?id=767192006)
   
   There is now a tendency to label all sorts of subjects as sciences.  It is not enough to adopt the methods of science to become a science.  Nor can medicine borrow science status from advances in other primary sciences, like physics, chemistry and microbiology.  There is a growing realisation that science-based medicine has not as yet reached a stage when it can cure many terminal, never mind other more minor autoimmune system generated chronic, diseases. 
   
   In the light of past fiascos, and its suck-and-see approach, some view science-based medicine as an immature pre-science in some areas.  Exaggerated claims for its know-how and methodology and the vendetta against other proven methods may have the adverse effect of provoking the public to regard science-based medicine as a pseudo science, professing scientism.  Whether science-based medicine can ever become an exact science begs debate given that individual human reactions are not only varied but also dynamic and changeable (as illustrated by the development of resistance or adverse reactions to sustained use of drugs).  Science-based medicine appears to be an artful/skilled application of science.
    
   Cancer Research UK notes an increase in research into Alternative Therapies despite current problems, including a lack of funding.    Moreover, to be valid, the experimental design and protocols for testing Alternative Therapies have be attuned to their System of Beliefs and treatment regimes, and test subjects should be selected with due regard to their classificatory models.  Also attention must be paid to restrictions; for example, a patient who cannot abstain from coffee, minted eatables and/or perfumes during treatment is unlikely to benefit from homeopathy. 
    

4. Who are these 13 leading experts in the Baum group?
    

   Dr Dixon said: "If you look at them, they are surgeons, a pathologist, and none of them represent any GPs or anyone in primary care. It seems to me odd that these clinical barons should be telling those of us who have to deal with daily human suffering what to do. It is almost like some protectionist guild."  (http://society.guardian.co.uk/health/story/0,,1781647,00.html).
   
   The Baum group's objections have the support of the Royal Society according to its Vice-President.  Unfortunately, an increasingly educated and intelligent public  prefer to trust the testimony of their personal experiences over the opinions of experts when it comes to funding-related controversies.  Many are glad that their heir to the throne, based on his own family's experience, is willing to believe personal testimonies, albeit anecdotal, and to champion their preference for Integrated Medicines. 
    

5. Michael Baum said "My concern is the issue of opportunity cost. If the NHS is spending good money on placebos at the cost of not providing effective medicines, then it does matter. The UCL hospital trust has spent £20m on refurbishing the Royal Homeopathic hospital. If that sum of money was spent on making available Herceptin and aromatase inhibitors [to treat breast cancer], then it could be saving in my own health district 600 lives a year." (http://society.guardian.co.uk/health/story/0,,1781647,00.html)
   
   It is important to remember that we live in uncertain and dangerous times.  Ancient urban civilizations are now believed to have collapsed because of political disruptions to the trade links which sustained urbanization and not necessarily because of other factors, such as famine and flood, as previously supposed.  We not only face terrorism but also an energy (and possibly water) shortage.  We cannot rule out war in a world full of conflicts and tensions.  If there was an emergency that sabotaged the provision of high-tech science-based health care, what is our Plan B?  Given the suck-and-see nature of medicine and the other uncertainties of life, it would be prudent to encourage R & D in Integrated Medicine (science-based and credible Complementary Therapies). 

    

   £20m is indeed a lot of money but this capital expenditure is modest when compared with our year-in-year-out health budgets.  Also, is it really the best use of expert time to wage a distracting vendetta against Alternative Therapies when there are more urgent challenges related to the existence and role of the NHS within the global health market as outlined at the start?   Prince Charles addressed a wider set of challenges confronting us today (http://www.fih.org.uk/NR/rdonlyres/95E771A9-8A8E-4F2B-99ED-C069454B0ED6/0/WHASpeechFinalVersion2.pdf). 

In 2002, the White House Commission on Complementary and Alternative Medicine made a number of recommendations for promoting research and adoption of Alternative Therapies in the U.S..  There has been vigorous opposition, for example by Quackwatch.  However, interdisciplinary centres for Integrated Medicine are already in place.  The Centre for Integrative Medicine within the University of Maryland Medical Centre includes, amongst other therapies, a list of medical uses and conditions for which herbs have been found to be effective.  The herbs are also listed by name. The pages on specific herbs provide information on not just the benefits but also on known and possible side effects and their interactions with conventional medications, which is most helpful.  The University of Chicago Tang Centre for Herbal Medicine is also undertaking research on the benefits and adverse effects of herbs but their list of herbs is not as extensive.  Readers will have to assess for themselves whether all sites listed on its Herbal Resources page provide impartial and helpful accounts.

 

The literature on diet too can be confusing and contradictory.  For example McLoughlin (2004) suggests that the polyphenols in Green Tea is one of the dietary goodies for cancer patients - several websites and texts suggest likewise.  However, the U.S. Food and Drug Administration rejects this claim (FDA : June 2005).  The main problem is that there is insufficient documented evidence on the benefits and limitations of therapies and treatments.  Organisations (such as Quackwatch) dismiss anecdotal accounts.  I believe that progress reports about individuals over some 10 years or more could provide helpful evidence.  Support Groups for various diseases are well placed to provide such collective testimonies about members' experiences.  We must not forget that many clinical drugs have their origins in home cures, folk medicine and anecdotal accounts.

 

This website does not seek to reproduce information which can be found in books and other websites.  It provides an anecdotal record of home cures which have worked/failed for me and people who are close to me.  It is a useful resource for us in case we forget what we did the last time.  I also note some of the triggers which I believe caused those ailments and illnesses and record other debatable ideas.  Scientists often draw on systematic records kept by others.  I hope that this rather belated effort will find wider use in the research of others into Alternative Therapies.

 

Disclaimer

Mahes Visvalingam                                              

Last updated on 01/11/06