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CONTROVERSY over NHS-funding for Alternative Medicines
Prince Charles, like the many of
us, applauds the achievements of science-based medicine. However, he
established his (now disbanded) 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 and Therapies, which are
based on ancient traditions. In his address to the World Health
Assembly, Prince Charles recommended that all nations should take positive
action towards providing integrated health within the next five years,
starting with some pilot schemes (BBC, 2003). A
group of 13 leading scientists led by Emeritus Professor Michael
Baum were not so convinced and argued in an open letter that NHS support
for Alternative Therapies is a waste of scarce NHS funds.
Here are just a few of their
objections and my thoughts on them.
a. '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.'
Let us look initially at the charge of adverse
effects. This is a charge that can be levied against science-based medicine
as well. The public have not forgotten Thalidomide, Opren,
Prozac etc. 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.
Without having sight of examples cited of
specific adverse effects in Baum’s letter, it is difficult to counter this
charge. Many Alternative Therapies, like Ayurveda and Chinese Medicine,
have evolved over centuries. They believe that aggravating symptoms can be
evidence of the process of healing and may actually seek to induce them, as
does Naturopathy. This does not rule out the possibility of unknown
and/or unintended adverse effects. Leaflets on many pharmaceutical drugs
list shocking side effects. When my husband suffered some, we were told to
stop reading the leaflets and internet sources.
b. "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)
Nature is wonderfully complex and
varied, and organisms can be unpredictably unique in their reactions.
Even within science-based medicine prediction is largely in terms of
probabilities, which vary across areas of medicine. It is difficult to
predict outcomes in many diseases, such as cancer. We know that while
some patients still respond to antibiotics for MRSA, Clostridium difficile and other bugs, others do not - and even die (Maidstone
Hospital). The
above statement by Baum and his associates shows a lack of understanding of complementary
therapies. 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 based on years of experiments with volunteers 'proving' the
cures and further observations of patients. 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
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? We know
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. So, experiments with Petri-dish, mice and even monkeys, may be
irrelevant as demonstrated by the case of TGN1412. Equally, the
subtle effects which natural therapies have on people may not be detected in
such experiments.
c. "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."
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 genuine 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, and 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 aspects.
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 noted an increase in research into Alternative Therapies
despite current hostility, including a lack of funding.
Moreover, to be valid, the experimental design and protocols for testing
Alternative Therapies have to 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. The Pfizer
vaccine for COVID-19 was declared to be very efficient and safe and yet
people have had potentially life-threatening allergic reactions. The U.K.'s Medicines & Healthcare
products Regulatory Agency (MHRA)
issued a warning that the vaccine should not be given to anyone with severe
allergic reactions to food or medicine.
Given the growing incidence of allergies, why were those with
allergies excluded from the trials?
Was it to make misleading claims?
d. 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. They make
the public distrust experts. The 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, was willing to believe personal testimonies, albeit anecdotal,
and to champion their preference for Integrated Medicines.
e. 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."
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, was 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?
In
2001, 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. Interdisciplinary centres for Integrated Medicine
emerged. The Centre for Integrative Medicine within the University of Maryland
Medical Centre included, amongst other therapies, a list of medical uses and
conditions for which herbs have been found to be effective. The herbs
were also listed by name. The pages on specific herbs provided information on
not just the benefits but also on known and possible side effects and their
interactions with conventional medications, which was most helpful.
This resource seems to have vanished. The University of Chicago Tang Centre for Herbal Medicine is still active undertaking research on the benefits
and adverse effects of herbs. 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. 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. But, many charities offering support to
those with life-threatening diseases, such as cancer, now offer a range of
complementary therapies. 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 we had a
problem. 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.
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