Complementary and alternative medicine

…and his Foundation for Integrated Health. An excellent analysis of a recent meeting held at the King’s Fund in London at David Colquhoun’s website .

This starts in the Royal Courts of Justice today. There are restrictions on what can be reported currently.  I am reliably informed that this legal blog http://jackofkent.blogspot.com/  will have updates.

Best wishes, Simon.

Thanks to Quackwatch for this link: the US Conference of Catholic Bishops have said that “For a Catholic to believe in Reiki therapy presents insoluble problems. In terms of caring for one’s physical health or the physical health of others, to employ a technique that has no scientific support (or even plausibility) is generally not prudent.”

So, will the NHS take the hint, follow suit, and suggest that this alternative therapy is dropped from being funded?

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More from the Prince’s Foundation for Integrated Health: we should look forward to May, when publication of guidelines with an “integrated approach… bringing together mainstream medical science with the best of other traditions… movement including exercise, yoga, tai chi/qi gong…” will apparently be published.

The PFIH is working with Mind and the Royal College of Psychiatrists, among others, to achieve this aim. I am horrified – the RCP has had (at least, up till now) a strong ethos for evidence-based treatments. I can’t imagine these reputable organisations working directly on guidelines with the pharmaceutical industry, for example, on how to use their products in hospitals. So why turn to the PFIH for “inspiration, understanding and practical tools” on “integrated health”?

Good facilities should be expected in psychiatric hospitals but are nothing to do with “integrated health”. Instead, they are everything to do with treating people well and with dignity. Integrated health is also nothing to do with the occupation which patients may benefit from - woodwork, gardening, crafts – but don’t often get the chance to thanks to the decimation of the numbers of occupational therapists in hospitals and the community.

I am dismayed to note that complementary therapists are now able to register with the CHNC. Ben Bradshaw, the health minister who is also so keen on the non-evidence based ‘iwantgreatcare.org’ doctor-rating website, is reported as saying:  ”I welcome the opening of the Complementary and Natural Healthcare Council (CNHC) register…which the public can turn to for help. Members of the public who use these therapies will be able to check whether the practitioner they’re seeing is registered with the CNHC. If they are, they have the reassurance of knowing that they have had to meet minimum standards of qualification … Practitioners too will benefit by increased public confidence. Public safety is paramount. Registration, whether voluntary or statutory, is about protecting patients, and I am pleased to see this important milestone in voluntary registration.”

This is nonsense. What about protecting the public from ineffective interventions? Or false hope, wasted time and effort or indeed, potential harm? What is the point of improving “public confidence” in things that don’t work? (And “alternative” therapies which do work are taken up into orthodox medicine.)  Bradshaw would be serving the public far better by advising them to be cautious when engaging with healthcare interventions which have not been proven to work. Isn’t that the best way to “protect” patients? And, incidentally, Bradshaw’s signing off line — “People should always seek their GP’s advice to ensure that any other therapy they use does not conflict with orthodox treatment” – is the epitome of weasel words: how can a GP ethically end up taking responsiblity for things he or she doesn’t prescribe or suggest?

Yep. In this week’s BMJ, is an advert for a ‘vacancy for a member’ for the Herbal Medicines Advisory Committee , which advises the Medicines and Healthcare Regulatory Agency on the ‘safety, quality and efficacy of herbal medicinal products for human use.’ Of further concern to me is that they wish their newly appointed member to have recent experience in paediatrics.

Herbal medicines are, if they work, nothing special – St John’s Wort, aspirin (willow extract), vincristine, a chemotherapy drug, which is derived from plants….they all have side effects and interactions with other drugs. In fact, one could say that herbal medicines which work are in fact just medicines, to be used with the same provisos as any other medicines.

These leaves the ‘other’ herbal medicines as the ones which don’t work. And which, by definition, we should be ensuring either aren’t used, or are properly researched so that we know whether they should be or not.

What is gained by having a Herbal Medicines Advisory Committee? Obfuscation, and the danger of having a different set of standards for one set of chemicals compared to another, I suggest.

Medical lore has created something of a cult around the measurement of children’s temperatures.

A fever seems to be something which is suspected and then recorded, swiftly followed by the administration of medicine to “bring it down”.

Some confessions. My home medical kit isn’t up to much. At one point it did contain a thermometer, which came free with a purchase at a petrol station and subsequently broke. It was a complement to what I saw as the only vital medical accessory for a household with children: infant paracetamol.

The remainder of the article can be read here. Please post comments below.

Would anyone like to help the cause of homeopathy? There is an interesting job description in the British Medical Journal this week. It is for both an expert and a lay person to ‘contribute actively’ to the Advisory Board on the Registration of Homeopathic Products. The pay is £275 a day, and they have 11 meetings a year.

 It is tempting to ask how many thousands of pounds the goverment are spending on this exercise. It is even more tempting to ask how, possibly, the Board can function. Any other medicine that the Medicines and Healthcare Regulatory licenses has to have evidence of it’s efficiacy and safety. The members of this committee will have to “give advice about safety and quality” on substances that don’t actually have proof of working.

If any FT readers are up to the challenge of bringing some sense into the boardroom, please do let me know how you get on.

One of the medical newspapers, Pulse, has a news article saying that there has been a drop in the number of  homeopathic prescriptions by GPs in the UK. In 2005, there were 83,000 written, and in 2007, it had fallen to 49,300.

This is good news. It could be that GPs are becoming more critical about the evidence for their prescriptions, or patients are being more critical of the evidence for what works. One UK NHS homeopathic hospital has had funding withdrawn. The National Institute for Clinical Excellence evaluates interventions and recommends that treatments of marginal or no cost effective benefit are not funded. However it is most unfair that homeopathy, which the evidence says doesn’t work beyond that of placebo, has yet to undergo a similar evaluation.

Having said that, homeopathy does have a placebo effect,  a valuable thing. The placebo effect could be regarded more broadly as the beneficial effects of medicine which are not mediated by a biologically active ‘medical’ intervention itself – placebo pills and even placebo surgery have been found to have beneficial effects for patients. So have, for example, continuity of care, and longer appointment times. The ethics of using placebos are fraught. However, there is no such ethical problem with providing longer appointments and continuous care. It seems most unfair that the  people currently allowed to benefit most from the placebo effect are those who are prepared to use homeopathy. There are other, better things that could be used for more people to benefit from such ‘caring effects’.

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