Complementary and Alternative Medicine : A Briefing by the Foundation for Integrated Medicine on the report by the House of Lords Select Committee on Science and Technology
The report on complementary and alternative medicine (CAM) by the House of Lords Select Committee on Science and Technology was produced following a 15 month enquiry which received more than 180 written submissions and took evidence from 46 different bodies. The 140 page report is wide ranging, but the main recommendations are:
• that there is a clear need for more effective guidance for the public as to what does or does not work
• that the public interest will be best served by improved regulatory structures of many CAM professions
• that government should, through a 10 year programme, develop a small number of centres of excellence for conducting CAM research
• that in terms of NHS provision, only those CAM therapies which are statutorily regulated, or have a powerful mechanism of voluntary regulation, should be made available through the NHS.
BACKGROUND TO THE ENQUIRY
With use of CAM across the developed world increasing, the enquiry set out to establish:
• whether there were good structures of regulation to protect the public
• whether an evidence base had been accumulated and research carried out
• whether there were adequate information sources available
• whether training arrangements were adequate
• what the NHS should provide
GROUPING OF THERAPIES
As CAM includes a large number of therapies the Committee proposed three broad groupings of therapies. Its main reason for differentiating amongst them was based on its judgement about the available evidence for the different therapies.
Professionally organised disciplines, with their own diagnostic approach. They have some scientific evidence of effectiveness and recognised systems of training for practitioners: acupuncture, chiropractic, herbal medicine, homoeopathy, osteopathy.
Complementary therapies which lack a firm scientific basis and are not regulated to protect the public, but which give help and comfort to many people: Alexander technique, aromatherapy, Bach flower remedies, bodywork therapies including massage, counselling stress therapy, healing, hypnotherapy, Maharishi ayurvedic medicine, meditation, nutritional medicine, reflexology, shiatsu, yoga
Alternative disciplines which have no established evidence base to support their claims for safety and efficacy.
3a - long established and traditional disciplines with very specific philosophies: anthroposophical medicine, ayurvedic medicine, chinese herbal medicine, Eastern medicine (Tibb), naturopathy, traditional Chinese medicine.
3b - other alternative disciplines: crystal therapy, dowsing, iridology, kinesiology, radionics
THE MAIN CONCLUSIONS OF THE REPORT
To protect the needs of patients and the public the Committee concluded that better regulation was essential. In their view this is meant, as a first step, the development of single voluntary regulatory bodies for each therapy. For two professions, herbal medicine and acupuncture, plus possibly homeopathy in the future, statutory regulation on a similar basis to chiropractice and osteopathy is recommended. The criteria for recommending statutory regulation are:
• the possible risk to the public from poor practice
• a pre-existing robust voluntary regulatory system
• the presence of a credible evidence base
The enquiry also concluded that in the absence of clear guidelines for regulation and training of statutory practitioners, such as doctors and nurses, who incorporate CAM therapies into their medical practice, the relevant regulatory body, for example the GMC or the UKCC, should develop clear guidelines on competences and training for their members.
Education and training
The Committee concluded that training courses in CAM varied unacceptably in content, depth and duration. It made a number of recommendations directed at CAM bodies, which it hoped would improve the position. These include proposals that:
• CAM training courses should become standardised, be accredited and validated
• continuing professional development should be a core requirement
• every therapist working in CAM should have a clear understanding of the principles of evidence base medicine and healthcare
• all CAM training should also define the limits of competence of their training
• in relation to conventional practitioners, it stressed the importance of becoming familiar with CAM therapies. It concluded that education about CAM therapies within medical and nursing schools was currently too uneven and made suggestions to improve this position.
Research and development
The Committee highlighted the fact that very little high quality CAM research existed because of
• a lack of training in the principles and methods of research
• inadequate research funding
• poor research structure within the CAM field
• methodological issues
As a result of these deficiences it recommended the establishment of a central mechanism to co-ordinate and advise on CAM research with funding being made available on a pump-priming basis by government. This would be the first step in enabling CAM to build up an evidence base with the same rigour as that required of conventional medicine.
The Committee identified that there was a clear need for effective guidance for the public on what does and does not work, which is not currently available. It recommended that central resources be made available to ensure that the public has access to balanced and fair advice on CAM.
The Committee recommended that there should be more integration between CAM and conventional medicine and urged CAM practitioners and GPs to keep an open mind about each other's ability to help their patients.
The Committee was concerned that patients could miss out on conventional medicine and medical diagnosis and recommended that all NHS provision of CAM should therefore continue to be through GP referrals. It also stressed that CAM disciplines should confirm their willingness to refer patients to conventional medical care when appropriate.
Importantly it decided that whilst it would be unfair to restrict NHS provision to only those CAM therapies with the firmly established evidence base, it however recommended that only those CAM therapies which are statutorily regulated or have robust systems of voluntary regulation should be made available through public funding.
'Complementary and Alternative Medicine' is the Sixth Report from the House of Lords Select Committee on Science and Technology. It is published by the Stationery Office (HL Paper 123), ISBN 0 10 483100 6, £15.50. The text of the report is also available on the Parliamentary website www.publications.parliament.uk/pa/ld/ldsctech.htm
The Foundation's viewpoint
We welcome the report and its recommendations. In particular we support:
• the emphasis that has been given to public safety and the need for effective regulation
• the positive proposals on the need for new funding for CAM research and better information for the public
We are concerned that:
• with other pressures on the NHS funding may not be readily available
• the capacity within the complementary sector to respond to these challenges is underdeveloped