Complementary medicine has come a long way since the British Medical Journal dismissed it as a “flight from sciences” and suggested chiropractic was no better than the “examination of a bird’s entrails”.
As many as one in five of us opts at some time for such treatments, and the the relationship between complementary therapies and science is distinctly warmer. But the thaw is not without lumps of ice. A report by the Lords Select Committee on Science and Technology has highlighted an urgent need for more research into alternatives to orthodox medical practice.
It makes good sense to evaluate complementary and alternative therapies. For one thing, since an estimated £1.6 billion is spent each year on them, then we want value for our money. The very popularity of the non-conventional approaches suggests that people are either dissatisfied with their orthodox treatment, or they find genuine relief in such therapies. Whatever the case, if they are proved to work, they should be made more widely available on the NHS.
There is already a greater acceptance of complementary medicine among healthcare professionals. About 40 per cent of GP practices offer access to some form of non-conventional treatment such as osteopathy or homoeopathy.
Acupuncture is increasingly routine in pain and rheumatology clinics, and in more than 90 per cent of hospices soothing therapies such as massage and aromatherapy are available. NHS cancer patients at Charing Cross and Hammersmith Hospitals can receive a wide choice of treatments from the complementary therapies team — reflexology, aromatherapy, massage therapy, relaxation training and art therapy.
But there remains the cry from the medical establishment of “where’s the proof?” — and clinical trials of the calibre that science demands cost money. For instance, there should be sufficient numbers of subjects — a trial that involves 300 or 3,000 people will obviously carry more weight than one with 13 or 30. And there should be a control, against which the treatment being tested is shown to perform better than the current treatment of choice.
The truth is that funding in the UK for research into complementary medicine is pitiful. NHS primary care groups and health authorities are reluctant to spend large sums on non-conventional approaches without evidence of cost-effectiveness and efficacy. But because so few complementary and alternative therapies are available on the NHS, there is little incentive to divert scarce funds into research. Truly a Catch-22 situation.
Much of the research funding for conventional medicine is from eminent bodies that are usually reluctant to muddy their reputation by delving into unorthodox waters, and from rich pharmaceutical companies. But few non-conventional therapies involve medication, and even where they do — as with herbal and homoeopathic remedies — the manufacturers are small companies with limited funds for research.
So where can funding come from? Many of the serious studies into complementary and alternative medicine have been carried out abroad. In the United States, for example, the Government’s National Centre for Complementary and Alternative Medicine (NCCAM) has a research budget of $68 million (£42.5 million) a year, expected to rise to more than $78 million in 2001. The money is used to fund 11 research centres across the country which evaluate alternative treatment for chronic health conditions such as asthma, arthritis and addictions. NCCAM also collaborates with other government organisations; for example, with the US National Cancer Institutes.
And in the UK? Figures from the department of complementary medicine at the University of Exeter show that less than 8p out of every £100 of NHS funds for medical research was spent on complementary medicine. In 1998-99 the Medical Research Council spent no money on it at all, and in 1999 only 0.05 per cent of the total research budget of UK medical charities went to this area.
The Arthritis Research Campaign is one of few such organisations to take account of the huge rise in the numbers of people using non-conventional therapies. It has announced funding into complementary and alternative therapies, beginning with a two-year clinical trial into the effects of acupuncture on patients with osteoarthritis of the knee.
What, then, is to be done? A national strategy for complementary and alternative medicine research would be a start. With new funding, the Foundation for Integrated Medicine, of which I am the president and founder, could provide a focus to co-ordinate this strategy, allocate funding, provide a networking resource, train researchers, disseminate information and monitor research development.
But serious funding is also needed for bursaries, fellowships, research centres linked to higher education institutes and to support “fledgeling” researchers, whether complementary practitioners with little experience of trial protocols, or old science hands unschooled in complementary medicine.
At the same time, we should be mindful that clinically controlled trials alone are not the only prerequisites to apply a healthcare intervention. Consumer-based surveys can explore why people choose complementary and alternative medicine and tease out the therapeutic powers of belief and trust.
A potentially powerful resource is at our fingertips, but its benefits will be limited — and often those who can least afford to pay for complementary medicine are the ones who would most benefit — unless somewhere, somehow, purses are opened and funds dedicated to its systematic study.