In 1997 the Foundation for Integrated Medicine, of which I am the president and founder, identified research and development based on rigorous scientific evidence as one of the keys to the medical establishment's acceptance of non-conventional approaches.
The fact that more people in the United Kingdom are turning to complementary and alternative medicine - and a BBC poll showed that one in five of us opts at some time for some kind of non-conventional therapy - has prompted an investigation into its use by the House of Lords, no less. Complementary medicine has come a long way since the days when the British Medical Journal dismissed it as a 'flight from science' and suggested chiropractic was no better than 'examination of a bird's entrails'.
Nowadays the relationship between complementary therapies and science is distinctly warmer. There are even signs of mutual curiosity. But the thaw is not without lumps of ice. The Lords' Select Committee on Science and Technology published its report on complementary and alternative medicine this week and, unsurprisingly perhaps, highlighted an urgent need for more research into treatments that use methods that offer either an alternative to, or are complementary to, orthodox medical practice. Are these therapies as good as orthodox medicine, or even in some instances better? If so, which therapies and for which conditions?
In 1997 the Foundation for Integrated Medicine, of which I am the president and founder, identified research and development based on rigorous scientific evidence as one of the keys to the medical establishment's acceptance of non-conventional approaches.
It makes sense to evaluate complementary and alternative therapies. For one thing, if we as consumers are spending considerable sums of money on such treatments - and current estimates put the figure at £1.6 billion a year in this country - then we want value for our money. The very popularity of non-conventional approaches suggests that people are either dissatisfied with the kind of orthodox treatment they are receiving, or find genuine relief in such therapies. Whatever the case, it is only reasonable to try to identify the factors that are contributing to their increased use. And if advantages are found, clearly they should not be limited only to those people who can pay, but should be made more widely available on the NHS.
Already, good evidence exists that some complementary medical treatments can help certain conditions. The traditional herbal remedy of St John's Wort, for example, has been found to work as well as tricyclic antidepressants in treating mild to moderate depression, with fewer side effects. Admittedly, there are reservations about its interaction with particular drugs - but sufficient science-based support is there to warrant its prescription in trained hands.
Saw palmetto, too, has been shown - in the prestigious journal, American Medical Association - to help relieve the symptoms of benign prostate problems. And a number of good studies have demonstrated that acupuncture can alleviate pain and nausea - enough evidence, indeed, for the British Medical Association to recommend its use in these areas earlier this year.
Complementary medicine is gaining a toehold on the rockface of medical science. This goes along with its greater acceptance among healthcare professionals - about 40% of GP practices offer access to some form of non-conventional treatment such as osteopathy or homeopathy. Acupuncture is increasingly routine in pain and rheumatology clinics, and in over 90% of hospices soothing therapies like massage and aromatherapy are available. NHS cancer patients at Charing Cross and Hammersmith Hospitals can receive a wider choice of treatments from the complementary therapies team - reflexology, aromatherapy, massage therapy, relaxation training and art therapy - that are especially helpful in offsetting the side- effects of potentially stressful procedures like chemotherapy and radiotherapy.
All well and good, but the greater the public pressure for integration of complementary and conventional medicine, the greater the cry from the medical establishment of 'where's the proof?' Complementary medicine's toehold is literally that, and it's an inescapable fact that clinical trials, of the calibre that medical science demands, cost money. For instance, there should be sufficient numbers of subjects - a trial that involves 300 or 3000 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. These strictures can be difficult to meet in complementary therapies. Supposing, for example, as in the so-called double blind trial that you want neither the patient nor the practitioner to know whether they have received conventional or unconventional treatment?
The truth is that funding in the UK for research into complementary medicine is pitiful. NHS primary care groups and health authorities quite reasonably are loath to spend significant sums of money 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 an archetypal Catch 22 situation. The tragedy is that, even in priority areas like cancer and heart disease, there are well-founded suggestions that additional simple interventions like aromatherapy, meditation and t'ai chi could save thousands of pounds in medication costs and improve quality of life by relieving anxiety and reducing high blood pressure.
Conventional medicine derives much of its research funding from eminent bodies that are largely reluctant to muddy their reputation by delving into unorthodox waters, and from pharmaceutical companies. The latter spend vast sums on the manufacture and testing of synthetic drug products that can yield even vaster profits. But few non-conventional therapies involve medication, and even where they do - as with herbal and homeopathic remedies - the manufacturers are small companies who simply do not have the funds for the kind of large scale fundamental testing required.
So where can funding come from? Many of the serious studies into complementary and alternative medicine to date have been carried out abroad. In the US, the government's National Center for Complementary and Alternative Medicine (NCCAM) has a research budget of $68 million (dollars) 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 governmental institutes; for example, with the US National Cancer Institutes to evaluate complementary and alternative medicine in cancer treatment and prevention.
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% 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 could provide a focus to coordinate 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 'fledgling' 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 pre-requisites 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.
