Acupuncture and it's impact in the UK Health Service

[Guest guest]

Hi all,

 

Taken from: http://www.guardian.co.uk/g2/story/0,,1330371,00.html

 

Medicine man

 

Edzard Ernst

Tuesday October 19, 2004

 

Britain is about to embark upon the most significant development in

healthcare since the creation of the NHS in 1948. At least this is

what some newspaper reports seem to indicate. According to the Daily

Telegraph, treatments such as acupuncture, homeopathy, osteopathy

and aromatherapy will soon be available on the NHS at no extra cost

to patients.

Prince Charles and Peter Hain, the leader of the House of Commons,

support the action. Britain's 20,000 GPs will be instructed to refer

patients to the UK's estimated 50,000 complementary medicine

practitioners. Hain, who is also Secretary of State for Wales,

said: " I would like to see Wales act as a model for further

development of alternative medicine " .

 

Is the country going mad or are we about to reform UK healthcare for

the better? Caution has been voiced by several leading experts. Dr

Hamish Meldrum, the chair of the BMA's GP committee, warned

that " regulation of complementary medicine is, at least, imperfect " .

Dr Tony Colland, chair of the BMA's Welsh Council, urged: " With the

NHS in Wales in such a critical state, any unproven or

unconventional treatment is ill-advised " .

 

Dr Richard Lewis, Welsh secretary of the BMA, says: " Much

complementary medicine is not evidence-based ... but anecdotal, and

until it is, the BMA would find it difficult to support funding it

at the expense of evidence-based, clinically proven medicine. "

 

Of course, complementary medicine should be used routinely where it

demonstrably generates more good than harm for patients. This means

that treatments have to be tested and proven to be reasonably safe,

effective and good value for money. There are dozens of unproven

treatments for hundreds of conditions, so even with adequate

funding, it would need a decades-long effort to generate the data

required.

 

But perhaps the British public doesn't want to wait until scientists

have finally done their homework, and perhaps the UK government

feels the pressure to do something positive now. Rather than running

blindly into unknown territory without any concept whatsoever, we

should first consider the existing evidence. What do we know beyond

reasonable doubt about complementary medicine? There are numerous

treatments that are backed up by excellent data from rigorous

clinical trials. To name just three: acupuncture alleviates nausea

and vomiting, caused, for instance, by cancer therapies; autogenic

training reduces stress in a range of situations and St John's Wort

helps with mild or moderate depression.

 

There are also numerous alternative therapies that have been

reasonably well-researched without yielding convincing evidence that

they work. For example: chiropractic manipulations are not superior

to conventional treatments for back or neck pain, chelation therapy

(an infusion into the blood, designed to eliminate excess calcium

and toxins) does not help circulatory problems.

 

There is already sound evidence to guide healthcare decisions.

Implementing it now should satisfy the government and the public.

More importantly, it could improve the NHS. All that is needed is

the input of independent experts who have this knowledge.

 

Peter Hain argues: " Our first baby was born with eczema ... and

asthma. It was only when - in desperation - we turned to homeopathy

and radical changes in diet that both ailments went away. " But this

is hardly a sound basis for decisions about the future of the NHS.

 

Acting on existing evidence is hardly enough. " For every one

definitive piece of evidence that we have about the effectiveness of

complementary therapies, there are 50 gaps, " says Dr Clive Wood -

the former editor of the British Journal of Holistic Medicine - of

Mr Hain's plans . What we need is a firm government commitment to

fund the research that is essential for filling these innumerable

gaps.

 

The worst thing that could happen to the NHS is that we introduce

double standards - opinion-based medicine in the realm of

complementary therapy and evidence-based medicine for all the rest.

Unfortunately, this is precisely what the incompetent waffle

about " integrated medicine " seems to be about. Let's not go back to

the dark ages for the sake of a politically correct election

gimmick.

 

 

· Edzard Ernst is professor of complementary medicine at the

Peninsula Medicine School at the universities of Exeter and Plymouth.

 

 

Attilio - I do agree that TCM should try and fit into a RCT model,

yet looking at WM in RCT it's not so clear. WM in RCTs is often

twisted by stat. manipulation. The targeted symtpoms disapate but

cause new symptoms. The pattern simply moves from one manifestation

to another. Also, carpet WM across the population doesn't work as

quoted by the head of Glaxo-Welcome.

 

I think the whole role and structure of the RCT will have to change.

Not only so it can include TCM, but also to gain lost WM

respectability amongst the patients. Drug companies need to be a bit

more honest and of course this will hit profits, but if they don't,

it's their own downfall. TCM can only go from strength to strength.

With proper regulation and education we can prevent herbal mishaps

that gave the whole field a bad image.

 

I can't say i know how the RCT model can change, i just know that it

has to and will. Perhaps Karl Popper has the answer?