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NHS told to abandon alternative medicine
· Top doctors say money should go to
conventional treatment
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A GROUP of Britain’s leading doctors has urged every NHS
trust to stop paying for alternative medicine and to use the money for
conventional treatments. Their appeal is a direct challenge to the Prince of Wales’s outspoken
campaign to widen access to complementary therapies.
Public funding of “unproven or disproved treatments” such as homoeopathy
and reflexology, which are promoted by the Prince, is unacceptable while
huge NHS deficits are forcing trusts to sack nurses and limit access to
life-saving drugs, the doctors say. The 13 scientists, who include some of the most eminent names in British
medicine, have written to the chief executives of all 476 acute and primary
care trusts to demand that only evidence-based therapies are provided free
to patients. Their letter, seen by The Times, has been sent as the Prince
today steps up his crusade for increased provision of alternative treatments
with a controversial speech to the World Health Organisation assembly in
Geneva. The Prince, who was yesterday given a lesson in crystal therapy while
touring a complementary health unit in Merthyr Tydfil, will ask the WHO to
embrace alternative therapies in the fight against serious disease. His
views have outraged clinicians and researchers, who claim that many of the
therapies that he advocates have been shown to be ineffective in trials or
have never been properly tested. The letter criticises two of his flagship initiatives on complementary
medicine: a government-funded patient guide prepared by his Foundation for
Integrated Medicine, and the Smallwood report last year, which he
commissioned to make a financial case for increasing NHS provision. Both documents, it is claimed, give misleading information about
scientific support for therapies such as homoeopathy, described as “an
implausible treatment for which over a dozen systematic reviews have failed
to produce convincing evidence of effectiveness”. The letter’s signatories include Sir James Black, who won the Nobel
Prize for Medicine in 1988, and Sir Keith Peters, president of the Academy
of Medical Science, which represents Britain’s leading clinical
researchers. It was organised by Michael Baum, Emeritus Professor of Surgery at
University College London, and other supporters include six Fellows of the
Royal Society, Britain’s national academy of science, and Professor Edzard
Ernst, of the Peninsula Medical School in Exeter, who holds the UK’s first
chair in complementary medicine. The doctors ask trust chief executives to review their policies so that
patients are given accurate information, and not to waste scarce resources
on therapies that have not been shown to work by rigorous clinical trials. They conclude: “At a time when the NHS is under intense pressure,
patients, the public and the NHS are best served by using the available
funds for treatments that are based on solid evidence.” Professor Baum, a cancer specialist, said that he had organised the
letter because of his “utter despair” at growing NHS acceptance of
alternative treatments while drugs of proven effectiveness are being
withheld. “At a time when we are struggling to gain access for our patients
to Herceptin, which is absolutely proven to extend survival in breast
cancer, I find it appalling that the NHS should be funding a therapy like
homoeopathy that is utterly bogus,” he said. He said that he was happy for the NHS to offer the treatments once
research has proven them effective, such as acupuncture for pain relief,
but that very few had reached the required standards. “If people want to spend their own money on it, fine, but it shouldn’t
be NHS money.” The Department of Health does not keep figures on the total NHS spending
on alternative medicine, but Britain’s total market is estimated at £1.6
billion. ______________________________________
There are two particular developments to which we would like to draw
your attention. First, there is now overt promotion of homeopathy in parts
of the NHS (including the NHS Direct website). It is an implausible
treatment for which over a dozen systematic reviews have failed to produce
convincing evidence of effectiveness. Despite this, a recently-published
patient guide, promoting use of homeopathy without making the lack of
proven efficacy clear to patients, is being made available through
government funding. Further suggestions about benefits of homeopathy in the
treatment of asthma have been made in the ‘Smallwood Report’ and in another
publication by the Department of Health designed to give primary care
groups “a basic source of reference on complementary and alternative
therapies.” A Cochrane review of all relevant studies, however, failed to
confirm any benefits for asthma treatment. There are two particular developments to which we would
like to draw your attention. First, there is now overt promotion of homeopathy
in parts of the NHS (including the NHS Direct website). It is an
implausible treatment for which over a dozen systematic reviews have failed
to produce convincing evidence of effectiveness. Despite this, a
recently-published patient guide, promoting use of homeopathy without
making the lack of proven efficacy clear to patients, is being made
available through government funding. Further suggestions about benefits of
homeopathy in the treatment of asthma have been made in the ‘Smallwood
Report’ and in another publication by the Department of Health designed to
give primary care groups “a basic source of reference on complementary and
alternative therapies.” A Cochrane review of all relevant studies, however,
failed to confirm any benefits for asthma treatment. Secondly, as you may know, there has been a concerted campaign to
promote complementary and alternative medicine as a component of healthcare
provision. Treatments covered by this definition include some which have
not been tested as pharmaceutical products, but which are known to cause
adverse effects, and others that have no demonstrable benefits. While
medical practice must remain open to new discoveries for which there is
convincing evidence, including any branded as ‘alternative’, it would be
highly irresponsible to embrace any medicine as though it were a matter of
principle. At a time when the NHS is under intense pressure, patients, the public
and the NHS are best served by using the available funds for treatments
that are based on solid evidence. Furthermore, as someone in a position of
accountability for resource distribution, you will be familiar with just
how publicly emotive the decisions concerning which therapies to provide
under the NHS can be; our ability to explain and justify to patients the
selection of treatments, and to account for expenditure on them more
widely, is compromised if we abandon our reference to evidence. We
are sensitive to the needs of patients for complementary care to enhance
well-being and for spiritual support to deal with the fear of death at a
time of critical illness, all of which can be supported through services
already available within the NHS without resorting to false claims. These are not trivial matters. We urge you to take an early opportunity to
review practice in your own trust with a view to ensuring that patients do
not receive misleading information about the effectiveness of alternative
medicines. We would also ask you to write to the Department of Health
requesting evidence-based information for trusts and for patients with
respect to alternative medicine. Yours sincerely Professor Michael Baum and Professor Edzard Ernst (All the usual suspects...Zeus) |
