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Complementary medicine roundup June 2018

THE NEED FOR A CAM LOBBY GROUP

Not for the first time, I add my voice to those of many others who advocate the benefits of CAM and call upon its practitioners and their professional organisations and regulators to combine to effectively present the case for CAM, before it is too late.

If anyone believes that Brexit will lead to a greater freedom to facilitate and use CAM, I fear they are mistaken. The Government, particularly as represented by the Department of Health and the National Health Service (NHS), together with the devolved UK health services, are simply not sufficiently engaged to assess, implement or permit a network of CAM services to serve patients within the UK public health and social care sectors, notwithstanding the guidance given by Health Education England. This is so despite the acceptance of CAM by the World Health Organisation (WHO), by many EU member states and in other countries across the world.

I believe this lack of engagement will continue until it can be successfully presented that, first, there is an active and combined CAM lobby group consisting of practitioners, patients, professional membership organisations, regulators and others promoting and using CAM and integrative medicine; secondly, that CAM is, insofar as it is possible and appropriate, evidenced-based (which, as I have argued in my August 2017 blog, should not be construed to mean exclusively by way of Randomised Controlled Trials), and thirdly, that CAM is cost-efficient and, preferably, actually saves money for the health and social care budgets.

Depressingly, it is the first of the above 3 requirements (the need for a pro-active CAM lobby group) that is so necessary but lacking. Surely, all professionals concerned could focus on what can be done about this omission?

Detailed analysis (193 pages) of the contribution by CAM to the NHS may be viewed in The Role of Complementary and Alternative Medicine in the NHS: An investigation into the Potential Contribution of Mainstream Complementary Therapies to Healthcare in the UK led by Christopher Smallwood and in other research papers, including those identified in my February 2017 blog.

 

CAM AND “EFFECTIVENESS GAPS”

The Smallwood Report refers to the potential of CAM where there are effectiveness gaps (EGs), being areas of clinical practice in which available treatments are not fully effective. CAM and EGs are further explored in the research paper Effectiveness gaps: a new concept for evaluating health service and research needs applied to complementary and alternative medicine, which, in part, concludes:

‘…Specifically, where effective CAM interventions exist but are not being applied, EGs form part of the “avoidable burden of illness” identified by early work on evidence-based medicine. Practice guidelines should incorporate CAM interventions where there is evidence. The CAM research agenda should focus on areas affected by EGs…’

A CAM Lobby Group could focus its combined strengths to initiate and support the search for funding to research the contribution of CAM to EGs or to pursue the aims identified in the paper The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations, described as follows:

‘… to review evaluations and audits of primary care complementary therapy services to determine the impact of these services on improving health outcomes and reducing NHS costs. Our intention is to help service users, service providers, clinicians and NHS commissioners make informed decisions about the potential of NHS based complementary therapy services…’

An interesting article in the London Journal of Primary Care (2008), also citing useful links, is Complementary Therapies in the NHS: some thoughts and three cases (David Peters) .

The integrated medicine approach is in the best interests of patients, whether in the public (NHS & Social Care) or private health sectors. Furthermore, integrative medicine is highly likely to be the desired option of a substantial number of those patients.

PATIENTS CALL FOR CAM SERVICES

It has been estimated that at least one in ten of the population use CAM for which they are either willing to pay or are able to receive from practitioners who are working, often on a voluntary basis, within the NHS and other public or third sector (i.e. charitable) organisations. Other (in 2003) ‘…stringent estimates of use suggested that between 6.6% and 20% of the population has utilised CAM in the previous 12 months…’ (Tremendous Growth in Consumer Choice for Complementary and Alternative Medicine: BMJ 2003; 326; 348).

For many years research has ‘…found that people who use CAM therapies are more likely to express a sense of greater control over their lives as a result of being given guidance on how to help themselves, and described great satisfaction in this new self-reliance…’ (Source: Complementary and Alternative Medicine and patient choice in primary care; Barnett. H, 2007 and Sharma U. Complementary Medicine Today: practitioners and patients. London; Routledge, 1992).

Failing to acknowledge this, patient preference has been found to be “insignificant” in the decisions of (some) management and clinicians, as revealed by the research paper Patient choice and evidence based decisions: The case for complementary therapies (2009), which concluded:

‘…In the case of NHS complementary therapy service provision, patient preference may be largely insignificant in clinician and PCT managerial decisions, with decisions based mainly on ‘evidence rhetoric’ devised from collectively agreed, unchallenged, tacit perceptions of research literature. If a patient-led NHS is to become a reality, NHS professionals need to cede the power that they wield with evidence rhetoric and acknowledge the legitimacy of patient preferences, views and alternative sources of evidence…’

It follows that there is a need for a truly combined and representative CAM lobby group that is ready, willing and able to present the case for CAM in every context and at short notice, including to NHS management, health professionals, CAM sceptics and the media.