COMPLEMENTARY MEDICINE NEWSLETTER – MARCH 2018
In this issue, my principle focus is on cancer and the use of Complementary and Alternative Medicine (CAM).
I also continue the theme of my December 2017 blog that CAM practitioners should be properly recognised by the public health and social care sectors, including within the National Health Service(NHS).
CAM practitioners and their patients must mobilise now to confront what appears to be a creeping polarisation between, respectively, the practise of CAM and orthodox/conventional medicine in the public sector. This has become apparent over the past 10 years. Today the professional expertise of CAM practitioners is urgently needed, especially within the NHS.
Practitioners of CAM are frequently called upon to provide a therapy to relieve the symptoms of cancer or the side-effects of treatment prescribed by a Consultant/Oncologist, sometimes as part of an integrated (possibly palliative) treatment plan, through which the patient aims to receive the best of CAM and orthodox medicine, or to provide such relief where no further orthodox medical treatments are either available to or desired by the patient.
THE CANCER ACT 1939: RELEVANCE TO CAM PRACTITIONERS
Practitioners of CAM will be aware that it is a criminal offence to take part in the publication of advertising of advice, treatments or remedies to a person who is either suffering, or suspected to be suffering, from cancer (see: Sections 4 and 5(2), Cancer Act 1939).
Cancer has been described as:
‘…a diverse class of diseases characterized by uncontrolled cell growth that constitutes the greatest cause of mortality and morbidity worldwide. Despite steady progress, the treatment modalities of cancer are still insufficient…’
Sections 4 (1) and 5 (2) of the Cancer Act 1939 provide, among other things, that:
‘…4 (1) No person shall take any part in the publication of any advertisement – (a) containing an offer to treat any person for cancer, or to prescribe any remedy therefore, or to give any advice in connection with the treatment thereof…’ [and further that] ‘…(8) In this section the expression “advertisement” includes any notice, circular, label, wrapper or other document, and any announcement made orally or by any means of producing or transmitting sounds…’
‘…5 (2) In this Act references to persons suffering from cancer shall be construed as including references to persons suspected to be so suffering…’
As always, this newsletter does not constitute legal, medical or other advice. If you are in any doubt about how this (or any other) legislation may affect you or your practice, I recommend that you seek the advice of a legal professional. Practitioners should also obtain any guidance and advice that is available from their professional membership organisation and regulator.
It is well known that CAM practitioners perform an immensely valuable professional healthcare role when practising in public (including NHS) and private sector surgeries, clinics, medical centres, cancer centres, hospital oncology departments, hospices and palliative care centres, often on a voluntary basis and following referral by a General Medical Practitioner (GP), a Hospital Consultant or other health professional.
THE COMPLEMENTARY AND NATURAL HEALTHCARE COUNCIL
In its February 2016 Newsupdate (issue 76) The Complementary and Natural Healthcare Council (CNHC), confirmed that its response to the (then) National Institute of Care Excellence (NICE) proposal to remove complementary therapies from supportive and palliative guidelines included the following key points:
‘…The provision of complementary therapies is demanded by patients hence the services provided. Approximately 40% of breast and prostate patients use complementary therapies and 20% of patients with other cancers. The evidence and audits are very patient-centred and almost always supportive of the service and what it has to offer. Complementary therapies are provided for patients, service users, carers and family members in almost every cancer and palliative care service in the country. Some of the most renowned cancer and palliative centres such as the Royal Marsden NHS Foundation Trust, Guy’s and St Thomas’s NHS Foundation Trust, St George’s University Hospital NHS Foundation Trust, the Christie NHS Foundation Trust and a wide range of hospices and Macmillan cancer centres provide complementary therapies as an integral part of their supportive and palliative care services…Complementary Therapies are now so embedded in the culture of cancer and palliative care that without proper guidance the door will be left open for ad hoc and unsafe practice, without reference to an evidence base. This would be a retrograde step and impinge on patient care and safe practice…’
The CNHC further confirms the contribution by complementary health practitioners, particularly in the cancer and palliative care sector, in its response to the Charity Commission Consultation (2017).
THE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE)
In March 2004, the (then called) National Institute for Clinical Excellence (NICE) published information and a guidance manual on cancer services titled Improving Supportive and Palliative Care for Adults with Cancer, section 11 of which (pages 148 to 154) provides guidance on the use of ‘complementary therapy services’.
My November 2016 blog referred to current project information published by the (now renamed) National Institute for Health and Care Excellence under the heading End of life care for adults in the last year of life: service delivery for which a publication is expected on 18.07.18 that will continue to include recommendations for complementary healthcare.
THE ROYAL MARSDEN NHS FOUNDATION TRUST
The Royal Marsden NHS Foundation Trust, London, in its patient information publication Your guide to support, practical help and complementary therapies (page 7), defines integrated care, as follows:
‘…Integrated care’ refers to complementary therapies which run alongside the standard medical care that you receive, either as an inpatient or an outpatient. It aims to take into account all your individual needs, and treats you as a whole person. Complementary therapies may include treatments such as acupuncture, massage therapy, reflexology and relaxation techniques. We encourage you to discuss with your medical team any complementary therapies you are having, or thinking of having, either from The Royal Marsden or from elsewhere. Some herbal and vitamin supplements interact with the drug treatment you may be receiving. The Trust therefore encourages patients and healthcare professionals to communicate with Medicines Information, Pharmacy and/or the Department of Nutrition and Dietetics, respectively, about using any herbs, homeopathic preparations, supplements, vitamins, minerals or exclusion diets. This is so that you can make an informed decision, particularly while you are having any form of active treatment for cancer…’
As evidenced above, there can be no doubt about the value of the appropriate, safe and cost-effective contribution by CAM Practitioners to relieving the symptoms of cancer and the side effects of cancer treatment.
CAM practitioners know that they should advise patients to inform their GP, Medical Consultant or other health professional that they are using CAM, whether in relation to cancer or any other health condition.
MACMILLAN CANCER SUPPORT & COMPLEMENTARY MEDICINE
The renowned registered charity Macmillan Cancer Support has, for some years, published its guide titled Cancer and Complementary Therapies. Online (as at January 2018), it describes the January 2017, 9th edition (MAC11645) as being:
‘…A realistic and balanced guide to the complementary therapies used by people living with cancer. These include mind therapies, physical therapies, acupuncture, complementary medicines, alternative therapies and psychological and self-help therapies. Also includes a list of relevant organisations and resources…’
On page 86 of the print version of that edition, it lists a sample of the sources used in the publication, namely:
Garcia MK et al. Systematic Review of Acupuncture in Cancer care: A Synthesis of the Evidence. Journal of Clinical Oncology. 2013; 31(7): 952-960;
Kassab S et al. Homeopathic medicines for the adverse effects of cancer treatments (Review). The Cochrane Library. 2010: Issue (11);
Lesi G et al. Acupunctire As an Integrative Approach for the Treatment of Hot Flushes in Women With Breast Cancer: A Prospective Multicenter Randomised Controlled Trial (AcCliMaT). Journal of Clinical Oncology. 2016; 34 (15): 1795-1802.
The Guide is due to be reviewed in 2019. Further Macmillan guidance on Complementary Therapies may be viewed here.
In view of this excellent publication, its invaluable other work and its charitable status, it is immensely regrettable that Macmillan did not respond to the recent Charity Commission Consultation on Complementary Medicine. For more information about this Consultation and an analysis of the probable reason for it, please refer to my May 2017 blog and August 2017 blog.
RESEARCH PAPERS, ARTICLES AND ORGANISATIONS CONCERNED WITH CANCER
As you would expect, there are countless research papers, articles and organisations investigating cancer-care and treatments.
Here are some preliminary sources:
PubMed: US National Library of Medicine, National Institutes of Health (search “Cancer”)
Cochrane Library (search “cancer”)
https://www.evidence.nhs.uk/ (search: “cancer-complementary medicine”)
HOSPITAL RESEARCH AND COURSES ON INTEGRATIVE ONCOLOGY: INITIATIVES IN HEIDELBERG, GERMANY
An editorial by the Carstens Foundation summarises an approach, which could be adopted by UK NHS and private sector hospitals, when it reports about courses provided by The Ev. Hospital Hamm:
‘…The Ev. Hospital Hamm (EVK) has been striving to treat its patients with a holistic approach for almost two decades. Thus, art therapists, psychoanalysts and pastoralists are integrated as well as the Institute for Traditional Chinese Medicine with its integrative treatment concepts.
For the inpatient and outpatient patients of the EVK, as well as for external patients, the offer of integrative modules is expanded. With different group therapies the mental stability is to be improved, the side effects are relieved and the inner power sources of the patients are opened up…’
Note opportunities for Complementary Medicine academic research initiatives such as that by the University of Heidelberg implementing a new doctoral dissertation titled Enlightenment of molecular mechanisms of action as the basis for an evidence-based complementary and integrative medicine set up by means of Baden-Württemberg’s state doctorate program (LGF); that is 4 Promotional Fellowships with a funding period of three years beginning on 1 October 2017 or possibly later. Also view details here and the announcement: 4 Postdoctoral positions in Naturopathy and Complementary Medicine: Carstens Foundation provides up to 1.2 million euros for science and research.
For updates on these CAM research and course initiatives (and much more) you can subscribe to the free, monthly Karl and Veronica Carstens Foundation Newsletter (for which an English translation is available) here.
PERSONALISED MEDICINE OFFERS NEW HOPE FOR PANCREATIC CANCER PATIENTS
On 24.11.17, the Alliance for Natural Health International (ANH-Intl) issued a press release under the above caption referring to a paper published in the peer-reviewed journal Integrative Molecular Medicinetitled Scientific rationale for integrative and personalised strategies for pancreatic ductal adenocarcinoma management, a review article (Peyda Korhan, Robert Verkerk and William R Critchley) which may be viewed here. The press release describes it as follows:
‘…The near exhaustive review article, which evaluates the multitude of genetic and environmental factors that influence pancreatic cancer, including a diverse range of emerging treatment options, is the result of a two-year collaboration between the Neuroscience Solutions to Cancer Research Group at Imperial College London and a non-profit active in the field of healthcare sustainability, the Alliance for Natural Health (ANH) International…’
Here is an extract from the paper sub-headed Potential application of integrative oncology for achieving optimal outcome and maximal QOL[i.e. Quality of Life]:
‘…Furthermore, the decrease in functional status and increase in disability that result from cancer and its treatment greatly affect the QOL of cancer survivors. Research has shown that evidence-based complementary approaches used in conjugation with standard medical treatments may help to facilitate health during both active oncology treatment and survivorship [267,268]. Complementary therapies include massage therapy, acupuncture, mind-body therapies, music therapy, physical exercise and nutrition and nutritional supplements and other modalities [269,270] Integrative Oncology serves to optimally combine conventional therapies and the best complementary therapies to positive influence outcomes and improve quality of life, whether or not a person is near the end of his or her life [265-268]. With the evolution of personalised cancer care and growing evidence to support the efficacy of multi-factorial, integrative therapies, personalised treatment plans might be more likely than conventional treatments on their own to meet the patients’ needs, while also helping to improve survival and QOL of people affected by cancer. The application of biomarkers to clinical practice may not only facilitate the design of personalised therapies and better predict clinical outcomes, but also provide information to improve survival and QOL. Biomarkers that are modifiable by physical activity, diet, stress and environmental factors may be useful to help plan personalised lifestyles and to monitor responses to interventions. For instance, relevant biomarkers for the observed associations among physical activity, overweight or obesity, and cancer are sex steroid hormones, hyperinsulinemia and insulin resistance, metabolic hormones, increased inflammation, depressed immune function, and oxidative stress …’
The review article concludes, among other things, that:
‘…Considering the limitations of current conventional chemotherapeutics, including serious toxicities and reduced QOL for cancer patients, the development of safe and efficacious supplementary or alternative interventions such as natural products with known/predictable mechanism of action seems to promote therapeutic efficacy while improving QOL. Further preclinical research followed by carefully designed clinical trials is highly necessary to accelerate the development of novel strategies offering best treatment to each patient. Personalised Medicine approach with lifestyle recommendations based on biomarkers may provide a novel means of assessing a PDAC patient’s health by empowering them with information they need to regain control of their life. It is hoped that incorporation of some of these approaches will go some way to improving QOL and survival for individuals with this devastating disease…’
Incidental to the personalised medicine approach is the NHS initiative referred to in the section of my December 2017 blog headed Integrated Personal Commissioning and Personal Health Budgets: Providing NHS Patients with CAM?
AROMATHERAPY AND PALLIATIVE CARE: A PILOT STUDY
Clinical Aromatherapists will be interested in the publication of the recent (October 2017) pilot study titled: Aroma oil therapy in palliative care: a pilot study with physiological parameters in conscious as well as unconscious patients[https://www.ncbi.nlm.nih.gov/pubmed/28634728], which concluded:
‘…Significant physiological reactions were measured after simulation with aroma oils in all three groups in this study. Healthy probands showed different reactions than palliative patients irrespective to their conscious state…’
An article about this study may be found here.
BAKING SODA CANCER THERAPY RESEARCH (US): MEDIA INTEREST & OUTCOME
Understandably, the media will eagerly report on any research that it perceives might have answers regarding the treatment of cancer.
This was the case with a biomedical engineering research proposal by the Arizona College of Engineering (University of Arizona) that was of interest to many CAM practitioners as it explored the medical properties of a non-toxic substance, baking soda. It appeared as a university news item (30.03.12) on UANews titled:
‘…Grant to Fuel Baking Soda Cancer Therapy Research: Drinking baking soda has been proven to reduce or eliminate the spread of breast cancer to the lungs, brain and bone, but too much of it can damage normal organs…’
My enquiries into the outcome of this research confirmed that it primarily focused on methods that measure tumour acidosis. The researchers tested baking soda to show that they could measure a change in pH in acidic tumours. It did not test baking soda as a treatment. The media, especially news outlets beyond the University of Arizona, picked up this story and morphed it to be more about treatment than diagnosis.
The Moffitt Cancer Center tested baking soda as a treatment. However, the clinical study was quickly suspended because patients could not drink enough soda to maintain a change in tumour pH. It was very unpleasant to drink in high concentrations so could not be recommended as a practical treatment.
RESEARCH INTO THE BENEFICIAL EFFECTS OF RESVERATROL
Resveratrol has, for many years, been of interest to CAM practitioners as a natural, plant-based, new concept, anti-cancer agent with chemo-preventive properties. Here are some links to research papers and articles:
‘…This review summarizes the known effects of resveratrol and its main metabolites on drug metabolism in order to help characterize which populations might benefit from resveratrol for the prevention of cancer, as well as those that may need to avoid supplementation due to potential drug interactions…’
‘…We conclude that resveratrol can modulate enzyme systems involved in carcinogen activation and detoxification, which may be one mechanism by which resveratrol inhibits carcinogenesis. However, pharmacologic doses of resveratrol could potentially lead to increased adverse drug reactions or altered drug efficacy due to inhibition or induction of certain CYPs. Further clinical development of resveratrol for cancer prevention should consider evaluation of lower doses of resveratrol to minimize adverse metabolic drug interactions…’
‘…These data indicate that resveratrol may exert lung cancer chemopreventive activity through altering the expression of genes involved in the metabolism of polycyclic aromatic hydrocarbons, resulting in altered formation of carcinogenic benzo[a]pyrene metabolites in human bronchial epithelial cells…’
‘…Many studies have reported the remarkable and significant properties of dietary plant polyphenols such as curcumin, resveratrol, flavopiridol, indirubin, magnolol, piceatannol, parthenolide, epigallocatechin gallate, and cucurbitacin as anticancer agents known for their pleiotropic effects on cancer, immune cells, and inflammation. Piceatannol, an analogue and metabolite of resveratrol, is a natural stilbene commonly found in grape skins and wine…This comprehensive review summarizes the current data regarding the mechanisms of action of piceatannol, its chemopreventive properties, and its possible therapeutic potential against various types of human cancer…’
UK GOVERNMENT AND NHS POLICY STATEMENTS CONCERNING RESEARCH INITIATIVES
If research is to enhance the NHS it needs the support and commitment of its health professionals and other staff, including those practising and working in primary care. Accordingly, research exploring the contribution of CAM to integrated medicine and healthcare requires that NHS professionals who are ready, willing and able to practise CAM within an NHS clinical setting should receive high-quality, well-informed and definitive guidance from their NHS employers, professional organisations and regulators. Is this happening?
COMPLEMENTARY THERAPIES IN NURSING, MIDWIFERY AND HEALTH VISITING PRACTICE: THE NEED FOR RCN GUIDANCE
NHS nursing, midwifery and health-care professionals are, rightly, held in high esteem especially by patients who have received their medical expertise, care and support.
A significant number of these professionals also hold one or more complementary therapy qualifications, which they desire to practise in the best interests of their patients. So it is reasonable to ask the question: Is their potential being made best use of within the NHS?Sadly and frustratingly, I suggest the answer to this must be “No”.
Writing on the College of Medicine website (Nurses are vital to progressive, integrated healthcare – because they have the trust of patients), Professor Dame Donna Kinnair opines:
‘…Nurses and midwives are in a unique position to ensure that every patient is able to access holistic care…For many of our patients, traditional medicines or clinical interventions are complemented by the use of a variety of herbal remedies, nutrition, acupuncture, mindfulness practices and yoga to name but a few…’
The Royal College of Nursing (RCN), describes itself as follows:
“The Royal College of Nursing is the world’s largest nursing union and professional body. We represent more than 435,000 nurses, student nurses, midwives and health care assistants in the UK and internationally.”
In 2003, the RCN produced its publication titled Complementary therapies in nursing, midwifery and health visiting practice: RCN guidance on integrating complementary therapies into clinical care (Publication code 002 204: October 2003) which consisted of 13, A4 size pages and, among other things, observed (page 3: The need for integration strategies):
‘…Complementary therapies are gaining in popularity (Ernst & White, 2000; Thomas et al, 2001) and finding a more substantial place in health care (Peters et al, 2002). Increasing interest amongst the public (Ong & Banks, 2003) and health care professionals seems to have created an assumption that complementary therapies are widely integrated into nursing and midwifery. Whether this is true is impossible to quantify, because there is no national strategy to collect data…’
[note: refer to my December 2017 blog section captioned: The need for statistical analysis of the use of CAM in the UK]
and continues (page 4: Which therapies are appropriate?):
‘…The therapies most frequently used by nurses and midwives, such as massage, aromatherapy and reflexology, come within the ‘comfort’ category. The most recent annual survey of RCN Complementary Therapy Nursing Forum Members (RCN, 2003a) shows that the use of Reiki healing by nurses has gained in popularity, and that acupuncture techniques are also used by a number of respondents in a variety of clinical settings. Members also showed a general interest in homeopathy. Issues have been raised about whether nurses can deliver the ‘whole’ therapy, and whether this is appropriate, or even possible, within clinical practice. For instance, nurses using essential oils are often not functioning as full aromatherapists – but they are using essential oils to enhance nursing care (Avis, 1999). Putting patients’ best interests first is the key that will help nurses to clarify the scope of intended practice…’
This 2003 RCN guidance concludes (page 11):
‘…it is the responsibility of each clinical area within employing organisations to define the parameters of practice, and to develop a framework for integration so that services are offered under the principles of clinical governance and professional nursing practice. The overarching philosophy must be the enhancement of safe, effective and appropriate patient care…’
The guidance focused on care that is in the best interests of the patient and indicates that registered healthcare professionals believe this should include the provision of complementary therapies.
Nevertheless, I am informed by the RCN that this guidance is ‘now obsolete and currently there is no replacement publication available’ although the RCN is currently ‘revisiting’ this omission and ‘having discussions about the public and member facing information [it]might need to develop’. As I write, there is only a brief (one page) section headed Complementary Therapies posted on the RCN website which may be viewed here.
For the benefit of its members and in the best interests of their patients, the publication of new, comprehensive and up-to-date RCNguidelines along the lines of those issued in 2003, which recognise the effective integration and use of complementary and alternative therapy, cannot come too soon.
Furthermore, this should be encouraged by the Nursing and Midwifery Council (the nursing and midwifery regulator for England, Wales, Scotland and Northern Ireland) and, where necessary, recommended in guidelines issued by the National Institute for Health and Care Excellence.
NHS IN CRISES: THE NEED TO INTEGRATE CAM
On page 11 of the Times newspaper dated 18.01.18, two press-reports appeared under, respectively, the headlines: GPs see over 40 patients a day and One in ten nurses leaves as NHS crisis deepens.
In the former, Mary McCarthy, vice-president of the European Union of General practitioners, is reported as saying the figures were “pretty dreadful” with British patients getting shorter appointments than elsewhere.
In the latter report, the RCN is reported as warning that the trend of more nurses leaving the health service than joining it will:
‘…lead to a lost generation of nurses. It is estimated that one in nine posts is vacant…’
and that, according to Janet Davies, head of the RCN:
“…We are haemorrhaging nurses at precisely the time when demand has never been higher…”
Arguably, one way of recruiting and retaining nursing staff would be to recognise, reward and make use of their hard-earned and properly regulated complementary therapy skills. This would enhance patient care and, to a significant extent, thereby reduce the pressure on GP appointments. With one in five doctors, according to a survey of 900 doctors by the GP magazine Pulse (reported in the first of the two reports mentioned above) doing more than 50 consultations a day, twice the number recommended under European safety guidance, this must be a sensible strategy which should be implemented without delay.
BREXIT: THE KING’S FUND UPDATE (13.12.17) & THE BREXIT HEALTH ALLIANCE (SUPPORTING HEALTHCARE AS THE UK LEAVES THE EU)
Added urgency for this strategy is revealed by this King’s Fundupdate. Also relevant are the aims of the Brexit Health Alliance.
In its comprehensive update: Brexit: the implications for health and social care the King’s Fund includes the following Key Message:
‘…Perhaps most importantly, if independent forecasts are correct and Brexit has a significant long term negative impact on the economy, this will reduce the funding available for health and social care…’
Again, this confirms the, surely irrefutable, proposition that the provision of cost-effective CAM services should be integrated into the health and social care sectors. I refer to the section of my December 2017 blog (paragraph 2) headed “A HEALTHCARE WORKFORCE IS READY AND WAITING…” See, also, the section below captioned “UNTAPPED RESOURCES: ACCREDITED REGISTERS IN THE WIDER WORKFORCE & COMPLEMENTARY THERAPY.”
Notwithstanding the logic of this proposition and the challenges presented by Brexit, I note that the recent Report of the King’s FundReimagining Community Services: making the most of our assets(23.01.18) which links to its reports on integrated care and a vision for the future of community-based health services, makes no express mention of CAM services. Readers may feel this is a serious, inexplicable and, yes, unimaginative oversight by the King’s Fund. This is regrettable in view of the often constructive support that CAM has received from the King’s Fund in the, admittedly not recent, past as identified in the third section of my December 2017 blog.
CAM professional organisations and regulators could seek to safeguard the interests of their members and, thereby, the interests of patients using CAM services, by lobbying, or by nominating a CAM representative for membership of, the Brexit Health Alliance (BHA), in recognition of the fact that CAM practitioners work within the NHS and also treat a significant percentage of the UK population in the private and corporate sectors. The BHA is described on its website as:
‘…Bringing together the NHS, medical research, industry, patients and public health organisations, the Brexit Health Alliance aims to safeguard the interests of patients and the healthcare and research they rely on during the Brexit negotiations…’
Further information about the Brexit Health Alliance may be viewed here.
NHS ENGLAND BOARD PAPER DATED 30.11.17: Items which should not be routinely prescribed in primary care – findings of consultation and next steps – for decision, re Homeopathy and Herbal Medicine
Contrary to the logic of the above and apparently ignoring the warning by the King’s Fund, the NHS England Board Paper(paragraphs 34 to 41 of the NHS England Board Paper, PB 30.11.2017/05 and paragraph 4.7 of Annex A), recommended as follows with regard to Homeopathy:
‘…38. Having considered the wide range of responses to our consultation, and taking into account of the findings of the SPS [Specialist Pharmacy Service] review, the clinical working group was of the view that the scientific review of the evidence should be preferred to the anecdotal evidence from patients and, notwithstanding what we perceive to be marginal cost issues, that the initial recommendations should stand…’
and in relation to Herbal Treatments:
‘…40. As with homeopathy, a large proportion of those who responded (approximately 40%) were self-identified patients, who expressed the view that herbal treatments are effective and safer than conventional medicines with fewer side effects. In contrast, 98% of CCGs and 66% of clinicians agreed that herbal treatments should not be initiated for new patients, and 93% of CCGs and 65% of clinicians agreed that herbal treatments should be de-prescribed for all patients. These groups highlighted that there is limited evidence of the effectiveness of herbal treatments…
41. The joint clinical working group reviewed the feedback and did not feel it necessary to amend the proposed recommendations for herbal treatments, and they remain unchanged…’
The NHS England Consultation (updated on 1st December 2017) titled: Items which should not be routinely prescribed in primary care: A Consultation on Guidance for CCGs has confirmed that NHS England ‘has taken action to reduce inappropriate prescribing of 18 medicines which will improve health and save millions of pounds a year’. This includes agreed plans recommending that herbal remediesand homeopathy be “blacklisted” and no longer be provided on the NHS by General Practitioners (GPs) and Clinical Commissioning Groups (CCGs), on the basis that:
‘… there is no clear or robust evidence to support its use…’
It is a cause for concern that, although the “large proportion of those who responded” to the NHS England Board Paper (PB 30) consultation was “self-identified patients” who supported the effectiveness and safety of homeopathy and herbal treatments, their views appeared to carry little weight. Also of concern, is the Board’s dismissal of the evidence of the cost-effectiveness of homeopathy as being simply “marginal cost issues.”
In 2016, against a total spend of £9.2 billion on prescription medicine by the NHS, only £92,412.00 was spent on Homeopathic treatments and £100,009.00 on Herbal Treatments. For further details search here. How much money does this clearly cost-effective treatment save the NHS? To what extent do patients receiving homeopathy and herbal treatments relieve the overall burden on the NHS? These are questions that should be explored and answered by NHS Digital. Refer to the section of my December 2017 newsletter/blog headed: THE NEED FOR STASTICAL ANALYSIS OF THE USE OF CAM IN THE UK
Review the outcome of the Board’s Paper and the proposed “blacklisting” by NHS England in the light of the British Medical Journal Clinical Evidence efficacy categorisations which find that only 11% of the 3000 (Randomised Controlled Trial) treatments (mainly involving drugs) reported are “Beneficial” and also contrast it with the objective of the Integrated personal commissioning and personal health budgets (IPC&PHB) policy initiatives promoted by NHS England (which aim to: “…promote a shift in power and decision-making, to enable a changed, more effective relationship between the NHS and the people it serves, aligning to the Five Year Forward View…”).
The British Homeopathic Association (BHA) is challenging the NHS England Consultation (which is now closed) on ‘items which should not be routinely prescribed in primary care’, insofar as it relates to homeopathy, by way of Judicial Review. Details of the challenge and how it is being funded may be viewed here and here.
It is clear from the above that the NHS England Board (30.11.17)objection with regard to homeopathy and herbal medicine is based on the alleged lack of its evidence-base. This is the case notwithstanding the views and wishes of many patients as to its effectiveness and also the existence of a comprehensive CAM evidence-base (including Randomised Controlled Trials), as has been extensively referred to in this and previous issues of my blog.
Meanwhile, the UK and Parliament Petition “Stop NHS England from removing herbal and homeopathic medicines” closes on 13th March 2018. Following the NHS England Board recommendation (above) and in view of the Government Response (Department of Health) to the Petition (endorsed on the Petition’s web-page), to date, there must be some doubt about the extent to which (if at all) the Department of Health will take account of the petitioners’ plea.
Further information about the IPC&PHB initiatives and the BMJ efficacy categorisations may be found in my December 2017 blog.
HOMEOPATHY: THE EUROPEAN COUNCIL OF SCIENCE ACADEMIES: ANALYSIS OF THE EASAC RECOMMENDATIONS FROM THE POINT OF VIEW OF EVIDENCE-BASED MEDICINE
The recommendations of the NHS England Board Paper and the views of the Department of Health noted above may be compared to those of the European Academies’ Science Advisory Council. Arguably, they all lack a full and proper perspective of the available evidence or take sufficient account of patient choice.
An article by Dr Jens Behnke of the Carstens Foundation reviews the statement/opinion (20.09.17) of the European Academies’ Science Advisory Council (EASAC) that contains recommendations about homeopathy from the point of view of evidence-based medicine in which “the authors try to formulate recommendations for decision-makers in the health system at European level”, may be viewed here. Dr Behnke’s analysis concludes with this assessment:
‘…The state of homeopathic research is not considered adequately in the opinion of the European Council of Science Academies: The main results of the research on homeopathy and the relevant reviews of controlled studies are not mentioned. Instead, there is a selective referencing of sources that have methodological discrepancies. The far-reaching demands made by EASAC can not be deduced from the available scientific evidence on homeopathy…’
THE COMMONWEALTH FUND: UK NHS FIRST IN OVERALL PERFORMANCE
As indicated above in relation to nurses and other RCN members, I, like most others, have the highest regard, admiration and respect for the objectives of the NHS and for the exemplary work of its staff, often undertaken in very difficult circumstances. These, I suggest, are sentiments held by medical professionals worldwide.
Writing in the Sunday Times newspaper on 15.10.17, Cally Palmer, National Cancer Director of NHS England, commented on the study (EC Schneider, DO Sarnak, D Squires, A Shah & MM Doty) by the Commonwealth Fund:
“…an independent health policy foundation based in New York, published its latest report comparing healthcare systems in 11 developed economies. The UK ranked first in performance overall and America came last…survival rates in the UK after diagnosis have never been higher…it is vital patients know of the progress made in Britain so they continue to have confidence in the NHS”
Practitioners of CAM will have, so far as they are permitted to do so, contributed to this outcome, for instance while working at the leading NHS Foundation Trust Hospitals identified by The Complementary and Natural Healthcare Council in its February 2016 News Update(see above).
“YES TO LIFE”: “STARTING THE CONVERSATION” ABOUT CANCER CARE
Initiatives promoting an integrative approach to cancer care include Yes to Life that defines its aims as follows:
‘…We want to change attitudes and make integrative cancer care (combining the best of conventional and complementary approaches) readily available so more people have the best chance of reclaiming their health. We provide support, information and financial assistance to those with cancer seeking to pursue approaches that are currently unavailable on the NHS…’
As organiser of the event (which has now ended) Starting the Conversation, that explored ways in which integrating conventional cancer care and lifestyle medicine can improve outcomes, Yes to Lifefacilitated a Conference on 25th November last year which presented the following Headline Speakers: Dr Rangan Chatterjee, Dr Rupy Aujla, Professor Robert Thomas, Dr Malcolm Kendrick and Sophie Sabbage together with other confirmed speakers, namely Robert Verkerk (Alliance of Natural health), Claudia Manchanda (Herbalist), Liz Butler (Body Soul Nutrition), Lizzy Davies (CanExercise), Justin Price (Regenerus: functional testing), Mark Boscher (Herts MS Therapy Centre), Dr Damien Downing (British Society for Integrative Oncology) and Catherine Zollman (Penny Brohn UK).
I list their names and details of some of the headline conference speakers here to demonstrate the diversity and expertise of those supporting this important integrative initiative.
AN INTEGRATED HEALTH PROPOSAL AND THE CASE FOR EXPLORING NATURAL CANCER CARE
Please refer to my February 2017 blog to review, once again, the research proposal launched by Dr Sandra Goodman, titled Cancer Patients’ Survival: Comparing Integrated Alternative Therapies and Chemotherapy/Radiotherapy Treatment which, surely, deserves the support of all health professionals (CAM and orthodox) and their patients.
As healthcare professionals, it is to be expected that cancer-care practitioners, academics and researchers should consider it their professional duty to analyse, understand and properly determine the clinical effectiveness of natural cancer treatments and that they should also acknowledge the extent to which non-toxic cancer treatment approaches are important to many patients, including to those who feel they have been abandoned by orthodox oncology.
To this end, they could start by reading the article The Suppression of a Natural Cancer Cure by Ty Bollinger before going on to read his book The Truth about Cancer (ISBN 978-1-4019-5223-5, published by Hay House in 2016) which has been reviewed here, including as follows:
‘…This is perhaps the most comprehensive, intelligible and well-researched book I have read in a long time which examines the political / historical / financial cancer saga, the dire consequences of most conventional treatments, as well as an in-depth elucidation of a myriad of non-toxic and clinically effective cancer treatment approaches…’
ENCOURAGING HEALTHCARE ORGANISATIONS TO ENGAGE WITH CAM
There is an urgent need for practitioners, their representatives and patients to engage with healthcare organisations and to lobby them to research and analyse the existing and potential contribution by CAM to the UK health and social care sectors. Such organisations could include:
The NHS Confederation which describes itself as “the authentic voice of NHS leadership” and as “the only membership body that brings together, and speaks on behalf of, the whole health and care system”;
The Nuffield Trust, “an independent health charity which aims to improve the quality of health care in the UK by providing evidenced-based research and policy analysis and informing and generating debate”;
The National Association of Primary Care “a national membership organisation representing and supporting the interests of all healthcare professionals, both clinicians and managers, working across the breadth of primary care. The organisation is at the centre of shaping the future of healthcare, spreading innovation, influencing policy, supporting and connecting professionals – enabling you to provide world-class sustainable patient-centred healthcare”;
Better Value Healthcare: which has a mission to “help health professionals and organisations achieve better health outcomes for individuals and populations, without using more money”;
NHS Improvement supports foundation trusts and NHS trusts to give patients consistently safe, high quality, compassionate care within the local health systems that are financially sustainable;
National Voices: “a coalition of health and social care charities in England that stands for people being in control of their health and care”;
Health watch: which describes its mission as: “independent national champion for people who use health and social care services. We’re here to make sure that those running services, and the government, put people at the heart of care”;
The Health Foundation an “independent charity committed to bringing about better health and health care for people in the UK.
It may be assumed that the aspirations pursued by these organisations accord with the overall aim of those practising CAM which is, to appropriate a quote from the Royal College of Nursing(RCN) 2003 guidance (referred to above): “Putting patients’ best interests first.”
Without delay, all healthcare organisations, including the above, should actively engage with CAM. As mentioned above, the NHS is enduring a funding and recruitment crises, particularly in the primary care sector. Now is the time to recognise the existing and potential contribution by CAM practitioners, including those who the NHS already employs as nursing, midwifery and health visiting professionals.
As I have tried to demonstrate in this newsletter, my understanding is that this is not happening at the moment. I urge everyone involved in health and social care to rectify this omission.
UNTAPPED RESOURCES: ACCREDITED REGISTERS IN THE WIDER WORKFORCE & COMPLEMENTARY THERAPY
Promoters of CAM and the healthcare organisations, including those referred to above, will find this publication useful.
Jointly published in November 2017 by The Professional Standards Authority and the Royal Society for Public Health, this report, which may be viewed here, confirms (pages 6 & 7) that there are 20,680 Complementary Therapy practitioners listed on accredited registersworking across the UK.
Included in the 15 most common occupations among respondents to an accredited registers workforce survey were: Reiki, Reflexology, Aromatherapy, Healing, Massage Therapy and Hypnotherapy. Other CAM practitioners are listed in a ‘breakdown of survey response by profession’ (page 30), as including: Acupuncture, Bowen Therapy, Yoga, Kinesiology, Naturopathy, CranioSacral Therapy, Shiatsu, Alexander Technique and Homeopathy.
These CAM practitioners promote public health. The report concludes (page 27) with regard to Complementary Therapy practitioners and other members of the accredited registers workforce:
‘…Practitioners on accredited registers make a large contribution to promoting the public’s health, and this report has drawn out some of the many ways they encourage and promote healthy behaviour and lifestyles in the UK. It is a key principle of the wider public health workforce that every contact between a professional and a member of the public can and should be capitalised upon in any number of ways to support their health and wellbeing. Despite this, it is clear that the large majority of AR practitioners consider themselves to be under-utilised in promoting the public’s health. Meeting the challenges outlined in this report will require the best practice in brief interventions, such as healthy conversations and accurate signposting advice, to be embedded more systematically in the AR workforce. Combined with the significant appetite among accredited registers to play a larger role in supporting the public’s health, the impact of these interventions can be extended as much as possible. With 80,000 practitioners now on accredited registers, many of whom naturally engage their clients in lifestyle discussions as part of their work already, this workforce should be recognised as an untapped resource, that has both the opportunity and ability to positively impact the public’s health…’
This is yet more proof of the contribution made by CAM practitioners to the health of the public.
INTEGRATED HEALTH AND WELL-BEING SERVICES: A QUALITIATIVE STUDY (2017)
Promoters could also refer to the article titled It is not a quick fix’ structural and contextual issues that affect implementation of integrated health and well-being services: a qualitiative study from North East England (Cheetham, M et al, November 2017) the objective of which was:
‘…to examine the factors affecting the design, commissioning and delivery of integrated health and well-being services (IHWSs), which seek to address multiple health-related behaviours, improve well-being and tackle health inequalities using holistic approaches…’
and which concluded:
‘…These findings provide useful learning in terms of the delivery and commissioning of similar IHWSs, contributing to understanding of the benefits and challenges of this model of working. [Abstract]…’
PLANS FOR 19 NEW INTEGRATED HEALTH AND CARE CENTRES ACROSS WALES BY 2021: AN OPPORTUNITY TO PRESENT CAM SERVICES
Here is some encouraging news from Wales which should present an opportunity for CAM practitioners and for patients seeking their services.
Health Secretary, Vaughan Gething, has announced funding of “up to” £68 million for the centres, adding:
“People in the 21st Century expect to be treated in modern, advanced health care centres that deliver a wide range of services all under one roof. We agree and by targeting investment in this way it is hoped that opportunities for delivering service change can be delivered upon.
…We’re funding the future of healthcare in Wales and the pipeline of projects I’m announcing today will make a significant difference to the care people receive closer to home in their communities.”
A key theme is integration and health boards are looking to work with a range of delivery partners. Practitioner organisations and their members could lobby the Health Secretary to include the provision of CAM services at the Centres as a contribution to the Taking Wales Forward commitment.
This announcement is also reported here.
USING YOGA FOR CHRONIC LOW BACK PAIN AND SCIATICA: NICE GUIDELINES (UPDATED) AND LINKS TO RESEARCH EVIDENCE
Turning now to a research update, readers of my August 2017 blogwill have read about the removal of acupuncture from the National Institute for Health & Care Excellence (NICE) guidelines for chronic low back pain and sciatica (paragraph 1.2.8).
I can now refer to updated NICE guidelines (30.11.16) that recommend the use of Yoga as a first step treatment:
‘…NICE’s updated guideline on low back pain and sciatica recommends exercise in all its forms – for example stretching, strengthening, aerobics or yoga – as the first step in managing the condition… The guideline also recommends encouraging people to continue with normal activities as far as possible. However the guideline says massage and manipulation should only be used with exercise because there is not enough evidence to show they are of benefit when used alone…’ (https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain)
These updated guidelines are also referred to in a BMJ “practice” article/ summary (BMJ 2017; 356: i6748 published on 06.01.17) , as follows:
‘…Consider exercises such as stretching, strengthening, aerobic, yoga, or Tai Chi in a group setting for all patients with low back pain and sciatica as the main component of non-invasive treatment…’
Further information may be found on the Yoga for Healthy Lower Backs Institute website.
Below are some links to research articles and evidence about the use of Yoga:
https://www.ncbi.nlm.nih.gov/pubmed/22041945 (Yoga for chronic low back pain: a randomised trial: 2011);
http://annals.org/aim/article/1033130/yoga-chronic-low-back-pain-randomized-trial (cost effective for NHS);
https://www.ncbi.nlm.nih.gov/pubmed/28076926 (Yoga treatment for chronic non-specific low back pain: 2017);
Information about Yoga for Healthy Lower Backs programme may be viewed here: http://www.yogaforbacks.co.uk/yoga-healthy-lower-backs-institute/.
Further research may be found here.
THE ADVERTISING STANDARDS AUTHORITY LTD (ASA) & CAM: UPDATE
Towards the end of my December 2017 blog, in the section headed In defence of Homeopathy (paragraph 6), I posed the following question: Has the ASA become a Health Regulator? To which I now add the supplementary question: and, if so, by what authority?
The following article and news-alerts aim to stimulate discussion about the answers to these questions:
- Menopause classified as serious medical condition in UK – UK drugs regulator and media industry unite to wipe out supplements and biomedical hormone alternatives to HRT(Alliance for Natural Health: 27.09.17) and, subsequently, ASA U-turn on Menopause Ruling (ANH on 29.11.17) [http://anhinternational.org/2017/11/29/news-alerts-week-48-2017/];
- Advertising Complementary Medicine: Where next with Regulation Reform? (Richard Eaton, PH Online Issue 242, November 2017 updating my previous article Your CAM Practice and the Advertising Standards Authority Ltd: Time to take Action, Issue 228, February 2016).
PATIENT RECORDS: PREPARE FOR THE GENERAL DATA PROTECTION REGULATION (GDPR)
The GDPR will apply from the 25th May 2018. Guidance about Data Protection Reform is available from The Information Commissioner’s Office (ICO) which has issued preliminary guidance, including as follows:
‘…Many of the GDPR’s main concepts and principles are much the same as those in the current Data Protection Act (DPA), so if you are complying properly with the current law then most of your approach to compliance will remain valid under the GDPR and can be the starting point to build from. However, there are new elements and significant enhancements, so you will have to do some things for the first time and some things differently…’
The ICO has launched a data protection advice service aimed at small and micro sized business, which includes most CAM practices, preparing for the GDPR. More details about the service may be found here.
Those CAM practitioners practising as small or micro sized business will need to ensure that their data protection processes comply with the new GDPR.
THE RESEARCH COUNCIL FOR COMPLEMENTARY MEDICINE: CAMRN NEWSLETTER, JANUARY 2018
Have you signed-up to receive RCCM newsletters yet?
The January 2018 newsletter highlighted the decision by the National Institute of Health Care Excellence (NICE) to remove the recommendation of acupuncture from the NICE guidelines for the treatment of chronic lower back pain notwithstanding the evidence (https://www.sciencedirect.com/science/journal/18763820/8/4) in support of its effectiveness (see my August 2017 blog)
It also informed about the RCCM ‘guideline development’ meetings with NICE and its membership of the Shared Decision Making Collaborative Forum, the aim of which is to:
‘…ensure people have an active role in determining their own care, based on their values and preferences…’
The newsletter announces the entry criteria for the Early Researcher Award for Integrative Medicine introduced by the European Journal of Integrative Medicine in 2016. For that year the winning article was Acupuncture for shoulder pain after stroke: A Randomized controlled Trial details of which may be read here.
SKILLS FOR HEALTH “OUR HEROES AWARDS 2018”: PREPARE TO MAKE A NOMINATION?
Although it is still early in the year, now is the time to give some thought about whom you might want to nominate for an award when the 2018 nomination process opens. In 2017, Skills for Health offered awards in the categories of:
Clinical Support Worker: “celebrating the input of clinical support workers in the direct delivery of care within the health sector. These workers play a crucial role in the delivery of patient care and are significant contributors in the effective delivery of healthcare practices”, and
The Integrated Team of the Year: about which Skills for Life advised last year: “…The Our Health Heroes Integrated Team of the Year Award will be given to a group of people operating as a ‘team’ to deliver person centred, integrated care across professional, organisational and/or sector boundaries. The winners of this award will demonstrate one or all of the following through a process of integrated care…”
[Please note that the above are extracts, now deleted, from the Skills for Health 2017 promotion].
There are many CAM practitioners who deserve nomination, including those practising in cancer and palliative care.
CAMSTRAND CONFERENCE 2018
Will be hosted by Manchester University this year on 26th – 27th June for which the Abstract deadline is16th April 2018:
‘…The conference provides a forum for researchers with a range of experience as well as health professionals and therapists/practitioners/students with an interest in complementary medicine research to share their work and knowledge amongst like minded people…’
INTERNATIONAL CONGRESS ON INTEGRATIVE MEDICINE RESEARCH 2018
A key partner and co-sponsor of which is the International Society for Complementary Medicine Research, acting in collaboration with the Academic Consortium for Integrative Medicine & Health, will take place in Baltimore, Maryland, USA during the 8th to 11th May 2018 on the Congress theme of:
THE FEDERATION OF HOLISTIC THERAPISTS (FHT)
The FHT is described as:
‘…the UK and Ireland’s largest professional association for complementary, holistic beauty and sports therapists. Founded in 1962, the FHT has been promoting the highest standards in education and therapy practice for more than 50 years. Its Complementary Healthcare Therapist Register has been independently accredited by the Professional Standards Authority for Health and Social Care…’ [FHT Release dated: 18.12.17]
Congratulations to Jane Long who has been appointed as a new Executive Director of the FHT.
Read about the key topics discussed at The College of Medicine ‘sannual Food Conference (September 2017) on pages 36 and 37 of the FHT’s excellent publication International Therapist (Issue 123, Winter 2018).
The FHT 2018 Training Congress will take place at the NEC Birmingham during the 20th – 21st May.
THE CONTRIBUTION OF HEALTH STORES TO NATURAL HEALTH
The role of Health Stores in providing and advising upon natural health remedies and products, where they do not require prescription by a qualified CAM practitioner following a consultation with a patient, should not be underestimated.
Information may be found on the website of the National Association of Health Stores (Nahs) which includes the following advice:
“To get you started before you visit a store we have collected the latest health information from some of the best known practitioners of natural medicine, such as Patrick Holford, Dr Marilyn Glenville, Janey Lee Grace and Jan de Vries.”
Full-length articles through a diverse selection of links are available on the website together with a store locator.
Review a guide on trading standards law headed Herbal Medicine and Health Food Shops.
SOME BOOKS TO READ: HEALING IN HOSPITAL
By clicking on the “Look Inside” facility of its amazon edition, inspect the Contents list of Healing in a Hospital: Scientific evidence that spiritual healing improves health by Sandy Edwards (Paperback: January 2017) and scroll down to read the extensive Foreword by Dr Michael Dixon of the College of Medicine.
Late last year, Angie Buxton-King, who was employed by University College London Hospital (UCLH) as a healer from 1999 to 2011, published her 2nd book titled The NHS Healer: Onwards and upwards(Paperback: 26th October 2017; Vanguard Press ISBN 978 1 784653 11 8). The following details are posted on amazon:
‘…Since Angie’s first book was written in 2004, the integration of Healing within the NHS and more generally in healthcare has substantially increased. So much so that Energy Healing (although still generally misunderstood) has found its place alongside conventional medicine in many areas of healthcare…’
One of a number of endorsements listed at the beginning of the book is that by Stephen Rowley, Senior Divisional Nurse Clinical Haematology UCLH, from which I quote as follows:
“…Seeing doctors ask for a healer to help support a patient through a medical procedure was not unusual and at the time represented a quiet but important evolution in cancer care. Over the subsequent decade, the supportive and clinical benefits that healing provides has provided the evidence and assurance for healing to be delivered alongside conventional treatments on a wider scale. The further expansion of well governed healing into 13 other centres via he SBSHT is further tangible evidence of the role healing is playing in the integrated care of patients.”
[Note: ‘SBHT’ refers to http://www.cancertherapies.org.uk/]
The author commences this exceptional book with the following quotation attributed to the Greek philosopher Plato (born circa 428/427 BC to circa 348/347BC). I cannot think of a better way to end than by quoting it again here:
‘We can easily forgive a child who is afraid of the dark; the real tragedy of life is when men are afraid of the light’.
1st March 2018