Dr Michael Dixon reviews the new World Health Organisation report.  You can read the whole text of the report here.

The report acknowledges the increasing world interest and use of complementary therapy. It would suggest that the UK Government, in particular, should be developing a policy on complementary health and care rather than simply ignoring it.

Three quotes below from Margaret Chan herself (Secretary General WHO) represent official mainstream WHO policy:-

• More countries have gradually come to accept the contribution that traditional and complementary medicine can make to the health and wellbeing of individuals and to the comprehensiveness of their healthcare systems”. (Foreword to WHO Strategy 2014-2023)
• “Many countries now recognise the need to develop a cohesive and integrative approach to healthcare that allows Governments, healthcare practitioners and, most importantly, those who use healthcare services to access traditional and complementary medicine in a safe, respectful, cost efficient and effective manner”. (Foreword to WHO Strategy 2014-2023)
• “The two systems of traditional Western medicine need not clash. Within the context of primary healthcare, they can blend together in a beneficial harmony, using the best features of each system, and compensating for certain weaknesses in each. This is not something that will happen all by itself. Deliberate policy decisions have to be made. But it can be done successfully”. (65th World Assembly Address May 2012).

The report makes a number of specific points:-

• The use of complementary medicine is increasing. For instance, 80% of member states now offer acupuncture to patients. Research on CAM is also on the increase with the number of member states with National Research Institutes for CAM increasing from 19 in 1999 to 73 in 2012. Meanwhile, almost 50% are offering education in CAM at University level.
• This increased use of CAM, the report argues, is appropriate because of the increasing burden of long term disease, the importance of patients being offered informed choice and the potential for improving the cost effectiveness of healthcare.
• The potential for increasing the cost effectiveness of healthcare by offering CAM has been insufficiently researched. The report quotes from a 2003 study in the British Medical Journal, which showed that manual therapy showed faster improvement for neck pain than traditional GP and physiotherapy care and this came at a third of the cost. It also quotes a recent (2012) study in the European Journal for Health Economics, which shows that GPs with additional complementary medicine training have lower healthcare costs and mortality rates than those who do not. The reduced costs were because of fewer hospital stays and fewer prescription drugs. I can reflect that in my own practice as my hospital referrals are 40% less than the least referring GP in our ten GP practice. Given the strictures of the National Institute for Clinical Excellence and the GP Quality Framework, I suspect that the potential drug savings are, however, less than Europe.
• Some countries are ahead of the game. In Switzerland, for example, where the average prevalence of complementary medicine use was almost 50%, certain complementary therapies are now part of the basic health insurance scheme available to every Swiss citizen. The national vote in 2009 saw 67% of voters opting for a review of CAM provision, which has also led to compulsory lessons for medical students and standardisation of training for both doctors and non-medical CAM practitioners.

“Many countries now recognise the need to develop a cohesive and integrative approach to healthcare that allows Governments, healthcare practitioners and, most importantly, those who use healthcare services to access traditional and complementary medicine in a safe, respectful, cost efficient and effective manner”

Recommendations from the report include:-

• Member states should recognise complementary medicine as a resource that could contribute to the improvement of health and care services.
• They should explore how conventional and complementary medicine might be integrated into the National Health Service delivery system.
• They should promote the research on a cost effectiveness of integrating conventional and complementary approaches.
• They should promote continuing education, evaluation, evidence and research into complementary approaches.

Comment:-
The UK is woefully lacking at present in its ability to meet any of these four recommendations. At present the UK largely ignores the potential of complementary medicine in both service provision and health promotion.

This is surprising in a national system that is explicitly committed to choice, cost effectiveness and improving population health. The WHO recommendations would suggest that it is time for the UK to develop a national policy that meets these recommendations and which encourages local commissioners and providers to become more responsive, inventive and progressive meeting these challenges.

The College of Medicine is an open church, which includes all statutory regulated professionals as well as patients. It will continue to support and encourage the development of a National Health Service that meets the ambitions of the WHO Report and will act as an “honest broker” in taking these recommendations forward.