What alternative health practitioners might not tell you

Letter to NHS Trust Chief Executives

To:

Mr Peter Homa, Chief Executive St George's Healthcare NHS Trust, St George's Hospital, Blackshaw Road, Tooting, London SW17 0QT

"We are a group of physicians and scientists who are concerned about ways in which unproven or disproved treatments are being encouraged for general use in the NHS. We would ask you to review practices in your own trust, and to join us in representing our concerns to the Department of Health because we want patients to benefit from the best treatments available.

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."

SIGNED:  Yours sincerely,   

Professor Michael Baum, Emeritus Professor of Surgery, University College London

Professor Frances Ashcroft FRS, University Laboratory of Physiology, Oxford

Professor Sir Colin Berry, Emeritus Professor of Pathology, Queen Mary, London

Professor Gustav Born FRS, Emeritus Professor of Pharmacology, Kings College London

Professor Sir James Black FRS, Kings College London

Professor David Colquhoun FRS, University College London

Professor Peter Dawson, Clinical Director of Imaging, University College London

Professor Edzard Ernst, Peninsula Medical School Exeter

Professor John Garrow, Emeritus Professor of Human Nutrition London

Professor Sir Keith Peters FRS President The Academy of Medical Sciences

Mr Leslie Rose, Consultant Clinical Scientist

Professor Raymond Tallis Emeritus, Professor of Geriatric Medicine University of Manchester

Professor Lewis Wolpert CBE FRS, University College London

The 'misrepresented' Charles refuses to follow his doctors' orders

"The Prince's speech came as the letter critical of alternative medicine was backed by the Royal Society, six of whose Fellows had signed it. Professor David Read, vice-president, said: "We share the concerns that some treatments labelled as complementary and alternative medicines have not been properly tested and are known to cause adverse effects, while others have no demonstrable benefits. We also support the view that patients should not receive misleading information about the effectiveness of complementary medicine." Evan Harris, a Liberal Democrat member of the Commons Science and Technology Committee, said that the Prince was abusing his constitutional position by taking a controversial stance without allowing himself to be cross-questioned." Article by Andrew Pierce and Mark Henderson, The Times (24th May 2006)

Snake oil — or NHS tool?

"There is medicine which works and medicine which doesn't. Anything which doesn't work is snake oil, and anyone who buys such stuff is either being duped, or has more money than sense." Michael Hanlon, Science Editor, The Daily Mail (24th May 2006)

Crazy medicine

"If the techniques of alternative medicine could be separated from the dubious theories that sometimes accompany them, the way would be open to a much more profound dialogue between orthodox and complementary practitioners, and a greater integration of conventional and complementary healthcare. There is always the possibility, of course, that doing away with the crackpot theories that provide alternative therapies with some of their appeal may actually rob them of their effectiveness, by destroying the vital belief that enables these therapies to mobilise the placebo response. In such cases, we face a choice of a clearly ethical nature: to preserve the effectiveness of these therapies by perpetuating crazy theories, or to seek the truth at the risk of robbing some patients of their favourite therapeutic resources. " A commentary by Dylan Evans, The Guardian (24th May 2006)

NHS must audit spending on alternative therapy, MPs say

"The Department of Health admitted that it had no idea how much taxpayers' money was being spent on non-conventional therapies. Phil Willis, chairman of the Commons Science and Technology Select Committee, said the department had a duty to collect accurate information on the extent of NHS support." Article by Mark Henderson and Fran Yeoman, The Times (24th May 2006)

NHS told to abandon alternative medicine

Lead article in The Times by Mark Henderson, Science Editor (23rd May 2006)

Alternative Therapies Attacked

Sky News segment. Includes an interview with another of the letter's signatories, Professor David Colquhoun, Research Professor of Pharmacology, University College London (23rd May 2006)

What's wrong with complementary medicine?

Interview with Dr Leslie Rose, one of the signatories to the above letter. Click on 'What's wrong with complementary medicine?' on the right-hand sidebar of this link. BBC Breakfast TV (23rd May 2006)