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Alternative medicine and the NHS Alliance

Professor Edzard Ernst, professor of complementary medicine at Peninsular Medical School, questions whether the NHS Alliance's promotion of alternative and complementary therapies puts it at odds with current standards of medical ethics.

Professor Edzard Ernst, professor of complementary medicine at Peninsular Medical School, questions whether the NHS Alliance's promotion of alternative and complementary therapies puts it at odds with current standards of medical ethics.



The website of the NHS Alliance informs us that this body, apparently one of the largest GP organisations in the UK, has a "representational role", and "plays a major part in supporting and developing Primary Care Trusts and similar primary care organisations and in providing opportunities for them (and the individuals within them) to network and exchange best practice" 1.

There is no clear mission statement and, after browsing through the site, one might easily get the impression that the NHS Alliance is a lobby group for "alternative" medicine.

Apart from the full text of several speeches its chairman (Dr. Michael Dixon) gave promoting this type of healthcare, we find a total of 10 press releases on the subject of complementary or alternative medicine. Most of us know that this topic is controversial, to say the least. One might therefore expect a degree of critical assessment on that site. However, all the press releases seem to be promotional. Here are quotes from the short experts of each press release that appear on the website 1:

• "Complementary medicine is becoming increasingly popular with patients…[and] has the potential to improve health and reduce demands on conventional health services" (2/12/1999).

• "Complementary medicine…provides a holistic approach in line with primary care" (1/12/1999).

• "GP practices and primary care increasingly provide their patients with access to therapies such as these [acupuncture, osteopathy, chiropractic, herbal medicine, hypnotherapy or homeopathy]" (26/2/2001).

• "Conventional medicine and the modernised NHS risk becoming too mechanistic" (29/1/2001).

• "The NHS Alliance today backed Health Ministers' support for alternative therapies to be made available to NHS patients" (4/1/2001).

• "…three quarters of the public believe complementary medicine should be available from the NHS" (26/2/2002).

• "…it is time for orthodox medicine to embrace complementary therapies…" (21/1/2004).

• "The NHS Alliance welcomes the government's proposals for statutory regulation of acupuncture and herbal medicine…" (3/3/2004.)

• "…HRH the Prince of Wales presented awards to the winners and runners-up of the NHS-Alliance Acorn Awards (22/5/2006).

We could be surprised by this relatively large number of press releases on "alternative" medicine, but we might find them acceptable in tone and contents. I beg to differ. As I said, this is a controversial subject, and the total lack of critical assessment is therefore disappointing. Moreover, several statements are misleading or incorrect.

For instance, contrary to some of the press releases, there is no good evidence demonstrating that, in the UK, the popularity of alternative medicine is increasing.

The notion that complementary medicine "provides a holistic approach" implies that primary care is no longer interested any longer in whole individuals.

Finally, I would argue that alternative therapies should not be "embraced" and "made available to NHS patients"; it should be scientifically tested, and those parts that are supported by sound evidence should be used. Sadly the vast majority of alternative therapies fail to fulfil this basic criterion 2.

But the NHS Alliance seems to condone even less evidenced-based practices: "A crusade against ignorance - enables patients to remove their straight jackets and take a new approach to improving health. Dr. Michael Dixon, Chairman of the NHS Alliance".

This endorsement appears on the front cover of a recent book entitled ‘Food is Better Medicine than Drugs. Your Prescription for Drug-Free Health' 3. In it, patients are advised for example not to take the drugs prescribed for heart disease: "If you are on one or more of these drugs [warfarin, heparin, aspirin], it's highly likely they are going to unbalance various complex systems in your body, possibly putting you at risk for a number of other problems in the future.

The same applies if you are reasonably healthy but have been given statins…" 3. As an alternative, the book recommends to take "several foods, nutrients and spices…[which] together…are likely to be far more effective…" 3. There is, of course, no sound evidence for this disturbing claim is true 2.

What strikes me most with the NHS-Alliance's promotion of "alternative" medicine is the absence of the term "evidence" in relation to alternative medicine. The GMC demands of its members: "You must provide effective treatments based on the best available evidence" 4.

This begs the question whether the NHS Alliance's uncritical promotion of alternative medicine does not put them into conflict with the currently accepted ethical standards of the UK medical profession.

E Ernst MD PhD FRCP FRCPEd; Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth

What strikes me most with the NHS-Alliance's promotion of "alternative" medicine is the absence of the term "evidence" in relation to alternative medicine. Professor Edzard Ernst

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