Far too often, in orthodox medicine, doctors are under pressure (partly self-imposed and partly imposed by the patient) to fix the patient. We are meant to intervene, rather than to enhance the patient’s own innate healing capacity.

The patient is perceived as the passive beneficiary, subject to our clever tests, measurements and interventions. But the more we depend on technology, the further we go from interpretation of the patient’s signs and from individualised patient care.  We end up treating the laboratory findings, and not the patient.

The patient as an individual gets lost along the way. We get further and further away from the patient’s own narrative. The patient becomes increasingly disempowered. Actually, whether we like it or not, the healing is performed by the patient, not the doctor.

In orthodox medicine there is a failure to identify either the notion of a life force, or ‘vitality’, such as the traditional Chinese medicine concept of ‘Qi’. There is also a failure to address a patient’s constitution or acknowledge the fact that many diseases can be silent in the body before they manifest as overt signs or symptoms. And it is only recently that we, in the West, have started to acknowledge the vital importance of prevention (nutrition, exercise, emotional well-being etc).

Many complementary therapies embrace these concepts and seek to address how to support normal restorative processes and enable a patient to regain balance, as well as holding fundamental to that process the importance of lifestyle issues such as nutrition. I have seen many patients helped back to better health by these approaches, when orthodox medicine had failed to do so.

Clearly, there are many circumstances where orthodox medicine can be invaluable and has a vital role to play in the management of many health problems, including emergency medicine, trauma and much more. Many workers in the field arrogantly and self-righteously claim that only orthodox medicine should be allowed to deliver healthcare because it is the only medicine with any ‘proper’ science behind it. 

How do these critics justify nullifying certain medical paradigms that have been in existence far longer and over far greater tracts of land than Westernised orthodox medicine? Were those millions of Asian people, over thousands of years, being completely duped by generation upon generation of traditional Chinese medicine or Ayurvedic doctors?

Why do so many people turn to CAM therapies to help them feel well again? Understandably, patients cannot understand why scientific medicine does not have a cure for so many diseases.

So let’s not allow arrogance and bigotry to prevail, but stay open-minded as to what CAMs might have to offer; we have a lot to learn.

Dr Karine Nohr is a GP in Sheffield

Critics of the research in complementary medicines need to take heed of the scepticism that is increasingly present regarding ‘evidence’ for orthodox treatments.

Of course we all want ‘evidence’, but evidence is only as good as the quality of the research, it’s transparency and the absence of bias. 85% of trials are sponsored by the pharmaceutical companies; when comparing drugs, the vast majority show that the sponsoring company’s drugs are more effective than the comparison drug. For example, we have all been lead to believe that the new neuroleptics are safer and more efficacious than the old.

'The story of the atypical antipsychotics is a tale of the triumph of profit over patient benefit, of marketing over ethics', says Prof Tim Kendall, director of the National Collaborating Centre for Mental Health. Doubts about the veracity of the superiority of second-generation atypicals started to emerge about 10 years ago and it is now thought that there is no difference in clinical efficacy between the two classes of drugs.

If you haven’t already done so, I would urge anybody who puts ‘evidence’ on a pedestal to read ‘Reality Check’ in the BMJ. Ray Moynihan refers to the mounting corroboration that there is a massive positive bias in the publication of trials.

In the past 15 years there have been quite a number of articles in eminent journals that raise this problem. For example, we find that in the New England Journal of Medicine among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. Access to the unpublished evidence was obtained under the Freedom to Information Act.

In the UK, NICE does not have a legal right of access to unpublished trial results which the industry submits to the regulator and the MHRA is unable to prosecute companies for witholding information, so how can NICE ensure that their recommendations are evidence based?

The problems of selective publication are further explored in the subsequent two articles of the same BMJ, urging greater access and transparency of data, disclosure of unpublished evidence and better quality reporting by the European Medicines Agency, in order to provide more useful information to all.

Much research now exists that demonstrates that company funded research is most likely to lead to positive results. Non-publication of inconvenient findings is only one of the mechanisms that may explain this finding. Others mechanisms might include multiple publication of positive results, incongruous interpretation of results, choice of comparator agents, aswell as ‘seeding trials’, or marketing trials, that are not trials at all but are marketing attempts to introduce an intervention to clinicians. No doubt there are other mechansims, too.

The UK Biobank has recruited half a million citizens and will follow them up, monitoring lifestyle, environment, health and disease. It is, to some extent, funded by the pharmaceutical industry. The data may in part be used to develop new drugs. An editorial in the Lancet discusses selective reporting, refers to John Bell, chair of its science committee, and states that he is also a director at Roche. I looked at the UK Biobank website’s page of its supporters and although John Bell is named, I cannot find a declaration of interests.

It seems blatantly obvious that commercial interests have a massive influence in the pharmaceutical world. Bilions of pounds of profit are at stake. Until we have an effective mechanism to ensure quality of information that addresses these factors and moreover as we move towards a medical service that is increasingly ruled by market forces, we should be mindful of the power of Big Pharma and stay wary, critical and questioning of ALL evidence.