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Should the NHS Provide Complementary Therapy?

Comment and Opinion

Edzard Ernst

Skeptical Inquirer Volume 30.5, September / October 2006

On May 23, Prince Charles addressed the World Health Organization (WHO) in Geneva. Officials at Clarence House said the Prince was gratified that the WHO had invited him to promote the cause of complementary therapies, a subject close to his heart for more than two decades. Back in 1982, he urged the British Medical Association to consider the subject more seriously. And so it did—the subsequent report was a damning account concluding that complementary medicine was based on little more than crank theories.

Today the climate has changed fundamentally. Complementary therapies seem to be encouraged everywhere. A government-sponsored patient guide published by the Prince of Wales’s Foundation for Integrated Health reads like a promotional brochure for complementary practitioners. The recent “Smallwood Report,” which was commissioned directly by Prince Charles (and funded by Dame Porter), goes one decisive step further: it advocates homeopathy as “an alternative” to conventional asthma treatments. And in his WHO address, Prince Charles again spoke out in favor of complementary medicine: “We need to re-discover and re-integrate some of the knowledge and well-tried practices that have been accumulated over thousand of years.”

With all this plugging and promoting, few people seem to bother about the scientific evidence. Is there, for instance, reasonable proof that homeopathy treats asthma effectively? If not, such advice could actually kill hundreds of British asthma patients per year! The answer is that the totality of the best evidence available today fails to show that homeopathy works for asthma. We therefore have a case in which the current trend toward “integrated health” is disclosed as being detrimental to the health of the nation.

Nonetheless, “integrated healthcare” is being pushed at all cost as the new buzzword for providing complementary medicine to the masses. According to Prince Charles, “We need to harness the best of modern science and technology, but not at the expense of losing the best of what complementary approaches have to offer. That is integrated health—it really is that simple.” In his WHO address he put it differently: “I believe that the proper mix of proven complementary, traditional, and modern remedies, which emphasizes the active participation of the patient, can help to create a powerful healing force for our world.”

This statement, it seems to me, is in fairly good agreement with the view expressed in a recent letter by thirteen British doctors (I was one of them) to all National Health Service (NHS) trusts. We urged the NHS to use those treatments (complementary or orthodox) that are backed up by good evidence and abandon those that are not. In other words, we did something entirely obvious and legitimate: we advocated the application of the rules of evidence-based medicine and pleaded for a single standard in healthcare. One could argue that Prince Charles’s public statements are a lay person’s expression of the concepts of evidence-based medicine. Great! I am delighted. But let’s be honest. If he means what he says, he should forthwith instruct all who work for him to stop promoting unproven or disproven treatments.

My team and I have researched complementary treatments for thirteen years. We have found many that generate more good than harm and many that don’t. In the second edition of our Desktop Guide to Complementary and Alternative Medicine (just published by Elsevier), we summarize the evidence in fifty-two different situations where one complementary therapy or another is unquestionably effective and many others where effectiveness is likely. If we all, including Prince Charles and his Foundation for Integrated Health, use this type of evidence wisely we can maximize the benefits of complementary medicine with minimal risk. But this approach requires critical analysis rather than unquestioning belief—and we don’t even need a new name for it. It’s called evidence-based medicine.

Edzard Ernst

Edzard Ernst, MD, PhD, is emeritus professor in the Complementary Medicine unit, Peninsula Medical School, Exeter, U.K.