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Debates about greater integration of complementary medicine within the NHS – what about patients’ expectations?
- Alison R G Shaw, Elizabeth A Thompson, Deborah J Sharp. (21 October 2005)
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Clinical trials not designed for plant medicines
- Stephanie Williams (14 December 2005)
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Alison R G Shaw, Lecturer University of Bristol, Academic Unit of Primary Health Care, Cotham Hill, Bristol, BS6 6JL, Elizabeth A Thompson, Deborah J Sharp.
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The last couple of weeks have witnessed a flurry of publications debating the potential integration of complementary medicine within the NHS. These include a report that Peter Hain, the secretary of state for Wales and Northern Ireland, has recommended greater availability of complementary medicine within the NHS.[1] This followed in the wake of the Smallwood report, commissioned by the Prince of Wales’ Foundation for Integrated Health, which claimed that savings in healthcare costs could be achieved by greater use of some complementary medicines.[2,3] But little attention has yet been give to patients’ views on this issue. In a qualitative study with patients and parents of children with asthma, we are exploring their expectations about greater NHS access to complementary medicine. Participants in this study who are using complementary medicine are doing so not primarily because their conventional asthma treatment is ineffective,[2] but because they have concerns about long-term dependence on and side-effects of their medication, especially steroids. They are seeking self-help strategies (e.g. breathing techniques) to enhance their personal control over their asthma, ideally with reduction in medication. Regarding NHS access to complementary medicine, our study participants are distinguishing between greater access to information and knowledge about complementary medicine (from NHS health professionals) and greater access to complementary medicine services. The recent debate has not made this important distinction clear – between what we term ‘information or knowledge integration’ and ‘service integration’. Patients and parents are expressing a range of expectations on these two issues, from the ‘skeptics’ through to the committed ‘believers’ in complementary medicine, mirroring the debates we have seen among academics. The 'skeptics' in our study argue that lack of scientific evidence of benefit is a key reason why health professionals do not need to know about complementary medicine and the NHS does not need to provide it. At the other end of the spectrum, the ‘committed’ complementary medicine users think that certain therapies under this broad umbrella term may offer potential cost savings for the NHS, through their role in preventative health and their capacity to reduce prescription costs. They perceive that a substantial amount of conventional medicine is based on less than rigorous scientific evidence and call for greater value to be given to a different form of ‘evidence’ – patient experience of complementary medicine. The majority of our study participants sit somewhere in the middle of this spectrum of expectations. They are wrestling with the issues, showing awareness of the constraints on health professionals’ capacity and willingness to gain more knowledge of complementary medicine, and the complex challenges for the NHS of weighing up which services can be provided within a finite (and already stretched) budget. They understand the need to target complementary therapy services if they are to be provided (e.g. particular therapies for particular conditions) and identify likely barriers to greater service integration (e.g. the power of the pharmaceutical industry and a ‘lack of political will’). Yet at the same time, they are expressing the desire that NHS professionals (GPs in particular) have a greater ‘openness’ to complementary medicine and know more about it than their patients – which they perceive as currently not the case. For asthma, they are particularly interested in the potential role of breathing techniques (e.g. Buteyko Method) and nutritional therapies for enhancing asthma management. Patient demand and choice are emerging as key reasons for health professionals to know more about, and potentially provide referral to, complementary medicine. Patients and parents also highlight the need to improve equity of access to complementary medicine for patients from less affluent backgrounds. The NHS is aiming to be increasingly patient-centred, provide greater patient choice and improve access to services. Questions of effectiveness and cost-effectiveness are undoubtedly important. However, it seems important to include patients’ expectations about greater integration of complementary medicine within ongoing debates if the above aims are to be realised, particularly with the emergence of practice based commissioning in primary care. 1.Godfrey K. New GP network will integrate conventional and complementary medicine. BMJ 2005;331:924. 2.Thompson T, Feder G. Complementary therapies and the NHS. BMJ 2005;331:856-857. 3.Dobson R. Alternative therapies could save the NHS money, says report commissioned by Prince Charles. BMJ 2005;331:795. Competing interests: None declared |
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Stephanie Williams, Treatments Officer AIDSAction Council of the ACT
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Many so-called complementary therapies are based on plant or phyto- medicines. It is probably true to say that there is to date no scientific study sophisticated enough to rigorously test the multiple and varied actions of plant medcinces on human and animal bodies. The double blind placebo controlled cross over trial is not suited to plants because they contain so many different chemicals, and these trials can measure only one at a time. Thus it is not possible to use the same test for whole plants which is used on pharmaceutical drugs. Empirical evidence for the use of whole plant medciine is the best we have to date, as it has been gathered over hundreds and thousands of years from and by people who have themselves used and benefited from plant medcines. My email address is: arrowwood@austarnet.com.au Competing interests: I am a practicing medical herbalist and health educator |
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