Intended for healthcare professionals

Clinical Review ABC of complementary medicine

What is complementary medicine?

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7211.693 (Published 11 September 1999) Cite this as: BMJ 1999;319:693

Complementary Therapies?

BMA Says Alternative Medicine is an Unregulated Free-for-all

On Monday November 1st the British Medical Association [BMA] released
a press statement, which also appears on their Website [www.bma.org.uk],
in which they claim that complementary and alternative medicine [CAM] is
too much of a free-for-all. They recommend that the entire field should be
much more tightly regulated, with single regulating bodies for each
therapy, registers of approved, competent practitioners, enforceable
ethical codes, disciplinary mechanisms and complaints procedures.

While recognising the growing public demand for CAM, the BMA warns
that patients are being placed at risk from unscrupulous practitioners. It
declares that patients should be protected from unskilled and unqualified
practitioners. Standards of good practice should be set for each therapy
to help both doctors and patients make sensible referrals and to make
better sense of what is on offer.

In general terms these proposals will probably be welcomed because
there is no doubt that the image of CAM in the public eye is that of a
bandwagon upon which just about anyone can climb, whether suitably
qualified or not. There is also a bewildering array of qualifications,
some of which are reputable, and based upon years of study and supervised
clinical practice, and some of which are not. In such a situation, the
appearance certainly is one of an unregulated mess. However, two problems,
hidden within all this, should be highlighted and which give cause for
some caution. Firstly, the history of medicine in general, unfortunately
shows that doctors have often been much more interested in protecting
their own high status, privileges and a monopolistic control of the
medical domain as a whole, and less in defending the interests of
patients.

Secondly, all the newly-emerging therapies are undergoing a natural
process of professionalisation at varying speeds. Perhaps they would be
better left to achieve more unity, organically, without being forced to do
so, interfered with or hurried along by what many might see as an
impatient and interfering medical profession. Considerable advances in the
directions recommended by the BMA have already been made, especially by
Acupuncture, Homeopathy, Herbalism and Osteopathy. Let us briefly expand
upon these two themes.

Earlier this century, some then-emerging paramedical professions,
such as radiographers, midwives, pharmacists, physiotherapists, opticians
and chiropodists, were subjected to sustained and vigorous opposition by
the medical profession. This caused protracted delays in their achieving
separation from medicine and their own professional status, such as would
enable them, quite rightly, to regulate their own affairs, unmolested by
attacks and hostility from doctors. That took a long while to achieve.
Though setting out along that path in 1900, many of them did not achieve
truly independent professional status until 1960, due almost entirely to
friction, hostility and delaying tactics from doctors. Similar friction
and hostility was even directed towards dentists, prior to their
attainment of separate professional status. Herbalists, Osteopaths and
Chiropractors were also subjected to similarly sustained medical
hostility, which entirely prevented their attainment of professional
status back in the 1920s. Clearly then, it is prudent of us to bear in
mind these facts about the past conduct and motives of the medical
profession, if we are to neutrally assess its current interest in this
field.

It is also true that the medical profession, as we see it today,
emerged naturally from a diverse array of therapies during the 1840s and
1850s. They sought, at their own speed, and obtained, the sanction first
of government and then of science, en route to becoming what is now a
medical monopoly. They should not, therefore, abuse their privileges or
status by seeking to coerce or intimidate the diverse therapies of today
into some type of professional status they are not yet ready to adopt.
Some of the more obscure therapies, like Crystal Healing and Shiatsu, may
never attain professional status, even in the next ten years, and thus we
should seriously question why they might ever need regulating bodies and
registers. Why therefore should they be stampeded down a road they do not
wish to travel along?

There are also other fundamental questions about this document. Can
we be confident that this interest in natural therapies on the part of the
dominant medical hegemony, is entirely benign and solely inspired by their
desire to protect the interests of would-be patients? The pattern of their
past behaviour reveals a medical profession vigorously hostile towards all
adjacent paramedical disciplines, which it jealously regards as enemies,
encroaching upon its own territory. And it has fought, on numerous
occasions, with every weapon at its disposal, including Parliament and the
Courts, all such moves on their part to achieve independent professional
status. These are the facts of their own history, which must be considered
before we accept this document as deriving from neutral and benign
interest in this field.

We might therefore draw a lesson from history about what is happening
now. The bare facts tell us that the current gaze of the medical
profession upon this whole area of CAM can in no sense be regarded as that
of a detached and emotionally neutral observer. They have not proved
themselves very trustworthy in the past, so why should anyone regard them
as trustworthy now? Therefore, while greater regulation of CAM probably is
desirable, for the sake of patients, the therapies themselves should
surely be permitted more time to get their own houses in order, while
being watched over and guided by the State, rather than by the impatient
dictates of a hostile medical profession, from whom most would not even
dream of asking for help.

Peter Morrell

Competing interests: No competing interests

03 November 1999
Peter Morrell
Lecturer in Science Stoke College; Hon. Research Associate History of Medicine Staffordshire Uni.
Stoke College, UK