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Introducing Complementary Therapies into Healthcare Organizations - Yes or No?
I have spent months, on and off, thinking about this subject.
It is clear, as things stand at the moment, that 'we', meaning the complementary therapist 'we', are on the outside, looking into the gigantic healthcare system, to see if we can get a toe in the door, when the great majority of effort on the part of these organizations, and in particular, the businesses in the supply chain, are trying desperately to keep us out.
This has been admirably demonstrated in recent press reports, the headlines of which stated that Homeopathy is witchcraft (ref: 1) A forceful campaign by many doctors and consultants have produced arguments that have convinced the NHS/PCT's to drop ties and continued funding for Homeopathy in general and London's main Homeopathic hospital in particular.
The GP's magazine Pulse, stated that over a fifth of PCT's (Primary Care Trusts) have cancelled or reduced homeopathy contracts since 2006 and this is likely to continue as attitudes harden. The January 2008 issue states that only 37% of PCT's still have contracts for any homeopathic services (ref: 2).
Perhaps to stall some of this exodus, the Government has asked NICE (National Institute for Clinical Excellence) to compare the cost-effectiveness of complementary therapies with other treatments. However, such treatments are only to be recommended if a sound scientific basis for their efficacy can be proven. Health minister Dawn Primarolo said PCTs needed to take the clinical and cost-effectiveness of complementary therapies into account and NICE could be a good source of this information.
'The issue for the Department is to ensure that PCTs are aware of the evidence where it is available. We would certainly wish to consider where it is appropriate for NICE to consider complementary therapies alongside other treatments,' she said. (ref:3)
Of course, this is political mumbo jumbo. It is obvious that the lack of efficacy data for many complementary therapies would prevent NICE from making fair judgements when comparing them with pharmacological treatments.
If there are no studies which compare hypnotherapy with anti-depressants, or reflexology with anti-emetics, guided imagery with analgesics, or lymphatic drainage massage with anti-inflammatories, the evidence does not exist and therefore NICE has nothing to compare.
This was not made any easier when the House of Lords created its 3 groups to categorize complementary and alternative therapies.
Group 1, known as the principle disciplines, are osteopathy, chiropractic, acupuncture, herbal medicine, and homeopathy. Certain elements picked the 'softest' target and have successfully ostracised homeopathy. Recent news reports by the BMA are casting doubt on the efficacy of chiropractic (sorry, I've lost the reference for this but even most chiropractic patients that I have spoken to know this to be true). This means the others will become a fair target, if, for no other reason, than association to Group 1. Once that happens, group 2 and 3 will be easy pickings.
The trouble with that, is, there is a danger the public will listen to a prolonged barrage of anti-integration propaganda, especially when it comes from recognized sources. For example:-
Professor Edzard Ernst (who I believe has become the biggest hypocrite in complementary history), professor of complementary medicine at Peninsula Medical School, Exeter, and a former homeopath himself, said he supported moves to withdraw funding for homeopathy as it was nothing more than a placebo. 'There can be no cost-effectiveness without effectiveness,' he warned. (ref: 4)
I'm sure Professor Ernst's former patients are delighted that he has been so-say, 'ripping them off' for years, but there seems to be no mention of reimbursing them.
Equally, in my own locality we have Kathy Sykes, a scientist lecturer at Bristol University, junking complementary therapies on TV at every opportunity. I know that her comments are slanted because I am a practitioner of many of the therapies that she has made programs on. You have to take into account what weight her comments and attitudes carry, when aimed at the general public, coming from a scientific background.
As well as the perceived (and actual) lack of scientific validity, there is uncertainty as to the cost effectiveness of full, limited or even partial integration. Integrated health care requires that the healthcare professional have at least a working knowledge of the many therapies that are on offer. This might include, acupuncture, osteopathy, herbalism, homeopathy, massage therapy, aromatherapy, reiki, hypnotherapy, NLP, reflexology and other systems like Ayurvedic and Traditional Chinese. The cost of training individuals in this regard is in addition to their training as doctors, consultants, technicians and nurses of the orthodox way.
The perceived high efficacy of modern medicine, when compared to the perceived low efficacy of complementary therapy, means this is something the NHS will shy away from funding. Of that I'm sure.
So who else? It is not in the interest of drug companies to provide funding for research into alternative therapies. Indeed we know the drug companies have a financial interest in keeping these things out of mainstream medicine, and will fight tooth and nail to keep them out if profits are threatened in any way. And there is no doubt, in my mind they would be, as more and more people choose the 'drug free' route whenever possible.
This is my view of how integration should be followed.
You do the research that demonstrates and proves that complementary therapy works. Then you take this back to NICE, preferably before the integration project is disbanded altogether, and present it in a way that leaves no question, once and for all, that it works in at least as good a way as mainstream medicine, and to at least the same percentages of success.
It's not actually that there is much to do in this regard. With the BMA admitting that as much as 64% of commonly used orthodox treatments range from 'unlikely to be beneficial' to 'unknown effectiveness' (ref: 5), it doesn't look to be such a big hill to climb to demonstrate effectiveness and the beneficial nature of complementary therapy, does it? In my own practice, which is predominately Spinal Touch Therapy, if I could only manage a 36% success rate, I think I'd look for another job.
So what can BMJ Clinical Evidence tell us about the state of our current knowledge? Of around 2500 treatments covered 13% are rated as beneficial, 23% likely to be beneficial, 8% as trade off between benefits and harms, 6% unlikely to be beneficial, 4% likely to be ineffective or harmful, and 46%, the largest proportion, as unknown effectiveness. (ref: 5)
The organizations that set themselves up as the therapists friend; The FHT, the NFSH, the CMA and all the others, are the ones that need to be doing this integration work, should have finished this work on behalf of their members long ago, and the evidence should be available now, already. Yet we are still talking about doing it. For heavens sake, stop talking and arguing amongst yourselves and do what your membership are paying you for!
The FHT has over 21,000 members, covering 200 therapies. They claim to be; 'a true not-for-profit organisation and we put our members at the heart of everything we do'. So what is happening to the over £1 million pounds a year in members subscriptions? Members get a quarterly magazine, and it seems not much else, except the requirement to train forevermore in things they will probably not need, just to gain enough CPD points to validate their membership for another year.
Equally the NFSH has over 5000 members (or had, I think the inner turmoil in this organization has seen members vote with their feet of late) with subscription revenue of £250,000 + donations.
And this is from the CMA website: Remember - the CMA is a not for profit organisation - working for you. It's up to you to take advantage of all the support that this prestigious organisation can give you. Get the professional recognition you deserve by joining now!
Thank you CMA. I've got professional recognition already, and certificates galore. What I need for you to do now, is make representations to NICE, with all the evidence that you have gathered, and to pave the way forward for me, and thousands more like me, to use our skills within the medical profession, and not only as a patient to patient referral, in private practice, that no doctor has ever heard of.
Perhaps these organizations could fund the additional training required of doctors and nurses by sponsoring University places, so many per year, so that as these people enter the NHS mainstream they begin an undercurrent of change. Each year their numbers will grow and grow.
Of course, the evidence isn't there is it? We are expecting the NHS to take the therapy/s we are practicing, which have been around for 5000 years, and give them some credence because of history and anecdotal evidence, which is clearly not good enough for today's working practice and medical legal framework. Science may not yet fully understand how healing or homeopathy works, but it is clear, because patients says so, that these therapies are having a powerful impact. It's just that a scientific and more conventional explanation is not currently available. So this must be our aim!
However, by moving forward too quickly, and striving for early integration, we stand the risk of alienating orthodox and complementary even more, and for a lot further into the future, making the job more difficult later on.
Of course, much of the dilemma comes from the term Complementary and Alternative. Complementary can be used alongside orthodox medicine quite amicably, and if it stays like that, most drug companies would probably let it ride. The problem lies with alternative therapy, where the public actively chooses to go somewhere else for its healthcare.
The irony is, the more people who choose complementary, the more they will begin to choose the alternative route, I'm sure. And those that choose the alternative route initially will naturally look at complementary therapy for their extended palliative care.
If this becomes a general trend then it will clearly become a threat to the giant drug companies, and a state of legal war will exist between us, the like of which we have not seen so far. I don't think any organizations and their therapist members are geared up for that kind of battle, financially, or otherwise.
Why is it impossible to get an NHS dentist anymore? Dentistry has progressively looked to service the high value end of the market; to the point that now the nation's teeth are rotting, with the knock on effects to the rest of the body. It is even a national news item that people are pulling their own teeth.
Glasses almost went the same way. But thankfully, too many companies have tried to service more than population for their product and so glasses are now more affordable than ever. They may have shot themselves in the foot, but dentists, who reach critical mass in local populations, won't make that same mistake in a hurry.
The reason for pointing this out is because I have thought about how this will affect my practice, and I do feel that integrated complementary therapy will go the same way.
The NHS will end up squeezing the professionals down to the lowest common denominator, by offering lower and lesser quality by virtue of shorter and shorter appointment times, with less and less going to the practitioner, until it is of little benefit to the end user, or the practitioner.
Even my own doctor, who is also Practice Manager for my local surgery, he stated to me that there is no interest among any of the doctors in the practice to include or make provision for complementary therapy inside, or even alongside the practice. A recent advert in the Bristol Evening Post by North Somerset Council was asking for 'expressions of interest' in providing services for the new PCT in Worle. Nowhere on the website, or on the application forms was there any mention of complementary therapy at all. When I made enquiries about same, I was told that 'outside therapies' were not being encouraged as there wouldn't be the room available to accommodate them. And all that after Prince Charles recently called for a £5 million pound fund to start meaningful dialogue between complementary therapies and mainstream healthcare providers.
This new PCT is being advertised as the way of the future. A future, it would seem, that does not include complementary therapies of any kind. And why should they? I recently spent a day at St Peters Hospice, in Bristol. How can we expect other organizations like the NHS to take us seriously, when the very place I went to learn about palliative care refuses to allow 'healers' in the building to treat people/patients with spiritual or reiki healing?
A close friend who is an NFSH full member and specializes in terminal illness was told she was not welcome as a healer at St Peters, but could volunteer as a helper to empty bins and other menial duties. Needless to say, she declined their generous offer.
Are we not better off, at this point in time, moving alongside the mainstream? At this stage of the debate, when we cannot even agree among ourselves what is worthy or not, complementary therapy will not be welcomed with open arms, because we are, quite rightly, being asked for evidence we simply don't have. Perhaps, our priority should be to do the research first, keeping our distance, until the ammunition is available to make a stronger case for integration.
Pretty soon, and to a large extent this is happening already, there will be a natural flow of patients coming from mainstream medicine into complementary therapy who find there are cost advantages to using therapy in a palliative way. Something that the NHS can't seem to do because sheer numbers means it is always at crisis point for appointments, operations and aftercare.
If practice-based commissioning and integration is going to mean anything at all in the future, it will have to incorporate greater patient choice. This will be the short term champion of complementary therapy. Perhaps NICE could create a voucher system, so that patients could be referred to regulated therapists and the GP's could then do their own consultation and feedback. This would demonstrate cost-savings and cost-effectiveness in house, and negate the need to provide outside evidence, which often suffers from claims of bias.
This might staunch the persistent flow of rather narrow-minded diatribes from doctors and consultants who seem determined to condemn complementary therapy at every opportunity. But, of course, it may not.
(Ref: 1): First published in the Telegraph 4th March 2004, and reiterated again in many more papers up until The Daily Mail, on 1 May 2007, which said, 'Homeopathy is to medicine what astrology is to astronomy: it's witchcraft - totally barmy, totally refuted, and yet it's available on the NHS'. (Professor Michael Baum, professor emeritus of surgery at University College London)
(Ref: 2): Pulse magazine. 2007 and Jan 2008
(Ref: 3): Pulse magazine. Feb 2008
(Ref: 4): Pulse magazine. Jan 2008
(Ref: 5): BMJ Clinical Evidence is one of the world's most authoritative medical resources for informing treatment decisions and improving patient care. Reference to this item can be found at: http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp
I am in private practice offering complementary therapy of an integrated kind myself. I have found that when you practice more than one therapy, you find yourself borrowing from one therapy to complement the other. Kind of what we're talking about here. You could say we are 'Borrowing the Benefits'. I have found this to be a most effective way to help my patients find a recovery system that works for them. If you live anywhere near Bath, Bristol, Radstock, Shepton Mallet or Weston-Super-Mare, you are well within a 2-40 minute drive of The Haven Healing Centre, and I'd be delighted to see you.
Please call Phil Chave on 01761 462722 to make your appointment or to talk about a treatment plan structured around your needs.
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Philip Chave © 2008-
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