Should Complementary Medicine be used on the NHS?

Hello everyone! After trying to deal with the heavy comprehensive and emotionally charged issue of the NHS existential pathology in my last post, this time we are going to focus on one aspect: should Complementary medicines like Acupuncture, Osteopathy, Homeopathy etc be used on our NHS? It’s a question I am often asked by my patients. It is usually more like: why can’t complementary medicine be used on the NHS? For people who benefit from Acupuncture or Chinese herbs or both it is a bit of a mystery. They are usually delighted with the treatment but also annoyed by the fact that they have to pay in order to sort out their health problems. After all, they paid their taxes all their lives so why then can’t they get this only treatment that helps them, through the NHS? Why indeed? The subject is also appearing on the fringe of the news from time to time-most commonly in the shape of the Establishment being astonished that Homeopathy is still available on the NHS. Well, that is not widely available. A few brave GPs who also practice Homeopathy managed to secure the agreement of prescribing Homeopathy on the NHS. Personally, I take my hat off to them. I haven’t got a clue how they manage to do it. The rest of the Medicine establishment however is outraged. Homeopathy is the enemy number one of modern medicine science. From all the complementary medicines it is the most hated. As far as modern science is concerned, when you take Homeopathic medicine you are basically taking nothing, zero, no active materials whatsoever, and so how can it possibly work? So instead of looking at the phenomenon in amazement and thinking “here is something that we don’t yet understand”, it is much easier to just denounce the whole thing as a con. So the poor few GPs who dare to use something else to conventional medicine on the NHS always get bad Press. I have probably heard about 6 times now, over the years, that their budget is going to be stopped and yet they are somehow carrying on! It’s admirable.
Apart from the Homeopathic GPs, my experience of the NHS trying to implement complementary medicine is as follows: there is some sort of cyclic process that repeated itself a few times over the last 20 years. It starts when the NHS, as a response to the rising popularity and demand for CM, decides to run a pilot scheme- that means that in one area of the UK (usually one Health Authority) there will be some limited and controlled availability of CM on the NHS. This pilot will run for a year or two and then it’s effectiveness will be analysed. I remember being present when one of these pilot schemes was presented, it was a good twenty years back. It ran somewhere in Scotland ( forgive me for the vagueness-it was a long time ago) and whilst I have forgotten some of the details I can remember clearly the important ones. The young lady who analysed the data from that pilot showed clearly it was a win win win situation. The therapies that were offered were Acupuncture, Osteopathy, Chiropractic and Homeopathy. Overall the data showed that the scheme benefited the patients as well as the GPs as well as the NHS. The patients benefited from improvements in their health. The GPs benefited by an ability to offer more options to the patients, as well as by reducing their inhuman workload and offloading some particularly difficult cases. The NHS benefited by saving money! Although CM cost money to the NHS, over the length of the scheme it saved money overall by having to pay less for prescriptions and for GP visits! These benefits and cost savings do not include the most important one which is the reduction in serious long term complications from taking long term medication. To our slight surprise, and no doubt the horror of the medical establishment, the most popular therapy in that pilot was Homeopathy.
Following the success of these pilots the NHS decides to try and implement them. The CM treatments then become available on the NHS in a slightly bigger area (a few more Health Authorities). All good so far. The problem is that without fail, due to the NHS’ very tight budget, these authorities will get into financial difficulties. Some expenses will have to be cut. Not surprisingly the CM budget is the first in line for the axe. I have seen it happen time and time again. This is, of course, short sightedness as the pilot shows that using the CM therapies is clearly saving the NHS money. However, they need to cut somewhere and this particular budget is politically the easiest to cut out.
A few years later there was another brave attempt to incorporate CM into the NHS. This time it took the form of an NHS CM Practitioners directory. The idea was that CM practitioners would be registered in an NHS directory which meant that they would be allowed to supply services to the NHS. Unfortunately this scheme has been proven to be just another waste of public money. The problem being that, at the moment, if any GP wants to give a patient medicine or send him for any treatment it has to be first approved by a body called the PCT (Primary Care Trust). Despite an intensive effort from myself and some GPs and Clinic Managers the PCT stood stern, no money for Acupuncture treatment! They just won’t budge!
There was however a short period in the past when I was able to treat people on the NHS. This was about 23 years ago. At that time some of the GP clinics were given the status of Fund holders. That meant that they were in charge of their own expenses and choices. It used to work beautifully. People who weren’t normally able to afford having Acupuncture treatment privately, were benefiting from the treatment paid by the NHS. As we mentioned before, everyone was happy: the patients, the GPs and myself. In 1997 a new Government came to power and some bright spark decided to change the system and created the aforementioned PCTs. Basically another expensive layer of Bureaucracy that has taken away the GPs’ ability to independently choose which treatment they would like to use. That was the end of that nice cooperation between the NHS and Complementary Medicine. Strangely enough, until recently the current Government tried to bring back the Fund holding system for GPs clinics. However, this plan was shelved after fierce reaction to it. It kind of demonstrates the point I made in my last post regarding overreaction to any attempts made to make any changes to the NHS.
The case then for using CM on the NHS is very clear, but what about the other side of the argument? Surprisingly I can see some arguments for why not to use these therapies on our National Health Service. I think the first problem is that, in comparison to modern Western medicine, the world of CM is in a bit of a mess. There are probably hundreds of different types of therapies that can be practiced in thousands of different ways and are probably loosely regulated by hundreds of different organisations. It is understandable then why people who have been asked to look at it as a possible treatment option on the NHS felt a bit dizzy and weren’t sure where even to start. We must narrow the field then and talk about only more established therapies like Acupuncture, Chiropractic, Osteopathy, Homeopathy and Herbal Medicine. Some Practitioners of other methods will justifiably feel upset by that. However, we have got to start with something.
Even after narrowing the field, many people will claim that there is not enough evidence to support the effectiveness of these therapies and therefore the NHS should not waste money on them. I can see where this claim is coming from (although not agreeing with it). The modern medicine Science is obsessed by a type of studies they call double blind placebo control studies. In those studies the patient and his Doctor don’t know if the medicine used is a real one or just a placebo. The idea here is to eliminate the placebo effect (where the patient feels better because he thinks the medicine he is taking is working, rather than the medicine itself is working). Of course, when it comes to Acupuncture or manual therapies this type of study is impossible to do. On top of this, in order to produce results which are statistically reliable, we need hundreds, or preferably thousands, of people to take part in the study. This, again, is a limiting factor since we, in the world of Complementary medicine, are all working in small private clinics. The cost is another factor as this type of Research is extremely expensive and unfortunately, the only ones who can produce it are the Pharmaceutical companies. That is the reason why they have almost a complete monopoly on modern Clinical research. Due to all these things CM is often referred to by modern medical speakers as unproven. Well, there is my point: unproven may sound bad but what does it actually mean? It definitely doesn’t mean it doesn’t work. It only means it hasn’t been shown to work through that particular process. My former patient, an eminent intensive care Consultant, told me once as a response to this: 75% of the meds we use are also unproven. There is plenty of research that demonstrates the effectiveness of therapies like Acupuncture, Chiropractic and Homeopathy. All you need is the will to look.
The last reason for resistance for the use of CM on the NHS, I think, is an emotional one. It is very hard for Doctors to recommend a therapy they don’t understand. To be fair, as a former Doctor, I can kind of understand it. However, I think they need to find a way to focus their minds on what is good for the patient.
There is a paradox here, the medical community claiming that Complementary Medicine is “not scientific”, while at the same time most of their arguments against including CM on the NHS are more emotional than scientific. To demonstrate this point of how emotionally charged is this topic we are conveniently having the Election campaign at the moment. The main subject is the NHS (more than Brexit believe it or not) and the Parties are falling over themselves to pledge more money for the NHS. Now, try and imagine in your mind what will happen to a Party who allows CM on the NHS. They’ll immediately be crucified by the Media and the Scientific community. It will be presented as a reckless waste of public money. This brave little imaginary Party is guaranteed to lose the Election!
But how come? At the beginning of this post I mentioned a series of pilots issued by the NHS which showed clearly that using established complementary therapies (Acupuncture, Chiropractic, Homeopathy and Herbal Medicine) on the NHS is not just a win win win situation ( for patients, practitioners and GPs) but also is saving money in the medium and long terms! The answer to this question is that in politics (make no mistake it is about politics) things are not simple or straightforward, let alone logical. Emotions often take over logic and short termism is king. For these reasons I think it will never happen, in a meaningful way anyway, However, our original question wasn’t” would” CM be used on the NHS, the question was “should” it be used.
So, let’s try and sum up: Should CM Therapies be used on the NHS?
The short answer is Yes. The established CM therapies (in my book-Acupuncture, Chiropractic, Osteopathy, Homeopathy and Herbal Medicine) are extremely effective and safe. Using them on the NHS will benefit the patients, the GPs and the NHS budget. In order to address the worries of the Medical Establishment start with a list of only the established therapies and use only qualified and experienced Practitioners. GPs judgement should be trusted to make the decision regarding referrals to CM medicine.

Best Health everyone,

 

Dr Ilan Shahor!