Head to Head, Irish Times, Monday 12 March 2007

Should alternative medicine be integrated into the health system?

The Final Results of the Public Vote

71% YES

29% NO

THE DEBATE

Yes

YES argues Ruth Cloherty, who says that alternative medicine can fill the gaps in the health service Alternative therapies are a cheap and effective way of increasing wellbeing. Evidence from studies in the UK indicates that some complementary and alternative therapies are successfully filling in the gaps in effectiveness recognised in the National Health Service. Studies show that people who consult complementary practitioners usually have long-standing conditions for which conventional medicine has not provided a satisfactory solution. As Ireland is in a similar position, why don't we integrate the two systems and increase efficacy of health care as a whole?

Let's take a couple of specific examples where complementary approaches could help increase the quality of health-care provision. Stress has now been recognised by conventional medicine as a contributing factor in many chronic diseases. Research into many complementary therapies has demonstrated a positive effect on reducing levels of stress. Poor nutritional status is also now accepted as a key predisposing factor in many illnesses, as it has a direct effect upon cellular health.

Sceptics of complementary and alternative medicine (CAM) believe any positive affects patients experience are due to the placebo effect. In many cases this is untrue - there is much evidence that cancer and heart disease respond well to, and can be prevented by, nutritional therapy, herbal medicine and other complementary therapies. They can all elicit physical changes within the body that cannot be explained away by the placebo effect. Even in more controversial cases, such as the use of acupuncture as an alternative to anaesthetic during surgery, magnetic resonance imaging has proven that acupuncture can slow down the physiological response to pain and acts on the pain matrix deep in the centre of the brain.

While there is scientific evidence to support the efficacy of acupuncture and nutritional therapy, complementary therapists readily accept that the placebo effect is a contributing (and potentially useful) factor in all areas of healthcare - including conventional medicine.

During randomly selected drug trials, there is often a significant number of people who respond positively to the sugar pill placebo. When we consider the known side effects that often come with prescription drugs, should we not be utilising the power of mind the placebo effect demonstrates alongside less aggressive complementary forms of treatment and save the drugs for only those who really need them? This placebo effect is not limited to drug trials; it has also been scientifically shown to be present in some surgical procedures.

The number of those who consult complementary practitioners is similar to the number of users of conventional healthcare. In both cases the majority of users are female. The users of complementary medicine tend to be in higher socio-economic groups and have higher levels of education than users of conventional care. This poses an interesting question about the equality of healthcare distribution. This is especially significant when we consider that it is more cost-effective to deliver complementary medicine than it is to deliver conventional medicine.

The NHS in the UK has various complementary medicine departments and clinics attached to hospitals as well as in the community. One acupuncture clinic based in London receives referrals from 175 GPs and carries out 20,000 treatments per year, each costing £4.70 (€7.00).

The delivery of a purely conventional healthcare service is becoming financially unsustainable. The healthcare system will be crippled if we don't integrate the most effective complementary and alternative practices such as acupuncture, osteopathy and nutritional therapy. The formation of national standards and a central register for CAM professions is under way and will enable the Health Service Executive to source highly qualified and experienced practitioners and therapists, thereby removing any concerns about the varying standards of therapists here.

With the increase in disabling chronic conditions in the younger generation, a change in how we live as well as in how we deliver health care is vital. Poor nutrition and unhealthy lifestyles are killing the nation. Scientific research shows there is good reason to integrate evidence-based therapies such as acupuncture and nutritional therapy into mainstream health care. As the common purpose in healthcare is to promote and maintain optimum health, it is important for all parties to make room for each other.

Ruth Cloherty is director of the Institute of Complementary and Integrated Medicine

THE PUBLICS COMMENTS FOR INTEGRATION

NO

argues Dr Brian Hughes, who says that alternative therapies simply do not work

These therapies are alternative precisely because they don't work. When used in relation to medicine, the terms "complementary" and "alternative" certainly sound positive: the former implies co-operation and synergy; the latter autonomy, choice and the freedom to make your own decisions. Many of us think it admirable when two things complement each other, and we all know it is wise to shop around for alternatives. However, when making decisions about healthcare, it is generally advisable to look for more than euphemistic verbiage.

Discussions about complementary and alternative medicine (CAM) are often highly charged. For whatever reason, many people are positively disposed toward CAM. I think terminology certainly represents part of the explanation. Criticising something that is complementary or alternative can appear like standing up for narrowmindedness or conservatism. Being "anti-complementary" or "anti-alternative" just isn't fashionable.

However, the proliferation of CAM in Irish healthcare represents a triumph of euphemism over common sense. By definition, what makes a particular practice "complementary" or "alternative" in the first place is the fact that the majority of scientific studies have found it to be medically inert. Quite simply, CAM is not real medicine.

Thousands of studies have been conducted into acupuncture, chiropracty, homoeopathy and the like, and yet none of these practices has been conclusively shown to be effective. Imagine buying a washing machine that, in factory trials, was unable to remove dirt from clothes; or a new car that, during its development, not only failed safety checks but also failed even to move! This is where we are with CAM: acupuncture, homoeopathy and the rest of them have all been tested - and all have failed their tests. If any of them had passed, they would cease to be classified as either "complementary" or "alternative". Of course, none of this is a surprise to mainstream medical scientists. This is because CAM practices are based on theories of the body that make no sense in scientific terms. Many practices claim to be based on "energy systems" that have never been demonstrated to exist.

The most common response to the above is the cry, "But science cannot explain everything!" This is where the power of euphemism comes in. Criticising things that are "complementary" or "alternative" is portrayed as a sign of epistemological infallibility - scientists are accused of being a bunch of know-it-alls. In reality, scientists never claim to be able to explain everything. The entire practice of science is based squarely on the assumption that we do not have a full explanation for anything. This is why scientific research is, and always will be, necessary. The most effective point favouring CAM, however, is the large number of its consumers who believe it has benefited them. "It worked for me!" is a claim made with great frequency. Many people do indeed feel better after undergoing a CAM therapy. However, psychologically, there are several reasons why being treated by a practitioner - any practitioner - should lead to improvements in health.

Psychological research has shown that any intervention that makes a person feel less stressed, less rushed, more valued, or more confident will enhance their ability to overcome symptoms of illness. Put simply, psychological changes help precipitate biological ones. Both our cardiovascular and immune systems respond positively to the removal of stress. Studies indicate that stress reduction makes postoperative wounds heal faster and patients spend less time in hospital after treatment. However, psychosomatic effects, in general, are restricted to pain, inflammation, nausea and minor infections. And research shows that these are precisely the types of ailment CAM practitioners have most "success" with.

CAM treatments are medically inert but psychologically beneficial, which helps explain their modest reputations. However, any psychological boost will have the same effect as a CAM. The big problem is that CAM can lead people to disregard mainstream medicine altogether. Such avoidance can be dangerous and, in extreme cases, fatal.

Any modern healthcare system should eschew euphemistic seduction. Expenditure should be confined to activities shown to have a basis in reality and to confer direct medical benefits. Psychological support is certainly important in helping people recover from illness, but dressing it up in mysticism and pseudoscience is an expensive insult to the ill, and a poor reflection on our scientific literacy.

Dr Brian Hughes lectures in psychology at the National University of Ireland, Galway

THE PUBLICS COMMENTS AGAINST INTEGRATION