A rational society should resist populist calls for a retreat from science - even when they come from the heir to the throne. But even before Prince Charles delivered his familiar call for a more holistic approach to complementary medicine yesterday, a group of 13 eminent clinical scientists sought to pre-empt him. A letter sent by the group to the chief executives of all 476 acute and primary care trusts urged them to restrict the NHS's use of complementary and alternative medicine to scientifically-proven treatment. It was already running in the media before the prince began his address to foreign health ministers at the World Health Assembly in Geneva.
About half of GPs in Britain already provide access to some form of alternative or complementary therapies. At least one in five people add a further £130m of treatment which they pay for themselves. The medical scientists' letter did not mince its words. It described homeopathy as an "implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness". It went on to add that while medical practice "must remain open to new discoveries", it would be "highly irresponsible to embrace any medicine as though it were a matter of principle." Michael Baum, emeritus professor of surgery at University College, London, the initiator of the move, told the BBC Radio Today programme: "I'm all in favour of treatments that make people better but there is the issue of evidence. My concern is the issue of opportunity cost. If the NHS is spending money on placebos at the cost of not providing effective medicines, then it does matter."
So far, so fair, many will believe. A Swiss-UK review of 110 trials found no convincing evidence that homeopathy treatment worked any better than a placebo. One of the world's leading medical journals, the Lancet, last year described homeopathy as no better than dummy drugs. In 2000, a distinguished group of medics on the Lords select committee on science and technology concluded that "any therapy that makes specific claims for being able to treat specific conditions should have the evidence of being able to do this above and beyond the placebo effect". And yet this committee did include homeopathy - along with acupuncture, chiropractic, herbal medicine and osteopathy - in a "big five" category which it believed ought to qualify for inclusion in NHS treatments.
Sensibly the health department leaves it to trusts and clinicians to decide whether complementary and alternative medicine is appropriate. It has provided £3m to boost research on the effectiveness of CAM. The defenders of these therapies do have studies which show some are effective. Acupuncture can reduce post-operative pain, herbal medicines relieve depression, and manipulation therapies alleviate lower back pain. Ideally, the National Institute for Clinical Excellence should be asked to conduct clinical and cost effective studies into other therapies, but its budget has been cut and it is already behind schedule in its research on proposed new mainstream treatments.
To be fair to Prince Charles, who has advocated greater use of complementary medicines for more than 20 years, yesterday's call for more integration was restricted to "proven" therapies. Where the 13 medical scientists went wrong yesterday was in their tone. The NHS is supposed to be seeking to become patient-centred, under which there is "shared decision-taking". Medicine aims to become a team effort. And scientists are in urgent need of more public support. All this will only be achieved, as Harry Cayton, the patient tsar has noted, if medical scientists change their approach and "begin to talk with us, rather than at us". Yesterday's declaration had the smack of yesterday's medical men failing to see the difference between wellbeing and clinical outcomes.
