My name is BrÃÂÂd Hehir and I work in as a nurse and lead for patient & public involvement in the NHS here in London. I have got a long standing interest in Complementary and Alternative Medicine and obviously I am quite curious about the motivation behind the drives, towards its integration into healthcare and the opposition to it on the other hand. I coordinate the Institute Of Idea, Science and Health Forum as well. And there is some information of that about that in your packets Right so while complementary and alternative medicine continues to be hugely popular, attracting royal patronages, celebrity support and NHS funding, there has been quite a bit of negative coverage of late. And you have got some PCTs for example who have stopped funding treatment to homeopathic treatment at Tunbridge Wells Hospital. Now, it's a homeopathic hospital. There has been, quite a bit in the media about 'Mickey Mouse' degrees in complementary and alternative medicine. I got one of those and and some want to stop the course as being classified as a science degree and to be taught instead as part of a cultural history or sociological course. Right so those of you who are familiar with the role of complementary and alternative medicine will know that the issue of evidence dominates discussions around it, quite over suggested that the vast majority is anecdotal Despite that it's very popular with the public. So is there room for Complementary and Alternative Medicine in 21st century healthcare? Those are the kind of discussions we want to have today. We got three speakers, very well suited to discuss this topic very familiar with it. To my immediate left, who the first speaker is Toby Murcott. He is a biochemist, turned science writer and broadcaster. And many of you will be familiar with his writings from in The Times. He also lectures in science communication at the University of Glamorgan and he is the author of "The Whole Story" which is on sale outside. Next to Toby is Professor Edzard Ernst and he was appointed in 1993 to establish the first chair in complementary medicine at the University of Exeter and now he is the laying chair in Complementary Medicine, which aims to conduct rigorous research into CAM's efficacy and promote analytical thinking about it. He is publishes prolifically and he is there is a desktop guide to "Complementary Therapies" on sale outside as well And at the end is Dr. Stuart Derbyshire and he is a psychology lecturer with a major research interest in pain and neuroscience. Some of you might have seen him recently on the Dispatches program talking that was discussing abortion. And he is particularly interested in discussions about pain and about acupuncture in particular. So our speakers have five minutes each to make their views to present their views in the topic. I am going to keep them to time. We have an hour and we want to make the most of it. So after that then their introduction, I will ask them a question or two about what's been said, and then I will open it up to the floor. So if you got questions, contributions or whatever; keep them until they have said their bit and then we will have a full discussion. Okay, Toby Would you mind turning off the mobile phones, because they apparently interfere with this technology. Just like taxis taxis used to be picked up by electric guitars, microphones; so mobile phones pick up this exactly the same way. So I think there is one waiting or somebody downstairs, you have to go in a hurry. Okay, well thank you very much BrÃÂÂd. I am going to start with a fairly cheap debating trick and take conventional take issue with the great pardon. All right, okay, I was okay speaking into these things, I have really had many, many years as a radio producer and maybe I should have learned something. I am going to take issue with the title of this. This is called "junk science or genuine alternative?" And my contention is that CAMs is neither or neither depending on your perspective. I will start with the second bit. A genuine alternative; there are very, very few situations where I have seen anything remotely approaching good quality evidence to say that there are any CAMs that can excuse me, replace many forms of conventional western allopathic whichever way you want to call it medicine. And so I think we are certainly not at a position where it can be or should be a viable alternative from that perspective. There is also the point of view, if something is set up as an alternative, that is inevitably set up as a conflict this is an either-or situation. And if you have that, imagine the individual experience of being transferred from one system to another. If you are undergoing healthcare, you want good continuity of healthcare. You want one person to hand you on to the next person whatever expert that might be; to talk to them properly and have to speak the same sort of language so that you have good continuity of care. Going between alternative systems, I think sets up potentially real problems with that. So, I think as an alternative, no But as a compliment, I think this is where it potentially and already does produce real benefit. Now there are many, many people who have experienced a whole range of different CAMs and got benefit from them. Now that benefit varies hugely. One of the things that I suspect we will get on to is working out how we measure that benefit and how we put a value on it and how we equate it to a genuine medical research. But benefit is gained on complementary medicines and by and therapies. By calling it a complement rather than an alternative, I think we actually have the opportunity to get whatever benefit it is available from both systems if we continue in seeing the two separate system as allopathic versus CAMs. So if it's a complement, then we have potential of getting benefit from both. If it's an alternative, we set up conflict a potentially harmful conflict Junk science? Well, it's not Junk science. Why? Because it isn't science. The application of CAMs is not science. But then in order to practice a medicine that's not science either. The practice of medicine is the application of knowledge gained by the particular doctor, particular surgeon, particular physician; to the patient sitting in front of him at the moment. Now some of that information you know Western NHS or whatever system you want to talk about this is common in the west; has come from scientific research from good quality scientific research. But some of what the doctor applies is their own personal understanding of the condition, their years of experience in training and this is a lot about the training of the physicians, the training of the doctor; ask somebody who can apply science and their own personal logic to the individual person in front of them, the experience of the person in front of them. There are many doctors who are scientists and there are some scientists who become doctors. But medicine as practiced is not a science. It is a craft and artisan, a very highly skilled one. It is the application of science. So when we talk about science, and sometimes scientists' uses sort of you know a brickbat to throw at complimentary I will call it CAMs, it is easier, to throw at CAMs. And yet we have to be careful. If that particular brickbat has been thrown, people in glasshouses has really mistimed it was badly, but my apologies for that. But if you are throwing that particular brickbat make sure you are doing it from the solid ground About 85 percent of the medicine techniques medical technology available on the NHS is considered not have gone through a rigorous set of clinical trials. That doesn't mean to say that it doesn't work. It doesn't mean to say that it's harmful; it doesn't mean to say that it's bad. It just means to say that it has not been tested to any high degree of rigor. It doesn't mean to say it hasn't been tested, but it's this high degree of rigor. Now clearly that 85 percent15 percent split varies when you look at it in this and are making generalizations here of course. This is you know, what you do when you are sitting on a panel like this and I have one minute left But we have to be very careful about questioning or criticizing CAMs with science without recognizing where science fits into medicine. And science fits into medicine in the sense that a lot of the information used and applied by scientists has been derived from medical research that broadly follows the scientific method. There are increasing amounts there are increasing my grammar is going all over the place there is an increasing amount of evidence on various different CAM therapies that again has been done with greater or lesser degrees of rigor; with greater or lesser degrees of whatever your parameters you are looking for from the from the scientific point of view. But the work that doctors and CAMs practitioners do is not science; it is application of knowledge. So really we are looking at the provenance of their knowledge and how it's applied. So it's doctors or therapists training and where does the information come from and how is it derived. From science? Good or bad, not science All right, thank you. Don't worry; you'll get time to talk them at the end and have more time. Okay, Edzard do you want to? Hi, everybody. I was afraid when we met over coffee, that we would agree on everything and I am sure we after hearing him, we won't. This 80 percent of conventional medicine not not being tested is nonsense. That that figure just is it's historically its its half a century old, and current figures are between 40 percent and 20 percent of of conventional medicine hasn't been properly tested. But I am not going to speak about that. I am going to speak about another hobby rose of mine, which is the Great British Public is systematically being misled about complimentary medicine. And obviously you are the Great British Public and I am the one who is who is watching that and is is suffering through that process. I am going to I am just making this one point and I am supporting it with six sub-points Complementary medicine is safe; that is what you hear when you open newspapers. Has writers I am trying to distinguish between journalists who are okay, and you are a journalist has writers who are not okay, who who write about complementary medicine that have an interest, sometimes even own the firm or or have shares in the firms, which products they they advertise, and somebody who is who is on top of my blacklist is Dr. Ali, who is a I believe, a private physician of Prince Charles and writes in the Daily Mail, regular weekly column, and advertises basically advertises his unproven products in this column. So these types of writers tell you day inday-out, complementary medicine is safe. It's simply not true, it's a lie. And and if you go on to the internet, you'll find 40 million websites on complementary medicine, and they tell you exactly the same lie. So, that's my first point. Second point, complementary medicine cannot be researched. This is so called experts in this field tell you that, it it cannot be submitted to the research tools that that we have developed in science and and medicine. It's not true. I haven't brought a bottle of wine but I am happy to send anybody a bottle of wine who tells me one treatment in complementary medicine which cannot be submitted to a randomized clinical trial. So when whenever you you will hear this notion, it cannot be researched, for whatever reason, and we can discuss the reasons, you can be sure it's not true. Third point, there is no evidence. Well, there is plenty of evidence. I estimated about 10,000 clinical trials of one sort of complementary medicine or another. So there is plenty of evidence; you just need to look and and often this is backed up by the little evidence that we have is of low quality, that is also not true. And in some areas at least the the quality is is very good. And then this is further backed up by people who say, "Well, the little evidence that we have shows it's all placebo." Well may be a lot is placebo, but it's not all placebo. Herbal remedies are not placebo quite simply because they can kill you. And fourth point, it's cheap. About two years ago, we we had Christopher Smallwood, Commissioned by Prince Charles to give a a report to Health Ministers, where he elaborated that using more complementary medicine would saves billions to the NHS. That is not true. The actual evidence is not there. We have we have done this a little bit more scientifically than Christopher Smallwood and published it in the BMJ, you can read it up. The evidence is not there. So anybody who would tells you otherwise is either ill-informed or lying. Fifth point, complementary medicine is holistic. It's more than just a diagnosis. Its it's more than treating physical symptoms. Well perhaps but all good medicine is holistic And I have to hurry up. My last point, it's cheap. Well, I will tell you the figure; 1.6 billion is our own estimation. Mr. Smallwood who have just mentioned, sited a figure of three billion per year, veterans are paying for this, so it's not cheap and anybody who says so is not telling the truth Thank you Great, okay Stuart. Thanks very much BrÃÂÂd. So, when I was first invited to give this talk my initial instinct was to basically go to the literature, do research on a number of different alternative medicines and compare them to other types of medicines. But then I realized that that was a lot of work. And I also realized that that's probably not the right thing to do. And main reason why it's not the right thing to do I think is because what's happening with alternative medicine isn't really to do with alternative medicine; it's to do with us. I mean the whole point of alternative medicine to some extent is that it doesn't change, it's traditional. It is what it is, it should work as it works, end of story. There is not really that much to investigate about alternative medicine per se. What's interesting is what's happened to us that makes alternative medicine seen much more useful than it was before So what's happened to us? Well, I am going to suggest just three things. Firstly, we have gotten physically much healthier. In all corners of the world, apart from the former Soviet Union, health and expectancy life expectancy is increasing, general health is increasing, you are going to live longer periods of your life in a healthy state than ever before. And many factors of course contributed to this happy state of affairs, improved sanitation, housing conditions and improved medicines Secondly and relatedly, we have resolved many serious illnesses that blighted lives up to the middle of the last century. But now scientific medicine is bumping up against more difficult problems, aging, wear and tear and existential diseases born from a living in a culture without meaning, to put it rather bluntly. So though physical health and longevity are both trending in a positive direction, there is now a sway of new problems that are defined by the subjective report of symptoms rather than the objective science of disease and damage. These are the illnesses such as Fibromyalgia, Chronic Fatigue Syndrome; illnesses of what you might call the worried well, or perhaps more precisely the worried sick, encouraged by a combination of people being healthy enough to be concerned about symptoms that are actually unlikely to indicate ill health, and being constantly bombarded with messages about ill health. It is a rare individuals who is unaware of the apparent need to reduce the calorific intake, watch the units of alcohol, stay out of the sun, eat five fruit and veg a day, exercise, self-examine, and heed the occasional twinge as a potential harbinger of disease and death. When the banalities of everyday life eating, drinking, catching the occasional ray of sunshine, are perceived as potential threats to continued life, it is little wonder that people are worried and flocked to their GP to parade symptoms without illness Thirdly, medicine in the 20th century became incredibly impersonal. Doctors are not much interested in your existential concerns; in fact they are quite happy to look straight through you and try and find the disease mechanisms lurking beneath you. Of course a good doctor will try and connect with you as well as your disease. But an increasingly target directed NHS or the United States and an increasingly financially driven HMO, the good doctor has less time to see you and only has time to see your illness; which brings me to my second and final point. It's tempting to deal with the advance of alternative medicine by cutting out randomized control trials and indeed that has been advocated here today. And there are some really good examples of this an excellent example came out last week by on a German group, on the German acupuncture on trials. And what they did is they compared acupuncture spots the that are based on conventional Chinese medicine, based on the meridians and with acupuncture spots that are based on non-meridian, sham spots as they call them, and also compared chronic low back-pain treatment with conventional techniques. And what they found was that both the acupuncture based on traditional Chinese medicines spots and the acupuncture based on non-traditional spots, both worked better in conventional therapy. And so it was concluded that the acupuncture needles can be a useful therapy for chronic low back pain; but it doesn't matter where you stick the needles. And it's quit similar to several reports that have come out in the British medical literature including one with the title "Is a cocktail stick as effective as an acupuncture needle?" And the answer to that was, "Yes, it is. But that's another I see it as a good reason why noxious stimulation of skin might actually affect pain. And I don't I haven't got many left not enough time to go into those. But I am basically dubious about the effectiveness of the acupuncture in this particular trial. And the reason I am dubious is because chronicle low back-pain is itself a very tricky disorder. More than 70 percent of all cases with low back pain have no identifiable course of pathology. We just don't know why the patients have the pain. And so the diagnosis is based on the report of pain rather than any observation of damage or disease. And these types of pains are increasing at a ferocious rate. And it seems unlikely that medical facts alone can account for this increase. So expenditures on these benefits for example has tripled expenditure on benefits relating to chronic low back pain and similar disorders has tripled over the past 30 years, despite improvements in life expectancy, despite improvements in health. And chronic low back pain seems to be more of a psycho-social problem rather than a disease of the back itself It's little wonder then that the conventional treatments for for low back pain in that study where pretty unconventional. So the therapies given in the conventional group were, "physiotherapy, massage, heat therapy, electrotherapy, back school, injections and guidance. And a few patients' therapies include infusions, yoga, hydrojet treatments and swimming". My rather critical interpretation to this study and this is where I will finish, is that at the current moment in time, patients with non specific existential disease prefer to spend time with an acupuncturist than with a heat therapist. And it is no surprise that patients report feeling better when they do things that they prefer to do. But it's not the role of medicine to run randomized control trials of stuff that makes people happy in order to prove that stuff that makes people happy tends to make them happy Right, actually I would like you said, Toby was saying or Edzard was saying, it was a worry that there wouldn't be too much distinction between what people said and it is obvious that there is very different takes on this here. So, Toby can I ask you first I mean you you assert and Edzard challenged you by saying that 85 percent wasn't tested of scientific medicine wasn't so called orthodox medicine wasn't tested; so do you think then is that part of the reason why you think so many doctors are practicing CAM these days? No. Because if because if it you know if their training is based on rational science and that practicing something that is patently irrational, how does that marry marry up? Okay a couple of points. The point I was making about the 85 percent or the fact 40 percent or 20 percent, I am not going to contest this because it's not that they have not been tested, but they are not not being tested rigorously to a high degree, and that's such a quite an important point. Secondly why doctors are practicing CAMs? Doctors part of doctor's training is about science. But it's about the application of science, and the other very important part of doctor's training is about working with the patient, using their own experience and their own clinical understanding to apply to the patient in front of them. And I have told to a lot of doctors about this and by and large, the ones who practice CAMs I don't really know why it works; there isn't a great deal of evidence. But if I give this to my patients or my patients they seem to get better. So they are doing it in a very empirical way, which has been part of medicine for as long as I think medicine has been around or definable. So I don't think it is an irrational irrational decision. It is "Hey this works on my patients." Cynically they no longer bother being surgery. And so it is much more gradual process of just "hey, it works." Okay, hold on. Edzard, can I ask you you said that the public are being misled. So do you think then that scientific illiteracy in the public is a problem? Hugely hugely. Obviously not this audience, but everybody else in Britain seems to be scientifically illiterate and gullible. I mean just just amazing amazes me how illiterate we are in Britain and the courses are well known about science education, and you know it starts at school and ends with this Okay, we are just gone that further. And Stuart, when you were talking I was reminded of the there was a battle in print on the IOI the Battle of Ideas website by Colin Berry, and he suggested that the absence of external stresses produces introspection and he sighted the fact that suicide rates fall fall during war years. And I think you seem to be saying something similar, that people are living in a because people are living in a world without meaning they dwell too much on the banalities of life and you almost said I think that health is banal, that a bit harsh isn't it I mean many of the health problems we have today are banal, I would say. I mean there is still serious illness around. You know people still get bowel cancer, people still have heart attacks, people still have brain tumors and what have you interestingly, they don't those kinds of things are not the sort of things that you go and see your alternative medicine practitioner or about. You know those are the kinds of things you go running to your GP and you are hospital bound. But things like "My bowel movements are not quite right," those are the kinds of things that you do go and see the alternative practitioner about and which your doctor will not have as much interest in, but really that is banal, you know, the old bowel movements are not very interesting and your life should not be about your bowel movements. But for many irritable bowel syndrome patients that is what their life is about
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