Woolly views on alternative treatments
Authors: Geoff Watts
Journal: BMJ (2006)

The announcement that Prince Charles would be addressing the World Health Organization on complementary medicine didn't exactly send the thermometer of journalistic excitement soaring. So the 13 eminent scientists and doctors who retaliated by writing a preemptive letter to NHS trusts suggesting that complementary medicine was a waste of money did the prince a public relations favour. Their intervention—and the debate that ensued—guaranteed at least some rise in the hitherto cool temperature of his event.

On 24 May three of the broadsheet newspapers devoted leader columns to the place of complementary medicine—but with sadly disappointing results. The views expressed were an amalgam of the inconclusive, the ill considered, and the contradictory. Least contentious of these papers, and least unsatisfactory, was the Times. Having told us what we already know—that treating patients' symptoms is not the same as enhancing their wellbeing—the paper went on to remind GPs that “they have may have much to learn from a homoeopath's ability to listen, empathise and consider the totality of a patient's condition.” Penetrating stuff, eh?

Conscious perhaps that breakfasting GP readers might already be spitting toast crumbs as they screamed “seven minutes per patient,” the leader sagely added that “the limiting factor in adopting alternative medicine's less controversial topics is time.” It gave no actual suggestions for squaring this circle, unfortunately.

Still, the writer did round off with a conciliatory and balancing afterthought: “Practitioners of therapies that cannot supply... evidence [of benefit] should continue the pursuit of proof.” However, a great many are reluctant even to start.

And so to the Guardian. Its leader began by arguing that “a rational society should resist populist calls for a retreat from science.” But having rehearsed some of the arguments against complementary medicine it lost its way in the boggy ground of patient centredness and shared decision making. The fault of the 13 scientists and doctors—also known as “yesterday's medical men”—apparently lies in the tone of their letter and their failure to understand the difference between wellbeing and clinical outcomes.

How they're supposed to enhance their patients' wellbeing is, once again, not disclosed. Should Professor Baum, ringleader of the letter writers, have been practising aromatherapy instead of surgery? Clearly not. So should he have at least ringfenced a part of his budget for spending on it? Certainly feasible. But would aromatherapy have been the right choice?

This interesting but unexplored question was left even more glaringly unexplored in the Independent's similar but still woollier leader. It too disparaged the letter writers, describing them as members of a closed shop mounting an absolutist attack on “anything not rooted in their biochemical model of medicine”—whatever that means. The Independent writer also drew attention to the undisputed fact that many unorthodox forms of treatment do make people feel better. A couple of weeks ago I heard the pianist Andrei Gavrilov playing Bach's Goldberg Variations at St John's, Smith Square, in London. Had I been suffering from a malady of some kind, those exhilarating 75 minutes might well have been as good for me as a homoeopathic tincture. Musicians already perform in some hospitals, but in limited numbers. So perhaps we should switch the NHS's homoeopathic budget entirely to music? Would it achieve more? It might; it might not. We have no idea. And that's the problem with demands to spend money on actions that, for good reasons or bad, have never been evaluated.

The Independent's final and most wildly misdirected strike reminds the reader—and more especially the tunnel visioned 13—that “open-mindedness is a scientific virtue.” Only someone who knows nothing of the prevalent mindset in complementary medicine could have wagged a finger in so totally the wrong direction. But don't take it from me. The late and much missed journalist John Diamond, who died from cancer of the tongue, had extensive personal experience of this mindset. After the publication of his book and the many occasions on which he wrote about his illness, he was inundated with advice from the fringe delivered by correspondents who all knew for a fact precisely how to cure him.​him.



Figure 1

Prince Charles expounding his alternative view of health care



The acceptance address he gave when receiving an award from the charity Health-Watch included this passage: “If you were to ask most alternativists [John's preferred term for them] they'd probably tell you that one of the big differences between their art and our science is that the medical establishment is so very sure of itself. It's closed minded. It knows it's right. But in fact that's the very opposite of the truth. Although we patients demand certainty of our doctors because we prefer certainty in our lives, medical science is as much about not knowing as it is about knowing. An experiment, by definition, is about what you don't know, about what you want to find out. It's the alternativists who are so certain of their beliefs that so many of them don't think it's necessary to submit them to proper scrutiny.”

For as long as the public continues to show enthusiasm for complementary medicine the papers will write about it. Fair enough: they are, let's not forget, commercial enterprises that need to turn a penny to stay in business. It's like the daily horoscope; newspapers print these cosmic conceits not because their proprietors believe in astrology but because they're popular and boost sales. But it's a bit depressing when what resembles gratuitous populism starts to infect the leader columns as well.