Appeasing CAM in the NHS

The UK’s National Health Service has made some progress towards embedding evidence based clinical practice in its service delivery. But there is still some fence-sitting going on. My attention has just been drawn to current guidance on complementary and alternative medicine which is less than definitive.

It’s surprising that under the heading “Defining CAMs” the word evidence does not appear. Isn’t this is foundational? Practices that have robust supporting evidence surely move out of CAM and into mainstream practice. But at least evidence is mentioned when deciding to use CAM. However why not briefly state how evidence is defined?

Much of the advice on this page is sound, eg “Do not visit a CAM practitioner instead of seeing your GP”. I would go further, never see a CAM practitioner. But I take issue most seriously with the section on regulation. It is simply untrue that the Professional Standards Authority applies “demanding standards”. The PSA never asks any accredited register to require registrants to follow evidence based practice. No accredited register requires this of any practitioner. Indeed, the PSA has bent over backwards to appease the Society of Homeopaths, by renewing its accreditation, despite failure to discipline non-compliant members. How is it possible for users to make an “informed choice” without an answer to the quite important question, “does it work”?

Yet astonishingly, this question does not appear in any form under “Questions to ask before starting a treatment”. Isn’t that the very first thing that would interest someone with a health problem? Without this, most of the other questions here are of little use. Certainly, “documentary proof of their qualifications” may look impressive, but a degree in nonsense is still nonsense. For the reasons given above, professional memberships are similarly valueless. Insurance also might look good, but these policies insure against such risks as injury and malpractice, and as CAMs generally do nothing at all the risk of injury is often negligible – apart from rejecting effective treatment. Sites such as whatstheharm.net show that CAM users would rather die than complain about their practitioner. Some of them do.

But at the end of this list we have “written references”. What on earth was the author of this page thinking of? Not only have they failed to define clinical evidence, they have implied that it is composed of anecdotes. The Advertising Standards Authority has a much better idea of what evidence is, and testimonials are not it. Indeed, publishing a patient recommendation for a health condition that is not supported by rigorous clinical trials is viewed by the ASA as a marketing claim, and may put the practitioner in breach of the advertising code of practice.

The problem is that pages like this get flagged as authoritative support for CAM and in particular its regulation. In reality CAM regulation is pretty much useless. The professional registers are primarily trade bodies and do next to nothing to set and enforce meaningful standards. Even the statutory regulator the General Chiropractic Council failed to do anything about registrants working outside their competence. There is a lot of good stuff from the NHS on what works and what doesn’t, but this page isn’t among it.