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Complementary Therapies in Clinical Practice (2006) 12, 177–180

1744-3881/$ - sdoi:10.1016/j.c

www.elsevierhealth.com/journals/ctnm

EDITORIAL

Paving the way for complementary medicine?

This issue of Complementary Therapies in ClinicalPractice (CTCP) highlights papers from Russia,Canada, Italy, USA, UK and Japan.

These papers reflect a concerted move towardsevaluating, monitoring and addressing the safetyand efficacy of CAM worldwide. The topics ad-dressed in this publication highlight innovativeresearch and management of a number of chronicdiseases or problems encountered from birth intoaging and care of the elderly population.

CAM and research

Research into CAM evaluates therapeutic efficacyand it can also reflect how consumers feel aboutreceiving a particular therapy—something thatconventional medicine commonly fails to reflectupon. As CAM grows it appears to be of increasingvalue in chronic illness management. This is worthconsidering when looking at the direction thathealth care is taking.

In the main, CAM research in the UK is developingalong a cautious path. Claims of therapeuticefficacy for particular conditions tend to berigorously assessed in CAM since opponents of CAMcan be quick to throw stones in order to demolish orchip away at claims. Lack of research funding inCAM worldwide, means that by definition, studieswill not develop as rapidly or be as large as thosefunded by pharmaceutical companies. In the UKthere has been a call for National Health Service(NHS) research and development directorate andthe Medical Research Council (MRC) to providegreater support into complementary therapies. Forinstance in 1999, UK medical research charitiesspent only 0.05% of their total research budget.This is in contrast to The National Center forComplementary and Alternative Medicine (NCCAM),established to support CAM research. NCCAM nowspend more than US $70 million annually funding

ee front matter & 2006 Published by Elsevier Ltd.tcp.2006.06.001

CAM research and this represents a powerful way ofencouraging research.

However, despite a general perception thatfunding bodies are biased against CAM, funding isavailable for CAM research in the UK. These includethe Wellcome Trust and the MRC. The success ratefor CAM applications to the Trust tends to begreater than for ‘conventional’ research proposalsbut the number of applications continues to be verysmall.

Current contentions

Research is fundamental to establishing safety andefficacy of any therapeutic modality. However, inthe UK, Professor Baum and colleagues recentlyargued that patients, the public and the NHS arebetter served by using NHS funds for availabletreatment based on solid evidence and called forthe rejection of unproven or disproved alternativetreatments currently being encouraged for use inthe NHS. Professor Baum and colleagues raisedconcerns that patients should benefit from the besttreatments available and avoid overt promotion oftherapies with implausible evidence but known tocause side effects or reject therapies not tested topharmaceutical standards.1

Such an approach may seem praiseworthy since itis always paramount to ensure patient safety.However, in numerous cases where extensiveresearch has occurred into pharmaceutical pro-ducts demonstrating efficacy, side effects fromtaking certain medications continue to occur. It isnot uncommon for further medication to berequired to offset these effects. Managing medicaliatrogenesis incurs a huge bill to the NHS annually.For example, a well-recognised side effect ofsome diuretics can result in hyponutraemia (lowblood sodium) and may initiate seizures. Thereare also a considerable number of medical

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practices currently perceived as conventionaltreatment that may fall short of current demandsfor research efficacy.

It is unfortunate that pharmaceutical productsare integrated so effectively within our culturetoday that we take the list of medication sideeffects for granted—even when these effects areseriously debilitating. We have become socialisedinto thinking that once a drug is on general releasethe manufacturers know all there is to be knownabout a drug’s interactions in the human body. Thisis rarely the case. Thus to challenge the overtpromotion of complementary medicine within theNHS purely and exclusively according to thestandards of pharmaceutical research may be afallacious argument.a

Research is important and so is the need tomake substantiated claims about therapeuticefficacy. However, it is overly simplistic to claim‘patients should benefit from the best treatmentsavailable’1 because certain assumptions arebeing made. Firstly, that orthodox medicine hasall the answers to current medical problems;secondly, that all the research that needs to bedone in current conventional medical practice hasalready been done—and upheld. Thirdly, patientscurrently do get the best treatment available.There is also an assumption that individual medicalpractitioners are aware of all treatment choicesand the extent to which an option has research tosupport it.

In reality choice of treatment is influenced byfinancial constraints and availability in a givenhealth district. Receiving the ‘best treatment’ isnot straightforward; it is a complex business.

Paradoxically, as a result of governmentinitiatives encouraging individuals to takeresponsibility for their own health care the generalpublic are exhibiting increasing levels of healthliteracy with individuals being more aware ofvarious medical options open to them than everbefore. In some instances they may knowmore about specific therapies than the medicalpractitioner.

As Baum et al.1 request, there should be a call fortrusts to review their practice—not only in the areaof claims about CAM but also review the cost of NHStreatment prescribed to counteract medical iatro-genesis.

It is apparent that whilst NHS money is indeedspent on complementary medicine the amounts

aA forthcoming book2 highlights current research into a rangeof therapies, herbs and acupuncture may go some way topresolving uncertainties in this field may go some way to guidingpractitioners.

involved are very small and need to be viewed incontext with a breakdown of NHS expenditure ingeneral.

Finding out how much money has been spent invarious fields of health care is not always easy. Thisis because in part, patterns of morbidity change,the social and economic context of health carevaries and our response is influenced by changes inhealth care policy and technology.3

Chronic illness management

Many people continue to seek out complementarytherapies for chronic diseases. This oftenmeans that they feel their problem has not beenresolved by other, more conventional approaches.It is also apparent that chronic disease is increas-ing, ironically partly as a result of the success oforthodox medicine managing to keep people alivefor longer.

Paradoxically, the Department of Health in theUK has not published a definition of chronic diseasenor does it keep a list of what is considered to be achronic disease.3 Thus it is not possible to accu-rately calculate how much of the health carebudget is spent on chronic disease. However, forthe sake of this paper, the definition of chronicdisease is taken from Last4 as an illness lasting morethan 3 months.

Locker5 suggests that up to 80% (180 million) ofgeneral practitioner (GP) visits in the UK arerelated to chronic illness. This burden is increasingrather than decreasing with the World HealthOrganisation (WHO) estimating that chronic dis-eases will double for those in the 65 year cohort by2030.6

Chronic heart disease and cancer are majorinfluencing factors in the growth of managed orchronic forms of disease.7 Although death rates forchronic heart failure have fallen since the 1970s inthe UK, morbidity does not appear to have followeda similar trend and may even appear to be rising.3

Indeed, the British Heart Foundation estimates thatbetween 2001 and 2004 the number of statins beingprescribed has more than doubled.10 The treatmentof chronic disease costs UK healthcare in excess of£1.75 billion with chronic heart disease the mostcostly disease in the UK.

In the field of cancer care the costs are alsoincreasing. With cancer now affecting 1:3people,8 the UK office of Health Economics putsthe total NHS expenditure for cancer services in2000–01 at £2106 million (10.6% of the totalbudget).9,11

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These figures are also influenced by changes inthe way we currently screen, diagnose andtreat many cancers. Three decades ago the picturewas very different. One result of earlier screeningand treatment however, is that people are livinglonger with chronic diseases rather than dyingfrom them.

It would seem than that there is clearly a need toexplore alternate forms of health care, which mayoffer economical and qualitative medical benefits.Substantial funds should be allocated to look atways to relieve aspects of chronic disease or at thevery least, enhance quality of life when living withchronic illness.

Interestingly, we are presented with an emerginghealth care conundrum. On the one hand there isan assumption that the state has a responsibility toprotect the health of its people; on the other handthe state also wishes to claim that individuals areexpected to monitor and guard their own health. Inan ideal world this implies a balanced contractbetween consumer and supplier. However, recentlythe balance of the contract is becoming weightedtowards personal responsibility for health. Thussuppliers (in this case the government and healthdepartments) appear to be arguing that wherepersonal health care maintenance appears not tohave been effectively managed then medicaltreatment may be restricted. This approach isexemplified by caveats on the treatment of obesityor smoking-related co-morbidities.

Restrictions of this sort may at first glance appearlogical, after all we live in a world of freedeterminism and if we get ill from e.g. smokingand other drug addictions should we expect thehealth care system to pay for our care? However,with the epidemiological evidence strongly indicat-ing a growing nation of elderly people withincreasing chronic illness, then treatment selectionwill occur.

It is ironic that at a time when statements arebeing made challenging the use of a very smallpercentage of NHS budget spent on CAM, thefeasibility of CAM providing cheaper managementof chronic disease(s) appear to have been over-looked. Unfortunately, we do not currently havethe funds to undertake research to support such acontention!

CAM and the future

Somewhere in amongst the billions of pounds spenton managing illness, is a very small amount ofmoney being spent on complementary medicine.

But to complain about current short-term lack offunding may be to overlook the larger trends ofhealthcare management. These are emerging fromour ability to keep people alive for longer. Chronicdiseases are long term and most medical budgetswork for the short term. In the UK, NHS hospitalfinancial budgets run on a 12-month cycle; govern-ments run on 4-year cycles. Against this settingfinancial health care planning is woefully inade-quate for an expanding population that is livinglonger and with an increased propensity for chronicillness. Added to this is a better-educated popula-tion who have now been taught by the governmentand health care practitioners to demonstratehealth literacy and it is highly likely that peoplewill demand CAM as part of chronic diseasemanagement.

In the future, CAM may well become central tothe management of chronic illness. What is neededis a coherent long-term strategy incorporatingadequate research funding to evaluate therapeuticefficacy.

It would appear that current health care is not ina position to acknowledge the enormous issue ofchronic disease management. If unattended,chronic illness will open a health care Pandora’sBox whereby acute illness management may wellexacerbate chronic illness.

One thing is clear though; chronic diseasewill increase as long as human longevity increases.However, as the health literacy of peopleincreases so will the demand for greater health-care. Conventional healthcare approaches mayhave to accept they have been hoist by their ownpetard.

References

1. Baum M, Ashcroft F, Berry C, Born G, Black J, Colquhoun D,et al. Use of alternative medicine in the NHS May 23 2006.Times online www.timesonline.co.uk/article/o

2. Rankin-Box D, Williamson E. Complementary medicine: aguide for pharmacists. Edinburgh: Churchill Livingstone;2006, to be published.

3. Rosenstrom Chang L, McAuley D, Slote Morris Z. Will Healthbe a burden? The Nuffield trust: policy themes, 2004.www.nuffieldtrust.org.uk/_themes/index

4. Last JM. A dictionary of epidemiology. Oxford: OxfordUniversity Press; 2001.

5. Locker D. Living with chronic stress. In: Scrambler G, editor.Sociology as applied to medicine. Edinburgh: Saunders;2003. p. 79–91.

6. Batty D. Reid unveils chronic care plans. London: TheGuardian; 2004.

7. Lewis R, Dixon J. Rethinking management of chronicdiseases. Br Med J 2004;328:220–2.

8. Wanless D. Securing good health for the whole population.Final report. London HM Treasury, 2004. p. 214.

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9. Bosanquet N, Sikora K. The economics of cancer care in theUK. Lancet Oncol 2004;5(September):568–74.

10. British Heart Foundation. True cost of heart disease.London: British Heart Foundation; 2004.

11. DoH. A better life for people with chronic disease. London:Department of Health; 2004.

Denise Rankin-BoxCentre for Complementary Med and MCI, P.O. Box

10, Macclesfield, Cheshire SK10 4HW, UKE-mail address: drankinbox@compuserve.com