Focus on Alternative and Complementary Therapies
www.pharmpress.com/fact
Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2004; 9: 85–6
The National Institute for Clinical Excellence (NICE) is the institution that decides which treatments will be paid for by the UK NHS and which will not. The decisions are usually based on systematic reviews of the literature. For the first time in their history NICE have considered CAM in one of their guidelines. The latest NICE report, entitled Multiple Sclerosis (MS), tells us that ‘people with MS should be informed that there is some evidence to suggest that the following items might be of benefit, although there is insufficient evidence to give more firm recommendations: reflexology and massage, fish oils, magnetic field therapy, neural therapy, massage plus bodywork, tai chi, and multi-modal therapy’.1 No explanations are given as to the nature of these therapies. No reference was provided for this ‘grade A recommendation’ but the message is similar to the one emerging from our systematic review of complementary treatments for MS.2 We found RCTs for the following therapies: nutrition, massage, Feldenkrais bodywork, reflexology, magnetic field therapy, neural therapy and counselling. Almost all the trials yielded positive results but, because of numerous shortcomings, our conclusion was that ‘the evidence is not compelling for any of these therapies’. None of the ‘guideline development group’, the ‘consensus reference group’ or the ‘guideline review panel’ working on the NICE guideline seems to have had a CAM expert on board.
The NICE report opens several questions. The most obvious one is will its readers know what the above named therapies refer to? I’m not actually sure that all FACT readers know what neural therapy is! But there are other, perhaps more important, issues. ‘Insufficient’ evidence surely exists for hundreds of other treatments; so why should we inform MS patients about those listed above? Is NICE yielding to political correctness in endorsing CAM? If the evidence for CAM is insufficient, how can progress be made and how can we determine its real value? Even though the report has a whole section entitled ‘research recommendation’, no advice is being issued for further research on CAM. However, in the section on CAM we find the following remark: ‘A person with MS who wishes to consider or try an alternative therapy should be recommended to evaluate any alternative therapy themselves, including the risks and the costs (financial and inconvenience)’.1 Does this mean that when our knowledge is incomplete in conventional medicine, institutions bear the responsibility for completing it, while in CAM it is up to the individual patient to do so? How should patients master this task and why is NICE using the term ‘alternative medicine’ here, which seems to imply that the above-listed CAM modalities can be employed as a substitute for conventional healthcare? It has long been recognised that ‘one of the main dangers of CAM is that patients could miss out on conventional medical diagnosis and treatment because they choose only to consult a CAM practitioner’.3
My conclusion to all this is that NICE, in their first adventure in CAM, have given us an intriguing insight into their own set of biases. In applying these biases they are in danger of perpetuating some of the double standards that have bedevilled CAM for many years. In the interest of our patients we should forsake double standards in CAM or any other type of healthcare. ‘CAM practitioners and researchers should attempt to build up an evidence base with the same rigour as is required for conventional medicine, using both RCTs and when appropriate other research designs’.3
