§ 3.42 p.m.
§ Lord Kindersley rose to call attention to recent developments in the field of complementary medicine and its relationship to conventional treatment; and to move for Papers.
§ The noble Lord said: My Lords, I should like to thank your Lordships for giving the House the opportunity to debate once again the subject of complementary or alternative medicine, or, as I prefer to call them, the natural therapies. Since the last debate took place much has happened and perhaps it would be sensible if I were to start by relating some of the significant events which have taken place since then so that your Lordships can understand why I am trying to focus attention on the subject at this time.
§ A series of eight colloquia has been completed at the Royal Society of Medicine. These were designed to allow practitioners from conventional and complementary medicine to get together to discuss the problem areas likely to arise in working alongside each other. They have succeeded wonderfully in allowing understanding to develop and problems to be pinpointed. A report on the colloquia is being published by the Royal Society, which will allow a much wider audience to benefit.
§ These colloquia were inspired by His Royal Highness the Prince of Wales, who attended several of them. He is very disappointed that public 1380 commitments have prevented him from taking part in the debate this afternoon as it is a subject on which he holds very strong views, which were clearly expressed in a memorable speech which he made when His Royal Highness was honorary president of the BMA in 1983.
§ That speech and the growing public interest in complementary medicine led the BMA to conduct a study upon the subject and its report was published soon after the last debate in this House. The seven-strong working party set up to conduct the study consisted of five pharmacologists and anaesthetists, no GPs and no one with any experience of complementary medicine. Against this background the natural therapy organisations refused to co-operate in the study and the conclusions of the report were, not surprisingly, highly critical of the alternative medicines. Much bad feeling was aroused by the report, 150 MPs passed a Motion criticising its negative nature, and the constructive dialogue which had been taking place between the conventional and the complementary world took two paces backwards.
§ Further criticism of the report came, interestingly enough, from general practitioners. At about the time the BMA report was published a survey was made in the Avon area of 145 GPs, more than half of whom said they thought that osteopathy, chiropractic, acupuncture and hypnosis were useful and 93 per cent. believed that complementary practitioners needed statutory regulation. Although this survey is much too small to generalise about the country as a whole, it nevertheless indicates a degree of support for complementary medicine by GPs which is not reflected in the report of their association.
§ What of the patients? A rather larger survey was conducted about a year ago by the Consumers' Association and published in its magazine Which?. Of its 28,000 readers, one in seven said they had used some form of complementary medicine during the preceding 12 months. A random sample was made of 2,000 of these users; 81 per cent. of them had sought conventional medical treatment and of these more than 80 per cent were dissatisfied either because they had not been cured, got only temporary relief or could not be treated. When they turned instead to complementary treatment 31 per cent. claimed to have been cured and a further 51 per cent. improved. These figures speak for themselves.
§ Why was the BMA report so negative? It would be easy to explain it in terms of the establishment being defensive about the intrusions of unqualified practitioners upon its preserve. A fairer explanation is that there is a genuine feeling in the conventional world that complementary practitioners have not reached sufficiently high standards of education and training and that their healing methods cannot be scientifically proven.
§ Taking the first point, it is impossible to generalise. Some therapy organisations are long established with first-class colleges and high professional standards. Others are not. The Council for Complementary and Alternative Medicine, CCAM, formed on the eve of the last debate in this House, has made much progress in persuading its members that minimum standards must be set to which they must all aspire.1381
§ The informal links of CCAM with government have led it to advise its members that the differences between their therapies and therefore their training are recognised and acceptable with the one common factor and requirement that they must have the knowledge to diagnose so that they can recognise a condition where referral to a registered medical practitioner would be more appropriate. In other words, sufficient training in conventional medicine must be included in each syllabus to satisfy this requirement and to qualify complementary therapists as primary care practitioners.
§ Although CCAM has provided the spark for these educational initiatives, the lead is being taken by the osteopathic profession, which has appointed the British Accreditation Council for Independent Further and Higher Education to undertake a survey of all osteopathic training institutions. It will be joined by representatives from the medical world and the Consumers' Association and its report will include recommendations on the minimum standards of osteopathic training required to protect the public.
§ The acupuncturists have a similar problem to the osteopaths with several different associations, but they too are getting their act together and have formed an education working party jointly with CCAM which has recently put proposals to the different acupuncture colleges suggesting methods of self-validation and the establishment of minimum standards of education.
§ So your Lordships can see that the complementary practitioners are well on the way to meeting the first anxiety of the conventional world. What of their second worry—scientific proof that their healing methods are valid? This will be more difficult to satisfy for the simple reason that much of complementary medicine depends upon our self-healing properties. Nevertheless, attempts are being made to meet this requirement. The main effort is being made through the Research Council for Complementary Medicine which has more members on its council from the conventional world than from the complementary. It is a distinguished list and it includes lay, members as well.
§ From this very neutral base the council has made great progress in establishing a number of research projects; and of particular importance the foundation this year has established a fellowship in research methodology in order to try to establish parameters for research to satisfy both the scientific and the self-healing schools. This fellowship has been established at Glasgow University and is being partly funded by the Medical Research Council.
§ There are other examples where academic and practical research is taking place: a Centre for the Study of Alternative Therapies at Southampton University; a Centre for Complementary Health Studies at the University of Exeter; research by the Department of Medical Electronics at Bart's into the natural therapies; the British Postgraduate Medical Federation's one-year course on holistic medicine, which will be open to complementary practitioners; the use by Charing Cross and other NHS hospitals of natural therapists.1382
§ While these various research and educational initiatives may satisfy the doubters, there is a danger at the other extreme of too much enthusiasm being generated among medical practitioners in favour of alternative therapies; and that is that they will be tempted to practise the therapies without sufficient training. If standards are established in complementary medicine, they must he accepted by all who practise. The British Holistic Medical Association have done much to make their members in general practice aware of the value of natural therapies and of the dangers of using them without sufficient training.
§ What else has been happening? A number of conferences have been held to continue the dialogue between natural therapists and conventional practitioners, including one organised by the DHSS at the initiative of the noble Baroness, Lady Trumpington. Health centres are springing up in response to public demand at which particular therapies, or more usually a choice of therapies, are made available to the public. There are a number of cases in which osteopaths and acupuncturists are working alongside general practitioners within NHS health centres. One such is to be found in the crypt of St. Marylebone Parish Church. Here everything is available to the sick in mind and body from faith in Our Lord to the most modern scientific scanner, and including on the way several different natural therapies and most importantly of all a conventional panel of general practitioners.
§ Perhaps this last vivid example of a combined initiative by Church, NHS and complementary practitioners to satisfy the demand of the public for treatment from whichever source is most likely to heal them will be sufficient to persuade your Lordships of the seriousness of the movement and of the need to make sure that the standards of practice in the natural therapies are sufficiently high to protect the public from abuse.
§ I have explained that the different groups within complementary medicine have recently taken it upon themselves to establish an independent audit of their existing colleges and training centres with the aim of raising all to an acceptable level. As each group achieves this target within their own register, I hope that Parliament will give statutory recognition to the standards achieved. In this process it will be vitally important that those skilled practitioners of many years' experience do not find themselves left out in the cold, and that grandfather clauses or two-tier systems are designed to cater for them, perhaps in the form proposed in the Osteopaths Bill of 1986.
§ With this emphasis on education and training, the position of natural healers needs to be taken into account. I expect most of us have had some experience, direct or indirect, of healing hands; and I know that some NHS hospitals are using healers to help their patients. Education and training is of no account for this gift of nature, but a close working relationship with a qualified doctor surely is. Here the Professions Supplementary to Medicine Act would seem to be an entirely suitable vehicle both to protect and to benefit the public by ensuring that only those healers whose patients were referred to them by general practitioners would qualify for treatment within the NHS. The GPs in turn will expect the 1383 recently formed Confederation of Healing Organisations to sort out the genuine healers from the charlatans and to establish a proper code of conduct.
§ My Lords, I hope you will have understood from what I have said that I have no axe to grind. I am as great an admirer of the achievements of scientific medicine as I am of the natural therapies. But I believe medicine to be an art as well as a science. If the healing of the patient in mind and body is the objective, it seems vital to me that our health system allows conventional and complementary practitioners to work in harmony with each other. I beg to move for Papers.
§ 3.57 p.m.
§ Lord Willis
My Lords, I should like to thank the noble Lord for his luck in the ballot and for introducing this important debate today in such an interesting way. I must begin by declaring an interest, in that I am the Honorary President of the Natural Medicine Society, although I hasten to add that I do not speak on their behalf today but on my own.
When I began to think about this debate I was struck by a peculiar circumstance, and this was to some extent echoed in the speech of the noble Lord. Today, alternative, or complementary, medicine is regarded by some people as a minority interest. Some even regard it as a hobby for cranks, an interest pursued by strange people who wear woolly hats and green wellies and who fortify themselves with non-alcoholic punch made up of carrot juice and herbs. Those noble Lords who know me will know that I like a glass of scotch and a cigar with the best.
At the best people take the view, which seems to be that of the Department of Health and Social Security, that alternative medicine is a fringe movement of recent vintage. This is in fact an historical distortion. In the medical sense the Johnny-come-lately on the scene is so-called conventional medicine. Natural medicines have existed for thousands of years since long before there were surgeons or members of the BMA, and they were in use long before the aspirin was invented.
Indeed, over the centuries man learned that if nature provides a problem it very often, if you look hard enough, provides a solution also. The simplest one we all learned in our childhood: if you get stung by a stinging nettle, you find a dock leaf. Over the centuries mankind did in fact build up an enormous amount of knowledge about nature and natural cures, and this exists in the culture of civilised man.
All that has been pushed aside. Since the emergence of what I call the "Aspirin Age" we have turned our backs on the fund of natural culture and natural medicine and all its wisdom, and we have relegated it to the back burner. People with vested interests and others have declared that it is old fashioned, out of date, not useful and that all we need to do is ignore it.
The great drug explosion of the past 40 or 50 years has turned medicine on its head. For every illness and every sickness, science, backed by the giant drug companies and entrenched medical interests, seeks to 1384 find a magic silver bullet: "Give us an illness and we will find a drug". That is the answer that the medical profession gives.
No one, least of all myself, would dispute the benefit that some drugs have brought to mankind, or dispute the incredible advances and achievements made by modern surgery. However, it is time to ask ourselves whether we are placing too much reliance on drugs. Have we not become a drug-orientated society? Is it not too easy to dispense drugs instead of looking for a cure?
I am not exaggerating. With the hundreds of millions of pounds that are spent on the National Health Service and the millions of pounds that drug companies have spent on drugs, we might be permitted to think ourselves a healthier nation than we were some time ago. Consider these facts. In this country one in two adults takes a synthetic drug every day; 75 per cent. of all visits to general practitioners end with the prescription of a synthetic drug; 15 million adults take synthetic drugs on a regular basis. Does that suggest a healthier nation? All those figures were taken from official or scientific reports.
There would be no cause for concern if the unprecedented growth in the use of drugs had led us to become healthy, but in many areas the indications are that our health is worse and not better. The Office of Population Censuses and Surveys reported that in the period 1972 to 1980 the incidence of chronic illness in this country rose from 20 per cent. to 29 per cent. in males and from 21 per cent. to 32 per cent. in females. At any one time almost one-third of the nation has a long-standing illness. We also know that the incidents of lung cancer and heart disease are rising, not falling.
Are we not therefore entitled to ask ourselves whether we are spending the money in the right way? Are we right in relegating to the background natural medicines, homoeopathic medicines and the holistic approach to medicines? Is there perhaps not some vested interest that is eager to keep them there, such as the big drug companies?
In the speech today I do not have time to enter into the history of the drug explosion but I should like to make two points in passing. We all know that drugs are a profitable business. For 15 years the profits of the drug industry have far outranked those of other big industries. An amount worth £25 of a drug called diazepam will be stamped into pills, packaged and sold for 140 times more than it cost. That is an enormous mark-up which any industrialist would envy. That drug is called Valium and the nation is stunned by Valium at this time. To promote Valium the manufacturers spent over £100 million in 10 years. That will give the House some idea of the penetration it has achieved in this country.
I shall not criticise doctors, but overworked doctors, when they have a queue in their surgery, find it far easier to prescribe a synthetic drug than to treat the patient in depth. If the patient has a headache, the doctor gives him a pill; he does not ask why the patient has a headache and what has caused it. He does not investigate the circumstances largely because he does not have the time or the interest. It is simpler to prescribe a Mogadon than to spend time 1385 discovering, "What causes your sleeplessness, my dear?". Doctors cannot do that and the result is that in this country millions of sleeping pills are being taken every day.
As regards drugs, doctors have only to look at the literature issued by the drug companies. Most of them know no more than the information given to them by the drug companies. We are in a dangerous situation. I am not saying that holistic medicine, alternative medicine or contemporary medicine has all the answers. I am saying that with the crisis in our health, with the enormous development in the use of drugs, we are throwing the baby out with the bathwater and we have turned our back on holistic and alternative medicine.
What is more, we find a strange hostility from the bigwigs of the medical profession and a strange hostility from the DHSS. The Department of Health and Social Security insists that all drugs must be tested. That is quite right and we do not disagree with that in view of what has happened as regards certain drugs issued by major drug manufacturers. However, it is also insisting that certain natural medicines should also be tested in the same way, though that is impossible. First, they have been tested for 100 years on human beings with no ill effects; they are perfectly natural products. Secondly, the natural medicines industry does not have the resources to put them through the kind of test upon which the department insists. We find it difficult to persuade the DHSS to take a different course. It has appointed one person to the committee but we think that there should be a whole committee advising the DHSS on alternative medicines. The department will not accept that view. I am not saying that the department is entirely unsympathetic but we have had great difficulty.
To reject alternative medicines is the same as saying that we should no longer read Dickens because we have Graham Greene, or that we should no longer use the railways because we have motorways. It is there, it is important, it is a weapon and it can be used in a complementary sense. What is needed is a recognition by the medical profession and the Government that they do not have all the answers. They should come to the Natural Medicines Society, and to the various organisations mentioned by the noble Lord, Lord Kindersley, and obtain advice and help. Two things would arise from that. First, one would cut the National Health bill; secondly, one would make a happier and healthier nation.
§ 4.8 p.m.
My Lords, I speak to your Lordships today under the handicap of the tail-end of a particularly nasty cold. I mention that fact for three reasons: first, as evidence of the total inability of my profession of medicine to deal effectively with certain ailments; secondly, to show that doctors are just as delighted to discuss their own ailments as anybody else; and thirdly, so that noble Lords will understand if I do not achieve the degree of audibility that I should wish. I say at once to the noble Lord, Lord Willis, that I have not taken a single tablet. I agree with him that the nation has become too dependent on remedies and particularly on a tablet as being a 1386 talisman to cure disease or to ward it off. Perhaps my own profession has been responsible for reinforcing that kind of dependence on remedies.
Tragically, when in general practice, I found that it took perhaps only 30 seconds to give a patient a bottle of inert medicine. It may have taken 20 minutes to explain to patients that they would get better with the expenditure of nothing more costly than time. I am afraid that we often prescribe unnecessarily and I speak as one who prescribes for many noble Lords (I see one of them looking at me now) and for honourable Members in another place. The degree of dependence on remedies is excessive. It is right that we should discuss the subject; it is one of immense importance.
I have had the honour of speaking in your Lordships' House for nearly 12 years. During that time we have, I believe, debated this or a closely related subject on six occasions. The first occasion was early in 1976—a debate initiated by the noble Lord, Lord Ferrier, who will speak later. I have spoken on the six occasions. My beliefs are just the same. It is a pity that our Standing Orders do not allow me to say, "See House of Lords' Hansard, column such and such, on such and such a date" and then sit down. The point is that I merely intend to say what I have said before. However, as far as I can, I shall try to summarise and recapitulate the basic issues that face us.
The noble Lord, Lord Kindersley, is entirely right. These problems have been with us for years. We have wrestled with them for far too long and it is high time that some of them were resolved. They are not yet resolved. But the noble Lord has told us of some of the steps being taken within alternative and complementary medicine groups outside the medical profession. Some of the developments will, I hope, assist toward a solution before long.
We have to look at the basic fact that there are two separate issues with which we should be deeply concerned. First, we have a duty to make as certain as possible that methods of treatment which are proved to be efficacious and not dangerous become generally available, particularly remedies and forms of treatment which come from sources outside the medical establishment. We have a duty to remove barriers. If some form of treatment is helpful, it should be available, and it is our duty to ensure that it is available not only in private practice but also in the National Health Service.
Our second duty is to protect the very vulnerable sections of our community; namely, the chronically sick and those suffering from incurable ailments. They must be protected from exploitation, even from fraud. In that connection I must make absolutely clear, as I have done before in this House, that there is no statute giving doctors a monopoly on practising medicine.
It is true that there is an Act concerning dentistry, which makes it a criminal offence for anyone who is not a registered and properly qualified dental practitioner to perform any dental operations within a patient's mouth. The noble Lord, Lord Colwyn, will confirm that. Similarly, another Act has provisions with regard to eyes, although that 1387 monopoly has recently been weakened with regard to optometry. However, there is no medical Act which confers a monopoly on doctors. Any person—any of your Lordships—may practise medicine and treat various conditions tomorrow.
So far as I am aware, there are only two statutes in relation to practising medicine. One was passed at the beginning of this century and makes it an offence for an unregistered and unqualified practitioner to treat pulmonary tuberculosis. There is now hardly any incidence of that disease, but the offence remains. Another Act, promulgated during the war, makes it an offence for unregistered and unqualified people to treat venereal disease. Apart from those two statutes, there is nothing to say that anybody may not practise medicine.
Of course, one cannot pretend fraudulently to be a registered or qualified medical practitioner when that is not the case, but anyone can practise medicine. There are certain handicaps—for example, such a person cannot issue prescriptions, National Health Service certificates of one kind or another, or death certificates, and he may find himself in grave difficulties if someone under his care dies. However, it must be remembered that there is no statute which gives doctors a monopoly on the practice of medicine. It is important to remember that fact.
There are no statutes to restrict the practice of various unorthodox forms of medicine. If one asks the question, "What is an osteopath?" the answer is that it is anybody who chooses to call himself an osteopath. Anyone can say, "I am an osteopath" and practise osteopathy. However, as the noble Lord in his introductory speech made clear, it is a fact that an increasing number of people who practise osteopathy are people who have had satisfactory and proper training and have passed a series of examinations which prove that they possess the necessary degree of skill and knowledge. They are members of organisations which prescribe standards of professional and ethical conduct. The osteopaths are becoming organised.
It is important that we have some kind of control over who can do what. I do not want to exceed the time allotted to me today, but I should like to tell the House about something that happened to me years ago when I was a medical student. A collier who worked at the coalface in Wrexham had a very serious accident and received a big lump sum payment in compensation. With that money he bought a shop and set up in business as a herbalist. After he had been there one year, a fire broke out in the shop. It was a perfectly genuine fire; it was not a case of arson.
I talked with the adjuster who dealt with his claim and a loss of profits claim was settled at the rate of £800 a week. A collier would never have earned £800 a week in the 1930s. One may ask what training he had received, and the answer would be none. I am not asserting that he did anything wrong. Perhaps the remedies he was selling were perfectly proper, but I feel there is a need to ensure that the public is protected.
1388 Therefore we have a duty to remove the impediments which stand in the way of making available forms of acceptable treatment. Osteopathy achieves results that my profession does not achieve. Acupuncture achieves results that, frankly, I cannot understand; nevertheless, it achieves them.
The noble Lord's Motion is concerned with recent developments, one of which is that an increasing number of qualified, registered medical practitioners are taking up such forms of treatment, and they practise them themselves. There are many medically qualified osteopaths and acupuncturists. However, I fear that the people who practise those disciplines, and perhaps practise them very efficiently, are not playing a great part in making it possible for their non-registered, non-medically qualified colleagues to enter into practice. In a sense, some of them are seeking to reinforce what to them is a closed shop. It is a trend that must be examined.
It is necessary, if we are to accept into the medical profession those forms of treatment and the people who practise them—and I am not talking merely about the Professions Supplementary to Medicine Act, which set up a council to look after physiotherapists, chiropodists and so on—that there should be separate bodies to oversee each area so that the public can be sure that there exist standards of skill and training and that such people are operating within certain disciplines and codes of professional practice and ethics. When that is achieved we shall be in a position to move much further ahead. They have already done so in New Zealand, as the noble Lord will tell us.
As a doctor, I welcome the increased understanding of the fact that there are people outside the medical profession who have skills that are not necessarily possessed by my own profession. I hope that somehow or other Parliament will take the necessary steps to ensure that some of those skills are made available not just privately but through the National Health Service. Other things, in addition to this debate, will have to take place before that can happen.
§ 4.17 p.m.
§ Lord Broadbridge
My Lords, let me start with the following words:If anything is certain in this uncertain world it is that complementary therapists are here to stay—and without doubt their use will continue to expand as the months and years go by".That was spoken by Dr. Tonkin, President of the Research Council for Complementary Medicine, when he read a paper to the Sixth Colloquium on Conventional Medicine and Complementary Therapies on 19th March 1986. Dr. Tonkin wisely balanced that optimistic statement of faith with the cautionary observation that there was an increasing number of publications purporting to provide guidance and advice on "improvement of health" and "the curing of illness" by people who were highly skilled in the art of presentation but short on the science of verification.
Because of the brief time that is allowed to me in this sort of debate, I should like first to confine my observations to the therapy of homoeopathy and 1389 then to make some more general remarks about recent developments in complementary medicine generally. Homoeopathy is the medical practice of treating like with like; that is to say, it treats an illness with a substance in extreme dilution that produces in a healthy person similar symptoms when taken in large doses. Current traditional medical opinion is that symptoms are caused by the illness—for example, the influenza virus produces headaches, aching limbs et cetera. Homoeopathy by contrast views the symptoms as the body's reaction against the illness as it attempts to overcome it.
The major disparity between homoeopathy and attitudes of conventional treatment is that homoeopathy concentrates on treating the whole patient rather than the disease and practitioners of homoeopathy believe that people vary in their response to illness according to their individual basic temperament. Accordingly, different medicines will probably be prescribed for different individuals suffering from the same illness.
The relationship between homoeopathy and conventional medicine was investigated by the BMA as part of an overall study of complementary medicine lasting three years, instigated, as we heard earlier from the noble Lord, Lord Kindersley, in 1983 as a result of a challenge by its president, Prince Charles, a member of a family that has followed homoeopathic practices for six generations. The BMA reported on 12th May 1986, exactly 18 months ago tomorrow.
A body which in a judicial sense might well be considered by origins, practice and teaching to be hardly standing on the Olympian summit of independence, the BMA reported that there was no proof that many alternative therapies are effective and that some risk harming patients. It approved a limited role for acupuncture, manipulation and hypnotherapy, but argued that the results of homoeopathy are due to a placebo effect, where the patient's belief in the treatment rather than any pharmacological effect leads to the patient feeling better.
I think it was encouraging that, in its conclusions about homoeopathy, the BMA conceded, albeit through gritted teeth, that the patient felt better. I think that by subsuming this within a failure of those treatments—which is what it obviously meant to project—it seems rather to have thrown out the baby with the bath water. If I go to a doctor of whatever sort feeling ill and I am made to feel better, that is what I want. That the medicine prescribed has no observable effect on, say, the pulse or blood pressure of 1,000 randomly selected rats does not matter to me very much, quite frankly.
For the record, doctors from the faculty of homoeopathy at the Royal London Homoeopathic Hospital reacted by saying that the report, "masquerades as a scientific document", and is deplorable. The British Holistic Medical Association said that the report was, "incomplete, faulty and biased". It said further that no discussion on treatment, as we have already heard, can exclude mention of the self-healing potential present in all human beings or a description of diet, exercise, 1390 relaxation, medication, counselling, psychotherapy and human support in the process of recovery, factors that I personally think crucial, especially counselling and human support.
In this context it is revealing that two doctors reported in The Lancet of 7th September 1985 that,the consultations of complementary practitioners are, at 36 minutes, six times longer than those of general practitioners".Furthermore, The Lancet of 17th October 1986 gave the closest demonstration to a scientific proof of homoeopathic medicine with the results of a trial involving 144 people who suffered from hay fever and were treated at clinics of the Glasgow and London homoeopathic hospitals and by 26 National Health Service family doctors. The purpose was to examine assertions that the beneficial effects of homoeopathic treatment were induced by suggestion or a case of mind over matter rather than by the action of the microdose of the medicine prescribed. Patients were given either a homoeopathic preparation of mixed grass pollens or a placebo. The improvement of those given subtoxic levels of the pollen mixture was effected in their reduced need for their normal antihistamine therapy to alleviate their hay fever—a promising experiment, I think.
I turn to complementary medicine generally. Observations across Western Europe show that there is a clear and quantifiable trend towards greater reliance on non-conventional medicine. A survey in the Netherlands in 1980 published by the Netherlands Institute of Preventive Medicine questioned 3,782 adults and showed that 6.9 per cent. had consulted complementary medical practitioners in the previous year, giving a national figure of 6 million consultations in a not over-large country. A survey conducted in 1983 and reported in the British Medical Journal showed that of general practitioner trainees 76 per cent. wished to learn one or more skills such as hypnotherapy, acupuncture or homoeopathy.
In a study on complementary medicine and the general practitioner two doctors, one a general practitioner, reported on responses of 145 randomly selected general practitioners in the Avon area, about which we have heard a little, in the BMJ of 7th June 1986. Overall general practitioners knew little about the techniques of complementary medicine. Despite this 110–76 per cent.—had referred patients for this type of treatment over the past year to medically qualified colleagues; and 104–72 per cent.—had referred patients to non-medically qualified practitioners. We must remember that it is only a decade since the General Medical Council rescinded a ban of referral of patients to non-medical practitioners. In parenthesis most—93 per cent.—of those who responded believed that complementary practitioners needed statutory regulation and only 3 per cent. thought that they should be banned. The BMJ article's abstract ends as follows:The results of the study show a surprisingly high interest in complementary medicine among general practitioners in the Avon area".Indeed, this interest on the part of general practitioners to become more involved with complementary medicine is one of the most marked recent developments in the relationship of 1391 complementary medicine to conventional treatment. In the study in The Lancet which I mentioned earlier, the highest levels of complementary consultation found were in Oxford, Cambridge and Exeter, which are well served medically. Other reports have established that complementary medicine does not thrive in regions where conventional medicine is poorly represented.
The disorders for which patients see complementary practitioners do not exactly overlap those for which they see conventional practitioners. The former tend to be chronic, mild and musculoskeletal and stress related rather than infectious. One-third of the complementary medical patients were seeking simultaneous help from doctors—38 per cent. in the Dutch survey. Thus the role of traditional medicine is truly complementary to rather than conflicting with conventional medicine, with each system finding its separate region of competence.
Finally, in summary, I believe that, if based on an acknowledgement of this separation of regions of competence, a decision by a person who is ill to consult a complementary medical practitioner can only make sense and that the fields of complementary and conventional treatment can, should and will draw even closer together.
§ 4.26 p.m.
§ Lord Colwyn
My Lords, some of you will be aware that I find the subject of our debate totally fascinating; so, before I start to compress my 30-minute speech into eight minutes, I must declare an interest in that as a dental surgeon I use some of the complementary natural therapies, and I am also chairman of the Natural Medicine Society.
Like my noble friend Lord Kindersley, I think it is appropriate for us to acknowledge the efforts that the Prince of Wales has made to try to establish a dialogue between complementary practitioners and those in conventional medicine. I know that his presence at some of the meetings of the recent series of colloquia at the Royal Society of Medicine devoted to this problem which I and my noble friend attended was very much appreciated.
As clinicians we all agree that the patient comes first and our role is to define the best and most appropriate treatment for any individual, taking into account his physical illness along with its social, emotional and spiritual components. Health is always in the news. Hardly a day goes by without some reference to the subject.
The Government must be congratulated for the recent announcement of yet more funds to be made available. I suppose that this is because we are continually told by doctors and politicians alike that the solution to the problem is more cash—money to build more hospitals, to buy more equipment and to pay more staff. As ever, this implies the long-standing myth that if only medicine had all the resources it wanted all our health problems would be solved; as it happens, nothing could be further from the truth.
An examination of the relative merits of professional and lay health care by the World Health Organisation found that modern medicine appeared 1392 to have contributed little to the overall decline and mortality. It concluded that that seemed to be a negative correlation between provision of medical services and health. It was always assumed once the backlog of demand for health services had been worked through that, with the massive benefits of free treatment and free advice on prevention linked with free immunisation procedures, fewer people would become ill. I should be interested to know—and perhaps the Minister can tell me—his views on why that has not happened. Why has there not been a considerable improvement in the nation's health despite the massive increase in spending in the NHS year by year? Rather than spending more time and money on measures designed to promote good health, it seems that we opted instead for the most inefficient route both in terms of finance and of health.
For the most part the NHS simply waits for people to fall ill before taking any action. Very little time is allocated to prevention. Having reached the stage of receiving the sick patient, the NHS in the form of its doctors applies increasingly expensive and technical means to deal with the illness ignoring the cheaper and safer alternatives, partly because doctors are not trained in those but mainly because the use of safer, cheaper alternatives would threaten the profitability of the drug companies.
It seems to me that conventional medicine has failed to promote good health and thus minimise the use of its medical services and has failed to incorporate cheaper, safer and often more beneficial alternative therapies in medicines. If my noble friend the Minister tells me when he replies that the NHS has always had an extensive programme of health education and preventive medicine, I would have to remind him that the proportion of the NHS budget devoted to those areas is only a tiny fraction of the total, and that preventive medicine as referred to by successive governments is really only a synonym for screening techniques. Those techniques are a form of early diagnosis, not prevention. Many of those aspects of screening and the other mainstay of preventive medicine, immunisation, are I believe very suspect.
One recent US study has shown that over half the people who died from cancer and heart attacks had been declared fit at their most recent annual medical checkup and that the treatments available after detection had proved to be largely ineffective. Here comes the point of our debate this afternoon for it is in the critique of conventional therapeutics that the movement for positive health and alternative medicine finds its justification.
As the myth of the effectiveness of modern medicine gives way to a growing awareness of the limits of the practice of conventional medical techniques more and more people are taking the decision to seek safer and, in many cases, more effective ways of coping with illness.
It seems reasonable in a democratic society to allow a minority to choose to opt out of the orthodox medical system but there are signs that even this basic freedom is being eroded. There is a feeling that the health establishment is seeking to discourage 1393 competition in the form of alternative medicines and practitioners in Britain by restricting the authority to assess medicines to orthodox qualified doctors and scientists, and in Europe generally by legislation limiting the practice of medicine in all its forms to those with orthodox qualifications.
My noble friend will be aware of the substantial increase in the work involved with the administration of the Medicines Act and of the consequential setting up of a commission led by Dr. Evans and Mr. Cunliffe who were looking at the problems faced by the DHSS in reviewing and running a licensed medicine system.
Those of us who are involved in complementary medicine are extremely concerned that the advisers to the department are predominantly experts in orthodox medicine. It seems sensible to me that the assessment of natural and herbal medicines and the vast range of homoepathic remedies should be carried out by experts who are familiar with their use and practical application.
Perhaps the Minister could tell us why it is that despite the fact that there is a provision for a special advisory committee on alternative medicines under the Medicines Act 1971 and that many other countries have such a committee, the DHSS continues to obstruct any contribution by such experts. I can assure the Minister that experts in the use and application of these alternative medicines are ready and willing to help with the problem of assessment and licensing.
The Natural Medicine Society has already formed a scientific committee which has prepared itself to supply the specialist input should the DHSS be persuaded that it is suitably qualified and expert.
In conclusion, I have said very little about recent developments. I am sorry that there is not a copy of the Journal of Alternative and Complementary Medicine in our Library so that your Lordships could read of the daily advances that take place. In my personal experience in the field of acupuncture with the Society of Biophysical Medicine I can report on the continued success in the treatment of heroin and tranquilliser addiction without the use of any drugs. I can also report on the new success in the treatment and management of patients with AIDS.
I ask my noble friend and other noble Lords to carefully examine the fact that the widespread use of antibiotics, steroids, major tranquillisers, antidepressants and other powerful chemicals will ultimately destroy our health. There has never been a more critical period for human health which will be enhanced by a closer relationship with those dedicated practitioners in the complementary therapies.
§ 4.37 p.m.
§ Lord Rea
My Lords, I am very tempted to go down the path of the noble Lord, Lord Colwyn, and have a discussion with him about preventive medicine and the persistence of much ill-health in our society today, but I shall have to reserve that to a discussion with the noble Lord afterwards because I have so little time at my disposal to talk about complementary medicine.
1394 I thought that it might be interesting for the House to hear the views of another practising conventional physician. I am conventional in professional terms but not in other ways! I like the term "complementary" because it assumes co-operation rather than separation or confrontation with science-based medicine. In my practice, I often refer patients to complementary therapists. Usually I choose osteopaths but sometimes I choose an Alexander teacher. Those are the two approaches that I feel are nearest in their bases to the anatomical and physiological concepts which I believe to be a reality. But I am often asked to comment on a variety of other disciplines such as homoeopathy, acupuncture and some of the more exotic such as cranial osteopathy or even aromatherapy.
There are many patients who consult both GPs and specialists with apparently physical symptoms but with very little to find in the way of demonstrable physical abnormalities, even after exhaustive investigations.
Here I shall diverge a little to consider the nature of pain, the symptom which brings most patients to seek our help. Although pain is triggered by the stimulation of pain sensitive nerve endings, what we actually experience is an unpleasant emotion which tends to make us cry out or swear, as the case may be. Very similar sensations can be caused by emotional distress without the nerve endings being stimulated. Many people feel emotional pain as if it were bodily pain. The existence of emotional pain per se is often denied. It is easier to blame it on a disordered organ or system. Such people comprise a substantial proportion of those attending GPs surgeries or outpatient departments and even occupying beds in hospital where their often obscure pains are being investigated.
Such patients do not find it easy either to accept a psycho-therapeutic approach. It is much more acceptable to have a displaced vertebra than to admit to a chronically unhappy marriage or a childhood deprived of affection. Many of these unhappy people find their way to one of the complementary therapies where they find a sympathetic ear and someone who can give them half an hour to one hour of their undivided attention, specifically directed to their symptom. A good therapist will ask a patient all about his life's concerns and usually uses a treatment involving touch or massage. The therapeutic component is much neglected by doctors and especially by psychiatrists. It is therefore not surprising that many people feel better. They may never have had enough holding and undivided attention in their lives, even as babies or children.
However, there are dangers, especially if patients go directly to complementary therapists. People are very easily led by plausible practitioners who promise relief from symptoms. I have two examples from my own experience where things went very wrong. One concerned a young woman who was an insulin-dependent diabetic. She was persuaded by a naturopath to give up her insulin injections and try natural remedies. She ended up in the ward where I was a duty house physician with a severe diabetic ketosis which had a fatal outcome.
1395 In another case a woman, who was a friend rather than a patient, was in her fifties and had carcinoma of the breast. She was persuaded to try a form of natural treatment involving a bizarre vegan diet with vegetable juice and coffee enemas. She had a painful death without the benefit of modern chemotherapy such as tamoxifen, the anti-oestrogen treatment, which helps many patients with breast cancer.
I therefore support all moves by the many therapies to draw up approved training programmes, as has been suggested by many speakers. I also agree with many speakers that the attitude of the BMA in its report, which does not necessarily represent the attitude of many of its members, is likely to exacerbate the division. That will increase the dangers of the type which I have mentioned in my two anecdotes. The Royal College of General Practitioners is a good deal more tolerant. We recognise complementary practitioners as potential allies rather than enemies. I very much welcome the establishment of the Research Council in Complementary Medicine, founded largely through the efforts of Dr. Richard Tonkin, as has been mentioned by the noble Lord, Lord Broadbridge.
As regards research, I believe that each complementary therapy must agree to conduct some form of randomised control trial. That is the established scientific method for assessing treatments and there is no reason why it should not be adapted in such a way that it can be applied to complementary medicine. That is the best way of assessing whether the therapy is such as to make a good case for inclusion or an increased role in the National Health Service.
It is not enough to point only to successes. It is necessary to look at everyone who is being treated. Failures must be examined as well, and there are failures. It is necessary to compare the outcome of using those methods with the outcome of using other methods and with the outcome of those who receive no treatment at all. As other speakers have pointed out, the human body and mind have remarkable powers of repair and recovery. It has been said that complementary therapies work mainly by providing a good environment in which those natural powers of repair can operate.
§ 4.55 p.m.
My Lords, the question of how much or how little we need of the many things we consume in our diet is closely related to complementary medicine in that it is not something which can only be prescribed by a doctor and does not need expensive drugs.
A case in point, which I have studied in some detail, is zinc. Zinc is needed by the body for many purposes. Professor Bryce Smith is a professor of organic chemistry at Reading University. He is not a medical doctor. He has, in co-operation with a medical doctor, investigated the effects of zinc on anorexia nervosa. Compulsive fasting is an important disease which is normally treated by psychiatrists. It usually takes some time to cure. Professor Bryce Smith is convinced that in many 1396 cases additional zinc is beneficial. He has naturally tried to interest doctors engaged in treating the disease. Their response can briefly and accurately be described as dismissive. I have also written to various people who might be interested and have had very much the same response.
My noble friend Lady Trumpington, when she was at the DHSS, told me that treatment is a matter for the doctor concerned and that the DHSS does not undertake to have any views. Of course doctors can read the medical literature and contribute to it. But it is extremely voluminous and it is difficult for the individual doctor to keep up to date. I know that many suggested treatments are put forward, some for unworthy motives. However, I think that this particular case is a strong one. A professor of organic chemistry cannot easily be dismissed as a crank. Furthermore, the suggested dose is well below the toxic level.
In speaking of Professor Bryce Smith, perhaps I may mention that he has done much detailed work on the possible toxicity of metals for which we have no known need. I think we can probably say that by now we know of all the elements which we actually need. However, we probably do not know all the uses they have. He has found that pregnant women in particular have too much lead and cadmium, which seems to have an undesirable effect on their babies.
The Natural Medicine Society, of which the first speaker is the president, has, in a recent booklet called The Health Crisis, described investigations regarding schoolchildren in New York as long ago as 1934. I do not know why there is nothing more recent. However, doctors looking at a block of children were asked whether or not the children should have their tonsils removed. On the whole, about half the children were classified as needing to have that organ removed. However, if the children who were regarded as not requiring treatment were then examined by another independent group of doctors, once again half the children were recommended to have their tonsils out. That investigation progressed through two stages, until the investigators ran out of independent doctors to examine the children.
There are dangers in finding fault with doctors. It may reduce the confidence that patients feel in them and that in turn may have an important effect on the cure. On the other hand, the Government who spend the taxpayers' money on the NHS, have a responsibility to look at the matters which I have mentioned.
As regards a way forward, I think that what might be called orthodox scientific investigations of complementary medicines, which the noble Lord, Lord Kindersley, has mentioned, are the proper way to proceed. I hope that the Government will feel able to give them all the support they can.
§ 4.50 p.m.
§ Lord Ritchie of Dundee
My Lords, I feel that today I am undergoing the experience which my pupils used to have in class when they were required to summarise a lengthy passage into something that occupied only two paragraphs. I have prepared a 1397 speech which must now be compressed, without any notice, into about a quarter of the time. I therefore have an enhanced respect for the medical profession7—for which I had great respect already—when I reflect that one of the problems that faces doctors is lack of time.
One of the things we seek when we consult a doctor is the time to tell him our troubles without feeling that we are keeping someone waiting and that the clock is being watched. I think that if we are at all critical of conventional medicine and of the profession, this is very often the reason, when the doctors themselves are the first to say,. "We would like to be able to give you what we want and what we know you need—time—but we are unable to do so because of pressure of work."
So many of us, probably as a result of the environmental and psychological pressures of the modern world, suffer from chronic conditions which cannot be cured by surgery and which can only be alleviated by drugs. These are conditions ranging from arthritis to insomnia. In such circumstances what we need is to be listened to by a sympathetic ear and the benefits that that gives us. We also desperately need the hope of a cure. We do not want to be told that we have got to learn to live with our condition. These are two of the things which alternative therapies can very often give us—namely, time and at least the hope of a betterment of our condition.
More generally and fundamentally, I think we reject the traditional mechanist, reductionist approach of conventional medicine. We have a visceral reaction against the concept that we are nothing more than highly complex machines needing perhaps a little chemical adjustment here or excision with a knife there.
How can I express it? We know that we are not mere machines and we deeply resent the attempt of science to downgrade us to that status. I think of the experience of an acquaintance who bared his soul to a psychiatrist for an hour. He turned to the doctor for an oracular reply and received this answer: "Well, I have listened very carefully to all that you have told me and what I have to say is that you should take two of these little white pills at night and one of these big blue ones in the morning. Come back and see me in a month if you are no better. Good morning."
This is perhaps an exaggeration and perhaps it happens much less now than it did. We all know that we live in a world which is increasingly dominated by science and one where everything must be provable and testable. Medicine is a scientific discipline, so everything has to be provable and testable. I know that here I may be exposing myself to attack, but I must say that in some deep sense the flight to alternative therapies is a humanistic rejection of this exclusively scientific domination, a sort of reassertion of metaphysical forces and an affirmation of our spiritual essence.
My own experience has been largely with acupuncture, from which I have derived, and seen others derive, enormous benefit and by no means only in the relief of pain, as suggested in the BMA report already referred to by several of your 1398 Lordships. I have seen it used to perform the function of a kind of tonic and to confer a general sense of well-being. I have seen the increased energy and alertness which it has induced in others. It is my belief that this effect is connected with what Samuel Hahnemann, the founder of homoeopathy, called "the vital force", the mysterious element of physical, psychological and spiritual energy which the Chinese have always referred to as "Ch'i". The nature of this is about to be scientifically investigated by Dr. Julian Kenyon of the Centre for the Study of Complementary Medicine, together with a team of researchers.
I should like just to mention another therapy of which I have considerable experience. I think its exponents would deny that it should be classified as medicine of any sort, complementary or otherwise. It is a bodily skill to be learned, and those who learn it are not patients but pupils. I am referring to the Alexander Technique, which has already been touched upon by the noble Lord, Lord Rea.
Your Lordships may know of the little man from Tasmania, an aspiring actor and reciter, who, in the process of investigating the failure of his own vocal powers, discovered by accident the existence of a dynamic relationship between head, neck and torso which, owing to stress and anxiety, has been largely lost by civilised man although it is still observable in children.
By laying guiding hands on others he was able to teach them how to regain poise and co-ordination, with enormous benefit to themselves in combating pain and tension and in achieving ease and grace of movement. It is much used by actors. It is also effective in counteracting the downward pull of gravity in age.
Unfortunately the virtues of this teaching are not recognised by the Establishment, so it is only obtainable at a price. I should like to see it taught to all growing children so that they learn to write without crouching over their desks and to improve the posture of many stooping and slumped adolescents.
I have just touched upon two areas of complementary medicine of which I happen to have first-hand experience. They are two out of many which unfortunately the profession looks at askance and the National Health Service will not use.
I was going to tell your Lordships what we should do about this situation but this has already been done much more ably that I could have achieved by, among others, my noble friend Lord Winstanley and the noble Lord, Lord Kindersley, who gave us an admirable survey of all that is already being done. We can but hope that this progress will continue to be made.
§ 4.56 p.m.
§ Baroness Strange
My Lords, I am particularly grateful to my noble friend Lord Kindersley for initiating this most interesting debate. I am also most grateful to his Royal Highness the Prince of Wales for bringing alternative medicine out of the shadows where it has been for far too long.
1399 Although I may have been observed carrying a lighted pumpkin into your Lordships' House about the time of Hallowe'en, I can assure your Lordships that I am not a witch. I did it rather to deter any witches who might have thought of parking their broomsticks at the Peers' entrance.
In the medical world, as in many other fields, there are so many new things being discovered. The horizons of knowledge are being so constantly expanded that what today may be considered as magic or an old wives' tale tomorrow will be taken for granted.
Flying has become commonplace; television communications across the world by means of a space satellite, continuous. Men have landed on the moon. Innoculation and immunisation have stamped out many of the old diseases and, with better diet, living conditions and medical care, people are living longer.
And yet—and yet, there is a basic urge among people to get back to their roots, to touch living animals and to grow living things; to eat brown bread and eggs that have been laid by hens scratching about in old orchards. In fact, a desire to go back to the cave. A turning away from orthodox medicine towards alternative therapies often fulfils this need.
In the old days a doctor had time to talk at length to his patients. Practitioners would be able to listen to the complaints. The bedside manner, the healing art of listening, is very often an important part of the cure. Now there is often no time. There are too many patients; some doctors have banded together into group practices so there is not always the close personal relationship between doctor and patient. Even worse, some doctors simply do not have more than five minutes to give to each patient. In five minutes there is not very much one can do. One can check the obvious things and if there is nothing chronically wrong one can give a pill and send the patient away. The practitioners of alternative medicine have often more time to give to their patients.
When alternative medicine is spoken of what exactly is meant? In the Board of Science working party report of the BMA which has been mentioned there are about 100 different types of alternative therapy, including astrology, Hellerwork, Rosicrucian healing, pyramid healing and thermal mud. Without wishing to waste your Lordships' time with a long speech, I should like to touch on some of the better known and more impressive alternative therapies, many of which I have found to be effective.
The noble Lord, Lord Broadbridge, has already said—better than I could—all that I intended to say about homoeopathy. However, I always carry arnica pills in my handbag for shock or bruising and have often found them most useful. Once we found two people who had just fallen off a motorbike but who were not injured. After some arnica pills and tea they were perfectly able to get on again and ride down the road. Another time the pills proved most effective when a lady was bitten by her own dog.
1400 In the area of placebos, this summer my whippet had her leg nearly severed. It was stitched up twice and saved by the local vet but he said that normal skin would not be likely to grow again. With homoeopathic hypercal cream and lotion the skin is now pretty well perfect and some of the hair has grown.
Acupuncture, first mentioned in the Yellow Emperor's Classic or Internal Medicine, about 100 BC, is a Chinese science of healing by piercing the skin at various points to increase the harmonious balance in the body between the forces of Yin and Yang. It is much used in Chinese hospitals today and there are many practising acupuncturists here, as we have heard.
I shall not go through manipulative therapy, osteopathy and chiropractic, because that has all been said. Healing, or the laying on of hands, has been practised since early times. Many doctors and nurses have this power and it comes also to many priests and some lay people. Quite simply, it is the power of God working through the hands of the healer. The healer is simply a conductor without whom nothing would happen, but it is through him that the power comes. Anyone who has been ill will know that some nurses have this power, and merely the touch of their hands makes one feel better.
Major Bruce Macmanaway, who has been practising and teaching as a healer internationally for over 20 years, has healed and taught healing to many people at his Westbank Centre in Fife, which he founded in 1959. Indeed, he cured my husband of severe migraine headaches from which he suffered as a result of a war injury.
There are also herbalism and radionics, but I dare not go into those because I shall run out of time. However, I should like to say that the President of the Royal College of Physicians in Scotland, Dr. Michael Oliver, says he believes that there is a place for alternative medicine. As the Royal Colleges, through the General Medical Council, are responsible for setting the standards of medicine, which are precise and internationally recognised, he also feels that standards of some kind relevant to each of the various alternative sciences should be set so that people can practise them. That would protect the practitioners, the public and the patients.
There are many other sources of alternative therapy, some more efficacious than others. I believe that most people now accept the idea that for real health the mind, the body and the spirit all must be made whole.
We are all like the Venerable Bede's sparrow flying across a lighted room from darkness into darkness. While we are there in the light, let us keep our feathers unruffled and our wings unbroken, and those of the other sparrows flying through with us, so that we can enjoy the light of this world, as do the robins who sing every Christmas on the Christmas tree at home.
§ 5.5 p.m.
§ Lord Thurlow
My Lords, it is difficult in a debate such as this to give our contributions the appearance of debating when there is such a wide measure of 1401 agreement between all who have spoken—agreement on the need for co-operation between the orthodox and the unorthodox.
I should like to develop two points in particular: the reference by noble Lord, Lord Kindersley, to the importance of proper training and that of the noble Lord, Lord Winstanley, to the public duty to see that effective treatments are sufficiently available. I take as my theme training and the career structure in the field of homoeopathy. The noble Lord, Lord Broadbridge, gave a great deal of information about homoeopathy, a very long established practice going back nearly 200 years. It is recognised within the National Health Service. There are fine hospitals and practitioners available all over the country.
The Faculty of Homoeopathy, established by statute in 1950, prescribes the very elaborate training recommended for homoeopathic specialists, a training built on three years' ordinary medical training before registration, three more years of ordinary medical training and then, on top of that, four years, I believe, of specialist training in homoeopathic practice, clinical practice and research. That is very long and effective training.
Does the medical establishment take any cognisance, give any blessing to this training in the field of homoeopathy? I regret to say that it does nothing of the kind. Within the medical establishment the arm responsible for training is the Joint Committee for Higher Medical Training set up by those great bodies, the Royal colleges. That joint committee has so far refused to associate itself with this very elaborate and sound general training recommended by the Faculty of Homoeopathy.
Does that matter? I have no desire to try to push people off their reserves, or even prejudices, if they have no practical ill effects. However, I regret to say that the failure of the joint committee in this direction has serious negative effects as a disincentive to the growing number of bright young doctors who are deeply interested in homoeopathy and who would like to add this to their own specialty. They have to embark, if they are going to acquire this specialty, on the additional seven years, or whatever it is, on top of their training for registration. It is somewhat of a gamble for them to embark on that when they cannot be sure of receiving recognised status within their profession at the end of the day.
I ask that a clear message go from this House to the Joint Committee for Higher Medical Training to ask it to reconsider its arrangements in relation to homoeopathic training. One step which would go a long way towards solving the problem—the gap in co-operation—would be if the joint committee were to appoint a qualified and experienced homoeopathic consultant to work as a full member or to be co-opted for ad hoc purposes. If that step can be taken, it will lead to measures that will remove the disincentive to bright young doctors wishing to acquire this specialty. That, in turn, will lead to an increased supply of doctors within the National Health Service to cater for the growing demand and to provide a better service for the public to the great benefit of the nation's health.
§ 5.11 p.m.
§ Lord Cullen of Ashbourne
My Lords, many of your Lordships know of my interest in osteopathy as I have been chairman of the Osteopathic Educational Foundation for many years. I am grateful to my noble friend Lord Kindersley for setting the scene and thus providing me with an opportunity to give an account of recent developments in the osteopathic profession since our last debate on this subject in 1985.
During that debate, my noble friend Lord Glenarthur, the then Minister, referred to the steps that a profession should take before full recognition could be bestowed upon it. He rightly pointed out that it is up to the profession concerned to decide whether it should be complementary, supplementary or alternative. I wish to say that osteopaths decided a long time ago that they are complementary to medicine, and the profession has worked successfully alongside orthodox medicine for many years. That view was supported by the BMA report, referred to by my noble friend Lord Kindersley, which emphasised the debt owed to osteopathy by demonstrating the value of palpation in the examination of the spine and the use of techniques using the minimum of force to relieve pain.
The first point made by my noble friend Lord Glenarthur related to the efficacy of a therapy in the treatment of specific conditions. The scope of osteopathy is, of course, well defined and involves the science of bio-mechanics. A recent research project conducted by the Genesis Osteopathic Foundation showed that of 1,110 consecutive new patients consulting 238 osteopaths, 95 per cent. had attended for spinal or extremity joint pain. That should be viewed in conjunction with the Which report of October last year, to which my noble friend also referred.
The Consumers' Association found that osteopathy was, by far, the most widely used form of complementary medicine, accounting for 42 per cent. of all complementary medical consultations. Eighty per cent. of patients attending an osteopath or chiropractor had done so because they were suffering from back pain, and over 80 per cent. of all patients claimed that their condition had been cured or improved by manipulative treatment. That is a high percentage.
The second point that my noble friend Lord Glenarthur made was that a profession must be shown to have reached maturity and to have an established and recognised governing body. In the case of osteopathy, the first School of Osteopathy was established in 1917. Your Lordships' House debated a Bill on the regulation and registration of osteopathy as long ago as 1935. That Bill was referred to a Select Committee, and while it eventually fell, the then Minister for Health recommended that a voluntary register of osteopaths be established.
As a result of that recommendation, the General Council and Register of Osteopaths was established and currently has a membership of almot 1,000 practitioners. There are other professional and postgraduate osteopathic associations with some 320 additional members.
1403 I am delighted to say that there is now a general consensus within the osteopathic profession to work together and to attempt to achieve statutory registration. A welcome development is that the postgraduate education programme of the British School of Osteopathy is now to be open to graduates of the other osteopathic schools. I am also pleased to know that closer links are being formed between the osteopathic and chiropractic professions, as they see the statutory registration of their professions as a common goal. I look forward to hearing what my noble friend Lord Ferrier says about chiropractic.
In that debate, the Minister also pointed out that a therapy must be based on a systematic body of knowledge, compatible with the acknowledged basis of contemporary medical practice. The BMA report has shown that to be the case for osteopathy, and there is clearly an organised, reputable and coherent body of knowledge underlining osteopathic practice. The BMA underlines that point by stating:The registered lay practitioner may be regarded as providing a generally safe and helpful service".The working relationship of a therapy to orthodox medicine was also referred to by the Minister. Your Lordships may be interested to learn that nearly 10 per cent. of the 1,110 new patients in the survey that I have mentioned were referred to an osteopath by their general practitioner. An appropriate code of practice is obviously vital for the protection of patients, and members of the major osteopathic bodies are all governed by a set code of ethics.
The Minister's final point was that a profession must have recognised courses of training with adequate examinations. Training is clearly the key to the future registration of osteopaths. I have mentioned before that the first osteopathic school, the British School of Osteopathy, was founded in 1917. It is now proud to have Her Royal Highness the Princess Royal as its patron. There are however other schools of osteopathy which offer a serious and worthwhile training, but it is vital that all osteopathic practitioners are aware of their limits of competence and are trained to distinguish between mechanical disorders and serious pathology. That is particularly important, as the Genesis survey has shown that over one-third of all new patients attending osteopaths did so without first having consulted a registered medical practitioner.
My noble friend Lord Kindersley drew attention to the educational initiative of an external assessment of all osteopathic training schools to be undertaken by the British Accreditation Council. My noble friend Lady Lane-Fox is the principal sponsor for that exercise and will shortly be providing your Lordships with more information about that most welcome development. My noble friend Lord Glenarthur rightly accepted that it is the Government's duty to protect the public from harmful medical products. Clearly, statutory registration of osteopaths would be a sound consumer protection measure. Any proposals put to Parliament by osteopaths must be soundly based on criteria which would safeguard the public's interest.
1404 I submit that it is also the Government's responsibility to support and encourage action that will ensure the early establishment of a statutory register of osteopaths. All the criteria necessary for registration have now been fulfilled. It remains only for osteopaths to agree upon an accepted standard of training on which legislation can be based. Parliament will then be in a position to grant osteopathy the legal status it deserves.
§ 5.20 p.m.
§ Baroness Lane-Fox
My Lords, I am grateful to my noble friend for initiating this debate. It is reassuring to hear of plans to undertake an independent assessment of the various provisions for osteopathic education in Great Britain. This development has been referred to by my noble friends Lord Cullen and Lord Kindersley. Those osteopaths who have given and are giving so much help to people in pain and in dire trouble should no longer be denied the status of full-blown professionals. At the same time the public deserve protection from anyone whose qualifications may not meet the required level. This assessment is to be conducted by the British Accreditation Council for further and higher independent education, known as BAC for short.
Set up with the assistance of the Department of Education and Science, BAC was established to monitor, inspect and improve independent institutions of further education and is therefore uniquely qualified to make a totally independent assessment of osteopathic training. The assessment will be offered to all schools who provide a training course in osteopathy. As funds have been made available to cover the considerable cost of the assessment, no school will be prevented from participating through lack of finance. The hope is that all schools will become involved since the BAC is in a position to give help and advice to individual institutions on the educational content of their courses.
The team of BAC's inspectors will include former HMIs, senior educationists, and a doctor who is currently head of the department of a London teaching hospital and who has considerable experience in medical education. A professor and doctor of osteopathic education from the Texas College of Osteopathic Medicine will provide an independent osteopathic opinion. I believe that I am not alone in this House in thinking that the inclusion of medical representation and an external osteopathic view are essential if this exercise is to be fully credible.
The BAC will furnish all these requirements. Clearly, it seems the right body to undertake this task. It is very encouraging to know that the Consumers' Association has nominated a representative to act as observer to the BAC team thus making sure that the interests of the public are properly represented. The aim of the inspection is to assess the scope and efficiency of all osteopathic education. The inspection team will discuss with the faculty of schools what it considers to be the appropriate standards for osteopathic training. By this process of consultation the BAC will then be able to make recommendations on what should constitute a 1405 minimum standard of osteopathic training to ensure the safe and efficient treatment of patients. I believe that the BAC inspection is a crucial step forward. It will enable sound proposals for the statutory registrations of osteopaths to be presented to Parliament.
§ 5.25 p.m.
§ Lord Ferrier
My Lords, we owe a debt of gratitude to the noble Lord who introduced this short debate. I do not mind confessing that I have laid aside all the notes that I had made as so much of what I had written has been said. I believe that I can make the best possible contribution to the debate by first turning to the debt which the world owes the medical profession. We are inclined to pour scorn on the pill wallahs and so on. In one of my incarnations I was chairman of a pharmaceutical company. It was only then that I found out the dedication of the medical profession to whom civilisation owes so much.
I now turn to this debate. It is in two parts: the recent developments in the field of complementary medicine and its relationships to conventional treatment. Instead of referring to my notes I should like to go back over my medical history. I was an orphan and was brought up by an uncle who was a very eminent physiologist. I was in the army when the 'flu epidemic broke out in 1917. I wrote to my uncle for advice. He wrote back on a postcard—which unfortunately I have lost; it had a halfpenny stamp on it—saying, "The medical profession knows nothing about what they call influenza. Alcohol is a preventive and possibly quinine." I applied myself to his advice and as a matter of fact I did not get 'flu.
A little later, I found myself in the tropics. As a working man I had to go abroad on a job and was struck down by malignant malaria. I was sent home, really I think to die, when I was 23. I was mended by quinine, which is of course a drug, a product of cinnamon bark. I took a lot of it. When I was 26 years old and home on leave, I told an eminent tropical medicine man that I had taken 6,000 grains of quinine in one calendar year. He said, "Good God man, if you can survive that you can survive anything." Fortunately it had knocked the malaria out of me.
However, those days are gone. We have had great advances in drugs dealing with malaria. We therefore come to the present developments in the field of complementary medicine. That leads me to refer to what the noble Lord, Lord Winstanley, and my noble friend Lord Cullen said. I have promoted the question of chiropractors for many years. Fourteen years ago I raised the question of X-rays. The position with regard to X-rays has advanced enormously. A chiropractor will not normally address himself to a diagnosis unless the patient has been X-rayed. That is a great advance. I remember the days when a noble Lord in this Chamber asked what a chiropractor was. Since other people have asked the same question, my definition is that chiropractics is a method of healing which relies upon the removal of nerve interference by manual adjustment of the spinal column.
My noble friend and the noble Baroness who has just spoken mentioned the importance of osteopathy. 1406 That is "a system of healing consisting largely of massage and manipulation". These two methods go hand in hand. Great progress has been made since the last debate on this subject. I think that was in 1976. It was the date that the noble Lord, Lord Winstanley, indicated.
I do not know whether noble Lords are aware of this fact. A couple of months ago the British Chiropractic Association organised an international conference on chiropractic in London which was attended by over 600 delegates from all over the world. I am not a chiropractor, but I am a happy and contented patient because I kept knocking myself about falling off horses. I owe a tremendous debt, not only to the 6,000 grains of quinine, but to the hours of care from chiropractors who have put my back straight, off and on, for a number of years. The conference was fascinating. I attended the opening ceremony and there met chiropractors, men and women, from all over the world—the US, Australia, New Zealand, Greece; they were all there—and we talked of the progress which had been made in treatment.
The noble Lords, Lord Thurlow and Lord Cullen, and the noble Baroness, Lady Lane-Fox, have urged the importance of training. The chiropractors foresaw that. They established an Anglo-European college in Bournemouth under the guidance of an eminent doctor of chiropractic who is a Dane. The college is making a tremendous contribution to the health of the nation. When we first talked about this, people asked, "Where are the chiropractors? There are none." That was quite right. But now there is a good number. The college produces each year 30 or 40 fully trained graduates who have undertaken an arduous four-year course. There are more practitioners available than ever before.
I shall go on waffling because I have a very nice and efficient GP who looks after me. My revered uncle, sending me out to India, said, "Fear God and keep your bowels open". Similarly, when I said to my doctor the other day, "Look here, when I get up quickly, I get frightfully giddy. Can you give me a pill for it?" he said "No. Don't get up quickly".
These are important factors in addressing ourselves to this fascinating debate. But the number of speakers involved and the wisdom which we have had uncovered indicates that we ought to have a longer debate on the subject if the powers-that-be think we should. We have not talked about diseases such as diabetes; we have not talked about Pasteur, the plagues, cholera and all sorts of tropical diseases which I have been in contact with in India. We owe a great debt of gratitude to the noble Lord who introduced this debate. I hope that the time will come when, by putting down a Motion, the powers-that-be will give us the opportunity of having a more extended debate on this interesting subject.
§ 5.34 p.m.
§ Lord Ennals
My Lords, I want to follow the delightful speech, almost life story, of the noble Lord, Lord Ferrier, and his last words in congratulating the noble Lord, Lord Kindersley, not only on the quality of his presentation but on the timing of the debate. I 1407 want to put it in the context of the role of the Secretary of State and the task that he now has before him. Before saying that, however, I must say that in the few years I have been here I have never ceased to be amazed by the breadth of experience contained in your Lordships' House, and that has come before us today. I feel deeply grateful.
The new Secretary of State, Mr. John Moore, has indicated that he will take a new look at the National Health Service. Obviously he has some serious financial problems to deal with. Right across the country there are hospital closures, specialist units are threatened with closure and hospital waiting lists continue to grow. I shall not go into those issues today. I hope that when the Secretary of State begins to have his new look at the National Health Service or the nation's health he will not just concentrate on the structure of the National Health Service and the problems of the funding of it. My hope is that he will, first, read today's debate in your Lordships' House and will take a much broader look at how this very unhealthy nation, spending such a low proportion of its gross domestic product on health, can be made more healthy.
Such a broad inquiry would look not only at the crucial role of natural medicine, as has been mentioned with absolute unanimity in the Chamber today, but at the whole field of health improvement rather than disease management, which has basically been the role of the National Health Service in its first 40 years. I hope he will look with far greater concentration at improving the nation's diet, increasing exercise, perhaps not getting up so quickly, decreasing smoking, excessive drinking and the problems of how we deal with chronic illness within the community. I hope that it will be a very broad sweep look in which essentially natural medicines or alternative medicines will play their part.
The Secretary of State has to do this in the light of the fact that there is a significant fall in confidence in the National Health Service. An opinion poll was published very recently which showed a significant fall.
I do not think the National Health Service is underfunded. In my view there is a growing body of opinion which believes that orthodox medicine has some serious shortcomings. I believe that those noble Lords who are general practitioners will accept this. I suspect that as time proceeds it will come to be recognised that current medical training fits its graduates for dealing with emergency interventions and what I call mechanical repair, but is a poor foundation for health promotion and that great range of disorders in which mind, body and environment so obviously inter-react.
If one considers what I call doctor-induced diseases we have a real problem before us. I saw a recent survey which showed that one person in 10 who enters hospital as an in-patient picks up an illness that he did not have before he went in. Some two out of five people receiving clinical drugs have side-effects and in many cases those side-effects are much more serious than the condition for which they were being treated. Obviously deaths by prescribed 1408 drugs are not easy to estimate, but the likely figure in this country according to responsible estimates is in the region of 15,000 a year; that is, rather more than twice as many as the number killed on the roads of our country.
It is not my intention to run down the medical profession. I have the greatest respect for it. Indeed I have much respect for the British Medical Association and the Royal Colleges. But in the past they have been extremely cautious. I am thinking especially of the BMA, in so far as it is representative of the medical profession; it certainly is not entirely representative of the medical profession in your Lordships' House, as we well know. The BMA has been very cautious, conservative and very protective of its own interests especially when it comes to complementary medicine. I suppose that I can make a similar criticism of the Association of the British Pharmaceutical Industry. One must recognise that people are inclined to defend their professions and their livelihoods. There is nothing surprising about that.
There has been a lot of criticism, starting with that from the noble Lord, Lord Kindersley, of the BMA's report of the Board of Science working party on alternative therapy. That shows just how entrenched the medical profession is. I should like to have quoted from the report but I cannot do so because at the bottom of every single page it says:Not to be published in any form".It is rather like the Government's attitude to Spycatcher. If a report is produced which says, "Not to be published in any form", I cannot say anything about it. But it reflects a certain attitude of the profession in terms of explaining itself to the public.
There are encouraging signs. The noble Lords, Lord Kindersley and Lord Broadbridge, referred to the study published in the British Medical Journal by Dr. Richard Wharton and Dr. George Lewith. I shall not go into the report because the noble Lords have quoted from it but shall quote one sentence which I thought was extremely encouraging. A questionnaire was sent to 200 general practitioners in Avon, of whom 145 responded. The report says that,(59%) thought that the complementary techniques being assessed were useful to their patients: (76%) had referred patients for this type of treatment over the past year to medically qualified colleagues and (72%) had referred patients to non-medically qualified practitioners".That show a striking difference of attitude between general practitioners and those who are hospital based.
It is my view that attitudes are changing both among the public and the medical profession. I believe that in the next few years we shall see a substantial increase in the take-up, if I may call it that, of complementary medicine. Reference has been made by a number of noble Lords to registration. It is of extreme importance. The DHSS has a responsibility to protect the health of the nation and equally the professions have a responsibility to ensure the quality of those who practise in their name. As regards registration, whether it is for osteopaths or other complementary therapists—whether in acupuncture, homoeopathy or herbal medicine—the principle is the same. Progress is being made in this area as well.
1409 Reference was made to a Which? report—it is not the same witch referred to by the noble Baroness, Lady Strange—which stated that 64 per cent. of the people who had consulted complementary practitioners went to osteopaths or chiropractors, that more than 80 per cent. of them had sought help because of back pain and that nearly 90 per cent. reported that their condition had been either cured or improved by treatment. That is a record of success which any more traditional medical practitioner would call high.
The BMA report stated that the registered lay practitioner provides a safe and helpful service. Since the publication of the Which? report the BMA has become more conciliatory, stating that there is evidence that a great many people may get benefit from alternative medicine. The changing attitude of the BMA owes something to the initiative and enthusiasm shown not only by his Royal Highness Prince Charles but also by other members of the Royal Family. There is no better way for the British nation to gain a lead than from the actual behaviour of the Royal Family. In this respect they have made a great contribution.
Britain is the only major English-speaking country in the Western world where there is no statutory registration for osteopaths and chiropractors. The point has been emphasised and it must now be carried into practice. The principle that lay behind the Bill that was published in 1986 is one that ought to be carried into practice and I hope that the Government will decide so to do. It is clear that the old idea of one umbrella organisation for all complementary therapies is seen to be unworkable. I understand that the DHSS now favours the statutory registration of osteopaths and does not see that this would bar any other complementary medicine groups from taking similar steps in the future. It has made it clear that any proposals for registration must be firmly based on criteria that safeguard the public interest, and rightly so.
The Council for Complementary and Alternative Medicine is undergoing a restructuring and is establishing more of a college structure. It is wise to do so. It is now generally accepted that in complementary medicine each profession is evolving at a different rate according to its own experience and needs and the availability of practitioners. Osteopaths have now reached a stage in their development when statutory registration is the next logical step to be undertaken.
In conclusion, I should like to restate the World Health Organisation's definition of health as,a state of complete physical, mental and social well being".I urge the Secretary of State in taking his new look at our health service to see it holistically, not just in terms of disease management, important though that is, but to see health in the broader context of the ills of our society; environmental stress caused by overcrowding, inadequate housing, pollution, declining welfare services both in rural areas and in inner cities, high noise levels, unemployment and increasing poverty for significant groups in our society. As the noble Lord, Lord Willis, said, there is much saving to be made in cash and caring by 1410 avoiding the belief that there is a pill for every ill and by mobilising all the skills of those who want to promote good health as opposed to curing disease.
The 40th anniversary of the National Health Service would be a good moment for the Secretary of State and those who work with him—the Minister himself and your Lordships—to stand back and have a look at the health of the nation to see whether the National Health Service for which we have worked in our different ways for more than 40 years is the right structure for dealing with the problems of the next 40 years. In doing this the Secretary of State must be able to carry with him the support of the Prime Minister and the Cabinet, and I hope that they too will read the report of your Lordships' debate.
§ 5.48 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Skelmersdale)
My Lords, every speaker in this debate is united in welcoming the good fortune of my noble friend Lord Kindersley in winning the ballot and so initiating this wide-ranging debate today. It is of boundless interest to people at all levels of society. I would tell my noble friend Lady Strange that in preparation for this debate I have read of no fewer than 160 therapies and variations of them, stretching, if that is the word, from absent healing, at one end—just because it is the first "a" and for no other reason—to yoga. It is hardly surprising then that the subject of my noble friend's speech is one which attracts what I can only describe as passion; now, I would accept after many years, more for than against.
We have heard about the need to protect the public, and one great step in this direction would be to reduce the obvious confusion there is both in this House and among the public at large about the terms we use. We bandy the terms "alternative", "complementary", "fringe", "natural", "supplementary" and even "unorthodox". I do not intend to open a semantic debate but these many terms used by the public and practitioners alike show me that there is a lack of real cohesion outside the conventional treatment world. I shall define my terms and, with your permission, my Lords, will take my noble friend's lead and refer for ease to natural therapies to embrace all such concepts, including medicines. Again I do so with no significance intended.
The need to protect the public goes far beyond the need to define terms. As I said in your Lordships' House the other day, people should be educated to believe that their health is the most precious thing they have. That is why, for example, we have set up the Health Education Authority, and my honourable friend the Parliamentary Under-Secretary for Health is giving the matter a very high profile indeed. I can tell my noble friend Lord Colwyn that we can, and will, do more.
The noble Lord, Lord Ennals, knows perfectly well that health care is more than just encouraging people to do or eat healthy things. Just like the doctors whom the noble Lord, Lord Winstanley, mentioned, the Government have a duty to try to protect the public from having a condition worsened and, at the 1411 extreme, from poisoning themselves. This duty was of course exercised by the noble Lord, Lord Ennals, himself. Protecting the public is what the National Health Service sets out to do.
One of the ways we do this is by means of the Medicines Act. This covers all medicines, including homoeopathic medicines. There are some 6,000 of these on the market approved by what is known as a "grandfather clause". That is to say that they were on the market before that Act came into force. Action against these is to be considered only on the grounds of risk to users. We have not had to consider rejecting an application to place a homoeopathic medicine on the market since the Medicines Act came into force, so the difficulty about efficacy has so far been theoretical. That is why we have not, up to now, felt the need to have natural therapists on the licensing authority, which, by law, has to be expert but not necessarily representative.
I agree with the noble Lord, Lord Willis, that we have to have testing to protect the public. The noble Lord accepted that principle as applying to natural medicine. That principle of testing must be pursued regardless of the cost to individual manufacturers.
The roles and scope of the various professional groups which work in the health service are clearly understood by the public and professionals alike. That understanding does not stem from a lack of complexity within those professions—far from it—but from standards which we all recognise and understand and to which all practitioners adhere. In spite of the 4 million people—growing by 15 per cent. a year, we are told—using natural therapies, such clearly-stated standards and objectives are not available for all to see in relation to the natural therapies.
I know that there are pockets of mutual understanding and agreement, but there are no defined terms which are accepted and recognised as standard by all practitioners of any one type of natural therapy. I regard that as a great handicap to furtherance of the natural therapists' case for greater recognition. If agreement cannot be reached among themselves, what are the public or the medical profession to make of it?
The need for the natural therapists to get their house in order is not a new concept. I think we all understand why it is such a difficult one for them to take on board, but it is one which no one, other than the practitioners themselves, can achieve. It is of course open to a particular therapy group, or groups, to decide that it would be in their own interests and those of their patients to pursue a tighter regulation of their affairs. This could only be welcomed if it achieved common, recognised standards for all to see and to which all practitioners subscribed.
One way of doing that could be some form of registration—statutory or otherwise As far as statutory registration is concerned, my noble friend Lord Cullen has asked for the Government's support in this. But I would remind him—and he indeed spoke on this matter from this Box in the past—that the Government have consistently said that, should organisations representative of alternative 1412 practitioners wish—separately or together—to set up a registration system for their members, it would probably be argued at some stage that this will require the force of law if the desired aim of providing protection for the public is to be achieved. If that is the case it will be for Parliament as a whole to decide whether proposals which are put forward are acceptable for statute either in whole or in part.
In regard to non-statutory registration it is important that any register should inspire the full confidence of the major professions and organisations concerned. But these matters are in the hands of the therapy groups themselves to pursue. We would not wish to restrict any individual's right of access to natural therapies, but those individuals have a right to expect quality of service from anyone professing to provide health care in any form, whether natural or conventional.
I return to the extreme value we all place on health, which is based on treatment prescribed or provided by registered medical practitioners either as general practitioners working in the community or as hospital doctors. Clinicians are free to prescribe any treatment regime—including any natural therapy—they feel appropriate to the care of individual patients. We see no reason to alter the basic principle that decisions on treatment must rest with the clinician concerned. Decisions about appropriate treatment for individual cases and about who should provide it are for the doctor. It is for his judgment, and he—or she, incidentally—must be satisfied as to the quality of care provided by himself or herself or by any health care professional or other therapist to whom a patient may be referred. I can tell my noble friend Lord Colwyn that European legislation does not restrict the practice of conventional or other medicine in the United Kingdom. The only restrictions are those of common law, to which all practitioners are bound.
I can understand the call that is sometimes made for some, if not all, natural therapies to be available within the National Health Service. Of course we should like to see available as wide a range as possible of effective treatments and therapies. But Ministers do not have the knowledge and experience to dictate what treatment shall be prescribed or provided, and cannot force upon the medical and other professions already practising within the health service the services of other therapists. Nor would we wish to be able to do so. Wider use of natural therapies is not in the Government's hands; it is very largely in the hands of the therapists themselves.
General practitioners and hospital doctors are free to use natural therapy techniques, and some do—for example, osteopathy, acupuncture, or homoeothapy—and in some areas healers have found a place working with conventional medicine. But wider use in the National Health Service must depend on those doctors who are already practising these methods convincing more of their fellow doctors of the benefits and effectiveness of such forms of treatment.
The inquiry in New Zealand which has been referred to today was to establish whether their medical insurance scheme should pay for natural therapists. Our systems are quite different, and in any 1413 case, as I shall explain, some, albeit limited, therapies are provided within the National Health Service already.
My noble friend Lord Kitchener has drawn attention to the views of Professor Bryce-Smith and others on the value of minerals in the diet. Minerals have long been thought valuable as an aid to health care, and in passing I should say that on a recent visit to China I noted the numerous entries for mineral substances which appear in their traditional pharmacopoeia.
Regulatory procedures for natural therapists would be useless without consensus among the practitioners. My noble friend Lord Kindersley has spoken about the Council for Complementary and Alternative Medicine, which was established in 1985 to develop a register to be policed and endorsed by some of the leading therapy organisations. There is also the Institute for Complementary Medicine, which has similar aims and wishes to be instrumental in establishing a Board of Complementary Medicine to govern the natural therapy world. While those aims are sound. I understand that not all the major organisations in the field are included in the institute's register, nor would they all endorse the qualifications of others on that register. These umbrella organisations are additional to the numerous bodies representative of groups of practitioners in many fields.
I cannot help feeling that such apparent duplication is unhelpful and a particular point of confusion for the public. But it is not an item on which I am prepared to be didactic. Therapists must make up their own minds. I noted the views of the noble Lord, Lord Thurlow, about the Joint Committee on Higher Education. The Government are not in a position to dictate to them. The training of medical practitioners is for the medical profession itself.
I made all these points also to representatives of the Council for Complementary and Alternative Medicine. I emphasised to both groups which came to see me in the past few weeks that the Government regard it solely as a matter for the therapy groups to decide whether, and if so how, they should set about seeking further recognition. One school of thought favoured the umbrella-board approach, another favoured the group-by-group approach. For myself I believe that the former will almost certainly be a spur to the latter, and there is also the option of applying to the Council for Professions Supplementary to Medicine. I do not know if my noble friend, Lord Kindersley, intended to suggest that the Council for Complementary Medicine provides the spark and that osteopaths have taken the lead. In fact, I am advised that the osteopaths started on the long road to registration as long ago as 1935. My noble friends Lord Kindersley, Lord Cullen and Lady Lane-Fox have set out for this House the stage which they have now reached in working towards a sound basis for seeking statutory recognition. I do not see such action by any one group as a bar to any other group taking similar steps. Indeed, I am aware that chiropractors are seeking to take action on similar lines. The Government would not wish to stand in their way.
1414 On the last occasion when this matter was discussed, my noble friend Lord Glenarthur, speaking from this Box, enumerated the basic principles required of practitioners before they could be given recognition, and before it is even worth considering their role within health care. The remarks of my noble friend Lord Kindersley have shown that those requirements did not fall on deaf ears. Representatives of osteopaths met me very recently to set out in some detail the plans they had for the future, which they hope might lead to a submission for statutory registration. It is heartening to learn that there has since been agreement among osteopaths on this issue. They have suggested that, as a precursor to reopening the question of statutory registration, an independent assessment of the educational standards of osteopathic training might be needed.
If Parliament is to consider legislation, I should certainly think it reasonable to expect any proposals to be soundly based on independent criteria which clearly safeguard the public interest and are, of course, accepted by all practitioners. Such an assessment would seem to provide a good method of establishing the educational status and credibility of training schools, and the task is one which must be carried out by a recognised and independent body. If as a result a new Bill were to be formulated, the important issue would be whether the provisions had the full agreement of those practitioners whom it would affect.
The view of the medical profession would also be important. We do, of course, now have the benefit of the British Medical Association's report on alternative medicines. I note that your Lordships have been pretty scathing about that, but the report was extensive in its coverage of the natural therapies and I, like others, had hoped it might break new ground in recommending a more generous perspective on this issue. Instead, it reminded us that efficacy is at the centre of any considerations affecting health care: upon that there could be no compromise. Dialogue on any level between the conventional and natural worlds is important, and it is heartening to hear of the steps being taken. The Royal Society of Medicine's series of colloquia and their report will, no doubt, provide interesting material.
As noble Lords have pointed out, there already exists a measure of natural therapy within the National Health Service. There is, for example, the homoeopathic hospital in Bristol and there are welcome moves, such as the St. Marylebone Parish Church crypt and the various University examples, in which both types of treatment co-exist.
Whether osteopaths or any other therapy groups do decide to seek registration, the Government have made it clear that any action which is considered must be based primarily on principles which safeguard the public interest. Questions such as new registration might work and whether existing untrained practitioners are allowed to continue practising must, in the first instance, be for therapy groups to decide among themselves, although I should tell the House that a two-tier system does seem to me to be more consistent with the overall aim of registration. The proof of any group's action will 1415 be in whether finally agreed proposals are able to be drawn into a Bill and whether Parliament and the public, as well as practitioners, find the proposals soundly and credibly based.
The noble Lord, Lord Ritchie, among several noble Lords, raised the question of the National Health Service saving of money through natural therapies. If natural therapies were undertaken within the National Health Service that would undoubtedly place an additional load on public resources. As one noble Lord pointed out, many therapies are in fact quite labour-intensive because of their essentially one-to-one nature and the longer consultation process which they need. Indeed, this is a factor which militates against their use in the health service.
On my long list was a therapy which struck me particularly. I remember that it was St. Paul who wrote:Use a little wine for thy stomach's sake".Medical science and the healing arts are, it seems, constantly developing. I discovered that in modern wine therapy champagne may be taken to provide strength and contractability of the muscles. Bordeaux, Burgundy and Loire wine all have their distinct and different uses. Be that as it may, since 1948 there has been no bar to the use of natural therapies by doctors who practise within the National Health Service. There has also been no bar to therapists practising under common law. The future is never certain, but increasingly natural therapy groups seem to recognise the need to demonstrate beyond reasonable doubt the efficacy of their procedures. That is essential if a general understanding is to develop between all those concerned with the provision of good health care. I hope and expect that neither the conventional and generally accepted side of health care, nor its unorthodox counterpart, will set its face against change.
The noble Lord, Lord Willis, reminded us that medicine has its origins in the things people found conveniently to hand many centuries ago. The earliest physicians used plants, herbs, leeches and diet to treat their patients; I do agree, of course, that we should never forget that. However, I do not know why the noble Lord decried aspirin—"the Aspirin Age", was, I believe, his phrase. I would remind him that many of those crude applications of natural entities have been refined and are in use today, including aspirin, which has its origins in willow bark.
I do not accept that we have turned our back on natural medicine; as I have said, many modern medicines have evolved from herbal or herbal-based medicines. What we do now is control the purity and potency of the essential substance. Examples of such evolution are digoxin, derived from foxglove, and atropine and, as I have already said, aspirin.
Health care is constantly changing and there is surely a need for open-mindedness to explore new and different techniques and to review older ones. There is, however, an even greater need to safeguard the health care which is available to the public: 1416 change for change's sake is not a tenable option. On the other hand, change—even if only of attitudes—and a mutual understanding where it can benefit patient care is worthy of consideration. This is not merely a one-sided affair but holds good for conventional and natural practitioners alike.
The Government must retain their even-handed view on the issues brought before us today. While wishing to see the best possible treatment available to patients, our general attitude remains—in a phrase which your Lordships know well—benignly neutral. We are concerned, above all, that the best treatment is provided by those best able to do so and in the most cost-effective way: health is too precious a commodity for anything else to be acceptable.
§ 6.8 p.m.
§ Lord Kindersley
My Lords, I am most grateful, but almost embarrassed, to find so much support in the House this afternoon for complementary medicine, including that from the noble Lord, Lord Skelmersdale, expressed in his rather guarded comments on the subject. There were, however, encouraging signs that the Department of Health and Social Security is now taking a much more positive attitude towards statutory registration than we have seen in the past.
There is one point I should like to make clear; it concerns a remark I made about the Council for Complementary and Alternative Medicine. It never had any intention at any time to form its own general register for all therapies. It was formed as an umbrella organisation, following advice from the Department of Health and Social Security that this was the right way to go about it. That advice has now changed slightly and the Council for Complementary and Alternative Medicine has changed its own shape slightly, but it remains the unofficial channel of communication between the Department of Health and Social Security and the separate therapy organisations. I hope it will become the official channel of communication in order that this dialogue can continue and the various steps which the noble Lord outlined in his concluding remarks can take place.
They are beginning to take place. I hope that the medical establishment, whose support is necessary if the DHSS is to take this positive role, the royal colleges and the BMA will read the report of this debate in Hansard and discover the tremendous support and unanimity in this House for complementary medicine.
I thank your Lordships for allowing the opportunity for this debate. I beg leave to withdraw the Motion.
§ Motion for Papers, by leave, withdrawn.