Non-conventional Medical Treatment

HL Deb 10 January 1996 vol 568 cc131-86

3.30 p.m.

Earl Baldwin of Bewdley rose to call attention to the benefits of non-conventional medical treatment for the health of the nation; and to move for Papers.

The noble Earl said: My Lords, I am deeply grateful for the opportunity to introduce the subject of non-conventional medical treatment in your Lordships' House this afternoon. It is close on six years since we last visited this field. I am encouraged by the number of speakers who have put their names down for this debate, and I know that we all look forward to hearing the maiden speeches of the noble and most reverend Lord, Lord Eames, and the noble Lord, Lord Winston. I am sure, also, that we all send our sympathy to the noble Baroness, Lady Cumberlege, who has been prevented by sudden illness from replying to this debate. We all wish her a speedy recovery. The noble Lord, Lord Kindersley, and my noble friends Lord St John of Bletso and Lord Walton of Detchant have told me of their disappointment at not being able to contribute today. But if all noble colleagues who have told me that their lives have been changed by a healer or an osteopath had decided to speak today, I doubt if we should have been allotted more than two minutes each!

I speak as a patient myself and as one who has studied the field for a number of years. I declare an interest as part-time chairman of the British Acupuncture Accreditation Board, and I am also joint chairman of the Parliamentary Group for and Complementary Medicine.

I believe this is an opportune time to take stock, to try to assess what non-conventional treatments can contribute, and to see how we can take the agenda forward. Much has changed in the last six years. I shall not recite all the statistics which show the vastly increased uptake and acceptance of complementary treatments. It is not just a British phenomenon. While a few of the old guard still speak of it in terms of a belief in magic, or a flight from science, what the surveys show is rather more prosaic. These patients, by and large, are not getting well with conventional treatment, do not like what those treatments are doing to them, and are getting better with non-conventional approaches.

A recent letter to the British Journal of General Practice makes the point. The chairman of the Royal College of General Practitioners' examination board wrote to tell of how a sudden attack of low back pain forced him to hold a telephone discussion with his senior colleagues, including, four regional advisers, senior RCGP officers, a couple of professors, and other leaders of our profession. Of the 12 doctors I spoke to, 10 advised me to see an osteopath. When you think how doctors have thought about and talked about complementary therapists in only the relatively recent past, this advice is quite astonishing and shows a dramatic change in mainstream medical thinking".

He goes on to say: I did see an osteopath, and he worked wonders".

In calling attention to the benefits of treatments outside the mainstream I shall have to be selective. What I want to do is highlight a few major areas where the evidence is strongly suggestive. I intend to concentrate on the more serious end of the scale, both for the benefit of those who still believe that complementary medicine is useful only for minor allergies and psychosomatic complaints and, more important, because we urgently need solutions and cannot afford to neglect any avenues that might bring results. I began by categorising examples according to the key areas of the 1992 White Paper, The Health of the Nation; but I quickly came up against the factor that most complementary practitioners will be familiar with, but which often bedevils understanding with conventionally trained doctors: the more truly holistic your therapy, the less you can claim that it may cure A, but has no role in B, C, or D. While some of my examples are linked to specific outcomes, others cover a much broader spectrum.

Coronary heart disease is still the major killer in the Western world. A few years ago a doctor in San Francisco, Dean Ornish, published a remarkable study. It sprang from his observation that by-pass surgery was a kind of metaphor for "by-passing" the real problem. He enrolled his patients in a controlled programme involving a low-fat vegetarian diet, yoga with relaxation, meditation and visualisation, moderate exercise, and regular support groups. At the end of a year even severely blocked arteries were becoming unblocked, a process previously thought impossible. Contrary to expectation, Ornish found no great problem in recruiting patients for this demanding regime. The difficulties have been more with the medical community and with funding.

In the realm of reproductive health Professor Barker in Southampton has been showing how malnutrition in the womb can affect health in later life. But few people know of the pioneering work of a small organisation called Foresight, which for years has been targeting the health of couples before conception. In this country one quarter of all pregnancies ends in miscarriage, one baby in 11 is born prematurely, one in 17 is malformed, to say nothing of those many couples who are unable to conceive at all. Foresight's doctors attend to the parents' diets, especially their micronutrient levels, to the possibility of toxic overload with lead or other substances, and to symptom-less genito-urinary infections.

In a recent uncontrolled trial involving 367 couples, 89 per cent. of the women became pregnant soon after, and every one of the 327 children was born healthy and without problems, including a high proportion to parents who had previously suffered from infertility or other difficulties. When you consider all that is involved in in vitro fertilisation you would think that some encouragement might be given to a low-cost alternative, instead of the demand that Foresight should fund and conduct a double-blind trial which by the nature of the treatment is an impossibility. Here we have a classic example of the mismatch between orthodox research tools and non-conventional approaches which sometimes blocks progress in promising fields. If the department of the noble Baroness the Minister could perhaps underwrite the need for appropriate evaluation criteria in such cases then we might be able to gain a better idea of the place for innovative treatments in overall health care provision.

I pass with reluctance over the AIDS scene, not because patients do not report being helped by a wide range of complementary approaches, but because the really promising development, from a naturopathic college in the States offering herbs, hydrotherapy and other treatments, has not had the funding to produce results beyond what were published five years ago.

Mental health suffers from the grip of the psychiatrists, whose orientation does not usually equip them to recognise those cases where brain functioning is affected by wrong nutrition, or toxic substances, or both. There is now a fairly ample literature to show that hyperactivity and even delinquency can be cured in some cases by diet; and food allergy as a factor in some so-called mental illness is not a new idea either. I have a close relative who was put on lithium for manic depression: she came off it, which she was told was unprecedented, as soon as she learnt to avoid wheat. It was as simple as that for her. It often is.

Meditation is still scarcely more mainstream. Yet there is now a substantial literature to show its benefits, not just in depression, anxiety and other conditions of the mind, but across a whole range of physical conditions. I would particularly commend the evidence for transcendental meditation, drawn from over 500 studies conducted at more than 200 research institutions and published in leading scientific journals. These show among other things dramatic reductions in hospital admissions in all disease categories, reduction of high blood pressure and cholesterol, weight reduction for the obese, together with an over 50 per cent. reduction in overall needs for health care. If only half of this were true it would deserve to be written in gold in every doctor's surgery in the land.

Finally, my Lords, cancer. There is far more of interest here than I have time for, ranging from the long-term trial of Chinese herbs to increase survival rates, to the anti-oxidant vitamin study in China which showed a marked reduction in deaths from all cancers, and indeed from all causes, to the recent Oxford study which suggests a 40 per cent. reduction in cancer deaths among vegetarians. The Bristol Cancer Help Centre is a beacon of light in this field, but I know other noble Lords will speak on that. I want to draw attention to one recently published study which, though retrospective, offers fascinating possibilities for a curative role for a non-conventional approach to cancer.

One hundred and fifty-three patients with malignant melanoma were surveyed in the United States for their five-year survival rates on the Gerson therapy, which is the oldest and most rigorous of the major nutritional treatments, involving an organic vegetarian diet and frequent fruit and vegetable juices. The survival advantage over orthodox treatment in the categories which were statistically significant, which involved the more seriously ill patients, was so massive that it is hard to see what kind of bias could account for it. Certainly, one of America's leading epidemiologists has declared himself satisfied that a real treatment effect has been shown.

If that is substantiated in further trials, it will represent one of the most striking advances since the war in an area which has not been conspicuous for orthodox success, despite the untold billions of pounds poured into cancer treatment and research. If it is not pursued, it will represent a betrayal of patients who have had to wait too long for genuine breakthroughs. Perhaps the noble Baroness the Minister, through the noble Lord the Chief Whip, would be good enough to bring that study to the notice of the Chief Medical Officer, as I should be very interested to hear his view on it.

Those are just a few examples of unorthodox approaches to serious disease which I have picked out, on the basis of evidence to date, as offering, I believe, realistic promise. There is a whole host of other areas—Chinese herbs for eczema, vegan diet and fasting for arthritis, acupuncture for nausea and substance abuse, and healing and homoeopathy across the board, not to mention the whole crucial area of environmental medicine in a polluted world—which I have been unable to cover but which I am sure other noble Lords will pick up. It is interesting to observe the strong role that nutrition plays in those examples. Yet this is still the Cinderella of the medical curriculum, unglamorous and long neglected, despite all the evidence which has gone to confirm what Gerson and the naturopaths have told us all along.

The other interesting feature is that so many of the examples involve self-help. Surely it must be right for people to take more responsibility for their own health rather than just go to a doctor to have things done to them. It is an approach which has enormous implications for the health budget at a time of spiralling costs in high-tech medicine. Cost-effectiveness, in the long if not the short run, will probably turn out to be one of the major benefits of complementary health care.

In concentrating, as I have done, on the clinical benefits, I can only mention in passing the question of the side-effects of treatment. It is a subject worthy of a whole debate in itself. The statistics for conventional medicine are positively frightening, and I believe that they play a greater part in patients' attitudes than most doctors will admit. While complementary practitioners cannot afford to be complacent, and there is work to be done in some areas, any damage there is of a wholly different order. In terms of costs and suffering, this is indeed a major benefit.

We need these new approaches. Patients demand and deserve them, in the face of medical science's lack of success with so many chronic diseases. Yet few if any of them are being followed through to see whether they can be validated and, if so, exactly what their role should be. Why is that? It is partly a matter of attitudes and beliefs in a deeply conservative medical profession. But it is also to do with resources.

There is not the money for healers and homoeopaths to fund good research out of their own pockets. Nor do they yet have the organisation nor the expertise. The Medical Research Council, when the chips are down, prefers the devils it knows. The drugs companies, which fund some two-thirds of all medical research and development, are not interested. There is nothing in it for them. That was vividly brought home to me by a friend, who, 10 years ago, conducted a very successful trial of acupuncture for breathlessness. His statistician told him, on studying the results, that had it been a drug trial, he could have guaranteed him £15 million in funding by the end of the week.

So, if we are to learn what we need to learn about the efficacy, the costs, and even the safety of some of these therapies that are already out in the market place, and in many cases now delivered by a health service whose watchwords include cost-effectiveness and evidence-based medicine, I see no alternative to government support. That is not a strange concept to the Americans, who even have an Office of Alternative Medicine with funding of many millions of dollars, or to many other countries. Perhaps I might make one or two suggestions to the noble Baroness, through the noble Lord the Chief Whip, for directions which might be explored in the near future, without necessarily pressing for concrete answers this afternoon.

At the top of the list would come help with basic medical audit. It need not involve a lot of new money. There are examples around and they need to be encouraged and built on. Studies of potential cost benefits could be a part of that.

Of course, too, we need more basic research, with appropriate methodologies. I understand that the idea of some ring-fenced funding would be favourably received in some medical circles.

Any support for training would pay dividends, whether toward an academic infrastructure for therapists, as an encouragement to research, or for familiarisation for doctors. Many difficulties arise through doctors not knowing enough about the terrain, and that applies nowhere more crucially than at the level of the MCA and its committees. In all this, help for the emerging professions to help themselves is probably the best kind of support.

May I end with a plea to the Government to encourage plurality in medicine? We have much to learn from other cultures. As to how much, I believe that we have hardly scratched the surface. I wish to express heartfelt gratitude for the Government's stance of benign neutrality, in contrast to the lack of medical freedom in many other countries. But I should like to repeat my plea of six years ago with even more emphasis: that for the sake of the health of the nation, for which they bear responsibility, the Government should now be a bit more benign and a bit less neutral. It is time to move forward.

My Lords, I beg to move for Papers.

3.47 p.m.

Lord Colwyn

My Lords, I am delighted that the noble Earl, Lord Baldwin of Bewdley, managed to secure some time for a debate on the subject of complementary medicine. I congratulate him on the clear and concise way in which he introduced the subject. I put down a similar Motion for the whole of the last Session without having any success at all. Obviously, there are some advantages in being on the Cross Benches. I should declare an interest as president of the All-Party Parliamentary Group for Alternative and Complementary Medicine. At this point perhaps I may say how sorry I am that Lord Ennals is no longer with us. He was joint president with me. I am also president of the Natural Medicines Society and patron of the Research Council for Complementary Medicine. As a practising dentist I use complementary therapies whenever appropriate for my patients.

As president of those two groups, I am able to look at the use of complementary medicine from two viewpoints: as a parliamentarian and as a patient representative. The Government and the public want accountability. Both want a guaranteed minimum standard of safety and an assurance that proper liability is available. Those who practise medicine must he properly trained and those who manufacture health care products must ensure the quality of their products in the interests of public protection.

The number of speakers in our debate is a guide to the interest in this subject shown in your Lordships' House. The public have expressed their interest by increased demand for such treatment. This afternoon, I should like to speak briefly on behalf of the consumers and their right to the treatment of their choice by the practitioners of their choice. The issue of freedom of choice in medicine is at the very heart of the Natural Medicines Society's aims. Yet it is also very aware that a total free-for-all is not in the public interest. By "free-for-all" I mean a situation in which products are placed on the market without any guarantee of quality or for which medicinal claims are made without substantiating bibliographical evidence, or where anyone can offer a medical treatment to patients without being appropriately trained.

Public safety is of paramount concern. There is a need to convince not only the medical establishment but also parliamentarians and the public of the practitioner's competence and ability to treat patients safely. The standard of training for doctors is high. The majority of people are reassured when seeking medical advice because they know the level and length of medical training. There is no justification for assuming that practitioners of complementary medicine should be allowed to treat patients without undergoing the same high standards of training, albeit of a different kind, if they want the responsibility and authority to practise their medicine. If professional practitioners wish to be considered on a par with doctors, the standard of training has to match theirs.

In Europe there have been calls to recognise the importance of alternative and complementary medicine and the non-medically qualified practitioner. In 1994 a report on the status of complementary medicine was presented by the Committee on the Environment, Public Health and Consumer Protection to the European Parliament. Although it failed to obtain a hearing at that time, it says much for the strength of feeling on these issues that the rapporteur, Paul Lannoye, was given permission to revise and re-submit a new report on the subject which is to be presented to the Environment Committee later this month. If approved, that report could pave the way for the recognition of alternative and complementary medicine throughout Europe.

In January 1995 the Natural Medicines Society initiated a move to unite the natural medicine community in the UK—involving practitioners, manufacturers, retailers and consumers—to work together to produce a position paper on the report from what is now known as the UK Forum for Alternative and Complementary Medicine.

That was a remarkable accomplishment. Never before had the industry joined forces to work together for mutual development. The strategy of a joint response from the UK organisations succeeded in gaining a weight and credibility that individual submissions would not otherwise have carried. M. Lannoye was impressed by the co-ordinated response, particularly as no other member country had achieved that. Many of the amendments suggested through the position paper have been incorporated into the new report.

For those noble Lords not familiar with the report on the status of complementary medicine in Europe, its primary objective is, To guarantee patients freedom of access to the treatment of their choice, whilst ensuring their safety, and at the same time allowing practitioners freedom of establishment and freedom to provide services. However these must be accompanied by effective guarantees to protect patients". To achieve that the report suggests expert representation and appropriate research criteria for the various disciplines. It states that there should be clarification of the definitions associated with the various disciplines, recommending appropriate research criteria and expert representation at European level, including a directive on food supplements which are on the borderline between dietetic foods and medicinal products. A European committee of experts would be responsible for assessing the clinical efficacy of the different methods of treatment and would also advise on recognising the various systems.

The report also recommends that adequate financial resources be made available for research in each branch of complementary medicine, carried out in close co-operation with experts in the field. It indicates a figure of 10 million ecus for a period of five years. In calling for the regulation and recognition of complementary practitioners, the report suggests that each discipline should belong to its own organisation with standardised training, codes of practice and a professional register. Each therapy, once organised appropriately, should be legally recognised and there should be a committee of experts to advise on it.

If the report receives approval from the Committee on the Environment and moves to the European Parliament for debate, I urge the British Government to give it their support. Those working in the field of complementary medicine need to accept that there are challenges ahead that must be met to provide the public with the necessary assurances. A challenge to provide new evaluation criteria appropriate to the therapy and the products used is work being undertaken by the Natural Medicines Society's medicines advisory research committee. There is a challenge to practitioners to prove their knowledge and skill and, to the manufacturers, to provide good quality and safe products. Finally, there is a challenge to the legislators and the medical profession to widen the conceptual framework within which their scientific theories are constructed.

I am sure that many noble Lords will have noticed the current series of articles in The Times on health. Yesterday's dealt with new ideas in relation to the detrimental effect of free radicals and the benefits of antioxidant therapy using simple substances like vitamins C and E and sticking to some basic nutritional schemes. Those of us who work with natural medicine have known about this for many years. I have spoken about the benefits of nutrition and the need to enhance our immune systems in health debates on many occasions for perhaps 15 or 20 years and have had my advice regularly dismissed by the Front. Bench as a load of nonsense.

We are right. Nutrition and natural therapies work. The only reason why no one takes any notice is that the treatments do not involve expensive medicaments. There is no interest among the large pharmaceutical companies who need to earn money by selling drugs.

Finally, the benefits of alternative and complementary medicines have been recognised by the public. There is an increasing demand for such treatments in the private sector and calls for wider availability through the NHS. It is up to the Government to respond with a respect for the individual's freedom of choice. I hope that the Government meet that demand with prompt and positive action.

3.54 p.m.

Lord Winston

My Lords, I rise to my feet in great fear and trembling for several reasons: first, because, I am told that I must in no way be controversial, and I always find that difficult; secondly, because the Leader of the House the Lord Privy Seal gave us grave admonition yesterday about what would happen to us if we overran our time. Having listened to the debate yesterday and seen how people overran their time, I am slightly less worried than I was.

I am also concerned about the idea of a new year's resolution. However, I feel that I am excluded from that as this is the first time I have risen to my feet in this House. As a maiden speaker I am perhaps uniquely qualified to speak in this debate because I know very little about alternative medicine. My area is fertility and contraception. I set up my plate in your Lordships' House just before Christmas and am disappointed to find that no one has yet consulted me on those issues.

The noble Earl is absolutely right; complementary medicine is definitely important. I would not argue with that. However, I should add that some areas of complementary medicine are already implemented in the health service. Acupuncture is now quite widely used; indeed, we refer patients for acupuncture. There is no doubt that controlled studies have been done which show that it works extremely well in specific cases.

Osteopathic treatment is another example of where alternative treatments are taking off. I have been called a member of the medical establishment, though I doubt that I am in fact a member of it, but I take some issue with the noble Earl. It would be ridiculous for me to criticise complementary medicine. My wife had excellent osteopathic treatment which undoubtedly helped and my late mother-in-law, Dr. Golomb, was a practitioner of homoeopathy. However, she was also medically qualified and that is a relevant point. I want to come back to that issue in a moment.

I fear, regrettably, that for much alternative medicine the evidence that it actually works is extremely anecdotal. Your Lordships will forgive me if I say that patients may well feel better, but I believe that they may well feel better because of the placebo effect. There is no doubt that when somebody listens sympathetically to what one is saying and relieves the stress of what is happening, one feels an undoubted benefit. Sadly, far too many medical practitioners are failing in their duty to talk to their patients properly.

What is the placebo effect? Let me describe two examples to your Lordships. When I was a medical student I remember being told about a study in the Welsh mining areas. A new drug had come onto the market and was thought by the drug manufacturers to be excellent for coughs. The drug was handed out to three groups of general practitioners. The first group thought that the drug was wonderful; it would be the answer to chronic cough and lung conditions. The second group was not so certain; it was equivocal about its effect. The third group felt that the drug was clearly a case of exploitation and was being foisted on them by a specific drug company.

A large number of patients—several hundred—went through those three practices. At the end of that time the patients were independently assessed by a panel of doctors who did not know to which practice the patients belonged. It was a blind, controlled study. The patients who went to the first group had an 87 per cent. improvement in symptoms; the patients who went to the second group had a 48 per cent. improvement in symptoms and the patients who went to the doctors who did not believe in the drug had something like a 17 per cent. improvement in symptoms. That is what I mean by the placebo effect.

The placebo effect can work in all sorts of ways. I can give an example of a study recently completed by my group at Hammersmith Hospital. We have been looking at the effect of growth hormone on the human ovary in patients who have repeatedly failed to ovulate. We had patients who were, by all standards, virtually sterile. The study was funded—admittedly, it was not a cheap study—and after ethical approval we gave one group of patients sterile water and the other growth hormone. None of the patients knew which they were receiving. I must tell your Lordships that it made no difference at all whether the patients received the growth hormone or sterile water injections. Both groups of patients had a much higher pregnancy rate than could possibly be expected. Therefore alternative medicine may work, but the placebo effect is remarkably powerful.

This is important. Professor Peckham, as he was retiring last week, pointed out that in the National Health Service at the moment more than £1 billion is wasted on medicine which is not properly evidence-based. We have to recognise that. The noble Earl, Lord Baldwin, referred to Foresight, the group examining mineral deficiency in pregnancy and miscarriage. But can we really believe in the concept of mineral deficiency? If mineral deficiency was a cause of infertility, does it not occur to Foresight that the burgeoning populations of Ethiopia, Bangladesh and India would be what they are? There is no evidence at all that these vitamin deficiencies play a serious role in human reproduction. The truth is that most miscarriages and most causes of infertility are due to defects in the human embryo. The sad thing is that I have seen patients who have gone through these treatments and whose proper treatment has in consequence been delayed. One knows the consequence of an older woman trying to seek treatment under the National Health Service. It becomes increasingly difficult and the delay in treatment makes her management more difficult to do.

Finally, perhaps I may take another example of complementary medicine. It is a ridiculous one but one which illustrates my concerns. Some noble Lords will be aware of the sex selection clinics. In fact, the noble Baroness, Lady Warnock, once mentioned sex selection as being a possibly useful thing for some Members of this House. Indeed, perhaps in another place there might be an urgent need to consider sex selection now that so many electoral difficulties are facing one of the major parties. There is a clinic in Hendon which has been set up to sex select. It filters sperm through a column which is supposed to produce either males or females and then patients are given this treatment. However, research in several places—at Hammersmith, and with my colleagues at University College, London, in Barcelona, in Belgium, in Israel and in Australia—quite clearly shows that this method of sex selection produces exactly a 50:50 ratio. Of course, some people will be satisfied because they get a baby of the desired sex but I submit that they would have done anyway.

Why does it matter? Leaving aside the moral issue, the matter for concern is this. At the moment one can practise in alternative medicine without a medical qualification. There is no regulation to stop that. Any one of your Lordships could set up a plate provided he is not medically qualified, and he could conduct his practice without any kind of rigorous method of appraisal. That should be considered and possibly there needs to be some thought to legislation about the issue.

4.3 p.m.

Lord Butterfield

My Lords, it is an immense pleasure to rise in the wake of a man who is obviously a very powerful contributor and educator and who has done such important work in the very important field of fertility studies. The noble Lord, Lord Winston, can be quite sure that we shall be listening with great interest to what I hope will be many more speeches to the House.

I remind the House that the noble Lord has been a visiting professor in the United States and Europe and that noble Lords may have seen him on many occasions looking at the whole problem of people's lives in doctors' hands, where he was the presenter for many years. The noble Lord has won the coveted Victor Bonney prize of the Royal College of Surgeons. We are delighted to embrace him and welcome him as a member of the medical profession to this House. I am not quite sure whether we shall turn so much to his expertise but we shall be delighted by his observations on the affairs of life.

Perhaps I may next say that I am fresh returned from the Far East. I have asked the noble Earl, Lord Baldwin, whether I may withdraw before the end of the debate because it appears that I am expected to be in Cambridge shortly after six o'clock to welcome some visiting Americans who are here for the night and tomorrow. I apologise to the House for this rudeness.

I should like to thank the noble Earl, Lord Baldwin, as I know all the other noble Lords who are to speak today will wish to thank him. I have been interested in unconventional medicine for all my professional life. The purpose of my communication this afternoon is to convey to the House that since around 650 BC conventional doctors have been concerned about the wisdom they have in attributing what they attribute to conventional treatments and have been looking at the whole question of evaluating conventional and non-conventional treatment. There is a famous aphorism attributed to Hippocrates. We do not know whether it is one man, Hippocrates, or whether there was a practice of them in Kos. The aphorism is that life is short; the art, the science or the technic is long—it takes a long time to learn it; the opportunity for doing good is fleeting; experiment, whenever one wants to undertake it, is hazardous; and—here is my important point—judgment in medicine is immensely difficult.

The noble Earl, Lord Baldwin, referred to the vast range of new non-conventional therapies that are appearing in our midst. I am very much in favour of that and I am sure that the noble Lord, Lore, Winston, is too. As we become more affluent, as there is better newspaper reporting, as there are better vehicles through the media to relay new pieces of information, things will spread more quickly. It took a long time for digitalis, reported to a professor in Birmingham, to become a world treatment for heart failure. I do not know anyone in conventional medicine who is opposed to the examination of the new therapies and to listening to the results that are coming through.

What we are all concerned about was touched on by the noble Lord, Lord Winston. I refer to the importance of accurate validation of the results. We have been very lucky in this country. In a physician called Gilbert we have had a great deal of the earliest work on experimental philosophy. Harvey unravelled circulation. Francis Bacon started the whole system of inductive logic. Incidentally, Bacon published a remark by which I am intrigued: Where there is much controversy there is, at many times, little inquiry". That is what is changing with alternative medicine today. There is much more inquiry and I am very much in favour of that.

Not all the philosophers have come from the doctors. For example, Voltaire was very concerned because he thought that, Doctors pour medicines"— he called it physic— about which they know little or nothing into bodies about which they know even less". So the doctors have not had it all their own way, even if they have been qualified.

We are fortunate in this country that. we have had in our midst a man who evolved a system for testing new ideas and new therapies, whether they were conventional or unconventional. His name was Archie Cochrane. He looked like James I and I think that privately he thought he probably was. He was a wildish man; he fought in the Spanish Civil War; he worked among the pneumoconiosis people in South Wales and he had a Chair at the University of Cardiff. He established a whole system of interrogation for new ideas which he called the randomised controlled clinical trial. The word "controlled" was to ensure that one diminished the false detection of the placebo effect. The word "randomised" was in order to ensure that one did not select patients who would automatically get better or not get better. One had to be very careful randomly to choose the people in the different: groups. If one could, one changed the treatment from being, one hoped, active to being the placebo in the middle of the trial.

Suffice it to say that that is being used more and more widely all over the world. It is being used with many conventional medicines. It is now being used for many treatments which have been regarded as conventional for a long time. The noble Lord, Lord Winston, pointed out that there are many things that we do that we are not really quite sure about. This is the method that is being used to unravel what I hope we shall all come to realise is a new and important development of informed, knowledge-based medicine.

There is now at Oxford a Cochrane Centre where this kind of endeavour is going forward and to which a lot of results are being referred. So, basically, there is a great broadening of unconventional medicine. There is a great widening of the methods of examining it. It is my hope that by degrees we shall get a safer and safer pursuit of the profession and the complementary professions with it.

4.12 p.m.

Baroness Rawlings

My Lords, I too would like to thank the noble Earl, Lord Baldwin of Bewdley, who is so knowledgeable on this subject, for initiating such an important debate today and for opening it with such eloquence and clarity. There is great and growing interest in non-conventional medicine today as we can see by the long list of speakers. I congratulate the noble Lord, Lord Winston, on his fascinating speech and I look forward to the maiden speech of the noble Lord, Lord Barnes. I, too, like my noble friend Lord Colwyn, tried for a debate on this subject, but unsuccessfully.

At this stage I would like to declare an interest as a director and member of the board of the Foundation for Integrated Medicine, a registered charity. I believe that I should add, in the present climate, another interest in this field, as having nursed and been an active member of the British Red Cross Society for 25 years.

The noble Lord, Lord Baldwin, initiated a previous debate on this large and complex subject in May 1990. So much has happened in the past six years in this field that it is most timely for this debate today. Medicine is changing so rapidly with new, exciting discoveries every day. That is a far cry from, as Moliere described it in the 17th century, when discussing the heart and liver: `It seems to me you are locating them wrongly: the heart is on the left and the liver is on the right' said Geronte.`Yes, in the old ways that was so, but we have changed all that, and we now practise medicine by a completely new method' answered Sganarelle". Wonderful new discoveries are saving more and more lives daily. Modern medicine has achieved outstanding results. However, there are increasing limitations and escalating costs. There are now real fears that the demands being placed upon the conventional health services may generate burdens which could prove impossible to meet. There is also some concern about the potential side effects of treatment. More could be achieved in our health care system, and often at lower cost, if effective complementary therapies were integrated into the existing practice.

Existing health care systems are experiencing growing difficulty in addressing 20th century illnesses, many of which are due to the effects of modern society. Even though Benjamin Franklin said, The best of all medicines are resting and fasting", which may be true with sleep of course, but often the pace and pressures of today no longer allow just this luxury. This is where the integration of orthodox and complementary medicine can really help.

Over the centuries vast experience has been gained all over the world from the use of traditional treatments. It is vital today that we safeguard the knowledge that has been handed down from generation to generation relatively untouched by our modern developments in countries like India and Brazil. Many of these treatments need to be researched so that the benefits can be enjoyed by people everywhere. These forms of treatment are becoming more and more popular, yet to be used on a large commercial scale further research is needed into effectiveness, safety, cost-effectiveness, and alas, as we all know, that costs money.

Complementary medicine should not be seen as a threat to conventional medicine. More and more doctors are interested in its potential and many people suffering ill health are using different therapies. A partnership is possible where all will benefit. Several "Establishment" bodies, some with full, others with partial government funding, like the BMA and the royal colleges, and some independent ones like the Research Council for Complementary Medicine and our own Parliamentary Group for Alternative and Complementary Medicine, are doing a magnificent job. This is surely a good moment for more recognition where national funding would be really popular. The most recent figures that we have are from 1991–92, when the National Health Service spent £1 million out of its £37 billion budget. I know that this is a vast area of medicine and there have been areas of recognition by an Act of Parliament both in osteopathy and chiropractic, as the noble Lord, Lord Winston, said in his maiden speech. But there is still a very long way to go. The figures are impressive: 2,500 osteopaths working all round Britain treating over 20,000 patients every working day—well over 5 million consultations a year.

Nurses are also pioneering the expansion of the use of complementary therapies. In approximately 80 per cent. of cases where policies in this field have been developed in the health services around the UK they have been spearheaded by nurses. A future nurses' formulary might contain complementary therapies such as herbal medicines, essential oils for internal use and homoeopathy for those who are trained.

Greater priority and funding is needed for research so that consumers can be given the information and reassurance that they require. Several other governments around the world are recognising the benefits of integrating orthodox medicine with complementary medicine. As we have heard, in the United States they set up in 1993 the Office of Alternative Medicine, which receives considerable funding and is proving a great success. The German Parliament entrusted the government with the task of assisting the scientific evaluation and future development in this area by means of targeted research support and in Switzerland the Swiss Government in 1990 launched a national research programme on complementary medicine.

It is surely not only in the Government's interest but also for the health of all their citizens to promote health and well-being in addition to treating illness. Integrated medicine tries to deal with people as whole individuals, obtaining their confidence and trust, building inner strength for the treatment of illness and finally to restore to people their feeling of self-worth and esteem through active participation in their own treatment, as the noble Earl, Lord Baldwin, stressed. That is often essential for recovery.

His Royal Highness the Prince of Wales, who has been so supportive for many years in this field, said in 1994: Sharing responsibility for the care of patients by integrating properly trained and registered complementary therapists alongside what are considered to be more conventional practitioners could provide exciting long term benefits". I hope that today will have stimulated debate on this topical and important subject and, more importantly, that complementary therapy can be further integrated within the National Health Service, providing positive benefits to patients. As in an old Arabian proverb: He who has health, has hope; and he who has hope, has everything".

4.19 p.m.

Lord Eames

My Lords, I greatly welcome the debate this afternoon and support the proposition so ably put to the House by my noble friend Lord Baldwin. In particular, like many of the speakers so far, I welcome the very sympathetic and practical approach that he adopted towards the subject. While I share the trepidation of the noble Lord, Lord Winston, on this occasion, it will soon become obvious that I certainly do not share his expertise. In fact, I am reminded of, and would share with the House, the report made of the fictitious cadet at Sandhurst who, having completed a rather haphazard career through that esteemed establishment, had written across his final report by an examiner, "Should this candidate ever become an officer in the British Army, I am convinced that his soldiers will follow him not out of loyalty, but out of a sense of curiosity".

It is for that reason that we can safely say that we live at a time when there is immense concern and interest across the nation about all aspects of medical treatment. Perhaps I may remind your Lordships that hardly a day passes when some aspect of medical care or medical concern does not fill the headlines. We have become a people aware as never before of the concerns of the medical profession and of the difficulties and yet opportunities which face it.

However. I also recognise that the whole subject of alternative or non-conventional medical treatment has become a somewhat sensitive issue for many of my friends and colleagues in the medical profession. I speak from a lifetime of experience of pastoral ministry to the people of Northern Ireland. I can assure your Lordships that, particularly over the past 25 years of violence, and of the suffering caused to so many because of violence, I have come to have a new appreciation of the value, integrity and professionalism of the medical profession in Northern Ireland. I gladly pay tribute to its members on the occasion of my maiden speech.

Perhaps I may presume in this debate to draw attention to a part of the subject before us which I do not feel receives adequate attention—certainly not to the extent that it deserves. On the one hand, as we have been told, we have structured professional medical care in hospitals and at bedsides in ordinary homes; on the other hand, we have that myriad of parallel and supportive work which we must surely recognise today as an integral part of healing. More and more, the phrase "pastoral care" is being used. Although it involves, in a rather narrow sense, members of my profession, it clearly has implications right across the board in new and exciting ways. Health is much more than a physical problem. As the noble Lord, Lord Winston, reminded us, the attitude of the patient to his or her illness is more and more becoming a vital feature in the healing process.

More than one writer has drawn our attention to the submission that much more attention must be paid to the relationship of modern medicine to healing. Too often we unfortunately have to conclude that scientific information has become the end rather than the means to the end of human service to human people. Eric Cassell wrote recently in one of his books of the danger of physicians viewing their job exclusively as the curing of disease and thereby being prevented from effectively making a lasting impact on the health, the overall health, of the nation.

That problem, which was highlighted by my noble friend in his opening speech, is of particular concern to the Church. Many efforts have been made in this century to bridge the gap between pastoral care and the expertise exercised by the Church and the work of medical practitioners. As your Lordships will recall, a major step forward was taken in 1947 when the British Medical Association approved a statement which said: Medicine and the Church working together should encourage a dynamic philosophy of health which would enable every citizen to find a way of life based on moral principle and on a sound knowledge of the factors which promote health and well-being". It is said that Chinese Mandarins used to pay physicians only so long as they remained well. Surely we need to learn the wisdom of that approach—for the caring professions are in the business of preserving health, not in addressing illness alone.

My plea today is that when we consider non-conventional medicine we give full recognition to the need, indeed the priority, of encouraging the fullest co-operation between the actual practice of medicine and the growing importance of pastoral care, pastoral support and pastoral concern for the health of our nation. This is a wide field and is one which, as I tried to say earlier, involves much more than the clergy. "Counselling" is a word which, like Topsy, has grown and grown. I, for one, am never quite certain what it means. However, that is part of a subject which is of immense importance and which is the real reason why I beg to presume to make a contribution today.

I plead for full acceptance that this co-operative process should become the norm. Tension and suspicion between the two aspects of medicine must be avoided at all costs. Each has its role. In the overall context of the health of the country, I believe that together the two professions can discover a new dimension to the compassion and wholeness which should be the real substance of a healthy nation. Perhaps I may conclude by reminding your Lordships of a remark made to me by a seven year-old child who fell out of bed when he was supposed to be asleep. He said, "I think that I fell out of bed because I stayed too near where I got in".

4.27 p.m.

Lord Desai

My Lords, it is my privilege and pleasure to congratulate the noble Lord, Lord Eames, on his remarkably witty and informative speech. The noble Lord brings a variety of talents to your Lordships' House. He is non-conventional enough to be a bishop but is to be found sitting far from where the Bishops normally sit. He is a lawyer; he is therefore not merely a "most reverend" but also a "learned" noble Lord. We know that he has brought a humane touch to what has been a very torn and sad part of our country. We all look forward very much to his future contributions.

I must spend a little more of my scarce time in welcoming my noble friend Lord Winston who made an excellent speech. I have known my noble friend for many years and shall say only that if he continues as he has begun he will surely be one of best heard speakers in our House.

I have no qualifications whatever for speaking this afternoon; I am not even a very good example of someone who has benefited from medicine, much less administered it. However, I merely wanted to say that among non-conventional medicines are systems from India and from China which we must take seriously as alternative systems of medicine. I refer to the Ayurvedic system, the Unani system and the Chinese system. Those systems of medicine do not have the same reasoned structure or scientific traditions as conventional medicine. But there is no reason why one could not use the same randomised, controlled clinical trial technique on all those medicine systems; why we could not see to it that if the local population, be it from South Asia, be it Hindus, be it Moslems, be it Chinese, wants to use these alternative systems of medicine, they should be confident that they will receive as good and as practised a person if they go to an Ayurvedic doctor as they would from a conventional doctor. My one plea is for research into whether we have ways of certifying and ensuring that that minimal guarantee of good practice is assured to all patients.

As other noble Lords have said, systems of medicine have much to learn from one another. There is no such thing as scientific medicine as such. We should not have just one view of science—A is science and B is not science. If a scientific method is practised, we can improve the performance of conventional medicine and non-conventional medicine.

As many noble Lords have pointed out, one thing we have learnt is that in the relationship between the doctor and the patient there are two active agents and not just one. It is not merely the doctor who is doing something to the patient; the patient himself or herself brings a whole host of attitudes, qualifications and beliefs, which could either be a help or a hindrance. We do not understand why that is. Much more research is needed.

When someone who practises Ayurvedic medicine tells me that he has a holistic approach, what he is trying to say in a way is that there are aspects of that relationship which are not fully understood, at least on a scientific basis as we understand science.

It would be a good practice, either through the NHS or some private foundation, to do comparative research on the effectiveness of different schools of medicine either on the same disease or complementary approaches to curing certain diseases. Again, as the noble Lord, Lord Eames, pointed out, it is not just a matter of curing patients; it is a matter of health. If we are to enhance the health of the nation, we shall have to learn to profit from as many different approaches as possible which boost the health of the nation in a variety of ways. I congratulate the noble Earl, Lord Baldwin of Bewdley, on giving us the opportunity to discuss the matter.

4.33 p.m.

Lord Menuhin

My Lords, I seem to be the third maiden today. There are more things in heaven and earth, Horatio, than are dreamt of in our philosophy". An item I read on the occasion of my mother's 100th birthday a few days ago (6th January) in the San Francisco Chronicle stated that King's County, Washington State, has approved a nature clinic supported by taxpayer's money. This is encouraging news.

I should like to give four instances from my own experience of therapies which would fall into what we call alternative practices in medicine. Pastoral care is certainly one. Music is, by definition, therapy. Music offers the only way to establish a dialogue with autistic children. That is well-documented, established, and available on film. I have seen it myself. It is hardly practised. The moment when the child begins to imitate, in this case, the pianist instead of the pianist imitating the child, is one of the most inspiring experiences in life.

My second example: I am engaged in a European Community project directed by my foundation which seeks out the most difficult schools in nine different countries. By "difficult" I mean riddled with prejudice and violence. As soon as the children begin to sing and dance together, as soon as the lungs and the heart act for the whole body, normality sets in. They become trusting of one another, of their teachers and the atmosphere is co-operative, positive and fruitful in terms of all other studies as well.

The London school is the Oxford Garden Primary School. In Brussels we have found a wonderful teacher of mime as well. When we move into the teen-aged schools we will include a martial art, for as soon as the chaotic energy is drawn to a goal of visible perfection and command, the energy becomes focused and there is virtually no more violence. That is also documented. It is the most effective treatment there is for juvenile delinquency.

The third example is a cheap and easy electronic acupuncture treatment involving practically no withdrawal symptoms. The patient is clinically free of any addiction within seven days. The treatment itself is done two or three times daily for a few minutes. It is pleasurable without being addictive. We owe it to every human being who has succumbed to the illegal and vast drug industry to enforce this cure. It is important that following the cure a good environment be provided so as to forestall any reversion to the addictive habit.

My fourth example is, of course, homoeopathy which is safe and effective and avoids every iatrogenic disease. What is it therefore that militates against a large investment in alternative prophylactic preventive medicine that could ultimately reduce the national health budget by a half, because at least half the population would be well instead of sick? I wonder whether noble Lords will allow me to explore what might appear to be a digression; that is, the very concept of "alternative". To discuss the subject of "alternative medicine" we must try to understand more clearly the role of alternative thinking in our general well-being. I think that it is the same mechanism at play. Alternative implies choice. Choice can only be based on memory together with objective assessment.

Man's brain is the triumph of choice over restriction. Genetically determined insects have no choice. Our own brain, with its innumerable network of nerves is a result of infinite possibilities of checks and counter checks, for we are equipped to take calculated risks and decisions. Then what is it that stands in the way? I shall list some of the human menaces that inhibit choice: prejudice annuls the faculty of choice in opinion and reduces the gift of objective analysis. Sometimes it is merely an old, cumbersome, bad habit. Short-sighted self and vested interests destroy those choices which are required for the general well-being. Those curiously often appear as open-mindedness. Dictatorships suppress choice and debase the life of the population in all aspects, impeding progress.

The feeling of exclusivity which enables a half truth to pretend to be a whole truth, which allows a theory to be enshrined as gospel, militates against the exercise of choice. Capitalist economies, with their free enterprise and free trade, find that they must curb monopolies, for we recognise that a monopoly, which is an exclusivity, reduces free choice. We cannot allow any one value to become obsessive at the expense of all other basic values. Choice is selective and is a school for subtlety. Brutality is unsubtle, unselective and therefore uncivilised.

People believe in police and prisons rather than in music, dance, mime, the martial arts, crafts, art and good education. "Lock them up" and "law and order" are convenient rallying points and are even necessary in the very short term. However, they are poisonously counterproductive. Those forceful measures have control and act as punishment but are of no permanent, social, intellectual aesthetic or therapeutic value. Few people understand that the gaolers and the gaoled became locked into each other's images and together they enhance the contagion of violence.

Only the sheerest hypocrisy can pretend that the media are not crime-provoking. Yet television, newspapers and pulp literature take no responsibility for guidance, education or crime. Universal truths must be allowed to speak for themselves. A defence of truth does not require propaganda or police but it requires all our hearts, minds and courage. By the way, my mother looks after herself very well.

4.41 p.m.

Baroness Masham of Ilton

My Lords, I thank my noble friend Lord Baldwin of Bewdley for this debate. My noble friend has much experience of, and enthusiasm for, this interesting subject.

Herbal medicine has enjoyed a great revival for both humans and animals. It seems that while herbal medicine is not usually the best first treatment in the case of severe accidents or acute illness, it may do a great deal to support conventional therapy. The herbalists would say that they are not just treating symptoms but are treating the patient holistically. A herb like garlic is used beneficially for both humans and horses. Yesterday I was given a box of pills for my dog who is losing his coat. The box stated that it contained a traditional herbal remedy for the relief of arthritis and kidney, eczema and common skin compaints in cats and dogs. It was produced by Natural Pet Care Limited. I shall watch and hope for improvement.

In recent years, there has been a great increase in the sale of herbal teas, enjoyed by many people. Not always are the ingredients written on the packet. There is concern that some may contain camphor, which may damage the liver. Perhaps, if there is such a risk, the Minister will ask the department to look into the matter.

My noble kinsman, my husband—I have his permission to mention this—had a problem last September when we went to Italy on noliday. One of his English doctors had told him that he could take his ted stockings off, which he had used since developing a deep-vein thrombosis after a stroke. When in Italy his leg became even more swollen than usual. I fetched a doctor to see him. He was also having bad cramps at night. Apart from elevating the leg and keeping him on bed rest for some time, the doctor gave him some tablets—Daflon 500 mg—to reduce the swelling and alleviate night cramps. The tablets contain natural products derived from plant sources. They are made in Italy, France, Spain, Belgium, Germany and Switzerland. As they helped, we are now provided with them by a doctor friend in France. As we are now in the European Union, it seems that we should also be able to share that sort of medication.

It is interesting to see the recent report on complementary therapy at Lewisham hospital. Evaluation and research is extremely important to help doctors, therapists and patients. I hope that that initiative is welcomed by the Department of Health.

I serve on the council of the London Lighthouse which looks after and helps people with HIV and AIDS. I have also been in touch with the Sanctuary in Bournemouth which provides similar support. I am also a member of the all-Party Parliamentary Group for HIV and AIDS. Non-conventional medical treatment is used alongside conventional medicine for those unfortunate patients with the agreement and co-operation of the patient, doctor or hospital unit.

Complementary therapies are able to provide comfort, emotional support, reassurance, relaxation, strengthening and balancing of the compromised immune system and help with working on opportunistic infections through the immune system. Many therapies are used which have been found helpful. The most usual are aromatherapy, reflexology, shiatsu, diet and nutrition, counselling and the use of a snoezelen room.

Aromatherapy clients are helped to minimise stress by the use of essential oils together with massage, inhalations, compresses, baths and diffusion. That can also help to balance the physical aspect—to stimulate the blood and lymphatic system which encourages the elimination of toxic waste from the body.

Doctors at London's Chelsea and Westminster Hospital, reported recently that 44 per cent. of outpatients attending the Kobler Centre were using at least one alternative or complementary therapy. Out of 375 separate treatments, 89.3 per cent. were described as being beneficial; 10.4 per cent. as having no effect; and 0.3 per cent., which was only one episode of one therapy in one patient, as having been harmful.

It has been found that complementary therapies are particularly attractive to counter some of the unwanted effects of essential medication. For example, someone who has been receiving chemotherapy for Kaposi's Sarcoma with anti-retroviral drug treatment may use massage and aromatherapy to relieve the pain in the hands and feet caused by neuropathy.

Less serious infections can be controlled with complementary forms of treatment, some of which have been tested and shown to be just as effective as standard drug treatments. Fungal infections, skin problems and night sweats are examples of the problems with which herbalists, acupuncturists and homoeopathists say they have considerable success in relieving. No doubt if those treatments were available and patients could afford them, they would be of value to many more people with serious illnesses and chronic disabilities.

Many people throughout the country are using complementary or non-conventional medicine. In some cases, advantage may be taken of those people. What codes of practice are there? Is there sufficient regulation to ensure that consumers of non-conventional medicine are protected?

4.48 p.m.

Viscount Addison

My Lords, I too thank the noble Earl, Lord Baldwin of Bewdley, for initiating today's debate. In the debate on the National Health Service and the role of the private sector on 8th June 1993 I spoke of the plight of aromatherapy. Today's debate offers me the opportunity to bolster that view.

Aromatherapy presently enjoys a popularity which seems to grow all the time. Its roots stem from thousands of years of plant medicine which has supported human and animal life alike. To be able to appreciate aromatherapy in its totality, it is vital to look at how aromatic plants develop from their natural environment. Aromatic plants, like many other organisms on the planet, are dependent on sunlight, water and oxygen for their growth. They grow in particular habitats which tend to influence their characteristics and they play an interactive part in the life of various insects, animals and humans.

An example of that is shown in the ancient practice of storing hay cut from hedges where wild aromatic plants such as fennel, angelica or dill are abundant. The hay was fed to sheep and cattle in the springtime to increase lactation and generally keep the animals healthy throughout the winter. That must have been a factor in keeping the food chain healthy without having to use too many dangerous substances, as is often the case today in industrial farming.

How do aromatic plants differ from any other plants? They are recognisable by their distinct smells which place them in a category of their own in the plant world. As breathing is a vital function in our life and smelling is something which we cannot easily prevent, we are in fact experiencing aromatherapy without thinking about it on countless occasions. Scents automatically enter the body while we breathe and provide us with interesting sensations.

There is no doubt that for most people the earthy smells of trees, flowers or wood evoke something natural and peaceful as they appease our sensitive nature. The feelings that we derive from open spaces such as meadows, forests or even a garden always seem to equate with an easier frame of mind and abandonment of worldly responsibilities.

Our perception of the world relies a lot on three of our senses: vision, hearing and smell, with the latter being the most intriguing as it links up with irrational regions of ourselves. Our sense of smell has a reputation for bringing up to the surface our most primitive survival instincts. Smells are well known to trigger memories from long-forgotten events, awakening many lost sensations. The relationship between the two is a source of fascination to every dedicated aromatherapist. The fact that people like nice smells and associate them with feeling good is what makes aromatherapy so popular.

Unfortunately, that "smell-good, feel-good factor" is in danger of being lost as it is still totally ignored by many medical authorities. Those authorities, in their zeal to look for professional and financial diversity, are trying to absorb aromatherapy into the allopathic medical system. It is hoped by some parties with strong vested interests that essential oils will be placed under the same regulations as apply to pharmaceutical products. That would effectively put essential oils out of the reach of a non-medical practitioner and would reduce greatly the multi-dimensional effect essential oils can offer. If that were allowed to happen, it would immediately send us back to the Dark Ages when human beings were treated like machines, devoid of sensations or feelings.

A scent is not something that can be easily pinned down or defined. However, aromatic plants can be made to yield their scent by transforming them from a gaseous state into a fluid substance. An essential oil is a hit like the genie in the bottle with many therapeutic, magical properties.

For their therapeutic properties to be active, essential oils need to be extracted in the correct manner. The right botanical species have to be picked and stored in proper conditions. More sophisticated and industrial methods of extraction are not suitable as they tend to destroy the integrity of the essential oils. The lifespan of essential oils is variable and one cannot expect a great deal of therapeutic impact if using a product which is past its sell-by date. Only a well experienced aromatherapist will be able to tell whether an essential oil is past its prime.

In practice, most aromatherapists use small amounts of essential oils diluted in a suitable medium, applied directly to the body by massaging the skin with the blend. That seems to be enough to initiate a change in mood and general health of the receiver. The latest explanation for the working of aromatherapy is that essential oils are easily absorbed in tiny quantities by the respiratory mucous membranes, the skin and the membranes of olfactory receptors. That seems to affect the activity of the membranes in a similar way to steroids.

A competent aromatherapist will work towards improving the state of mind of a person as that bears some relation to the natural healing process of the body. The role of an aromatherapist is very difficult to define as it requires the therapist to be gifted with human qualities such as warmth and patience but also to possess a sound understanding of the workings of the human body and to be nothing less than expert in aromatic science.

The effect of the therapy can be quite immediate as in the relief of symptoms, long term as in dealing with chronic ailments or supportive if dealing with a life-threatening illness. One of the greatest benefits which aromatherapy can claim over many other therapies is that it is the most efficient therapy in the release of stress.

Aromatherapy evolved with a small number of people who were dedicated to what they believed to he revolutionary therapy. In the past 10 years the aromatherapy movement has grown rather big. As there is a rising demand for the therapy, aromatherapy practices have multiplied. Not all of that is a good thing as many of the would-be practitioners have trained very quickly in colleges or adult education centres which employ teachers unqualified to teach the subject and who themselves have not practised. That is a state of affairs which needs to be remedied as soon as possible.

There are at present a number of professional aromatherapy associations whose members are working very hard to define and establish the standard for the practice of aromatherapy. One such body is the International Federation of Aromatherapists. That organisation was founded 10 years ago by the pioneers of aromatherapy and has some of the most experienced practitioners in the UK in its membership. Its main aim is to play an informative role to the public and to promote and maintain standards in aromatherapy. It is a charitable organisation and, when it was founded 10 years ago, it established a network of volunteer aromatherapists and offered this free service to hospitals and hospices. Those activities made nurses aware of the existence and benefits of aromatherapy.

Currently, the Royal College of Nursing and other medical organisations are running their own training courses having extracted from the therapy what they consider suitable for the medical profession. Those courses are not designed to emphasise the psychological side of aromatherapy or a commitment to a holistic approach, as these cannot be rationalised and are time-consuming to teach and practise. That is unfortunate as it is in direct contradiction with this person-centered therapy. Many nurses have now turned to the IFA for further training in the field and it is hoped that aromatherapy will not be hijacked by the wrong parties and destroyed in the process of rationalising its deeper implications.

Most aromatherapists look forward to government regulation and sincerely hope that that will be done with the inclusion of the original practitioners' point of view.

4.56 p.m.

The Countess of Mar

My Lords, I am very conscious of the fact that, had I not received treatment from complementary medicine practitioners, I would not be well enough to be in your Lordshibs' House today. I am more than grateful to my noble friend Lord Baldwin of Bewdley for giving us the opportunity to discuss the subject. Noble Lords can hardly fail to have noticed that, for the past three-and-a-half years, I have been campaigning on behalf of those who, like me, feel that their chronic ill health is as a result of exposure to organophosphates. I should like to take this opportunity to thank noble Lords for their support and perhaps most of all for their forbearance.

As well as getting myself well, my objectives have been threefold: to gain recognition for the sufferers; to obtain treatment for them; and to prevent any more individuals suffering from the effects of exposure to those toxins. I also support those who are too ill to work in their quest for compensation.

Most practitioners of conventional medicine either do not believe or are sceptical about claims that long-term, low-level exposure to environmental toxins such as organophosphates can give rise to chronic health problems. Many of the sufferers with whom I work tell me that their GPs and consultants believe that they are psychosomatics. For those whose GPs accept the reality of their symptoms and sometimes even the cause, there is little help from allopathic medicine. Treatment is symptomatic, and often those who have been affected by chemicals do not respond to standard drugs as other patients do. As a result, there are at the very least several hundred individuals and their families struggling to maintain some kind of life who are ill, confused and distressed.

I first became ill in 1989 after a sheep dipping session. I went through the NHS mill of diagnostic tests, all of which drew a blank, and attempts to alleviate my symptoms (which I shall not detail here) for a period of two years. I am extremely fortunate in that my GP suggested that I try complementary medicine. At that stage we had no idea of the cause and I was never asked whether I had had any chemical exposures. In any case, I would not have made the association, as, like the majority of the population, I naively believed that licensed chemicals were safe if the recommended precautions were observed.

Again, I was fortunate in my choice of complementary therapist. After taking a complete history she came to the conclusion that I had been poisoned. She used kinesiology as part of her armoury, both to assess my condition and to decide upon treatment. I must admit that I was sceptical, but I began to feel better after taking the herbal, vitamin and mineral supplements that she recommended. Her conclusions about the effects that the poison has had upon my organs and nervous and immune systems have subsequently been confirmed by scientific means.

It was not until May 1992 that we made the association between my health problems and exposure to OPs. Sadly my therapist died in 1993. For a year I tried to find a replacement for her, mainly on recommendation, but without success. I learnt a salutary lesson; not all those who profess to have the answers do. Fortune eventually led me to Doctor Jean Monro and the Breakspear Hospital in the spring of 1995. She and her colleagues are all conventionally trained and have also been trained in environmental and nutritional medicine. Their methods of diagnosis and treatment are scientifically based. Many of their patients suffer allergies, or multiple food and chemical sensitivities—a syndrome not accepted by the establishment.

In the 15 years since the Breakspear Hospital was established, over 12,000 patients have been treated. They come from most of the European countries, Israel, Pakistan, Australia and the USA as well as from the United Kingdom. Approximately 40 per cent. of its UK patients are National Health Service extra-contractual referrals. Treatment is based upon establishing the cause of the illness and the nutritional status of the patient rather than treating the symptoms. It is apparent that most of the patients suffer gross sulphoxidation deficits. Sulphoxidation is the means by which we rid our bodies of toxins. With the aid of vitamin and mineral supplements which are known anti-oxidants, a balanced diet and vaccines licensed by the Medicines Control Agency, the patients' health status is vastly improved and most are able to resume their previous occupations and activities. I am constantly delighted by the return of my energy, strength and mental activity to levels which are almost what they were seven years ago.

There are a number of medically qualified practitioners who specialise in environmental medicine. Many are members of the British Society for Allergy and Environmental Medicine and the British Society for Nutritional Medicine. I have already said that these fields are, for some unaccountable reason, found to be unacceptable by the medical establishment. As a farmer I find this inexplicable. My husband and I breed pedigree cattle, sheep and goats. We are conscious that the health status of our animals depends upon our ensuring that they receive a balanced diet, and because our soils lack certain trace elements which are essential for their development, for their fertility and for the uncomplicated birth of their progeny, we supplement their feed with necessary minerals. We also know that their needs change with the seasons and that, as individuals, they have varying requirements. It seems odd to me that, while the veterinary profession and most farmers as well as ourselves have this knowledge, for some reason those who treat humans do not take into account the fact that even small deficits in trace elements, vitamins or minerals can cause quite severe health problems for humans.

I have no doubt that the noble Baroness has seen the BSAEM and BSNM submissions on effective allergy practice and effective nutritional medicine but, if the noble Lord, Lord Strathclyde, will let me know if she has not received those, I shall ensure that she is sent them. The noble Baroness, Lady Cumberlege, is aware from discussions I have had with her that there are many sick people for whom orthodox medicine cannot provide a cure or respite from their symptoms. She is also aware that there is a wide disparity in the willingness of GPs and health authorities and boards to agree to provide extra—contractual referrals of these patients to facilities, such as those at the Breakspear Hospital, where there is demonstrable clinical evidence of effectiveness. Many patients who would, I am absolutely certain, benefit from its approach to the treatment of these illnesses are deterred by the cost.

May I therefore ask the noble Lord, Lord Strathclyde, whether he will ask his colleagues to give serious consideration to the long-term benefits of environmental and nutritional medicine both to the health of the population and to the costs of the National Health Service and ask also whether the Government would consider setting up a facility within the NHS for this speciality? It is accepted by both Germany and the USA, and I cannot believe that the improvement in the health of more than 12,000 patients from one hospital can be attributed to a placebo effect.

5.4 p.m.

The Earl of Clanwilliam

My Lords, I also rise to thank the noble Earl, Lord Baldwin of Bewdley, for giving us the opportunity to debate this important subject. I should also point out that I have his kind permission to mention that Lady Baldwin has recently recovered from a serious illness and that has been achieved entirely by non-conventional means. I am sure that we all wish her well. That certainly would be no part of the placebo effect. As the noble Countess, Lady Mar, has just pointed out, she is a living example of someone who has recovered from illness by these methods. I am sure that no one in this House would ever accuse her of 'being subject to the placebo effect.

I refer to some examples of where co-operation on this matter already exists within the NHS. I was delighted to read in the Daily Telegraph only last Friday of an interview with the Chief Medical Officer adumbrating a, big cultural shift in that it is absolutely essential that we involve patients on the decisions that affect them and allow them to make choices". That is indeed a big shift, and a shift towards holistic practice. Perhaps it augers well for good results from this debate. I only hope that the CMO has the ear of the BMA.

I wish to refer to the subject of herbalism. In 1969 I became, unexpectedly, the chairman of the Society of Herbalists and since that day I have been impressed by the results achieved with patients under the auspices of the various practitioners with whom I have been associated. I have noted how their health has improved as a result of the herbal treatments they have received. I hasten to add that they have all been treated by registered practitioners.

I also wish to talk about traditional Chinese medicine which uses acupuncture, Chinese herbalism and modern medicine rolled into one. It is the regular practice in Chinese hospitals for patients to be assessed according to their perceived need for treatment by any one or by any combination of the three therapies that they practise. The words "alternative" and "complementary" are relevant to these practices and I use the word "non-conventional" with great reservations. As regards acupuncture, a recent research paper points out that in China the Government actively support research into the mechanism whereby acupuncture works, which is still obviously not clearly understood in either China or the West. That, of course, begs the question: does it work? There can be no doubt that today millions of people are being relieved of pain by means of acupuncture. I ask my noble friend whether we cannot have support for research into this mechanism.

As regards Chinese herbalism, a herbal treatment prepared by Dr. Ding Hui Luo, who is president of the Association of Traditional Chinese Medicine, is discussed in a paper written by Mary Sheehan and David Atherton, who are consultants in the Department of Dermatology at the Great Ormond Street Hospital for Sick Children. They conducted a placebo-controlled double-blind trial of a specific herbal decoction prescribed by Dr. Luo to treat severe atopic eczema. I shall not go into all the details of the trial but I would merely say that 21 severe cases were cured or substantially relieved out of 37 entrants. That is a remarkable achievement, as will be readily agreed. I am glad to report that the treatment continues to give relief to children who resist orthodox or conventional treatment. For the record, those results were published and discussed in the British Journal of Dermatology in 1992 (volume 126, pp.483–488) and in the Lancet in 1992 (volume 340; pp.13–17).

The second instance concerns infertility treatment. I take this opportunity to congratulate the noble Lord, Lord Winston, on his maiden speech. This second instance concerns Dr. Xiao who runs the Zhai Natural Remedies Clinic in Chiswick and who is also a member of the National Fertility Association. She and Mr. D. K. Edmonds, who is the consultant obstetrician and gynaecologist at Queen Charlotte's and Chelsea Hospitals—perhaps the noble Lord, Lord Winston, knows of him—are conducting trials involving both herbalism and acupuncture on low sperm count and on unexplained fertility. Funding has been found for the herbal treatment but it remains to be found for the acupuncture trials. Surely this again is a matter which requires positive support.

Chinese medicine has a well defined history of success in clinical trials on both low sperm counts and infertility as well as in other related fields. Both Mr. Atherton and Professor Ka-Wen Ma, who is a consultant at the celebrated Wellcome Institute, have prepared papers on the subject recommending recognition of traditional Chinese medicine in the UK. It would be greatly appreciated if further talks could take place with my noble friend's officials.

I shall not go into details about traditional Chinese medicine in China, but there are 480,000 professionals in China and 70,000 have been trained in the past 30 years. There are 1,500 hospitals practising traditional Chinese medicine very successfully.

The greatest problem with all complementary medicine is credibility. That can only come with professional recognition of the practitioners. We have the very satisfactory examples of chiropractors and osteopaths, whose training and certification derive from established and approved centres of learning. That is particularly relevant to herbalists, whether British or Chinese. The UK national institute has moved forward by arranging a four-year BSc degree course at Middlesex University and is planning an entry of 40 students a year. The College of Phytotherapy at Hailsham in Sussex has a similar arrangement.

I ask that these strands of developrnent be brought together under one supervisory body to collate and disseminate the findings. There is much to be done and encouraging advances have already been made. It is imperative that the efforts should be co-ordinated.

5.11 p.m.

Lord McNair

My Lords, I add my thanks to the noble Earl, Lord Baldwin of Bewdley, for initiating this important debate. Its importance is obvious to those of your Lordships who prefer to keep healthy using complementary, alternative or holistic treatments. However, I take issue with the use of the words "complementary" and "alternative". There is a tendency to regard the march of medical and pharmaceutical technology as constituting the norm and holistic treatments as complementary. In fact, taking a broad historical and geographical perspective, the opposite is true. It is modern medicine which is complementary, or an alternative, to traditional and holistic treatment.

We had the misfortune in this country to burn at the stake most of our traditional practitioners in the witch hunts of the 17th century. Other cultures have been less extreme and so retain a body of traditional practitioners and of treatments, many of which can play a valuable and useful role in the spectrum of treatments available today. New technology can also provide insights and breakthroughs of tremendous significance. In other words, not all holistic treatments predate modern medicine.

The word "holistic" means "to do with the whole person". The billions spent annually on pharmaceutical and other areas of medical research are aimed, one hopes, at curing bodies of illness; yet we are more than bodies. We are body, mind and spirit, and it is the interaction between all three which should be addressed in any sane and truly scientific approach to healing.

Some speakers in today's debate have their own particular interest, as we have heard. The Minister, were she able to be here—and we all wish her a speedy recovery—would not be surprised that I have chosen to speak about the part that hydrogen peroxide can and should play in maintaining the nation's health. In fact, it already plays an indescribably important part in maintaining the nation's health because every time a white blood cell destroys a bacterium or a virus it does so by engulfing it with hydrogen peroxide.

To understand why that is so and why it has such immense possibilities for human health we need to journey back in time many millions of years. At the time when viruses and bacteria evolved the earth's atmosphere contained a much lower proportion of oxygen than it does today. At present the normal percentage of oxygen is around 20, although in a polluted urban environment it can drop to as low as 11. Humans and other animals evolved much later when the proportion of oxygen had risen to its present level. A well-oxygenated body is generally a healthy body. Good fresh food and plenty of exercise in an unpolluted atmosphere definitely help, but with any condition that is caused or precipitated by an infectious organism additional oxygen in the form of hydrogen peroxide, either by ingestion or by intravenous injection, should be the first priority.

In 1993 and 1994 the noble Baroness the Minister was kind enough to invite me to tea to discuss with her and some of her advisers matters connected with hydrogen peroxide. On the second of those occasions her advisers were adamant that if the substance had the benefits that I said it had, then it must be commercially viable to carry out clinical trials. Hydrogen peroxide is produced by methods which are not only in the public domain but are the province of A-level or even GCSE chemistry. There is no prospect of a trade mark, patent or even biotechnological development in the production of hydrogen peroxide. One manufacturer has calculated that it would take 18 years to recoup the £100,000 or so that it would cost to undertake the clinical trials. It is a sad distortion of the free market philosophy which I share when mathematics become subordinated to politics. It reminds me of the attempt by the Indiana state legislature in the late 19th century to pass a law which made pi equal 3 rather than the 3.1412 or whatever in fact it does equal. Wiser counsel prevailed on that occasion and I sincerely hope that it will do so in the matter I am speaking about today.

I read in the Independent of Tuesday 2nd January the same quotation that was mentioned by the noble Lord, Lord Winston. I make no further comment about that now but I may be tempted to do so if the Minister, when she has recovered, tells me that it is impossible to contemplate spending £100,000 to £150,000 on research into the possible benefits of hydrogen peroxide in treatment and prevention. If I am right, those benefits would save the health service many millions of pounds a year.

Bodies are not as complex and, as a general rule, not as difficult to maintain in good health as those with a vested interest in the opposite proposition would have us believe. The impetus for restrictions on herbal medicines and food supplements comes primarily from the pharmaceutical companies. Let there be no doubt about that. I helped to head off one such move a few years ago. Others of your Lordships have more recent experience. The dire warnings about hydrogen peroxide clearly originate from the same source. No wonder, as the noble Lord, Lord Colwyn, discovered, tooth whiteners based on hydrogen peroxide are being squeezed out by European Union edict, via the cosmetics regulations in this case. I was tempted to ask the noble Lord, Lord Chesham, who answered the noble Lord, Lord Colwyn, about the 8,000 published medical papers which have appeared over the past 100 years since the benefits of hydrogen peroxide in combating and preventing disease were discovered in Germany in the second half of the 19th century. I did not ask my question on that occasion because I was as flummoxed as the noble Lord was at having his Question answered by a Minister at the Department of Trade and Industry, but I do ask it now.

What about the huge body of evidence in favour of hydrogen peroxide either ingested or given intravenously? Does the department have that information in its reference section? Has it been studied? What is the real reason for the Government's reluctance to carry out a simple clinical trial that, compared to the £1 billion wasted on ineffective treatments, will cost peanuts and could save millions? Could it be—and I choose my words carefully here—the cross-fertilisation between the pharmaceutical industry, the Department of Health and the medical profession?

There is so much evidence in favour of the benefits of hydrogen peroxide that the Government should at least have the decency to try and prove me wrong and also the thousands of people who attest to the benefits they have gained from drinking, yes drinking, hydrogen peroxide, in a sensible dilution of course. I should add that it tastes horrible, but that proves nothing. If the department is so sure that I am wrong let it prove it. If I am proven wrong I shall slink away and rue the day that I ever heard of hydrogen peroxide.

I have been forthright in what I have said. I considered being more restrained. Then I decided that it was my duty to the thousands of people who have benefited from ingesting hydrogen peroxide and the millions who could do so to speak as plainly as I have.

5.20 p.m.

Baroness Flather

My Lords, perhaps I may begin by pointing out that I have changed places in the list of speakers with the noble Lord, Lord Menuhin, as he had a flight to catch. I therefore apologise for the changes in the list.

How I wish that I had a personal interest to declare—whether financial, because I was chairman or patron of one of the societies, or because I was a user of so-called alternative systems. I have no such interest to declare. I have never used any medical system other than the conventional system. I have tried and failed at transcendental meditation; I have not been successful at yoga; I am not a vegetarian. However, I speak in support of the different forms of treatment that we discuss today.

When we spoke about the debate, I heard whispers of words such as "cranks". All that I can say is that I am proud to be part of this group of cranks if that is so. As I come from India, I probably come from the ultimate culture of cranks because the definition would clearly apply in that way. It is interesting that in India recently we have noticed a renaissance of Ayurvedic medicine. Various kinds of Indian systems, and the Islamic system, are becoming more widely used. The so-called mainstream medical profession is taking a greater interest.

My personal view is that we are moving away from the era of post-Imperial condescension. I believe that that is happening in many other countries. One of the reasons why any unconventional or different system of medicine was looked clown upon may have been the cultural attitude towards the countries which produced the systems. Many of the systems are very old. While clearly they cannot be accepted lock, stock and barrel because we know more than was known—we ought to know more, though sometimes one wonders—we ought to consider which systems we can take on board. We have a treasure-house around the world. It is important that we keep an open mind.

Perhaps I may say how much I enjoyed the two delightful maiden speeches. I see that the noble Lord, Lord Winston, is in his place. I should like to congratulate him. That is not done out of convention because the noble Lord will know that he has been congratulated for conventional reasons. Both speeches were light of touch and full of wisdom—and shall we not enjoy their future speeches, my Lords?

I was interested in the comment of the noble Lord, Lord Winston, about the placebo effect. How are we to know that in many other instances there is not a placebo effect? The noble Lord mentioned the wonderfully interesting episode of the cough medicine. Every day our doctors say, "This medication is new. It is very good. I am sure you will benefit from it", and quite often we benefit. Perhaps the medication is new and better, but perhaps the effect is because we have been told that if we take it we shall benefit. The mind is a very powerful instrument. I have no problem with the placebo effect. The more we can harness the mind to heal ourselves, the better we shall be. We cannot lose. After all, conventional medicine has only drugs with their possible side effects to offer. Almost nothing can be taken as a cure that does not create some side effects. We all know that. If we can harness the power of the body and of the mind to make us better, we cannot say that that is not a good thing.

Sometimes when one talks about alternative or complementary medical systems, it seems that one is attacking the conventional medical system. That cannot be true. We are utterly dependent on conventional medicine in today's world. I would never think of attacking conventional medicine. What I would say is that we need to have an open mind. We need to consider how best an individual human's needs can be met. If the needs are there, we must look everywhere to see how to meet them.

Recently, I read an article about massaging new-born babies, and babies as they grow, before bathing. In the East, over generations, babies have been massaged. Every baby is massaged with oil before being bathed. Suddenly it is being discovered this year in The Times. When I first came to this country, no one ever talked about massages. My mother always had a massage lady. We now have aromatherapy and many different kinds of massage which certainly help. If any noble Lord has not tried them, I hope that he will immediately contact my noble friend Lord Addison for a good practitioner.

Finally, there is the danger of pulling up the drawbridge. Yes, it has been accepted that acupuncture is a useful tool, in particular for pain relief. But let us not stop there. Let us continue to search for other methods. Let us not stop at the point at which everyone agrees that some method is valuable. The practitioners of alternative medicine are the ones who are keen to pull up the drawbridge. That is not the way forward. Let us keep an open mind to ensure that we meet the needs of those whom we treat.

5.27 p.m.

Earl Kitchener

My Lords, I shall concentrate on our possible need for a particular nutrient, the element boron, and on some general points which have arisen from my inquiries into what is happening about boron.

It is agreed that boron is essential for many green plants, but the evidence that it is needed by humans, or other vertebrates, does not convince everybody. Its toxicity has been thoroughly investigated and what seems to be the most useful measure—the no observed adverse effect level—is well above any recommended intake. Its claimed beneficial effects are on bone healing and the prevention and correction of many forms of arthritis.

The Arthritis and Rheumatism Research Council and the Medical Research Council both tell me that they are reactive as opposed to proactive and that they evaluate proposals from people planning to do research rather than first forming their own opinion about what is most worth doing. A patentable, and therefore potentially profitable, drug naturally stands a better chance of attracting research funds than does the question of whether the recommended intake of boron should be increased from no-mention to something, or whether that of other minerals or vitamins should be altered. Both MAFF and the Department of Health are obviously concerned with the subject and there is something to be said for one or the other being given the main responsibility. This could be extended to research councils and research establishments. Some years ago, I was told by the director of one establishment, "You have whetted my appetite about boron", but later I was referred to another establishment. Specialisation would produce economies in record keeping and would protect other Ministers and establishments from the burden of answering questions from peers and others. In my limited experience, the Biotechnology and Biological Sciences Research Council has the best approach, in that an establishment connected with it is planning some work on boron.

There is a tendency to ignore anecdotal evidence, about which we have heard much today, and it is right not to do anything on a large scale, particularly if it is expensive or dangerous, unless it has been proved by thorough trials. But many important ideas have started as anecdotes. There are now so many peer-reviewed scientific journals that people may feel that it takes them all their time to keep up to date with them. The specialisation I referred to earlier would provide a place to which anecdotal evidence, whether from this country or abroad, could be sent with a good chance of being studied. A case which I have come across in another field where this would be helpful is the Hyperactive Children's Support Group. They have a certain standing, in that, I am glad to say, the Department of Health pays part of their costs. They have experience of improving behaviour by diet changes, but have difficulty in getting anything published.

It may well be that the research which the scientific establishment wants to do is not the same as that which would be most beneficial to the public and that therefore Ministers should be closely involved. The intake of boron varies widely from place to place and a link between high boron and low arthritis has been reported. A repetition of this work would be a simple and fairly cheap way of making progress. There is also anecdotal evidence that extra zinc is good for anorexia nervosa, and this would seem easy to prove or disprove.

I have had helpful correspondence and meetings with Ministers, but have come across two cases where most reputable and reasonable people met with a less than forthcoming response. I appreciate that Ministers are busy, but at least a meeting with an official would have been justified. A knowledge of the views of those outside official circles can be useful to those inside them.

The public must be protected from harmful levels of nutrients, but I hope this will be done mainly by forcing the display of analyses and warnings on the lines of those in force for tobacco, rather than by making more criminal offences. The single thing that would most conduce to us all consuming appropriate levels of each nutrient would be a general awareness that Ministers feel a responsibility for finding out what those levels are.

5.31 p.m.

Lord Thurlow

My Lords, it is always extraordinary in our debates on wide areas to experience the range of knowledge that your Lordships can bring to bear. I am afraid that I cannot add to it, but I have benefited from both mainstream medical treatment and also non-conventional, in particular homoeopathy.

I should like to draw your Lordships' attention to a problem for the homoeopathic profession that has arisen from a ruling of the European Court. That is the finding that the British system of specialist medical training is out of line with European law. This may sound a narrow issue, but it is closely connected to the wider issue of how homoeopathy fits into the general NHS structure. The court ruling brings to a head the unsatisfactory state of affairs for the training and appointment of homoeopathic consultants that has persisted for many years.

The structural arrangements of the royal colleges do not take suitably into account the needs of homoeopathic representation. The issue was aired in our debate five years ago. The insufficient number of homoeopathic consultants has been relieved in the meantime to some extent by ad hominem appointments. It is welcome that new appointments have been made in London, Glasgow, Liverpool and Bristol. But this kind of relief has now been ruled out by the European Court finding and the new rigidity which we have been obliged to impose, so there is now an urgent problem for homoeopathic specialists which calls for a new initiative. It appears to offer an opportunity to improve the unsatisfactory structure of the past and introduce better co-operation between the Royal College of Physicians and the Faculty of Homoeopathy.

In response to the European Court, all specialist consultants will have to acquire a new certificate. Homoeopathic specialists, who of course already have to undergo several years of general medical training to qualify, will have to undergo a long and pointless additional general medical training to qualify for the new certificate. No plans currently exist for a specific certificate issued with conditions suitable to homoeopathic specialists. They will be appointed only as sub-specialists in general medicine, with a considerably longer training period, as I mentioned. Also, general practitioners and private homoeopathic practitioners will be left in limbo.

Again, there has of course to be an advisory committee on specialist training and there are no plans for a parallel advisory committee to cover specialist homoeopathic training. The royal colleges no doubt have a great deal always on their plate, but the European Court ruling has made it urgent for something to be done to relieve the new obstacles in the way of homoeopathic specialists. The first necessary step, so far as a layman can see, is for the Royal College of Physicians to enter urgently into discussion with the Faculty of Homoeopathy. This would create a new and long-awaited opportunity to lay foundations for better co-operation in the selection, training and funding that may repair the structural deficiencies of the past.

There is a separate but parallel issue in the failure of the official bodies such as the GMC and the NHS Executive to promote research and development in complementary therapies. The noble Baroness, Lady Rawlings, referred to it. The MRC, for its part, sees no objection in principle but complementary medical research is not in practice getting a share of the cake. There are similar problems in some health authorities over purchase by fund-holders. Some authorities such as Cambridge and Huntingdon have refused to allow purchase of complementary medical treatment.

In conclusion, I revert to the problem caused by the European Court ruling. We hope that the Minister's recovery will be speedy and I ask her, through the noble Lord the Lord Chief Whip, to bring to the attention of the Secretary of State the problem of the court ruling and suggest that the Department of Health should make known to the Royal College of Physicians its interest in the initiation of early discussion with the Faculty of Homoeopathy.

Baroness Trumpington

My Lords, I hesitate to interrupt but we are running rather badly behind time. Perhaps I may remind noble Lords that when seven minutes comes up on the clock, we are in the eighth minute. I ask very kindly that Members who have yet to speak stop after five minutes if possible in order to allow the winders up and the Chief Whip to have sufficient time to reply to your Lordships' learned remarks.

5.40 p.m.

Baroness Sharples

My Lords, I thank the noble Earl, Lord Baldwin, for initiating today's debate.

For all the animals produced to feed our nation, the use of non-conventional treatments can involve solely nutritional supplements in unique forms, which reduces the amount of antibiotics and artificial growth promoters and reduce death rates. We benefit as the end consumer, and the farmer can also do this economically. Too much over-use of antibiotics, as we have already heard, leads to drug resistance. We are now seeing that certain bugs are resistant to all new antibiotics. Is this not a catastrophe waiting to happen?

There is a great deal of scientific evidence to prove that we can alter the progress of arthritis, both in animals and in humans, using nutritional supplementation. Imagine the lack of pain and drug side effects in those sufferers, both animals and humans, and the consequent reduction in surgical procedures. It is surely a matter of education both within the medical profession and of the general public. These treatments should not be considered non-conventional but should go hand in hand with the accepted therapies.

Such approaches are better understood in Europe. Last year. herbal drug sales (many of them prescription only) in Germany accounted for 3 billion dollars; in France 1.6 billion; in Italy 600 million: and in the UK, much below, at 300 million dollars.

The noble Earl who introduced today's debate said that the large pharmaceutical companies were not sufficiently interested in non-conventional medicine. Why then have companies such as Boots, Johnson & Johnson. Bausch & Lomb, Degussa, Fujisawa etc. bought established phytomedical companies? They have not changed their names, and they have let those companies trade as before. Is it because this growth in the market is between 8 per cent. and 10 per cent. per annum? I suspect so. If the giant companies see the benefit of such operations, surely it is time that everyone was given the same opportunity to benefit.

5.43 p.m.

Lord Broadbridge

My Lords, I believe that complementary medicine suffers from an inferiority complex. Many complementary treatments have been used for centuries, if not millennia, and countless generations have benefited from them. It is the so—called conventional medicine that is the newcomer, using treatments "thoroughly researched" for perhaps three to five years. A large number of orthodox drugs now in widespread use have yet to pass the single generation of use mark. I do not wish to start by being pedantic, but it is really the so-called conventional medicine which is complementary, not the traditional variety. The very use of the word "conventional" gives immeasurable prestige and respectability to its products and practices, the deserving of which in many cases has yet to he proved on a long-term basis. We all remember thalidomide. So let us at the outset at least give prestige of long use to complementary medicines.

If we were in India I believe the semantics would indeed be reversed. Most people in one of the largest populations of the world rely on complementary therapies. As an example, was not a conventional preventive for malaria discovered through the observation that certain natives who did not seem to suffer from it regularly chewed the bark of the cinchona tree, which analysis showed to contain a high proportion of quinine?

The single non-conventional treatment that is generally available on the NHS is homoeopathy. Many people believe that doses of natural products, powdered leaves, seeds etc. are lacking in potency compared to conventional products. Indeed, I heard a man only recently say of homoeopathy, "You might as well eat grass". He was an educated man, too. If we pause for a moment and think of opium, marijuana, cocaine and belladonna, it is all too evident that natural products can be potent—indeed, even to the degree of being a public menace. But I say this only to satisfy those to whom degree of potency is a benchmark, for in fact homoeopathy relies on small, often minute, doses of natural products to mobilise the body's natural antibodies. By this preparation, should the main illness strike, unpleasant side effects—such as death—are avoided. Homoeopathy draws on a vast range of natural products in tiny doses to cure by mobilising agents already within the body. Because the dosages are tiny, side effects are practically unknown.

But above all stands the principle of homoeopathy; namely, to treat the whole person. A total audit of a presenting patient is taken by a homoeopathic doctor in consultations which average 45 minutes. By comparison, an average NHS GP consultation lasts three minutes and gives rise to elastoplast remedies—that is, prescribing specifically for the symptoms rather than investigating their root cause. This commonly leads to the patient presenting again in a little while with new and different symptoms, which are treated conventionally with more elastoplast. The patient's health frequently deteriorates and sinks into in-patient or out-patient hospitalisation. In the terms of our debate, that is terrible for the health of the nation and vastly expensive for the NHS and also for the nation's economy, since the patient's labour is largely or totally lost: a triple disbenefit. While the homoeopathic approach may be more expensive at the outset, it offers greater savings over the longer term. It is a tragedy that most of our health budgeting is short-term.

Perhaps the Minister who is to reply will indicate whether he thinks longer term views may one day be taken. Certainly the relevant move towards GP primary care and early-warning diagnosis and treatment and away from hospitalisation later is a policy on which to congratulate Her Majesty's Government—except that I think they are hopelessly optimistic about the time that this will take to implement.

No doubt the Minister is aware of a very interesting experiment in course at the Lewisham Hospital NHS Trust, where a November 1995 report presents findings of the first year of a complementary therapy out-patient service within a district general hospital, embodying a review of control trials in acupuncture, osteopathy and homoeopathy, together with details of the kind of patients referred and an assessment of the outcome of treatments. Recommendations are made for the future of the service.

The report states: This report is likely to be of interest to Health Authorities and policy makers, primary care and hospital providers who are considering purchasing or providing such therapies, or are reviewing how such services are currently provided. It will also be of interest to those complementary practitioners or professional bodies working with (or hoping to work with) the National Health Service". The report makes the point that evidence suggests that non-conventional therapies are increasing in popularity with large numbers of the population seeking consultation and treatment. They believe that this is in part triggered by a more articulate public and attempts to integrate patients' views into health and decision-making. The report cites evidence for the effectiveness of non-conventional therapies for a number of conditions, in particular the homoeopathic treatment of diseases of the respiratory system, including asthma, of gastro-intestinal problems, migraine, some rheumatological disease, childhood behaviour, myalgia and skin disease. Acupuncture is said to have demonstrable benefit in pain control, asthma, arthritis, gastro-intestinal disorders, musculo-skeletal problems and gynaecological problems. Studies suggest that osteopathy and chiropractic are effective in back and musculo-skeletal problems. The report concludes that there is clearly a move to integrate non-conventional therapies into the NHS (particularly in primary care) with a number of hospitals and general practices employing non-conventional practitioners.

In conclusion, the centre is funded primarily on a block contract basis by Lambeth, Southwark and Lewisham Health Commission and received over 800 referrals in its first financial year, demonstrating a high demand for that service in the Lewisham area. Ninety-six per cent. of the referrals were made by general practitioners, which shows an interest in non-conventional therapies among doctors in primary care.

5.50 p.m.

Lord Harlech

My Lords, I am very grateful to my noble friend Lord Baldwin for initiating a debate on this most important and indeed vital issue. I trust that it will be the forerunner not just of a forum of discussion but of some dynamic action. I also congratulate the two maiden speakers, the noble Lords, Lord Winston and Lord Eames.

We have heard vigorous and informed discussion from noble Lords which has clearly demonstrated the interest in this field. Indeed, as we learned from the noble Lord, Lord Menuhin, in particular, medicine can come from both music and dance just as surely as from a bottle. I should rather not use the term "non-conventional medical treatment" since, in my view, it implies that the so-called modern medical system of healthcare and treatment is the only approach. In fact, as many noble Lords have pointed out, much medicine, healthcare and treatments of disease have their roots in a wealth of knowledge stretching back over centuries. Therefore, I believe that it is to mankind's detriment that we ignore the holistic or complementary approach to the nation's health. The advances in medical science can work in tandem with traditional and indeed ancient forms of care, cure and the prevention of disease for the promotion of health (to say nothing about the enormous savings to a country's Exchequer) in an enlightened understanding.

A national health system such as the one that we have in this country spends an enormous proportion of its resources in responding to ill health. Sickness is, so to speak, the response of the body to a lack of primary knowledge in looking after ourselves. Liberating the potential of mankind's vitality, the natural awareness of the self and the creativity of one's own energy and drive needs education. Education, therefore, must be one of the main keys.

Already considerable investment in research proves that dietary factors which relate to the maintenance of good health and the prevention of heart disease and cancer are still greatly ignored. We know that despite vast investment and a greater awareness of the facts through every conceivable advertising and advisory campaign directing one towards the path of good health, human nature, being what it is, regrettably finds it virtually impossible to make changes take effect, whether it be with regard to not smoking, eating less fat, taking more exercise or acquiring knowledge of a healthier diet or indeed the skills of obtaining and preparing healthier food.

I am sure that many noble Lords arc well aware of how, despite the rigours of a diet such as that which had to be adopted for the nation's health during the last war, statistically the nation's health improved markedly. I say with regret that, in schools, good culinary training to a great extent has now been replaced by what is called "home economics". The vital window of opportunity to teach self-help and health skills to that age group has been largely removed.

In the most recent UK Mintel survey of 1995, 75 per cent. of those questioned said that they would use complementary medicine and teaching, if they were available, on the National Health Service. Of those questioned, 35 per cent. of their own volition now use those therapies; 30 per cent. of the 35 per cent. would do so exclusively.

The perceived risk of embarking on supporting the community's health—positive health, as I prefer to call it—through a complementary approach is that it might be thought to increase the burden upon general practitioners, placing another tier upon their precious time and responsibilities. However, I believe that it would be possible to make available, by way of part of the existing budget, a separate ring-fenced provision directed only to the provision of complementary medicine and ways of getting well and staying healthy. It may be possible even to grant awards and give increased budgetary help to practices for establishing best practice in given areas of complementary medicine. One could have an overall system leading to a European, indeed international, accreditation process for complementary medical practitioners. That would give doctors security and the incentive in the early stages of referral and recommendation to offer treatments which increasingly will be recognised worldwide as a proven means of achieving a healthier, less stress-filled life.

5.56 p.m.

Lord Palmer

My Lords, I too am grateful to my noble friend Lord Baldwin for once again introducing this important subject. I was not a Member of your Lordships' House five-and-a-half years ago when the subject was last debated. Had I been a Member, certainly I should not have listened to the debate and doubt very much whether I should have read it in Hansard. But that was five-and-a-half years ago.

For most of my life, from April to October, I was crippled by hay fever and used to spend an annual sum of £50 on Triludan tablets, which in turn cost the National Health Service £71 a year. For the past four years I have taken the equivalent of a teaspoonful of white powder, which contains, among other things, Psorinum, at —18 a shot. Since then, I have taken just one Triludan tablet and that was to ease the swelling from a wasp sting, after having visited the nurse's station in another place only to find it closed because the other place was not sitting. This House was, of course, sitting. For years I have had a weak back and, since visiting an acupuncturist, it has improved out of all recognition. I now swear by homoeopathy and indeed acupuncture. The Government Deputy Chief Whip is joining me on my next visit, as an experiment.

When Lothian Health Board opened a new homoeopathic clinic in April 1994, within four weeks 40 per cent. of every GP practice in the Lothian area had referred a patient and every practice had done so within eight months. The demand at Glasgow Homoeopathic Hospital is increasing. It is 40 per cent. up over the past five years—40 per cent., my Lords! It now averages 220 referrals a month, 87 per cent. of which come direct from GPs.

A MORI poll in The Times of 13th November 1989 showed a doubling of the use of complementary medicine between 1986 and 1991. Consumer surveys affirm that patients are satisfied, with four out of five users claiming significant benefit or cure and 75 per cent. saying that they would use complementary medicine again. Indeed, they want it integrated into the National Health Service. A growing number of doctors want to train in complementary medicine and the Government must accept that it is a genuine postgraduate training.

I join with other noble Lords in asking for additional funding, particularly into research and development. In complementary medicine a little goes a very long way. We have recently seen the successful passage of the osteopaths and chiropractic Bills. Surely it is time to regulate other forms of complementary medicine.

It is also important that homoeopathic medicines are correctly made in accordance with the traditional homoeopathic methods because, as in other professions, there are cowboy manufacturers in abundance. The need for regulation is great, as patients are becoming increasingly confused. Perhaps even a committee could be set up to examine the whole area.

In Scotland we must all applaud the setting up of an NMAC, which has been asked by the Scottish Office how—I emphasise "how"—to integrate complementary therapies into the National Health Service. I also believe that more training establishments need to be set up to re-educate the existing workers at all levels in the National Health Service. The Glasgow Education Model is an example of what I have in mind—and here we are talking about evolution not revolution.

The interprofessional postgraduate education programmes of the academic departments of Glasgow Homoeopathic Hospital has become the most popular postgraduate medical course in the United Kingdom—orthodox or otherwise. Almost 20 per cent. of Scottish GPs have completed basic level training in homoeopathy; that is a 300 per cent. increase over the past five years. Research has shown that two years after attending a foundation course 78 per cent. of attending doctors were still integrating elements of homoeopathy into their National Health Service care. Clinical trial programmes carried out in Glasgow in, for example, asthma, suggest that a combination of orthodox and homoeopathic approaches can often enhance the care of a given patient. It is important that as complementary therapies become more popular patients do not experience a fragmentation of their care through an either/or mentality, placing them in positions of conflict between different therapies or therapists.

The good health of our nation is surely one of our most precious possessions. We need integrated care of a high quality with an emphasis on the art of healing; a human relationship of trust blended with skill. We deserve no less. Let us hope and pray that we get it.

6.2 p.m.

Lord Pearson of Rannoch

My Lords, I join other noble Lords in congratulating the noble Earl, Lord Baldwin, on so powerful an introduction to this debate. It is indeed timely, coming as it does so soon after our debates last year on what became the Medical (Professional Performance) Act, which confirmed that not all is healthy in the practice of conventional medicine.

There is the increasing worry, too, that conventional medicine may be reaching its limits. Bacteria, which have been around for some 7,000 million years longer than us, are adapting in a most disturbing way to the antibiotics we so routinely throw at them. The AIDS saga has shaken our arrogant assumption that we shall always be able to stay ahead of disease. Viruses and bacteria may yet hold terrible surprises in store for humanity.

It may be that my own experience of illness is unusual. But I have to declare an interest in the debate because on at least six occasions in the past six years I or a close member of my family have been cured by non-conventional medicine when conventional medicine had failed. Were it not for the conventions of your Lordships' House whereby one does not criticise a maiden speech, I would have to say to the noble Lord, Lord Winston, that I understand about the placebo effect—and I agree with it—but that it would not apply to any of those examples, so stark are they. Those experiences and millions of stories like them have had the effect of putting conventional medicine on the defensive. So it is good that so many GPs are now opening up to complementary medicine, as indeed is Harley Street itself. Let us hope that this debate today contributes to that process.

However, there is one ghost of past antagonism which has not been laid to rest, to which I should draw your Lordships' attention. This is the saga of the excellent Bristol Cancer Help Centre, which was wrongly accused, in research supported by the Imperial Cancer Research Fund, of causing its breast cancer patients to die twice as quickly and to relapse three times as often as they would have done under conventional cancer treatments. Reverse statistics would have been nearer the mark and the research was, of course, eventually proved to be complete nonsense—but only after much damaging publicity had been inflicted on the centre. I gather that the authors and sponsors of the research have now apologised, but they have not asked for it to be withdrawn. Perhaps I may therefore use this opportunity to ask my noble friend whether the Department of Health can help finally to lay that ghost to rest. I have ideas as to how that may be done, which, in order to save time now, I could perhaps discuss with my noble friend Lady Cumberlege when she recovers.

But there is another broader area where alternative practitioners require my noble friend's help; that is, in relation to the future regulation of their profession. Other noble Lords have referred to this. I shall deal particularly with herbal medicines, which often suffer from the problem of being both food and a medicine; an example is garlic.

I regret to say that our herbal practitioners, who have joined up with fellow practitioners in Europe to form the European Herbal Practitioners Association, are running into trouble—perhaps fatal trouble—with the European Commission in Brussels. From her Written Answer to me today I suspect that my noble friend Lady Cumberlege may not be aware of what is happening there. I should therefore inform her that Spain, France and Italy at least (all with strong cultures of conventional medicine, inspired by powerful cartels of drug companies, pharmacists and doctors) are ganging up to produce a directive which will insist that all herbs are to be treated as though they were manufactured drugs, with all the attendant licensing and testing costs.

I understand that the European Court of Justice has issued a series of rulings which suggest support for such a view, which, if enforced, will mean the death of the herbal and other alternative medicine industries. Perhaps more likely, it will drive them underground and make it impossible to police them. Can my noble friend therefore see that our representatives in Brussels are instructed to inform DG3 in the Commission and its relevant committee that the United Kingdom will not accept such a directive? I am assuming that the Cabinet decision 18 months ago to squash a similar initiative in this country will remain unaltered and that my noble friend will therefore agree that this country should for once become strongly involved in the design stage of this particular piece of Euro-nonsense.

I should confirm that our Medicines Control Agency is doing its best in Brussels for our herbal medicine practitioners, but I fear that we are once again under the shadow of a qualified majority vote which may go against us. Can my noble friend therefore look into this as a matter of urgency? There are moves afoot which may help us to escape the dread hand of Brussels, but which again, in the interests of time, I hope I may be allowed to discuss with my noble friend Lady Cumberlege when she recovers.

6.8 p.m.

Viscount Tenby

My Lords, I thank my noble friend Lord Baldwin for initiating this debate and also the noble Viscount the Leader of the House and the noble Baroness Lady Trumpington for giving us tail-enders a window of opportunity in which I promise not to get stuck.

I should like briefly to highlight the overwhelming need to start to build bridges now between the worlds of conventional and non-conventional medicine. Though no doubt some co-operation can take place—and already has—between the two disciplines independently, the bridges themselves can only be put in place by government.

Let me at this point declare an interest as a one-time member of the fund-raising committee of the Research Council for Complementary Medicine and as a current patron of that body. As a recent bulletin of the council confirmed, there appears to be growing public demand for the provision of complementary therapies within the NHS". It goes on to point out that that produces problems in that practitioners in complementary medicine may be unfamiliar with NHS procedures and in turn their purchasers may not be conversant with what is entailed in the provision of complementary therapies.

The recent evaluation of the first year of a complementary therapy service based in the Lewisham Hospital NHS Trust provides valuable evidence of the need for conventional and non-conventional therapies to get their acts together. With 800 referrals in the first year, 96 per cent. of them from the 25 practices participating in the scheme, and with a 97 per cent. high satisfaction rate revealed in subsequent assessments, it is clear that that out-patient service is providing valuable and cost-effective skills in acupuncture, osteopathy and homoeopathy, and helping to solve some of the often long-term medical problems in that area of South London.

What is needed, however, is unrestricted exchange of information between the two disciplines, not only on what therapies may be available but also on individual case histories. NHS practitioners need to know whether the treatments are successful; whether they are cost-effective compared to conventional medicine and, above all, whether they are safe for their patients. That kind of information can only be forthcoming as a result of systematic and professional evaluation on a basis agreed to by both sides.

Although non-conventional medicine (without the benefit of a powerful and wealthy pharmaceutical industry, it must be remembered) raised a great deal of money itself—for example, over —1.5 million by the RCCM over the past 13 years—it would surely be appropriate for the Government now to make their own contribution. That is just one important aspect of what I may term the familiarisation process. But there are others and I should like to refer to two of them on which I would welcome the observations of the noble Lord the Chief Whip.

The first is a need for the establishment of university chairs and university studies. The Laing Chair at Exeter and the past Research Fellowship at Glasgow point the way forward, but although government funding for the Sheffield University project was greatly appreciated it would seem that in view of the ever increasing demands for non-conventional medical therapies the time is now ripe for the funding of further projects by government. Secondly, as the popularity of non-conventional medicine grows, and more and more referrals are being made by GPs—close on 40 per cent. of practices in England are said to offer their patients access to these therapies—it appears to be desirable that the doctors of the future should have at least a basic knowledge of the more popular and tested non-conventional therapies, or at least know their way around the world of non-conventional medicine.

We all know that prevention is better than cure, none more so than the Government, who continually seek to wean people away from the seeds of self-destruction implicit in their lifestyles by repeated warnings on smoking, drinking and diet. I would he tempted to add a fourth category—the overuse of drugs supplied in all good faith by many in the medical profession.

Perhaps I may respectfully suggest that non-conventional medicine, too, has an important part to play in this ceaseless battle for good health by providing not only solutions to certain medical conditions but in many instances safeguards against their recurrence. In making health care more efficacious, more cost-effective and more user-friendly we need to utilise every available resource, and the right non-conventional therapies can be important contributors to that desirable objective.

6.11 p.m.

Lord Rennell

My Lords, it is always a great privilege to speak in any debate initiated by the noble Earl, Lord Baldwin of Bewdley. I cannot think of anything more important to us all than our health. This has been a most opportune and important debate. The nice thing about it today is that on all sides of your Lordships' Chamber we seem to have agreed. So why cannot we make quicker and greater strides towards improving the health of the nation with greater use of non-conventional medicine? Is it genuine doubts about the efficacy and safety of alternative medicine, or is it money? I suspect it is money. Yet many of us feel that allowing non-conventional medicine to flourish will save millions of pounds annually. The trouble is that we are not long-sighted enough.

The National Health Service spends some £30 billion a year but alternative non-conventional services receive only —1 million. That is £100 to every £3 million spent on National Health Service conventional medicines. Lewisham hospital has produced an excellent report which many noble Lords have been sent. The hospital's total budget for non-conventional services for the year was a miserly £51,000.

More than 100 years ago inoculations were first discovered. In his play "The Doctor's Dilemma" Bernard Shaw has Sir Patrick Cullen saying: Ive tried these modern inoculations a bit myself. I've cured people with them; I've killed people with them; but I gave them up because I never could tell which I was going to do". We must now move on with non-conventional medicines. The noble Earl, Lord Baldwin of Bewdley, put the case in his usual eloquent style. I shall not reiterate the many points made. My own interest in the subject is as a sportsman. I have needed for 60 years to keep fit and able; for the past 35 years, with joints beginning to creak and in need of oiling, I have used every avenue available to keep myself on the field of play whatever he sport, chess included. I have used osteopathy, chiropractors, physiotherapists, acupuncturists and homoeopaths. I have spent a year sleeping with my feet in the air—and so has my wife—and I have taken cold baths every day. I have taken mineral water from the Pyrenees, near to Lourdes. Surprisingly, some may say, all the remedies have worked, so I feel well qualified to support the Motion today.

One often takes alternative remedies only when conventional cures have failed to work or have not worked quickly enough. Indeed, 42.8 per cent. of people who use alternative medicine or therapy say they do so because conventional medical treatment has not worked. Complementary medicine, therefore, when it does work, where all else has failed, must be very efficacious. I am convinced that we as a nation should embrace non-conventional medical treatment wholeheartedly and now.

Reverting to my comment on chess, my family had a lovely Russian girl staying with us last summer whose father looks after the world chess champion, Karpov, keeping him fit physically and mentally. I was very pleased because the girl, Leana, was able to help me with the Alexander Technique, which is frequently used by singers, actors and, indeed, for public speaking. If I may demonstrate to your Lordships, even more benefit may come from this very important debate. If, using the technique, I stand upright and allow all the forces in the body to flow up and down in the correct position, I will completely relax myself. That will allow me to speak more slowly and with more confidence. It can also help me to sink long putts on the golf course.

I would have liked to talk about dietary education because I believe that it is upon good eating that the health of our nation depends. I prefer, however, to compliment the two maiden speakers on their truly brilliant speeches. Each one touched on a most essential element of alternative medicine and care. That is faith. One could call it the placebo effect, as the noble Lord, Lord Winston, did. One could call it confidence. Whatever religion we are, faith and belief cure all.

I endorse also the words of the noble Lord, Lord Eames, about the very fine work that the National Health Service does. I am full of admiration for the National Health Service. My wife has just been looked after absolutely brilliantly. If things do go wrong—and of course they do—it is the person—to person relationship—the pastoral care—which is so essential and which is sometimes lacking.

If it were not for the restraint of money, the use of non-conventional medicine and services would flourish, to the benefit of the great majority. It should be freely available on the National Health Service. In the longer term, with an all-embracing health education a part of the national curriculum, I believe figures would show that the country's health bill was decreasing. Would it not be wonderful to plan to be able to say, "We are the healthiest country in the world"?

6.19 p.m.

Baroness Robson of Kiddington

My Lords, it has gone back into place—I have a hip that pops out sometimes. I should very much like to consult the noble Lord, Lord Rennell, on this particular posture, which gives one confidence, because I could do with it just now. Like all other speakers, I am deeply grateful to the noble Earl, Lord Baldwin, for having introduced this debate. He rightly referred to the large number of therapies which now exist. I have listened to 24 speakers in this House and I have probably listened to a description of 24 different therapies for various complaints. The unanimity of the speakers in the House so far has been amazing to me, except perhaps for the noble Lord, Lord Winston. In his most amusing and brilliant speech, he was perhaps the only mild sceptic in the whole debate, but that is very healthy in a debate of this kind. Perhaps we need one or two more sceptics or we may be running away with ourselves. The noble Lord has been the only speaker who mentioned the possibility of a connection between the placebo effect and complementary medicine. That must have something to do with certain therapies which are used in this country.

The popularity of complementary medicine has been created by the general public because some things in conventional medicine have not satisfied their demands. There is disappointment with medical treatment in certain cases. A case in point with the modern generation is back trouble, where it has to be admitted that osteopathy has been on the whole more successful than the medical profession. There are many patients who cannot quite explain what their problem is, although they know that they are not well, and their doctors do not take them seriously. In such a situation, complementary therapists give their time and listen, and that is important. There is also the patients' dislike of taking drugs and the resulting side-effects of many drugs.

It is heartening that an increasing number of GPs are now prepared to refer patients to non-conventional practitioners. As many as 38 per cent. of general practitioners have received some form of additional training in non-conventional therapies. It is also interesting that in a study in 1993 it was found that, among medical students, 70 per cent. considered non-conventional medicine useful and 63 per cent. were in favour of the inclusion of such therapies in the National Health Service. The medical objection to non-conventional medicine is based on the argument that its safety and effectiveness is not based on randomised control trials. But are we so certain that all conventional medical practice is based on such trials? Much of it is based on opinion rather than on scientifically controlled trials. There is a similarity between the two.

For instance, I can remember that when I had cranial arthritis I went to a leading specialist and he said, "Well, we know what it is. I cannot explain why it is going to help you, but you take steroids and you will be all right in six months' time". I said to him, "You must tell me why I have to take this horrible stuff'. He said, "I cannot tell you why but it works". In my view that was not very scientific, but I am happy to say that the treatment did work.

The noble Lord, Lord Broadbridge, referred to the Lewisham Hospital Trust and its report. I found it a most fascinating document. It proves the advantages of providing a service on an out-patient basis because it offers an opportunity for more knowledge to be obtained. The referral patterns in that setting can be monitored and randomised control trials can be collated. Practitioners are screened for relevant qualifications, experience, insurance and membership of professional bodies. Above all, the treatment of large numbers of patients encourages thorough assessment of outcome and treatment effectiveness.

Therefore, it is very important that we create within the hospital context packages of care. The patient may be receiving conventional treatment but would benefit from a package of treatment consisting of a mixture of both types of treatment. I believe that in time such an approach will militate against the antipathy between conventional and non-conventional medicine and that they will slowly come together and work together more happily. I believe that non-conventional medicine is very important in the way in which it may just make a patient's life happier and better. For many patients suffering from illnesses and with a very short life expectancy, there are therapies like massage and aromatherapy, which can make their last few months or years happier and more satisfying. That is something which non-conventional medicine can provide for them.

Complementary medicine is here to stay. It is a growing part of our National Health Service. I ask the Government to recognise the work of organisations such as the Research Council for Complementary Medicine, which has been mentioned by a patron of that organisation, and to harness their skills by encouraging a well-founded programme of research. Funds are needed and it is time for national funding to be allocated to research into the evidence to date and to the study of practical or potential cost benefits and effectiveness for the future. Most importantly, all practitioners of complementary therapies should be educated and trained appropriately and individual therapists should receive statutory recognition in order to ensure uniformly high standards. Above all, it is essential to safeguard the patient and to reassure him that he can safely go to a practitioner who is a recognised practitioner.

6.28 p.m.

Lord Rea

My Lords, the noble Earl, Lord Baldwin, has certainly struck a rich vein in choosing complementary medicine for this afternoon's debate. He should also be congratulated on attracting two exceptionally gifted maiden speakers who have both entertained us with their wit and knowledge. They are obviously both very highly effective communicators. I am delighted that a member of my profession should join me and give me support on these Benches after the sad loss of Lord Pitt.

I find that my first remarks are remarkably similar to those of the noble Baroness, Lady Robson. but there are perhaps one or two slants on them which are different. Many noble Lords and the noble Baroness have said that the great increase in the use of complementary medicine is due to the dissatisfaction of patients with orthodox and, I was going to say, science-based medicine. I take her point that some of the practice of medicine is not particularly science-based. It is said that doctors do not listen to patients long enough or carefully enough and that drug treatment is too easily prescribed, with the resultant danger of iatrogenic effects which may be worse than the initial complaint. Indeed, in many cases what for want of a better title I shall call "science-based medicine" does not provide satisfactory answers to an increasing number of symptoms, many of which have no easily demonstrable physical basis, such as migraine, irritable bowel syndrome and back pain, which was mentioned by the noble Baroness. There is a very long list.

One reason for that dissatisfaction may be that medicine has come such a long way. An impressive number of conditions can now be treated which were previously fatal or caused serious illness. Treatment can take the form of antibiotics or other drugs or reparative or replacement "spare part" surgical procedures which in the past were impossible. So expectations have been raised and it could be held that one reason for the dissatisfaction with science-based medicine is its success.

However, many of the criticisms that I have mentioned are real enough. Doctors often do not have a "whole person" approach to patients. That is not merely due to time constraints, although they are real enough in the National Health Service. It is often due to a failure of training, to the example set by the medical teachers in our medical schools and to the failure to develop a holistic attitude or approach in our medical students.

Therefore, it is tempting to ascribe, as other noble Lords have done, at least some of the success of complementary medicine to the fact that such consultations are usually longer, sometimes lasting up to an hour and to the fact that the practitioner (whatever the school of complementary medicine) can devote individual personal attention to the patient during that time. Very often any physical treatment that is given is accompanied by sympathetic listening on the part of the practitioner as patients describe their problems and relate them to their whole life situation. That sympathetic listening is often—in fact, usually—associated with gentle (but sometimes not quite so gentle) physical contact which has a healing effect in itself, quite apart from any benefit arising from the manipulation or the effect of the acupuncture needle.

I would not go so far as to say that that is entirely a placebo effect, although that plays a part. There is also very much of a healing effect. Both maiden speakers referred to that. The noble Lord, Lord Eames, said that spiritual healing and the effect of a healing approach was extremely important. I know how much better patients feel in orthodox science-based medicine when they have had a good physical examination. It is not only that they are reassured that a thorough job has been done, but I think that they get some benefit from the actual physical touch.

I have spent a little time on this aspect in order to show the importance of taking the healing or placebo effect into account when making claims that complementary medicine is beneficial. We need to be careful when assessing any research reports. Research projects must deal with that aspect when they are being planned. Of the briefings that I have received, I have been most impressed by that from the Research Council for Complementary Medicine, which takes a sympathetic but neutral stance, producing reviews and evaluation of published research data to enable health professionals to make informed choices". This is not the forum to go into great detail about research methodology. It may be that randomised controlled trials are the gold standard. They have been valuable in assessing new methods of treatment. Perhaps they are not always appropriate or possible in complementary medicine, but I should like to hear a very good case being made out for why they are not appropriate in each case where another method is adopted. Some of the claims made for complementary medicine have been based on research that would not stand up to critical examination, although there are many other instances of excellent research.

Perhaps I may divert to refer to the report from Lewisham which has been mentioned by several noble Lords. That is an excellently written report, with 101 references and with a control group, but the control group did not receive any comparable treatment. No wonder those who received some treatment felt better. That study needs to be followed up to see whether the improvement lasts. We also need to know whether those patients need less in the way of conventional treatment as a result of having had alternative treatments.

I suggest that, if the resources of the National Health Service are to be used to fund complementary medicine, rather than being diverted to scattered single schemes which are started because of local enthusiasms, those resources would be better diverted to funding really good research, as is suggested by the Research Council for Complementary Medicine. Where local schemes have been introduced, they must be critically evaluated. I join several noble Lords in asking the Government to make a commitment to fund more research into complementary medicine. That may well save money in the long term. We on these Benches will in due course set up an office of complementary medicine to co-ordinate such research, following the example of the United States.

Complementary medicine is at present used predominantly, although not entirely, by the better-off. A small study in our practice showed that complementary medicine was three times as likely to be commonly used by those in the professional social classes as by those in manual work. Members of the higher social classes tend to have better health, but I do not think that the noble Earl, Lord Baldwin, would claim that complementary medicine was the reason for that. The health of the nation depends on much more than health services, whether they be complementary or provided by the National Health Service.

I should like to reclaim nutrition for orthodox science-based medicine. I do not think that it is entirely the preserve of complementary medicine, just because it has been neglected in medical training. I believe that nutrition with a science base can play an important part.

To conclude, complementary medicine is popular because it often relieves unpleasant symptoms and makes people feel better, on many occasions where science-based medicine has failed. However, it does not deal with the underlying causes of disease, which include poverty, poor nutrition, poor housing and bad working conditions. Therefore, it is of only marginal importance to the health of the nation. Any introduction of complementary medicine into the National Health Service must be handled with care so that it assists rather than detracts from the main task of the National Health Service, which is to prevent and, if possible, deal effectively with the nation's burden of ill-health, which falls mainly on those in less fortunate economic circumstances.

6.38 p.m.

Lord Strathclyde

My Lords, one of the strengths of this House is its ability to deal with complex subjects, competently and concisely. I agree with the noble Baroness, Lady Robson, who marvelled at the degree of agreement that we have witnessed in the House this afternoon. We have witnessed also a wide variety of speakers, with speeches from doctors, archbishops, academics, those with great technological knowledge and expertise, and also those who just have an interest in the subject from a lay point of view. I very much welcome that mixture. I suspect that many of those who have listened to the debate have been refreshed by the experience. I know that I certainly have.

I was particularly impressed, as I think was my noble friend, Lady Flather, by the number of chairmen, presidents, patrons and members of various organisations that were represented by many of the speakers. It just goes to show how much Members of this House are appreciated by outside organisations. There is still much vigour in the House.

I know that it is somewhat unusual for the Chief Whip to wind up a debate of this type. I hope that noble Lords are not too disappointed. As the House knows, the Minister, my noble friend Lady Cumberlege, is unwell. I know that she will read Hansard with great care and interest and will want to respond by letter to points which have been made if I do not do so to her satisfaction. I congratulate the noble Earl, Lord Baldwin, on initiating today's debate, and thank all those who have contributed. I pay a particular tribute to the noble Earl on his chairing of the Parliamentary Group for Alternative and Complementary Medicine. It is equally a tribute to him that the debate has attracted two maiden speakers.

I felt for the noble Lord, Lord Winston, when he said that he did not know a great deal about complementary medicine. That was my position, but I have since learnt a great deal about it. I am wiser than I was. I welcome the noble Lord, Lord Winston, and I hope that we shall hear more of him in the future. I was also much impressed by the words by the most reverend Primate of All Ireland. It was not just a powerful maiden speech but a powerful speech in its own right. I am equally certain that he will play a great part in the deliberations of this House.

Many noble Lords who have spoken in support of complementary medicine have done so with great enthusiasm. It has been encouraging to hear the examples of people benefiting from the treatments that they have received. While I would agree with the many speakers who have implied that it would be arrogant to suggest that conventional medicine has the answer to every individual's medical need, it is also important to maintain a sense of perspective and to seek clarity.

"Complementary medicine" is a term used, almost carelessly, to cover a plethora of treatments and professional practices. As a consequence, there often exist tremendous differences of approach and philosophy, forms of treatment, and standards of professionalism and expertise. I therefore agree with the call for evaluation made by the noble Lord, Lord Butterfield. We need to show discernment and to exercise judgment. That does not mean closing our minds, but neither does it mean having to accept the whole package.

There are many, like the noble Lord, Lord Broadbridge, who reminded us that traditional remedies have been around for centuries. Others will tell us that making complementary medicine available on the NHS will save the country over £2 billion a year. Some traditional remedies might prove positively harmful. Where there is evidence to suggest that they are we must, in the interests of public safety, take appropriate action. The belief that complementary medicine can save the NHS money is based on little more than an assertion, whereas in fact the costs may be additional to the cost of more conventional forms of treatment.

If there is one message the Government wish to put across this afternoon, it is a call for clarity. I appreciated the comments of the noble Lord, Lord McNair. He may be aware that different views are held strongly over the terms "alternative" and "complementary". The reality is that there is no universally accepted definition. To begin at this point, therefore, why do so many insist upon using terms such as "complementary or alternative medicine" and "complementary therapies" when they can create so much confusion and division? Dentists, opticians or chiropodists, for example, are not usually referred to as "practitioners of orthodox medicine". Perhaps I may suggest therefore that we have osteopaths, homoeopaths, and aromatherapists rather thana "complementary practitioners".

Clarity is the key. Help in that area came from a perhaps unexpected quarter—the medical profession. In 1993, the BMA published a report on complementary medicine. I understand that that is a most helpful document and reflects a great deal of courage and foresight on the part of the BMA. It highlighted the need to distinguish clearly between those therapies and self-help measures which may be used as an adjunctive form of treatment, and the complete professions of osteopathy, chiropractic, homoeopathy, medical herbalism and acupuncture, which it described as the "discrete clinical disciplines".

Your Lordships will he aware that the Government's position towards complementary medicine has been traditionally one of benevolent neutrality. We have no wish unduly to restrict its practice or the public's choice in consulting practitioners. A common theme, one raised again by the noble Earl, Lord Baldwin, has been one of urging the Government to be more benevolent and less neutral. I hope that the House recognises that since we last had this debate in 1990 a great deal has been done and we have come a long way. There have been times when government support has been very forthcoming. Perhaps the most significant example was the support given to the osteopaths and chiropractors Bills. However, to gain that support, the professions concerned have first to fulfill a number of criteria and to demonstrate that the move to statutory regulation was in the public interest. The osteopathic and chiropractic professions work hard to establish clarity—clarity in pursuing high quality patient care; establishing education, training and assessment criteria; and clarity in demonstrating that they could regulate themselves effectively. The challenge today to the individual groups and professions is to chart their own similar and independent course.

I believe positive outcomes will then follow. The NHS, for example, is making greater use of some forms of complementary medicine, such as homoeopathy, osteopathy, chiropractic and acupuncture. This, in part, is as a result of the reforms we introduced to the NHS. It is also due to some of the professions clarifying their role in helping to meet particular health needs. Because, for example, osteopathy and chiropractic have been able to demonstrate the role they can play in the treatment of back pain, they have been included in research investigating the scientific evidence into the treatment of this condition. The Department of Health has also recently invited bids from GP fundholders to participate in a small number of pilots to assess whether osteopathy and chiropractic should be added to the list of goods and services that fundholders can purchase on behalf of their patients. The Government have no desire to stifle innovation or new ideas, but our policy in relation to health care cannot be founded on those principles alone.

I agree with the sentiments expressed by the most reverend Primate of All Ireland that there is almost certainly truth in the maxim that the physician comforts while nature heals. There is, however, also a need for evidence-based health care. That brings me to the stormy waters of research. There are those who claim that complementary therapies do not lend themselves to be researched while others demand that the Government should fund more research in that area. I am sure that my noble friend Lady Rawlings and the noble Viscount, Lord Tenby, will be pleased to know that the Government are currently sponsoring some research which may help shed some light on whether the availability of, for example, homoeopathy, osteopathy and chiropractic in general practice impacts on other parts of the NHS. At present the evidence suggests that complementary medicine is often used in addition to conventional medicine. However, as I am sure noble Lords will appreciate, we cannot fund or consider funding every research proposal that happens to mention a complementary therapy. The Department of Health does not operate a responsive research grant scheme. It normally meets its research requirements against policy priorities on a commissioning basis, largely via competitive tendering.

But I must emphasise to my noble friend Lord Rennell that the department's R&D programme supports research into non-conventional therapies. For example, one of the !,13 priorities for research funds is the evaluation of manipulation therapies for lower back pain, supported jointly with the Medical Research Council.

The noble Viscount, Lord Tenby, and the noble Lord, Lord Rea, mentioned the Research Council for Complementary Medicine. It might be of some use to the House to know that discussions have been held between the department's R&D managers and that body about extending the opportunities for research into complementary medicine and drawing upon their expertise for considering research proposals.

As was mentioned by the noble Lord, Lord Desai, we support the call to apply the standard scientific approach of the controlled clinical trial to assess the benefits of non-western therapeutic systems.

I understand that among the majority of complementary therapy groups there has been a long-standing reluctance to grasp the research nettle. Notable exceptions to that are the chiropractic, osteopathic, acupuncture and homoeopathic professions. The research ethos must, however, be cultivated in all the therapies and professions. I appreciate that that will take time. There is also the challenge, perhaps, of finding an appropriate research paradigm, but this is not a problem that faces only complementary medicine. Quite recently my noble friend Lady Cumberlege attended a meeting at which hospital chaplains were setting themselves the challenge of finding effective outcome measurements for their own care for patients. As the most reverend Primate said—I paraphrase him—more attention must be paid to the process of healing.

Research does not have to be the large scale, multi-centred trial. As the noble Earl, Lord Baldwin, said, much can be achieved at a local level using such tools as clinical audit. We believe that certain professions within complementary medicine would benefit from access to national support for clinical audit in the same way that the Department of Health supports the clinical professions. I am pleased to be able to tell your Lordships that the department will be looking at ways in which support to the recognised and independent complementary professions might be provided.

It is of course important that anyone who practises any form of complementary medicine should do so to a high standard. I agree with my noble friend Lord Colwyn who I hope will be pleased by my call this afternoon for clarity in training, professionalism and practice among all the various groups.

The Government take very seriously the quality of health care provided by all the professions and therapies, especially the "discrete clinical disciplines". While we believe it is for each group to determine for itself whether or not to pursue statutory regulation, for many the establishment of a credible system of independent, voluntary self regulation might be sufficient. But even voluntary systems should contain the essential elements found in a statutory scheme.

We are strongly of the opinion that such measures should be introduced by the professions and therapy groups themselves on an individual profession-by-profession basis, and not under the cover of so-called umbrella groups. In the interest of clarity, where there are different bodies representing members of the same therapy or profession, they should consider getting together under their own single, professionally-led independent self-regulatory body.

A number of noble Lords, especially my noble friends Lord Harlech and Lady Sharples referred to nutritional therapy. Noble Lords will be aware that the Government's Health of the Nation strategy explicitly recognises that better nutrition is important for the promotion and maintenance of better health. Part of the strategy for achieving the targets for a reduction in coronary heart disease is based on diet.

The Committee on Medical Aspects of Food Policy—COMA—is reviewing the role of diet in the development of various cancers. We are also aware of the dietary regimes, such as the Gerson and Bristol diets, from which many cancer patients feel they have derived much benefit. Dietary supplements are sometimes advocated as means of improving the nutritional quality of the diet. However, while there is substantial evidence that fruit and vegetables, for example, might reduce the risk of a number of diseases, there is insufficient information to identify which components of fruit and vegetables are responsible for any protective effect.

I appreciate that my noble friend Lord Kitchener believes that boron deficiency accounts for much bone and joint disease. Boron has not been identified in independent reviews of priorities for Department of Health nutrition research.

The noble Earl, Lord Baldwin, called the Bristol Cancer Help Centre a beacon of light. Of course, that centre received great support from my noble friend Lord Pearson of Rannoch. We recognise the work of the Bristol Cancer Help Centre in developing an holistic approach to the care of people with cancer. Some forms of complementary therapies can play an important role in enhancing emotional, psychological, and physical well-being. The centre has not applied to the Department of Health for any funding. It is open to the centre to seek funding support from health authorities whose patients are receiving care from the centre.

Certainly I pay tribute to those on therapies such as the Gerson and Bristol therapies because they put so much commitment into those various nutritional therapies. Patients, families and friends often dedicate their lives to implementing an arduous and vigorous regime. In turn, that provides hope where conventional medicine has failed.

A number of other points were raised. I shall not be able to reply to all of them. But I am much encouraged, as was, I think, my noble friend Lady Flather, to see some of the traditional hallmarks of complementary medicine—the holistic approach, spending time with patients, individual care and even touch—being incorporated more and more into conventional medicine. Of course, that view was confirmed by the noble Lord, Lord Rea.

The noble Countess, Lady Mar, asked about the outcome of some research and whether or not my noble friend Lady Cumberlege has received it. I shall make sure that she has. If she has not, I am sure that she will write to the noble Countess.

We have heard a great deal this afternoon about the many different forms of complementary medicine. The Government appreciate that a great many people derive benefit from them. We uphold the principle that practitioners should enjoy the relative freedom to offer their services and the public's right to use them. But as popular interest grows, that must be matched by increased standards within the different professions and therapy groups in the way that I have described this afternoon.

I have thoroughly enjoyed today's debate. I am sorry that there is not more time to reply in greater detail. Again, I thank the noble Earl, Lord Baldwin, for initiating the debate. I hope, as has been the case with previous debates, it will come to represent another important milestone for complementary medicine.

6.59 p.m.

Earl Baldwin of Bewdley

My Lords, I reckon I have perhaps just a couple of minutes in which to wind up. Clearly everyone saw through the wording of my Motion. It was just that I got fed up with the old words "complementary" and "alternative", which are used so much, and so I thought I would put it in a different way this time.

We have had a wide-ranging debate from the philosophical to the very detailed. I am extremely grateful to all the participants who have given us their views and experiences this afternoon. I would like to point out that most of the things we refer to as "new" therapies—and this has been said—are in fact as old as the hills, going back to what used to be conventional long ago.

The noble Lord, Lord Rea, claims back nutrition for the mainstream. I am more than happy to give it back to him where it belongs. It has simply been by default that it has been elsewhere all this time.

I am tempted to rise to some of the more anecdotal remarks of the noble Lord, Lord Winston. I much enjoyed his speech. But I think that I will forbear there, except to say that I think it behoves any profession to listen carefully to what its clients are saying. I think we would both be interested to know why it is that more and more people seem to be doing better on the non-conventional placebo effect than on the conventional.

I was a little disappointed by some of the things said by the noble Lord the Chief Whip. But, on the other hand, I derived some encouragement from him. I shall obviously read his remarks carefully in Hansard. I am grateful for the encouragement on the help with audit, which was the main plank of my argument. Obviously that can be subject to further discussions.

It has been a good debate. I am most grateful for having had the opportunity to hold it this afternoon. I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.