Allan Sweeney
Letter to ‘British Medical Journal, Rapid Response’.
I very much enjoyed Dr Michael Baum’s attack against Complementary Medicine. It was enjoyable because it was so audaciously hardhitting against both aristocracy, timed when Prince Charles was delivering a speech to the World Health Assembly in Geneva, and against the explosion of grassroots people who are now seeking CAM (Complementary and Alternative Medicine). Though for a moment I saw his name as Bohm, the chap who invented the atom bomb to destroy much of humanity.
I note Michael Baum's past concerns about smoking. Could his apparent addiction to "an NHS old world order" be at least equally destructive?
Perhaps he could read the Final Report on Clinical Governance for CAM in Primary Care by Westminster University to the Department of Health and King's fund. He will not be pleased to note that recommendations are advanced to promote adequate measures of CAM therapies within the NHS. However, if he reads on he will also note that PCTs and GPs are currently conducting studies into the efficacy versus effectiveness arguments, and that a key recommendation is that a business case be made for each CAM therapy.
The notion is already widespread that CAM could be appropriately and cost-effectively integrated into medical practice. Such integration will have its greatest impact wherever current conventional practice is less than fully satisfactory, perhaps because of adverse effects, their unacceptability to patients, poor compliance, or because of economic or other reasons, and where CAM has effective options to offer. CAM is often shown to be very cost-effective. Access (for CAM) to mainstream funding is opening up.
There are now moves by many governments towards exploring the actualities of CAM, such as when, why, and how it works. We have reached the stage of funds being made available for CAM research. For example: it is only recently that university departments, statisticians, large databases and full-time research staff - all the elements that help build and maintain a research culture in conventional medicine - are backing CAM practitioners who want to conduct research. As CAM therapists'
professional bodies develop and academic groups form, coherent research programmes are developing. So there has been a steady growth in the volume of published evidence on CAM. Access to mainstream funding is opening up. For example, the Department of Health is currently running an awards scheme to develop research capacity for CAM in Universities across the country (in the UK).
A successful pilot in Newcastle West PCG (now a Newcastle PCT locality) provided complementary therapy to NHS patients to address patient choice and inequity of provision of this service. Conditions chosen were those where the patient's needs were poorly met by conventional treatments. The pilot clearly demonstrated that
· Complementary therapies provided are well-tolerated and popular treatments.
· A high level of patient satisfaction was reported
· There was evidence of health improvement, and a cost offset for conventional care.
· The savings in primary care alone amounted to 41% of the pilot cost.
· There was a reduction in the use of conventional medicines
· The number of GP consultations was reduced
· There was a beneficial impact on other services
Although randomised controlled trials RCTs are sometimes seen as the
apex of clinical research, there have been recent moves towards Energy Based Medicine (EBM). Relatively few RCTs looking into the efficacy of CAM have been conducted. However, much of what is done in conventional health care, for example most surgery, physiotherapy, counselling therapy has hardly been the subject of RCTs. Moreover, it is estimated that only a quarter of what is published in the best professional journals is based on RCTs: clinical case studies, qualitative research and basic research all figure there too.
David Sackett, originator of the EBM movement, defined EBM as integration of a range of the best available research evidence in the light of clinical experience and taking patient preferences into account. It seems that RCTs may not be the most appropriate research modality for many CAM therapies, and other types of research protocols may be more relevant to exploring CAM.
There is potential for CAM research and service provision. Micozzi (1996) has described these as:
Persistent or relapsing illness with little or no tissue damage;
No effective conventional treatment is available;
Conventional treatment is unsatisfactory or requires continual use of conventional drugs;
Elective surgery has been proposed, but immediate attention is unnecessary;
Conventional treatment is inappropriate;
The nature of the disease is intractable, or the patient is determinedly non-compliant.
Within the past 30 years, there have been increasing numbers of studies around the world researching, and demonstrating that the CAM therapy, healing, can have significant or highly significant efficacy, effectiveness, and cost-effectiveness, with fewer contra-indications, when compared to orthodox medicine. Ref Dr Dan Benor, Healing Research Volumes 1-3.
Although I realise Michael Baum is not in a minority of one on the issues he raises about CAM, it seems he and his few friends could be left behind and become like the last smokers left alive.
By the way, the granddaughter of the atom bomb inventor is now a priest, and has studied CAM therapies. I wonder how Michael Baum's grandchildren might evolve?
I would welcome private correspondence from such a hardhitting man as Michael Baum. But would he want to correspond with me? I doubt it. Go ahead Michael, make my day, prove me wrong.
Allan J Sweeney
info@allansweeney.com
Letter to ‘British Medical Journal, Rapid Response’.
I very much enjoyed Dr Michael Baum’s attack against Complementary Medicine. It was enjoyable because it was so audaciously hardhitting against both aristocracy, timed when Prince Charles was delivering a speech to the World Health Assembly in Geneva, and against the explosion of grassroots people who are now seeking CAM (Complementary and Alternative Medicine). Though for a moment I saw his name as Bohm, the chap who invented the atom bomb to destroy much of humanity.
I note Michael Baum's past concerns about smoking. Could his apparent addiction to "an NHS old world order" be at least equally destructive?
Perhaps he could read the Final Report on Clinical Governance for CAM in Primary Care by Westminster University to the Department of Health and King's fund. He will not be pleased to note that recommendations are advanced to promote adequate measures of CAM therapies within the NHS. However, if he reads on he will also note that PCTs and GPs are currently conducting studies into the efficacy versus effectiveness arguments, and that a key recommendation is that a business case be made for each CAM therapy.
The notion is already widespread that CAM could be appropriately and cost-effectively integrated into medical practice. Such integration will have its greatest impact wherever current conventional practice is less than fully satisfactory, perhaps because of adverse effects, their unacceptability to patients, poor compliance, or because of economic or other reasons, and where CAM has effective options to offer. CAM is often shown to be very cost-effective. Access (for CAM) to mainstream funding is opening up.
There are now moves by many governments towards exploring the actualities of CAM, such as when, why, and how it works. We have reached the stage of funds being made available for CAM research. For example: it is only recently that university departments, statisticians, large databases and full-time research staff - all the elements that help build and maintain a research culture in conventional medicine - are backing CAM practitioners who want to conduct research. As CAM therapists'
professional bodies develop and academic groups form, coherent research programmes are developing. So there has been a steady growth in the volume of published evidence on CAM. Access to mainstream funding is opening up. For example, the Department of Health is currently running an awards scheme to develop research capacity for CAM in Universities across the country (in the UK).
A successful pilot in Newcastle West PCG (now a Newcastle PCT locality) provided complementary therapy to NHS patients to address patient choice and inequity of provision of this service. Conditions chosen were those where the patient's needs were poorly met by conventional treatments. The pilot clearly demonstrated that
· Complementary therapies provided are well-tolerated and popular treatments.
· A high level of patient satisfaction was reported
· There was evidence of health improvement, and a cost offset for conventional care.
· The savings in primary care alone amounted to 41% of the pilot cost.
· There was a reduction in the use of conventional medicines
· The number of GP consultations was reduced
· There was a beneficial impact on other services
Although randomised controlled trials RCTs are sometimes seen as the
apex of clinical research, there have been recent moves towards Energy Based Medicine (EBM). Relatively few RCTs looking into the efficacy of CAM have been conducted. However, much of what is done in conventional health care, for example most surgery, physiotherapy, counselling therapy has hardly been the subject of RCTs. Moreover, it is estimated that only a quarter of what is published in the best professional journals is based on RCTs: clinical case studies, qualitative research and basic research all figure there too.
David Sackett, originator of the EBM movement, defined EBM as integration of a range of the best available research evidence in the light of clinical experience and taking patient preferences into account. It seems that RCTs may not be the most appropriate research modality for many CAM therapies, and other types of research protocols may be more relevant to exploring CAM.
There is potential for CAM research and service provision. Micozzi (1996) has described these as:
Persistent or relapsing illness with little or no tissue damage;
No effective conventional treatment is available;
Conventional treatment is unsatisfactory or requires continual use of conventional drugs;
Elective surgery has been proposed, but immediate attention is unnecessary;
Conventional treatment is inappropriate;
The nature of the disease is intractable, or the patient is determinedly non-compliant.
Within the past 30 years, there have been increasing numbers of studies around the world researching, and demonstrating that the CAM therapy, healing, can have significant or highly significant efficacy, effectiveness, and cost-effectiveness, with fewer contra-indications, when compared to orthodox medicine. Ref Dr Dan Benor, Healing Research Volumes 1-3.
Although I realise Michael Baum is not in a minority of one on the issues he raises about CAM, it seems he and his few friends could be left behind and become like the last smokers left alive.
By the way, the granddaughter of the atom bomb inventor is now a priest, and has studied CAM therapies. I wonder how Michael Baum's grandchildren might evolve?
I would welcome private correspondence from such a hardhitting man as Michael Baum. But would he want to correspond with me? I doubt it. Go ahead Michael, make my day, prove me wrong.
Allan J Sweeney
info@allansweeney.com