A dose of the same medicine

Alternative therapies must be subject to the same standards as orthodox medicine, argues Jack Howell. For nearly 140 years since the introduction of the Medical Act 1858, which introduced the registration procedure for medical practitioners, doctors providing conventional medical treatment have been separated from other practitioners in the complementary field. This accident of history has placed us apart from many other countries in the European Union, where "orthodox" doctors often offer a range of therapies and find the UK's highly delineated distinctions between both camps puzzling.

Increasing public interest in complementary or alternative therapies has placed further demands on today's doctors. Not only are they expected to cope with the rigorous medical training they receive in what has been called, by way of contrast, conventional medicine, but they are also expected by modern patients to be familiar with the techniques, benefits and drawbacks of non-conventional therapies.

For young doctors to meet these challenges, they need to be well informed about the range of therapies on offer and their suitability for various medical conditions. But the whole basis of medical training is focused on the scientific method of deciding which remedies and treatments work, yet very few complementary or alternative therapies have been studied or subjected to the same research protocols demand of orthodox medical procedures or new pharmaceuticals. In both its 1986 and 1993 reports on alternative therapies, the British Medical Association has highlighted the need for more research, and the Medical Research Council has also invited applications for funding research into complementary therapies.

The question remains as to how much knowledge we need to give, or in fact are able to give medical students and doctors in training when we already have an overcrowded medical curriculum further pressurised by the burgeoning advances in medical treatment. These advances, based as they are on understanding the nature of pathological processes and discovering or even designing treatments to deal with them has led to medicine becoming increasingly disease-centred; unfortunately, this has often been at the expense of considering the patient as a whole. The threat of litigation has led to more "defensive" medicine, moving us even further towards objective, "organ-based" medicine, often at the expense of the needs of the whole person.

Is it any wonder patients are attracted to alternative techniques that pay more attention to the individual, giving time and a sympathetic ear to their worries and fears? Or that the quasimystical absolutes of some therapies, unchanged and unevaluated since their introduction, provide a welcome antidote to the uncertainties of the health service and its time-starved practitioners? We must recognise these needs without compromising our professional and scientific standards, and to do this we need to be sure that the standards we apply to our orthodox practice are reflected in our approach to the alternative therapies. This does not necessarily mean subjecting each and every therapy to the rigours of double-blind randomly controlled trials, as when scientific methodology is applied to the assessment of these therapies, with few exceptions, there is little evidence that they are effective. Whether we can accept or understand the models and approaches of alternative and complementary therapies is not in itself essential if it can be shown that the therapies work and produce genuine benefit to patients.

If we cannot demonstrate the success of complementary therapies in scientific trials, there still remains the question of why patients say they benefit, or their medical conditions can even be seen to improve after such treatment. If, as seems likely, patient improvement is simply due to the placebo effect, does this invalidate the treatment?

Jack Howell is chairman of the BMA's board of science and education and emeritus professor of medicine at Southampton University.