Memorandum submitted by the National Institute
for Health and Clinical Excellence (NICE) (HO 45)
I am writing to provide written evidence in
answer to the following questions:
1. Why don't NICE provide guidance/evaluation
2. Has there ever been an interest in NICE evaluating
homeopathy? If so, why was this not approved?
The National Institute for Health and Clinical
Excellence (NICE) is the independent organisation responsible
for providing national guidance on the promotion of good health
and the prevention and treatment of ill health.
NICE produces guidance in three areas of health:
public healthguidance on the promotion
of good health and the prevention of ill health for those working
in the NHS, local authorities and the wider public and voluntary
health technologies (including technology
appraisals)guidance on the use of new and existing medicines,
treatments and procedures within the NHS; and
clinical practiceguidance on the
appropriate treatment and care of people with specific diseases
and conditions within the NHS.
Topics for guidance development are referred
to NICE by the Secretary of State for Health, in line with national
priorities established for the NHSfor example; policy importance
(ie whether the topic falls within a government priority area)
and whether there is inappropriate variation in practice across
the country. Once a topic has been referred, the development of
the subsequent advice is entirely the responsibility of NICE.
There are two specific NICE guidance processes
on the use of new and existing medicines and treatments within
the NHS. NICE is asked to look at particular drugs and devices
when the availability of the drug or device varies across the
country. This may be because of different local prescribing or
funding policies, or because there is confusion or uncertainty
over its value.
by NICE on the appropriate treatment and care of people with specific
diseases and conditions within the NHS.
NICE does not produce blanket guidance on the
use of "groups" of therapies, whether complementary
and alternative medicines (CAM) or not. To date NICE has not been
asked to develop specific guidance on the use of individual complementary
therapies. If the Secretary of State for Health referred this
topic to us for guidance development, we would develop this guidance.
We have not been asked to, and have not turned down a request
to evaluate CAM therapies.
Where the evidence exists, we have considered
CAM therapies, including homeopathy, alongside other conventional
treatments in a number of our clinical guidelines. NICE has already
made recommendations on where complementary therapies do and don't
add benefit in relation to specific conditions, including multiple
sclerosis, antenatal care, palliative care and most recently,
low back pain. A summary of these recommendations is at Appendix
1. Because these guidelines are based on a specific disease or
condition, we would not use this process to look at CAM therapies
as a whole. We would evaluate, based on available evidence, which
specific therapies may be of benefit.
SUMMARY OF NICE CLINICAL GUIDELINES WHERE, BASED
ON EVIDENCE, NICE HAS MADE RECOMMENDATIONS ON THE USE OF CAM THERAPIES
Few complementary therapies have been
established as being safe and effective during pregnancy.
The following interventions appear to be effective in reducing
morning sickness: Ginger; and
There is some evidence to suggest that
the following items might be of benefit, although there is insufficient
evidence to give more flexible recommendations: Reflexology
Magnetic field therapy.
Massage plus body work.
In the dementia guideline recommendation
that for comorbid agitation, interventions tailored to the person's
preferences, skills and abilities should be considered. Options
to consider include: Aromatherapy.
Therapeutic use of music and/or dancing.
Recommending that the Alexander Technique
may be offered to benefit people with Parkinson's disease (PD)
by helping them to make lifestyle adjustments that affect both
the physical nature of the condition and the person's attitude
to having PD.
When organising supportive and palliative
care services for people with cancer, commissioners and the NHS
and voluntary sector providers should work in partnership across
a Cancer Network to decide how to best meet the needs of patients
for complementary therapies where there is evidence to support
their use. As a minimum, high quality information should be made
available to patients about complementary therapies and services.
Provider organisation should ensure that any practitioner delivering
complementary therapies in NHS settings conforms to policies designed
to ensure best practice agreed by the Cancer Network.
Informing people with hypertension that
relaxation therapies can reduce blood pressure and individual
patients may wish to pursue these as part of their treatment.
However, routine provision by primary care teams is not currently
recommended. Examples include: stress management, meditation,
cognitive therapies, muscle relaxation and biofeedback.
Although there is evidence that St John's
Wort may be of benefit in mild or moderate depression, healthcare
professionals should not prescribe or advise its use by patients
because of uncertainty about appropriate doses, variation in the
nature of preparations and potential serious interactions with
other drugs (including oral contraceptives, anticoagualnts and
Consider offering a course of manual
therapy, including spinal manipulation, spinal mobilisation and
massage. Treatment may be provided by a range of health professionals
including chiropractors, osteopaths, manipulative physiotherapists
or doctors who have had specialist training. Consider
offering a course of acupuncture needling, up to a maximum of
10 sessions over a period of up to 12 weeks.
Injections of therapeutic substances
into the back for non-specific low back pain are not recommended.
Professor Peter Littlejohns
Clinical and Public Health Director