Memorandum submitted by the
National Institute for Health and Clinical Excellence (
I am writing to provide written evidence in answer to the following questions:
1. Why don't
2. Has there
ever been an interest in
The National Institute for Health and Clinical
· public health - guidance 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 sector
· health technologies (including technology appraisals) - guidance on the use of new and existing medicines, treatments and procedures within the NHS
· clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
Topics for guidance development are referred to
There are two specific
Appraisals - recommendations on the use of new and existing medicines and
treatments within the NHS.
· Clinical guidelines
- recommendations by
Where the evidence exists, we have considered
Professor Peter Littlejohns
Clinical and Public Health Director
Appendix 1: Summary of
· Few complementary therapies have been established as being safe and effective during pregnancy.
· The following interventions appear to be effective in reducing morning sickness:
o P6 acupressure
· There is some evidence to suggest that the following items might be of benefit, although there is insufficient evidence to give more flexible recommendations
o Reflexology and massage
o Fish oils
o Magnetic field therapy
o Neural therapy
o Massage plus body work
o T'ai chi
o Multi-modal therapy
· 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:
o Multisensory stimulation
o Therapeutic use of music and/or dancing
o Animal-assisted therapy
· 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.
Supportive and palliative care
· 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 anticonvulsants).
Low back pain
· 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