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Business of the House: Debate, 18th January

Lord Strathclyde: My Lords, on behalf of my noble friend I beg to move the Motion standing in his name on the Order Paper.

Moved, That Standing Order 38 (Arrangement of the Order Paper) be dispensed with to enable the Motion standing in his name to be taken before the Arbitration Bill on Thursday 18th January.--(Lord Strathclyde.)

On Question, Motion agreed to.

Non-conventional Medical Treatment

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

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Accreditation Board, and I am also joint chairman of the Parliamentary Group for Alternative 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.

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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

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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

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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.

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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 be 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

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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,

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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.

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