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10 Jan 1996 : Column 139

3.54 p.m.

Lord Winston: My Lords, I rise to my feet in great fear and trembling for several reasons: first, because, I am told that I must in no way be controversial, and I always find that difficult; secondly, because the Leader of the House the Lord Privy Seal gave us grave admonition yesterday about what would happen to us if we overran our time. Having listened to the debate yesterday and seen how people overran their time, I am slightly less worried than I was.

I am also concerned about the idea of a new year's resolution. However, I feel that I am excluded from that as this is the first time I have risen to my feet in this House. As a maiden speaker I am perhaps uniquely qualified to speak in this debate because I know very little about alternative medicine. My area is fertility and contraception. I set up my plate in your Lordships' House just before Christmas and am disappointed to find that no one has yet consulted me on those issues.

The noble Earl is absolutely right; complementary medicine is definitely important. I would not argue with that. However, I should add that some areas of complementary medicine are already implemented in the health service. Acupuncture is now quite widely used; indeed, we refer patients for acupuncture. There is no doubt that controlled studies have been done which show that it works extremely well in specific cases.

Osteopathic treatment is another example of where alternative treatments are taking off. I have been called a member of the medical establishment, though I doubt that I am in fact a member of it, but I take some issue with the noble Earl. It would be ridiculous for me to criticise complementary medicine. My wife had excellent osteopathic treatment which undoubtedly helped and my late mother-in-law, Dr. Golomb, was a practitioner of homoeopathy. However, she was also medically qualified and that is a relevant point. I want to come back to that issue in a moment.

I fear, regrettably, that for much alternative medicine the evidence that it actually works is extremely anecdotal. Your Lordships will forgive me if I say that patients may well feel better, but I believe that they may well feel better because of the placebo effect. There is no doubt that when somebody listens sympathetically to what one is saying and relieves the stress of what is happening, one feels an undoubted benefit. Sadly, far too many medical practitioners are failing in their duty to talk to their patients properly.

What is the placebo effect? Let me describe two examples to your Lordships. When I was a medical student I remember being told about a study in the Welsh mining areas. A new drug had come onto the market and was thought by the drug manufacturers to be excellent for coughs. The drug was handed out to three groups of general practitioners. The first group thought that the drug was wonderful; it would be the answer to chronic cough and lung conditions. The second group was not so certain; it was equivocal about its effect. The third group felt that the drug was clearly a case of exploitation and was being foisted on them by a specific drug company.

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A large number of patients--several hundred--went through those three practices. At the end of that time the patients were independently assessed by a panel of doctors who did not know to which practice the patients belonged. It was a blind, controlled study. The patients who went to the first group had an 87 per cent. improvement in symptoms; the patients who went to the second group had a 48 per cent. improvement in symptoms and the patients who went to the doctors who did not believe in the drug had something like a 17 per cent. improvement in symptoms. That is what I mean by the placebo effect.

The placebo effect can work in all sorts of ways. I can give an example of a study recently completed by my group at Hammersmith Hospital. We have been looking at the effect of growth hormone on the human ovary in patients who have repeatedly failed to ovulate. We had patients who were, by all standards, virtually sterile. The study was funded--admittedly, it was not a cheap study--and after ethical approval we gave one group of patients sterile water and the other growth hormone. None of the patients knew which they were receiving. I must tell your Lordships that it made no difference at all whether the patients received the growth hormone or sterile water injections. Both groups of patients had a much higher pregnancy rate than could possibly be expected. Therefore alternative medicine may work, but the placebo effect is remarkably powerful.

This is important. Professor Peckham, as he was retiring last week, pointed out that in the National Health Service at the moment more than £1 billion is wasted on medicine which is not properly evidence-based. We have to recognise that. The noble Earl, Lord Baldwin, referred to Foresight, the group examining mineral deficiency in pregnancy and miscarriage. But can we really believe in the concept of mineral deficiency? If mineral deficiency was a cause of infertility, does it not occur to Foresight that the burgeoning populations of Ethiopia, Bangladesh and India would be what they are? There is no evidence at all that these vitamin deficiencies play a serious role in human reproduction. The truth is that most miscarriages and most causes of infertility are due to defects in the human embryo. The sad thing is that I have seen patients who have gone through these treatments and whose proper treatment has in consequence been delayed. One knows the consequence of an older woman trying to seek treatment under the National Health Service. It becomes increasingly difficult and the delay in treatment makes her management more difficult to do.

Finally, perhaps I may take another example of complementary medicine. It is a ridiculous one but one which illustrates my concerns. Some noble Lords will be aware of the sex selection clinics. In fact, the noble Baroness, Lady Warnock, once mentioned sex selection as being a possibly useful thing for some Members of this House. Indeed, perhaps in another place there might be an urgent need to consider sex selection now that so many electoral difficulties are facing one of the major parties. There is a clinic in Hendon which has been set up to sex select. It filters sperm through a column which is supposed to produce either males or females and then

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patients are given this treatment. However, research in several places--at Hammersmith, and with my colleagues at University College, London, in Barcelona, in Belgium, in Israel and in Australia--quite clearly shows that this method of sex selection produces exactly a 50:50 ratio. Of course, some people will be satisfied because they get a baby of the desired sex but I submit that they would have done anyway.

Why does it matter? Leaving aside the moral issue, the matter for concern is this. At the moment one can practise in alternative medicine without a medical qualification. There is no regulation to stop that. Any one of your Lordships could set up a plate provided he is not medically qualified, and he could conduct his practice without any kind of rigorous method of appraisal. That should be considered and possibly there needs to be some thought to legislation about the issue.

4.3 p.m.

Lord Butterfield: My Lords, it is an immense pleasure to rise in the wake of a man who is obviously a very powerful contributor and educator and who has done such important work in the very important field of fertility studies. The noble Lord, Lord Winston, can be quite sure that we shall be listening with great interest to what I hope will be many more speeches to the House.

I remind the House that the noble Lord has been a visiting professor in the United States and Europe and that noble Lords may have seen him on many occasions looking at the whole problem of people's lives in doctors' hands, where he was the presenter for many years. The noble Lord has won the coveted Victor Bonney prize of the Royal College of Surgeons. We are delighted to embrace him and welcome him as a member of the medical profession to this House. I am not quite sure whether we shall turn so much to his expertise but we shall be delighted by his observations on the affairs of life.

Perhaps I may next say that I am fresh returned from the Far East. I have asked the noble Earl, Lord Baldwin, whether I may withdraw before the end of the debate because it appears that I am expected to be in Cambridge shortly after six o'clock to welcome some visiting Americans who are here for the night and tomorrow. I apologise to the House for this rudeness.

I should like to thank the noble Earl, Lord Baldwin, as I know all the other noble Lords who are to speak today will wish to thank him. I have been interested in unconventional medicine for all my professional life. The purpose of my communication this afternoon is to convey to the House that since around 650 BC conventional doctors have been concerned about the wisdom they have in attributing what they attribute to conventional treatments and have been looking at the whole question of evaluating conventional and non-conventional treatment. There is a famous aphorism attributed to Hippocrates. We do not know whether it is one man, Hippocrates, or whether there was a practice of them in Kos. The aphorism is that life is short; the art, the science or the technic is long--it takes a long time to learn it; the opportunity for doing good is

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fleeting; experiment, whenever one wants to undertake it, is hazardous; and--here is my important point--judgment in medicine is immensely difficult.

The noble Earl, Lord Baldwin, referred to the vast range of new non-conventional therapies that are appearing in our midst. I am very much in favour of that and I am sure that the noble Lord, Lord Winston, is too. As we become more affluent, as there is better newspaper reporting, as there are better vehicles through the media to relay new pieces of information, things will spread more quickly. It took a long time for digitalis, reported to a professor in Birmingham, to become a world treatment for heart failure. I do not know anyone in conventional medicine who is opposed to the examination of the new therapies and to listening to the results that are coming through.

What we are all concerned about was touched on by the noble Lord, Lord Winston. I refer to the importance of accurate validation of the results. We have been very lucky in this country. In a physician called Gilbert we have had a great deal of the earliest work on experimental philosophy. Harvey unravelled circulation. Francis Bacon started the whole system of inductive logic. Incidentally, Bacon published a remark by which I am intrigued:

    "Where there is much controversy there is, at many times, little inquiry".
That is what is changing with alternative medicine today. There is much more inquiry and I am very much in favour of that.

Not all the philosophers have come from the doctors. For example, Voltaire was very concerned because he thought that,

    "Doctors pour medicines"--
he called it physic--

    "about which they know little or nothing into bodies about which they know even less".
So the doctors have not had it all their own way, even if they have been qualified.

We are fortunate in this country that we have had in our midst a man who evolved a system for testing new ideas and new therapies, whether they were conventional or unconventional. His name was Archie Cochrane. He looked like James I and I think that privately he thought he probably was. He was a wildish man; he fought in the Spanish Civil War; he worked among the pneumoconiosis people in South Wales and he had a Chair at the University of Cardiff. He established a whole system of interrogation for new ideas which he called the randomised controlled clinical trial. The word "controlled" was to ensure that one diminished the false detection of the placebo effect. The word "randomised" was in order to ensure that one did not select patients who would automatically get better or not get better. One had to be very careful randomly to choose the people in the different groups. If one could, one changed the treatment from being, one hoped, active to being the placebo in the middle of the trial.

Suffice it to say that that is being used more and more widely all over the world. It is being used with many conventional medicines. It is now being used for many

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treatments which have been regarded as conventional for a long time. The noble Lord, Lord Winston, pointed out that there are many things that we do that we are not really quite sure about. This is the method that is being used to unravel what I hope we shall all come to realise is a new and important development of informed, knowledge-based medicine.

There is now at Oxford a Cochrane Centre where this kind of endeavour is going forward and to which a lot of results are being referred. So, basically, there is a great broadening of unconventional medicine. There is a great widening of the methods of examining it. It is my hope that by degrees we shall get a safer and safer pursuit of the profession and the complementary professions with it.

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