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Baroness Trumpington: My Lords, I hesitate to interrupt but we are running rather badly behind time. Perhaps I may remind noble Lords that when seven minutes comes up on the clock, we are in the eighth minute. I ask very kindly that Members who have yet to speak stop after five minutes if possible in order to allow the winders up and the Chief Whip to have sufficient time to reply to your Lordships' learned remarks.

5.40 p.m.

Baroness Sharples: My Lords, I thank the noble Earl, Lord Baldwin, for initiating today's debate.

For all the animals produced to feed our nation, the use of non-conventional treatments can involve solely nutritional supplements in unique forms, which reduces the amount of antibiotics and artificial growth promoters and reduce death rates. We benefit as the end consumer, and the farmer can also do this economically. Too much over-use of antibiotics, as we have already heard, leads to drug resistance. We are now seeing that certain bugs are resistant to all new antibiotics. Is this not a catastrophe waiting to happen?

There is a great deal of scientific evidence to prove that we can alter the progress of arthritis, both in animals and in humans, using nutritional supplementation. Imagine the lack of pain and drug side effects in those sufferers, both animals and humans, and the consequent reduction in surgical procedures. It is surely a matter of education both within the medical profession and of the general public. These treatments should not be considered non-conventional but should go hand in hand with the accepted therapies.

Such approaches are better understood in Europe. Last year, herbal drug sales (many of them prescription only) in Germany accounted for 3 billion dollars; in France 1.6 billion; in Italy 600 million; and in the UK, much below, at 300 million dollars.

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The noble Earl who introduced today's debate said that the large pharmaceutical companies were not sufficiently interested in non-conventional medicine. Why then have companies such as Boots, Johnson & Johnson, Bausch & Lomb, Degussa, Fujisawa etc. bought established phytomedical companies? They have not changed their names, and they have let those companies trade as before. Is it because this growth in the market is between 8 per cent. and 10 per cent. per annum? I suspect so. If the giant companies see the benefit of such operations, surely it is time that everyone was given the same opportunity to benefit.

5.43 p.m.

Lord Broadbridge: My Lords, I believe that complementary medicine suffers from an inferiority complex. Many complementary treatments have been used for centuries, if not millennia, and countless generations have benefited from them. It is the so-called conventional medicine that is the newcomer, using treatments "thoroughly researched" for perhaps three to five years. A large number of orthodox drugs now in widespread use have yet to pass the single generation of use mark. I do not wish to start by being pedantic, but it is really the so-called conventional medicine which is complementary, not the traditional variety. The very use of the word "conventional" gives immeasurable prestige and respectability to its products and practices, the deserving of which in many cases has yet to be proved on a long-term basis. We all remember thalidomide. So let us at the outset at least give prestige of long use to complementary medicines.

If we were in India I believe the semantics would indeed be reversed. Most people in one of the largest populations of the world rely on complementary therapies. As an example, was not a conventional preventive for malaria discovered through the observation that certain natives who did not seem to suffer from it regularly chewed the bark of the cinchona tree, which analysis showed to contain a high proportion of quinine?

The single non-conventional treatment that is generally available on the NHS is homoeopathy. Many people believe that doses of natural products, powdered leaves, seeds etc. are lacking in potency compared to conventional products. Indeed, I heard a man only recently say of homoeopathy, "You might as well eat grass". He was an educated man, too. If we pause for a moment and think of opium, marijuana, cocaine and belladonna, it is all too evident that natural products can be potent--indeed, even to the degree of being a public menace. But I say this only to satisfy those to whom degree of potency is a benchmark, for in fact homoeopathy relies on small, often minute, doses of natural products to mobilise the body's natural antibodies. By this preparation, should the main illness strike, unpleasant side effects--such as death--are avoided. Homoeopathy draws on a vast range of natural products in tiny doses to cure by mobilising agents already within the body. Because the dosages are tiny, side effects are practically unknown.

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But above all stands the principle of homoeopathy; namely, to treat the whole person. A total audit of a presenting patient is taken by a homoeopathic doctor in consultations which average 45 minutes. By comparison, an average NHS GP consultation lasts three minutes and gives rise to elastoplast remedies--that is, prescribing specifically for the symptoms rather than investigating their root cause. This commonly leads to the patient presenting again in a little while with new and different symptoms, which are treated conventionally with more elastoplast. The patient's health frequently deteriorates and sinks into in-patient or out-patient hospitalisation. In the terms of our debate, that is terrible for the health of the nation and vastly expensive for the NHS and also for the nation's economy, since the patient's labour is largely or totally lost: a triple disbenefit. While the homoeopathic approach may be more expensive at the outset, it offers greater savings over the longer term. It is a tragedy that most of our health budgeting is short-term.

Perhaps the Minister who is to reply will indicate whether he thinks longer term views may one day be taken. Certainly the relevant move towards GP primary care and early-warning diagnosis and treatment and away from hospitalisation later is a policy on which to congratulate Her Majesty's Government--except that I think they are hopelessly optimistic about the time that this will take to implement.

No doubt the Minister is aware of a very interesting experiment in course at the Lewisham Hospital NHS Trust, where a November 1995 report presents findings of the first year of a complementary therapy out-patient service within a district general hospital, embodying a review of control trials in acupuncture, osteopathy and homoeopathy, together with details of the kind of patients referred and an assessment of the outcome of treatments. Recommendations are made for the future of the service.

The report states:

    "This report is likely to be of interest to Health Authorities and policy makers, primary care and hospital providers who are considering purchasing or providing such therapies, or are reviewing how such services are currently provided. It will also be of interest to those complementary practitioners or professional bodies working with (or hoping to work with) the National Health Service".

The report makes the point that evidence suggests that non-conventional therapies are increasing in popularity with large numbers of the population seeking consultation and treatment. They believe that this is in part triggered by a more articulate public and attempts to integrate patients' views into health and decision-making. The report cites evidence for the effectiveness of non-conventional therapies for a number of conditions, in particular the homoeopathic treatment of diseases of the respiratory system, including asthma, of gastro-intestinal problems, migraine, some rheumatological disease, childhood behaviour, myalgia and skin disease. Acupuncture is said to have demonstrable benefit in pain control, asthma, arthritis, gastro-intestinal disorders, musculo-skeletal problems and gynaecological problems. Studies suggest that osteopathy and

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chiropractic are effective in back and musculo-skeletal problems. The report concludes that there is clearly a move to integrate non-conventional therapies into the NHS (particularly in primary care) with a number of hospitals and general practices employing non-conventional practitioners.

In conclusion, the centre is funded primarily on a block contract basis by Lambeth, Southwark and Lewisham Health Commission and received over 800 referrals in its first financial year, demonstrating a high demand for that service in the Lewisham area. Ninety-six per cent. of the referrals were made by general practitioners, which shows an interest in non-conventional therapies among doctors in primary care.

5.50 p.m.

Lord Harlech: My Lords, I am very grateful to my noble friend Lord Baldwin for initiating a debate on this most important and indeed vital issue. I trust that it will be the forerunner not just of a forum of discussion but of some dynamic action. I also congratulate the two maiden speakers, the noble Lords, Lord Winston and Lord Eames.

We have heard vigorous and informed discussion from noble Lords which has clearly demonstrated the interest in this field. Indeed, as we learned from the noble Lord, Lord Menuhin, in particular, medicine can come from both music and dance just as surely as from a bottle. I should rather not use the term "non-conventional medical treatment" since, in my view, it implies that the so-called modern medical system of healthcare and treatment is the only approach. In fact, as many noble Lords have pointed out, much medicine, healthcare and treatments of disease have their roots in a wealth of knowledge stretching back over centuries. Therefore, I believe that it is to mankind's detriment that we ignore the holistic or complementary approach to the nation's health. The advances in medical science can work in tandem with traditional and indeed ancient forms of care, cure and the prevention of disease for the promotion of health (to say nothing about the enormous savings to a country's Exchequer) in an enlightened understanding.

A national health system such as the one that we have in this country spends an enormous proportion of its resources in responding to ill health. Sickness is, so to speak, the response of the body to a lack of primary knowledge in looking after ourselves. Liberating the potential of mankind's vitality, the natural awareness of the self and the creativity of one's own energy and drive needs education. Education, therefore, must be one of the main keys.

Already considerable investment in research proves that dietary factors which relate to the maintenance of good health and the prevention of heart disease and cancer are still greatly ignored. We know that despite vast investment and a greater awareness of the facts through every conceivable advertising and advisory campaign directing one towards the path of good health, human nature, being what it is, regrettably finds it virtually impossible to make changes take effect,

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whether it be with regard to not smoking, eating less fat, taking more exercise or acquiring knowledge of a healthier diet or indeed the skills of obtaining and preparing healthier food.

I am sure that many noble Lords are well aware of how, despite the rigours of a diet such as that which had to be adopted for the nation's health during the last war, statistically the nation's health improved markedly. I say with regret that, in schools, good culinary training to a great extent has now been replaced by what is called "home economics". The vital window of opportunity to teach self-help and health skills to that age group has been largely removed.

In the most recent UK Mintel survey of 1995, 75 per cent. of those questioned said that they would use complementary medicine and teaching, if they were available, on the National Health Service. Of those questioned, 35 per cent. of their own volition now use those therapies; 30 per cent. of the 35 per cent. would do so exclusively.

The perceived risk of embarking on supporting the community's health--positive health, as I prefer to call it--through a complementary approach is that it might be thought to increase the burden upon general practitioners, placing another tier upon their precious time and responsibilities. However, I believe that it would be possible to make available, by way of part of the existing budget, a separate ring-fenced provision directed only to the provision of complementary medicine and ways of getting well and staying healthy. It may be possible even to grant awards and give increased budgetary help to practices for establishing best practice in given areas of complementary medicine. One could have an overall system leading to a European, indeed international, accreditation process for complementary medical practitioners. That would give doctors security and the incentive in the early stages of referral and recommendation to offer treatments which increasingly will be recognised worldwide as a proven means of achieving a healthier, less stress-filled life.

5.56 p.m.

Lord Palmer: My Lords, I too am grateful to my noble friend Lord Baldwin for once again introducing this important subject. I was not a Member of your Lordships' House five-and-a-half years ago when the subject was last debated. Had I been a Member, certainly I should not have listened to the debate and doubt very much whether I should have read it in Hansard. But that was five-and-a-half years ago.

For most of my life, from April to October, I was crippled by hay fever and used to spend an annual sum of £50 on Triludan tablets, which in turn cost the National Health Service £71 a year. For the past four years I have taken the equivalent of a teaspoonful of white powder, which contains, among other things, Psorinum, at £18 a shot. Since then, I have taken just one Triludan tablet and that was to ease the swelling from a wasp sting, after having visited the nurse's station in another place only to find it closed because the other place was not sitting. This House was, of course, sitting. For years I have had a weak back and,

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since visiting an acupuncturist, it has improved out of all recognition. I now swear by homoeopathy and indeed acupuncture. The Government Deputy Chief Whip is joining me on my next visit, as an experiment.

When Lothian Health Board opened a new homoeopathic clinic in April 1994, within four weeks 40 per cent. of every GP practice in the Lothian area had referred a patient and every practice had done so within eight months. The demand at Glasgow Homoeopathic Hospital is increasing. It is 40 per cent. up over the past five years--40 per cent., my Lords! It now averages 220 referrals a month, 87 per cent. of which come direct from GPs.

A MORI poll in The Times of 13th November 1989 showed a doubling of the use of complementary medicine between 1986 and 1991. Consumer surveys affirm that patients are satisfied, with four out of five users claiming significant benefit or cure and 75 per cent. saying that they would use complementary medicine again. Indeed, they want it integrated into the National Health Service. A growing number of doctors want to train in complementary medicine and the Government must accept that it is a genuine postgraduate training.

I join with other noble Lords in asking for additional funding, particularly into research and development. In complementary medicine a little goes a very long way. We have recently seen the successful passage of the osteopaths and chiropractic Bills. Surely it is time to regulate other forms of complementary medicine.

It is also important that homoeopathic medicines are correctly made in accordance with the traditional homoeopathic methods because, as in other professions, there are cowboy manufacturers in abundance. The need for regulation is great, as patients are becoming increasingly confused. Perhaps even a committee could be set up to examine the whole area.

In Scotland we must all applaud the setting up of an NMAC, which has been asked by the Scottish Office how--I emphasise "how"--to integrate complementary therapies into the National Health Service. I also believe that more training establishments need to be set up to re-educate the existing workers at all levels in the National Health Service. The Glasgow Education Model is an example of what I have in mind--and here we are talking about evolution not revolution.

The interprofessional postgraduate education programmes of the academic departments of Glasgow Homoeopathic Hospital has become the most popular postgraduate medical course in the United Kingdom--orthodox or otherwise. Almost 20 per cent. of Scottish GPs have completed basic level training in homoeopathy; that is a 300 per cent. increase over the past five years. Research has shown that two years after attending a foundation course 78 per cent. of attending doctors were still integrating elements of homoeopathy into their National Health Service care. Clinical trial programmes carried out in Glasgow in, for example, asthma, suggest that a combination of orthodox and homoeopathic approaches can often enhance the care of a given patient. It is important that as complementary therapies become more popular patients do not

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experience a fragmentation of their care through an either/or mentality, placing them in positions of conflict between different therapies or therapists.

The good health of our nation is surely one of our most precious possessions. We need integrated care of a high quality with an emphasis on the art of healing; a human relationship of trust blended with skill. We deserve no less. Let us hope and pray that we get it.

6.2 p.m.

Lord Pearson of Rannoch: My Lords, I join other noble Lords in congratulating the noble Earl, Lord Baldwin, on so powerful an introduction to this debate. It is indeed timely, coming as it does so soon after our debates last year on what became the Medical (Professional Performance) Act, which confirmed that not all is healthy in the practice of conventional medicine.

There is the increasing worry, too, that conventional medicine may be reaching its limits. Bacteria, which have been around for some 7,000 million years longer than us, are adapting in a most disturbing way to the antibiotics we so routinely throw at them. The AIDS saga has shaken our arrogant assumption that we shall always be able to stay ahead of disease. Viruses and bacteria may yet hold terrible surprises in store for humanity.

It may be that my own experience of illness is unusual. But I have to declare an interest in the debate because on at least six occasions in the past six years I or a close member of my family have been cured by non-conventional medicine when conventional medicine had failed. Were it not for the conventions of your Lordships' House whereby one does not criticise a maiden speech, I would have to say to the noble Lord, Lord Winston, that I understand about the placebo effect--and I agree with it--but that it would not apply to any of those examples, so stark are they. Those experiences and millions of stories like them have had the effect of putting conventional medicine on the defensive. So it is good that so many GPs are now opening up to complementary medicine, as indeed is Harley Street itself. Let us hope that this debate today contributes to that process.

However, there is one ghost of past antagonism which has not been laid to rest, to which I should draw your Lordships' attention. This is the saga of the excellent Bristol Cancer Help Centre, which was wrongly accused, in research supported by the Imperial Cancer Research Fund, of causing its breast cancer patients to die twice as quickly and to relapse three times as often as they would have done under conventional cancer treatments. Reverse statistics would have been nearer the mark and the research was, of course, eventually proved to be complete nonsense--but only after much damaging publicity had been inflicted on the centre. I gather that the authors and sponsors of the research have now apologised, but they have not asked for it to be withdrawn. Perhaps I may therefore use this opportunity to ask my noble friend whether the Department of Health can help finally to lay that ghost to rest. I have

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ideas as to how that may be done, which, in order to save time now, I could perhaps discuss with my noble friend Lady Cumberlege when she recovers.

But there is another broader area where alternative practitioners require my noble friend's help; that is, in relation to the future regulation of their profession. Other noble Lords have referred to this. I shall deal particularly with herbal medicines, which often suffer from the problem of being both food and a medicine; an example is garlic.

I regret to say that our herbal practitioners, who have joined up with fellow practitioners in Europe to form the European Herbal Practitioners Association, are running into trouble--perhaps fatal trouble--with the European Commission in Brussels. From her Written Answer to me today I suspect that my noble friend Lady Cumberlege may not be aware of what is happening there. I should therefore inform her that Spain, France and Italy at least (all with strong cultures of conventional medicine, inspired by powerful cartels of drug companies, pharmacists and doctors) are ganging up to produce a directive which will insist that all herbs are to be treated as though they were manufactured drugs, with all the attendant licensing and testing costs.

I understand that the European Court of Justice has issued a series of rulings which suggest support for such a view, which, if enforced, will mean the death of the herbal and other alternative medicine industries. Perhaps more likely, it will drive them underground and make it impossible to police them. Can my noble friend therefore see that our representatives in Brussels are instructed to inform DG3 in the Commission and its relevant committee that the United Kingdom will not accept such a directive? I am assuming that the Cabinet decision 18 months ago to squash a similar initiative in this country will remain unaltered and that my noble friend will therefore agree that this country should for once become strongly involved in the design stage of this particular piece of Euro-nonsense.

I should confirm that our Medicines Control Agency is doing its best in Brussels for our herbal medicine practitioners, but I fear that we are once again under the shadow of a qualified majority vote which may go against us. Can my noble friend therefore look into this as a matter of urgency? There are moves afoot which may help us to escape the dread hand of Brussels, but which again, in the interests of time, I hope I may be allowed to discuss with my noble friend Lady Cumberlege when she recovers.

6.8 p.m.

Viscount Tenby: My Lords, I thank my noble friend Lord Baldwin for initiating this debate and also the noble Viscount the Leader of the House and the noble Baroness Lady Trumpington for giving us tail-enders a window of opportunity in which I promise not to get stuck.

I should like briefly to highlight the overwhelming need to start to build bridges now between the worlds of conventional and non-conventional medicine. Though no doubt some co-operation can take place--and already

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has--between the two disciplines independently, the bridges themselves can only be put in place by government.

Let me at this point declare an interest as a one-time member of the fund-raising committee of the Research Council for Complementary Medicine and as a current patron of that body. As a recent bulletin of the council confirmed,

    "there appears to be growing public demand for the provision of complementary therapies within the NHS".

It goes on to point out that that produces problems in that practitioners in complementary medicine may be unfamiliar with NHS procedures and in turn their purchasers may not be conversant with what is entailed in the provision of complementary therapies.

The recent evaluation of the first year of a complementary therapy service based in the Lewisham Hospital NHS Trust provides valuable evidence of the need for conventional and non-conventional therapies to get their acts together. With 800 referrals in the first year, 96 per cent. of them from the 25 practices participating in the scheme, and with a 97 per cent. high satisfaction rate revealed in subsequent assessments, it is clear that that out-patient service is providing valuable and cost-effective skills in acupuncture, osteopathy and homoeopathy, and helping to solve some of the often long-term medical problems in that area of South London.

What is needed, however, is unrestricted exchange of information between the two disciplines, not only on what therapies may be available but also on individual case histories. NHS practitioners need to know whether the treatments are successful; whether they are cost-effective compared to conventional medicine and, above all, whether they are safe for their patients. That kind of information can only be forthcoming as a result of systematic and professional evaluation on a basis agreed to by both sides.

Although non-conventional medicine (without the benefit of a powerful and wealthy pharmaceutical industry, it must be remembered) raised a great deal of money itself--for example, over £1·5 million by the RCCM over the past 13 years--it would surely be appropriate for the Government now to make their own contribution. That is just one important aspect of what I may term the familiarisation process. But there are others and I should like to refer to two of them on which I would welcome the observations of the noble Lord the Chief Whip.

The first is a need for the establishment of university chairs and university studies. The Laing Chair at Exeter and the past Research Fellowship at Glasgow point the way forward, but although government funding for the Sheffield University project was greatly appreciated it would seem that in view of the ever increasing demands for non-conventional medical therapies the time is now ripe for the funding of further projects by government. Secondly, as the popularity of non-conventional medicine grows, and more and more referrals are being made by GPs--close on 40 per cent. of practices in England are said to offer their patients access to these therapies--it appears to be desirable that the doctors of

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the future should have at least a basic knowledge of the more popular and tested non-conventional therapies, or at least know their way around the world of non-conventional medicine.

We all know that prevention is better than cure, none more so than the Government, who continually seek to wean people away from the seeds of self-destruction implicit in their lifestyles by repeated warnings on smoking, drinking and diet. I would be tempted to add a fourth category--the overuse of drugs supplied in all good faith by many in the medical profession.

Perhaps I may respectfully suggest that non-conventional medicine, too, has an important part to play in this ceaseless battle for good health by providing not only solutions to certain medical conditions but in many instances safeguards against their recurrence. In making health care more efficacious, more cost-effective and more user-friendly we need to utilise every available resource, and the right non-conventional therapies can be important contributors to that desirable objective.

6.11 p.m.

Lord Rennell: My Lords, it is always a great privilege to speak in any debate initiated by the noble Earl, Lord Baldwin of Bewdley. I cannot think of anything more important to us all than our health. This has been a most opportune and important debate. The nice thing about it today is that on all sides of your Lordships' Chamber we seem to have agreed. So why cannot we make quicker and greater strides towards improving the health of the nation with greater use of non-conventional medicine? Is it genuine doubts about the efficacy and safety of alternative medicine, or is it money? I suspect it is money. Yet many of us feel that allowing non-conventional medicine to flourish will save millions of pounds annually. The trouble is that we are not long-sighted enough.

The National Health Service spends some £30 billion a year but alternative non-conventional services receive only £1 million. That is £100 to every £3 million spent on National Health Service conventional medicines. Lewisham hospital has produced an excellent report which many noble Lords have been sent. The hospital's total budget for non-conventional services for the year was a miserly £51,000.

More than 100 years ago inoculations were first discovered. In his play "The Doctor's Dilemma" Bernard Shaw has Sir Patrick Cullen saying:

    "Ive tried these modern inoculations a bit myself. I've cured people with them; I've killed people with them; but I gave them up because I never could tell which I was going to do".

We must now move on with non-conventional medicines. The noble Earl, Lord Baldwin of Bewdley, put the case in his usual eloquent style. I shall not reiterate the many points made. My own interest in the subject is as a sportsman. I have needed for 60 years to keep fit and able; for the past 35 years, with joints beginning to creak and in need of oiling, I have used every avenue available to keep myself on the field of play whatever the sport, chess included. I have used osteopathy, chiropractors, physiotherapists, acupuncturists and homoeopaths. I have

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spent a year sleeping with my feet in the air--and so has my wife--and I have taken cold baths every day. I have taken mineral water from the Pyrenees, near to Lourdes. Surprisingly, some may say, all the remedies have worked, so I feel well qualified to support the Motion today.

One often takes alternative remedies only when conventional cures have failed to work or have not worked quickly enough. Indeed, 42.8 per cent. of people who use alternative medicine or therapy say they do so because conventional medical treatment has not worked. Complementary medicine, therefore, when it does work, where all else has failed, must be very efficacious. I am convinced that we as a nation should embrace non-conventional medical treatment wholeheartedly and now.

Reverting to my comment on chess, my family had a lovely Russian girl staying with us last summer whose father looks after the world chess champion, Karpov, keeping him fit physically and mentally. I was very pleased because the girl, Leana, was able to help me with the Alexander Technique, which is frequently used by singers, actors and, indeed, for public speaking. If I may demonstrate to your Lordships, even more benefit may come from this very important debate. If, using the technique, I stand upright and allow all the forces in the body to flow up and down in the correct position, I will completely relax myself. That will allow me to speak more slowly and with more confidence. It can also help me to sink long putts on the golf course.

I would have liked to talk about dietary education because I believe that it is upon good eating that the health of our nation depends. I prefer, however, to compliment the two maiden speakers on their truly brilliant speeches. Each one touched on a most essential element of alternative medicine and care. That is faith. One could call it the placebo effect, as the noble Lord, Lord Winston, did. One could call it confidence. Whatever religion we are, faith and belief cure all.

I endorse also the words of the noble Lord, Lord Eames, about the very fine work that the National Health Service does. I am full of admiration for the National Health Service. My wife has just been looked after absolutely brilliantly. If things do go wrong--and of course they do--it is the person-to person relationship--the pastoral care--which is so essential and which is sometimes lacking.

If it were not for the restraint of money, the use of non-conventional medicine and services would flourish, to the benefit of the great majority. It should be freely available on the National Health Service. In the longer term, with an all-embracing health education a part of the national curriculum, I believe figures would show that the country's health bill was decreasing. Would it not be wonderful to plan to be able to say, "We are the healthiest country in the world"?

6.19 p.m.

Baroness Robson of Kiddington: My Lords, it has gone back into place--I have a hip that pops out sometimes. I should very much like to consult the noble

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Lord, Lord Rennell, on this particular posture, which gives one confidence, because I could do with it just now. Like all other speakers, I am deeply grateful to the noble Earl, Lord Baldwin, for having introduced this debate. He rightly referred to the large number of therapies which now exist. I have listened to 24 speakers in this House and I have probably listened to a description of 24 different therapies for various complaints. The unanimity of the speakers in the House so far has been amazing to me, except perhaps for the noble Lord, Lord Winston. In his most amusing and brilliant speech, he was perhaps the only mild sceptic in the whole debate, but that is very healthy in a debate of this kind. Perhaps we need one or two more sceptics or we may be running away with ourselves. The noble Lord has been the only speaker who mentioned the possibility of a connection between the placebo effect and complementary medicine. That must have something to do with certain therapies which are used in this country.

The popularity of complementary medicine has been created by the general public because some things in conventional medicine have not satisfied their demands. There is disappointment with medical treatment in certain cases. A case in point with the modern generation is back trouble, where it has to be admitted that osteopathy has been on the whole more successful than the medical profession. There are many patients who cannot quite explain what their problem is, although they know that they are not well, and their doctors do not take them seriously. In such a situation, complementary therapists give their time and listen, and that is important. There is also the patients' dislike of taking drugs and the resulting side-effects of many drugs.

It is heartening that an increasing number of GPs are now prepared to refer patients to non-conventional practitioners. As many as 38 per cent. of general practitioners have received some form of additional training in non-conventional therapies. It is also interesting that in a study in 1993 it was found that, among medical students, 70 per cent. considered non-conventional medicine useful and 63 per cent. were in favour of the inclusion of such therapies in the National Health Service. The medical objection to non-conventional medicine is based on the argument that its safety and effectiveness is not based on randomised control trials. But are we so certain that all conventional medical practice is based on such trials? Much of it is based on opinion rather than on scientifically controlled trials. There is a similarity between the two.

For instance, I can remember that when I had cranial arthritis I went to a leading specialist and he said, "Well, we know what it is. I cannot explain why it is going to help you, but you take steroids and you will be all right in six months' time". I said to him, "You must tell me why I have to take this horrible stuff". He said, "I cannot tell you why but it works". In my view that was not very scientific, but I am happy to say that the treatment did work.

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The noble Lord, Lord Broadbridge, referred to the Lewisham Hospital Trust and its report. I found it a most fascinating document. It proves the advantages of providing a service on an out-patient basis because it offers an opportunity for more knowledge to be obtained. The referral patterns in that setting can be monitored and randomised control trials can be collated. Practitioners are screened for relevant qualifications, experience, insurance and membership of professional bodies. Above all, the treatment of large numbers of patients encourages thorough assessment of outcome and treatment effectiveness.

Therefore, it is very important that we create within the hospital context packages of care. The patient may be receiving conventional treatment but would benefit from a package of treatment consisting of a mixture of both types of treatment. I believe that in time such an approach will militate against the antipathy between conventional and non-conventional medicine and that they will slowly come together and work together more happily. I believe that non-conventional medicine is very important in the way in which it may just make a patient's life happier and better. For many patients suffering from illnesses and with a very short life expectancy, there are therapies like massage and aromatherapy, which can make their last few months or years happier and more satisfying. That is something which non-conventional medicine can provide for them.

Complementary medicine is here to stay. It is a growing part of our National Health Service. I ask the Government to recognise the work of organisations such as the Research Council for Complementary Medicine, which has been mentioned by a patron of that organisation, and to harness their skills by encouraging a well-founded programme of research. Funds are needed and it is time for national funding to be allocated to research into the evidence to date and to the study of practical or potential cost benefits and effectiveness for the future. Most importantly, all practitioners of complementary therapies should be educated and trained appropriately and individual therapists should receive statutory recognition in order to ensure uniformly high standards. Above all, it is essential to safeguard the patient and to reassure him that he can safely go to a practitioner who is a recognised practitioner.

6.28 p.m.

Lord Rea: My Lords, the noble Earl, Lord Baldwin, has certainly struck a rich vein in choosing complementary medicine for this afternoon's debate. He should also be congratulated on attracting two exceptionally gifted maiden speakers who have both entertained us with their wit and knowledge. They are obviously both very highly effective communicators. I am delighted that a member of my profession should join me and give me support on these Benches after the sad loss of Lord Pitt.

I find that my first remarks are remarkably similar to those of the noble Baroness, Lady Robson. but there are perhaps one or two slants on them which are different. Many noble Lords and the noble Baroness have said that

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the great increase in the use of complementary medicine is due to the dissatisfaction of patients with orthodox and, I was going to say, science-based medicine. I take her point that some of the practice of medicine is not particularly science-based. It is said that doctors do not listen to patients long enough or carefully enough and that drug treatment is too easily prescribed, with the resultant danger of iatrogenic effects which may be worse than the initial complaint. Indeed, in many cases what for want of a better title I shall call "science-based medicine" does not provide satisfactory answers to an increasing number of symptoms, many of which have no easily demonstrable physical basis, such as migraine, irritable bowel syndrome and back pain, which was mentioned by the noble Baroness. There is a very long list.

One reason for that dissatisfaction may be that medicine has come such a long way. An impressive number of conditions can now be treated which were previously fatal or caused serious illness. Treatment can take the form of antibiotics or other drugs or reparative or replacement "spare part" surgical procedures which in the past were impossible. So expectations have been raised and it could be held that one reason for the dissatisfaction with science-based medicine is its success.

However, many of the criticisms that I have mentioned are real enough. Doctors often do not have a "whole person" approach to patients. That is not merely due to time constraints, although they are real enough in the National Health Service. It is often due to a failure of training, to the example set by the medical teachers in our medical schools and to the failure to develop a holistic attitude or approach in our medical students.

Therefore, it is tempting to ascribe, as other noble Lords have done, at least some of the success of complementary medicine to the fact that such consultations are usually longer, sometimes lasting up to an hour and to the fact that the practitioner (whatever the school of complementary medicine) can devote individual personal attention to the patient during that time. Very often any physical treatment that is given is accompanied by sympathetic listening on the part of the practitioner as patients describe their problems and relate them to their whole life situation. That sympathetic listening is often--in fact, usually--associated with gentle (but sometimes not quite so gentle) physical contact which has a healing effect in itself, quite apart from any benefit arising from the manipulation or the effect of the acupuncture needle.

I would not go so far as to say that that is entirely a placebo effect, although that plays a part. There is also very much of a healing effect. Both maiden speakers referred to that. The noble Lord, Lord Eames, said that spiritual healing and the effect of a healing approach was extremely important. I know how much better patients feel in orthodox science-based medicine when they have had a good physical examination. It is not only that they are reassured that a thorough job has been done, but I think that they get some benefit from the actual physical touch.

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I have spent a little time on this aspect in order to show the importance of taking the healing or placebo effect into account when making claims that complementary medicine is beneficial. We need to be careful when assessing any research reports. Research projects must deal with that aspect when they are being planned. Of the briefings that I have received, I have been most impressed by that from the Research Council for Complementary Medicine, which takes a sympathetic but neutral stance,

    "producing reviews and evaluation of published research data to enable health professionals to make informed choices".

This is not the forum to go into great detail about research methodology. It may be that randomised controlled trials are the gold standard. They have been valuable in assessing new methods of treatment. Perhaps they are not always appropriate or possible in complementary medicine, but I should like to hear a very good case being made out for why they are not appropriate in each case where another method is adopted. Some of the claims made for complementary medicine have been based on research that would not stand up to critical examination, although there are many other instances of excellent research.

Perhaps I may divert to refer to the report from Lewisham which has been mentioned by several noble Lords. That is an excellently written report, with 101 references and with a control group, but the control group did not receive any comparable treatment. No wonder those who received some treatment felt better. That study needs to be followed up to see whether the improvement lasts. We also need to know whether those patients need less in the way of conventional treatment as a result of having had alternative treatments.

I suggest that, if the resources of the National Health Service are to be used to fund complementary medicine, rather than being diverted to scattered single schemes which are started because of local enthusiasms, those resources would be better diverted to funding really good research, as is suggested by the Research Council for Complementary Medicine. Where local schemes have been introduced, they must be critically evaluated. I join several noble Lords in asking the Government to make a commitment to fund more research into complementary medicine. That may well save money in the long term. We on these Benches will in due course set up an office of complementary medicine to co-ordinate such research, following the example of the United States.

Complementary medicine is at present used predominantly, although not entirely, by the better-off. A small study in our practice showed that complementary medicine was three times as likely to be commonly used by those in the professional social classes as by those in manual work. Members of the higher social classes tend to have better health, but I do not think that the noble Earl, Lord Baldwin, would claim that complementary medicine was the reason for that. The health of the nation depends on much more than health services, whether they be complementary or provided by the National Health Service.

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I should like to reclaim nutrition for orthodox science-based medicine. I do not think that it is entirely the preserve of complementary medicine, just because it has been neglected in medical training. I believe that nutrition with a science base can play an important part.

To conclude, complementary medicine is popular because it often relieves unpleasant symptoms and makes people feel better, on many occasions where science-based medicine has failed. However, it does not deal with the underlying causes of disease, which include poverty, poor nutrition, poor housing and bad working conditions. Therefore, it is of only marginal importance to the health of the nation. Any introduction of complementary medicine into the National Health Service must be handled with care so that it assists rather than detracts from the main task of the National Health Service, which is to prevent and, if possible, deal effectively with the nation's burden of ill-health, which falls mainly on those in less fortunate economic circumstances.

6.38 p.m.

Lord Strathclyde: My Lords, one of the strengths of this House is its ability to deal with complex subjects, competently and concisely. I agree with the noble Baroness, Lady Robson, who marvelled at the degree of agreement that we have witnessed in the House this afternoon. We have witnessed also a wide variety of speakers, with speeches from doctors, archbishops, academics, those with great technological knowledge and expertise, and also those who just have an interest in the subject from a lay point of view. I very much welcome that mixture. I suspect that many of those who have listened to the debate have been refreshed by the experience. I know that I certainly have.

I was particularly impressed, as I think was my noble friend, Lady Flather, by the number of chairmen, presidents, patrons and members of various organisations that were represented by many of the speakers. It just goes to show how much Members of this House are appreciated by outside organisations. There is still much vigour in the House.

I know that it is somewhat unusual for the Chief Whip to wind up a debate of this type. I hope that noble Lords are not too disappointed. As the House knows, the Minister, my noble friend Lady Cumberlege, is unwell. I know that she will read Hansard with great care and interest and will want to respond by letter to points which have been made if I do not do so to her satisfaction. I congratulate the noble Earl, Lord Baldwin, on initiating today's debate, and thank all those who have contributed. I pay a particular tribute to the noble Earl on his chairing of the Parliamentary Group for Alternative and Complementary Medicine. It is equally a tribute to him that the debate has attracted two maiden speakers.

I felt for the noble Lord, Lord Winston, when he said that he did not know a great deal about complementary medicine. That was my position, but I have since learnt a great deal about it. I am wiser than I was. I welcome the noble Lord, Lord Winston, and I hope that we shall hear more of him in the future. I was also much impressed by the words by the most reverend Primate

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of All Ireland. It was not just a powerful maiden speech but a powerful speech in its own right. I am equally certain that he will play a great part in the deliberations of this House.

Many noble Lords who have spoken in support of complementary medicine have done so with great enthusiasm. It has been encouraging to hear the examples of people benefiting from the treatments that they have received. While I would agree with the many speakers who have implied that it would be arrogant to suggest that conventional medicine has the answer to every individual's medical need, it is also important to maintain a sense of perspective and to seek clarity.

"Complementary medicine" is a term used, almost carelessly, to cover a plethora of treatments and professional practices. As a consequence, there often exist tremendous differences of approach and philosophy, forms of treatment, and standards of professionalism and expertise. I therefore agree with the call for evaluation made by the noble Lord, Lord Butterfield. We need to show discernment and to exercise judgment. That does not mean closing our minds, but neither does it mean having to accept the whole package.

There are many, like the noble Lord, Lord Broadbridge, who reminded us that traditional remedies have been around for centuries. Others will tell us that making complementary medicine available on the NHS will save the country over £2 billion a year. Some traditional remedies might prove positively harmful. Where there is evidence to suggest that they are we must, in the interests of public safety, take appropriate action. The belief that complementary medicine can save the NHS money is based on little more than an assertion, whereas in fact the costs may be additional to the cost of more conventional forms of treatment.

If there is one message the Government wish to put across this afternoon, it is a call for clarity. I appreciated the comments of the noble Lord, Lord McNair. He may be aware that different views are held strongly over the terms "alternative" and "complementary". The reality is that there is no universally accepted definition. To begin at this point, therefore, why do so many insist upon using terms such as "complementary or alternative medicine" and "complementary therapies" when they can create so much confusion and division? Dentists, opticians or chiropodists, for example, are not usually referred to as "practitioners of orthodox medicine". Perhaps I may suggest therefore that we have osteopaths, homoeopaths, and aromatherapists rather thana "complementary practitioners".

Clarity is the key. Help in that area came from a perhaps unexpected quarter--the medical profession. In 1993, the BMA published a report on complementary medicine. I understand that that is a most helpful document and reflects a great deal of courage and foresight on the part of the BMA. It highlighted the need to distinguish clearly between those therapies and self-help measures which may be used as an adjunctive form of treatment, and the complete professions of osteopathy, chiropractic, homoeopathy, medical herbalism and acupuncture, which it described as the "discrete clinical disciplines".

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Your Lordships will be aware that the Government's position towards complementary medicine has been traditionally one of benevolent neutrality. We have no wish unduly to restrict its practice or the public's choice in consulting practitioners. A common theme, one raised again by the noble Earl, Lord Baldwin, has been one of urging the Government to be more benevolent and less neutral. I hope that the House recognises that since we last had this debate in 1990 a great deal has been done and we have come a long way. There have been times when government support has been very forthcoming. Perhaps the most significant example was the support given to the osteopaths and chiropractors Bills. However, to gain that support, the professions concerned have first to fulfill a number of criteria and to demonstrate that the move to statutory regulation was in the public interest. The osteopathic and chiropractic professions work hard to establish clarity--clarity in pursuing high quality patient care; establishing education, training and assessment criteria; and clarity in demonstrating that they could regulate themselves effectively. The challenge today to the individual groups and professions is to chart their own similar and independent course.

I believe positive outcomes will then follow. The NHS, for example, is making greater use of some forms of complementary medicine, such as homoeopathy, osteopathy, chiropractic and acupuncture. This, in part, is as a result of the reforms we introduced to the NHS. It is also due to some of the professions clarifying their role in helping to meet particular health needs. Because, for example, osteopathy and chiropractic have been able to demonstrate the role they can play in the treatment of back pain, they have been included in research investigating the scientific evidence into the treatment of this condition. The Department of Health has also recently invited bids from GP fundholders to participate in a small number of pilots to assess whether osteopathy and chiropractic should be added to the list of goods and services that fundholders can purchase on behalf of their patients. The Government have no desire to stifle innovation or new ideas, but our policy in relation to health care cannot be founded on those principles alone.

I agree with the sentiments expressed by the most reverend Primate of All Ireland that there is almost certainly truth in the maxim that the physician comforts while nature heals. There is, however, also a need for evidence-based health care. That brings me to the stormy waters of research. There are those who claim that complementary therapies do not lend themselves to be researched while others demand that the Government should fund more research in that area. I am sure that my noble friend Lady Rawlings and the noble Viscount, Lord Tenby, will be pleased to know that the Government are currently sponsoring some research which may help shed some light on whether the availability of, for example, homoeopathy, osteopathy and chiropractic in general practice impacts on other parts of the NHS. At present the evidence suggests that complementary medicine is often used in addition to conventional medicine. However, as I am sure noble Lords will appreciate, we cannot fund or consider funding every research proposal that happens to mention

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a complementary therapy. The Department of Health does not operate a responsive research grant scheme. It normally meets its research requirements against policy priorities on a commissioning basis, largely via competitive tendering.

But I must emphasise to my noble friend Lord Rennell that the department's R&D programme supports research into non-conventional therapies. For example, one of the top priorities for research funds is the evaluation of manipulation therapies for lower back pain, supported jointly with the Medical Research Council.

The noble Viscount, Lord Tenby, and the noble Lord, Lord Rea, mentioned the Research Council for Complementary Medicine. It might be of some use to the House to know that discussions have been held between the department's R&D managers and that body about extending the opportunities for research into complementary medicine and drawing upon their expertise for considering research proposals.

As was mentioned by the noble Lord, Lord Desai, we support the call to apply the standard scientific approach of the controlled clinical trial to assess the benefits of non-western therapeutic systems.

I understand that among the majority of complementary therapy groups there has been a long-standing reluctance to grasp the research nettle. Notable exceptions to that are the chiropractic, osteopathic, acupuncture and homoeopathic professions. The research ethos must, however, be cultivated in all the therapies and professions. I appreciate that that will take time. There is also the challenge, perhaps, of finding an appropriate research paradigm, but this is not a problem that faces only complementary medicine. Quite recently my noble friend Lady Cumberlege attended a meeting at which hospital chaplains were setting themselves the challenge of finding effective outcome measurements for their own care for patients. As the most reverend Primate said--I paraphrase him--more attention must be paid to the process of healing.

Research does not have to be the large scale, multi-centred trial. As the noble Earl, Lord Baldwin, said, much can be achieved at a local level using such tools as clinical audit. We believe that certain professions within complementary medicine would benefit from access to national support for clinical audit in the same way that the Department of Health supports the clinical professions. I am pleased to be able to tell your Lordships that the department will be looking at ways in which support to the recognised and independent complementary professions might be provided.

It is of course important that anyone who practises any form of complementary medicine should do so to a high standard. I agree with my noble friend Lord Colwyn who I hope will be pleased by my call this afternoon for clarity in training, professionalism and practice among all the various groups.

The Government take very seriously the quality of health care provided by all the professions and therapies, especially the "discrete clinical disciplines". While we

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believe it is for each group to determine for itself whether or not to pursue statutory regulation, for many the establishment of a credible system of independent, voluntary self regulation might be sufficient. But even voluntary systems should contain the essential elements found in a statutory scheme.

We are strongly of the opinion that such measures should be introduced by the professions and therapy groups themselves on an individual profession-by-profession basis, and not under the cover of so-called umbrella groups. In the interest of clarity, where there are different bodies representing members of the same therapy or profession, they should consider getting together under their own single, professionally-led independent self-regulatory body.

A number of noble Lords, especially my noble friends Lord Harlech and Lady Sharples referred to nutritional therapy. Noble Lords will be aware that the Government's Health of the Nation strategy explicitly recognises that better nutrition is important for the promotion and maintenance of better health. Part of the strategy for achieving the targets for a reduction in coronary heart disease is based on diet.

The Committee on Medical Aspects of Food Policy--COMA--is reviewing the role of diet in the development of various cancers. We are also aware of the dietary regimes, such as the Gerson and Bristol diets, from which many cancer patients feel they have derived much benefit. Dietary supplements are sometimes advocated as means of improving the nutritional quality of the diet. However, while there is substantial evidence that fruit and vegetables, for example, might reduce the risk of a number of diseases, there is insufficient information to identify which components of fruit and vegetables are responsible for any protective effect.

I appreciate that my noble friend Lord Kitchener believes that boron deficiency accounts for much bone and joint disease. Boron has not been identified in independent reviews of priorities for Department of Health nutrition research.

The noble Earl, Lord Baldwin, called the Bristol Cancer Help Centre a beacon of light. Of course, that centre received great support from my noble friend Lord Pearson of Rannoch. We recognise the work of the Bristol Cancer Help Centre in developing an holistic approach to the care of people with cancer. Some forms of complementary therapies can play an important role in enhancing emotional, psychological, and physical well-being. The centre has not applied to the Department of Health for any funding. It is open to the centre to seek funding support from health authorities whose patients are receiving care from the centre.

Certainly I pay tribute to those on therapies such as the Gerson and Bristol therapies because they put so much commitment into those various nutritional therapies. Patients, families and friends often dedicate their lives to implementing an arduous and vigorous regime. In turn, that provides hope where conventional medicine has failed.

A number of other points were raised. I shall not be able to reply to all of them. But I am much encouraged, as was, I think, my noble friend Lady Flather, to see

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some of the traditional hallmarks of complementary medicine--the holistic approach, spending time with patients, individual care and even touch--being incorporated more and more into conventional medicine. Of course, that view was confirmed by the noble Lord, Lord Rea.

The noble Countess, Lady Mar, asked about the outcome of some research and whether or not my noble friend Lady Cumberlege has received it. I shall make sure that she has. If she has not, I am sure that she will write to the noble Countess.

We have heard a great deal this afternoon about the many different forms of complementary medicine. The Government appreciate that a great many people derive benefit from them. We uphold the principle that practitioners should enjoy the relative freedom to offer their services and the public's right to use them. But as popular interest grows, that must be matched by increased standards within the different professions and therapy groups in the way that I have described this afternoon.

I have thoroughly enjoyed today's debate. I am sorry that there is not more time to reply in greater detail. Again, I thank the noble Earl, Lord Baldwin, for initiating the debate. I hope, as has been the case with previous debates, it will come to represent another important milestone for complementary medicine.

6.59 p.m.

Earl Baldwin of Bewdley: My Lords, I reckon I have perhaps just a couple of minutes in which to wind up. Clearly everyone saw through the wording of my Motion. It was just that I got fed up with the old words "complementary" and "alternative", which are used so much, and so I thought I would put it in a different way this time.

We have had a wide-ranging debate from the philosophical to the very detailed. I am extremely grateful to all the participants who have given us their views and experiences this afternoon. I would like to point out that most of the things we refer to as "new" therapies--and this has been said--are in fact as old as the hills, going back to what used to be conventional long ago.

The noble Lord, Lord Rea, claims back nutrition for the mainstream. I am more than happy to give it back to him where it belongs. It has simply been by default that it has been elsewhere all this time.

I am tempted to rise to some of the more anecdotal remarks of the noble Lord, Lord Winston. I much enjoyed his speech. But I think that I will forbear there, except to say that I think it behoves any profession to listen carefully to what its clients are saying. I think we would both be interested to know why it is that more and more people seem to be doing better on the non-conventional placebo effect than on the conventional.

I was a little disappointed by some of the things said by the noble Lord the Chief Whip. But, on the other hand, I derived some encouragement from him. I shall obviously read his remarks carefully in Hansard. I am

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grateful for the encouragement on the help with audit, which was the main plank of my argument. Obviously that can be subject to further discussions.

It has been a good debate. I am most grateful for having had the opportunity to hold it this afternoon. I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

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