Visit to the University of Southampton
Medical School and the Centre for the Study of Complementary Medicine,
Southampton, on 9 June 2000
|Earl Baldwin of Bewdley
|Lord Walton of Detchant
Complementary Medicine Research Unit: School of Medicine, University
Professor Arthur, Head of School of Medicine
Professor Arthur, Head of the School of Medicine, welcomed the
Committee and explained that the research structure was developed
'from the ground up' from 1990. Their research concentrates on
areas of expertise which are: human genetics; infection, inflammation
and repair; cancer services; foetal origins of adult disease;
and community clinical services. The medical school is the second
smallest in the country but was rated in the top ten in the research
assessment exercise and scored well in the quality assessment
Dr George Lewith
Dr George Lewith, doctor, researcher and CAM practitioner, discussed
his work as Head of the Complementary Medicine Research Unit where
he works for half a day per week. The unit was set up in 1995
and is situated within the infection, inflammation and repair
unit of the research division of the medical school. The unit
is financed by 'soft money' rather than by the medical school.
Its main funding source is a grant from the Laing Foundation (which
also funded much of the work the Committee saw at Exeter), which
has covered all their administrative costs since May 1995 to May
1998 with a further three years support promised until May 2001.
They have also received money for research from the Wellcome Trust
and the British Medical Association as well as some money from
industry for commercial research.
The aim of the research unit is to evaluate the clinical effects
of complementary medicine and investigate the scientific basis
for its mechanisms. They believe that 'these innovative techniques
should be rigorously assessed and, where appropriate, integrated
into mainstream conventional medicine.'
The research that they do falls into five main headings: rheumatology
and rehabilitation work, respiratory disease, cancer, fundamental
research (including health psychology and research on the effects
of attitudes on outcomes), chronic fatigue syndrome and miscellaneous
Dr Lewith highlighted some of the lessons that they had learnt
in their work at the unit. Firstly, large, good quality clinical
trials can help uncover information that even people working as
practitioners had not thought about. Secondly, having a CAM research
unit within an undergraduate medical school provides a clear research
structure as well as administrative and research support, and
working in an NHS environment provides access to patients as well
as providing credibility for the unit. Thirdly, designing and
carrying out rigorous trials in CAM is more intellectually challenging
than orthodox medicine research: it can be done but it is not
easy. Dr Lewith's final point was that setting up a research unit
and carrying out good quality research in the CAM area takes a
long time. They found that it took four to five years of hard
work before they had good quality, interesting papers coming through.
Overview of various trials
The next set of presentations was given by some researchers and
students who worked within the unit. Dr Lewith said the Unit had
made an effort to show a cross section of studies including ones
with positive and negative results and ones in progress as well
as ones completed. The studies included work into acupuncture
for chronic neck pain, work on the relationship between patients'
attitudes to CAM and the outcomes of their treatment, the proving
of Belladonna in homeopathic dilutions, electrodermal testing
for allergies and acupuncture in stroke rehabilitation.
When asked if the level of funding the unit got from its NHS region
was unusual, George Lewith said it was but he believed part of
the reason for this is that they submit unusually high-quality
proposals and they take account of any criticisms their proposals
receive during peer review and re-submit accordingly. He also
mentioned that NHS review can be useful even if the NHS region
can not afford to fund the project. If the NHS peer review says
it is a good quality proposal, the Unit can use that recommendation
to get support from charities which are too small to have their
own peer review panels but want validation of a proposal before
they fund it.
However Professor Arthur noted that Southampton has recently changed
NHS regions from the South West to the South East region and since
this change they have noticed a drop in medical school funding
(not just for CAM proposals) because the South East is a more
Dr Chris Stevens gave a brief overview of the medical school curriculum.
It is a five year undergraduate course with optional modules (one
option being in CAM) available in year three and an in-depth research
study unit in year four. In year five students take up placements
across the region.
Dr David Owen, a local homeopathic physician and President of
the Faculty of Homeopathy, is the course tutor for the CAM module.
This covers eight half days and is a familiarisation course, not
a training one. It covers questions such as: which therapies can
be used for which conditions? and, what is CAM appropriate and
inappropriate for? The main therapies the students come into contact
with, and consider evidence about, are acupuncture, homeopathy,
chiropractic, osteopathy and herbal medicine.
Dr Owen said the course is centred around the question: "If
you had a loved one who was suffering from an illness not well
treated by orthodox medicine, what would you want their doctor
to know about CAM?" The course involves complementary practitioners
in the local area and offers medical students an opportunity to
experience CAM as practised in the community. The course is in
great demand, with numbers limited by places, not by the amount
of interest shown by students.
The learning objectives for the course have been developed by
the teaching team, with input from medical students studying the
- To have examined (constructively and critically) the merits
and claims of different complementary medicines.
- To describe the concepts of individualisation and holism,
and to give examples of when different CAM treatment approaches
are used to treat different patients with the same diagnosis.
- To have examined the students' own attitudes towards complementary
medicine and reflect on the variety of attitudes that exist among
patients, health care practitioners and providers.
- To be able to assess and advise patients who enquire about
or benefit from CAM.
- To have participated in consultations and discussions to identify
how patients perceive different treatment approaches and the role
patients play in healing themselves.
- To state the basic principles and evidence for complementary
medicine. To describe the context in which it is practised in
the community and how to obtain more information, including key
points on training and regulation.
Dr Owen also outlined some issues that had arisen when deciding
how to design the course. These included:
- Which CAM therapies to teach
- Whether to include clinical attachments
- How to develop common objectives with courses at other medical
- What methods to use in assessment
- Limitations of the module structure
Other healthcare practitioners training at Southampton (e.g. nurses)
can attend the course as can students from the Bournemouth College
of Chiropractic who may want to learn about other CAM therapies.
This encourages interdisciplinary learning and understanding.
Aside from the CAM module several of the medical students have
been involved with the unit through pilot research projects on
CAM issues during the research part of their course in the fourth
year). The medical school also runs lectures in the second year
of the curriculum on acupuncture and pain management.
Dr Owen also mentioned his work outside Southampton. He has done
some work on Continuing Professional Development in CAM for doctors;
he has found the postgraduate course in homeopathy at the Glasgow
Homeopathic Hospital is the most popular postgraduate course for
doctors in Scotland.
Centre for the Study of Complementary Medicine
Introduction and Background
After lunch the Committee visited the centre for the Study of
Complementary Medicine where they were welcomed by Jacqueline
Tuson, Practice Manager. She introduced the other members of staff
- Dr George Lewith - GP, CAM practitioner and joint partner
in the centre
- Dr Michael Clerk - GP, CAM practitioner and joint partner.
- Maureen Middleton - Nurse manager
- Val Hopwood - Physiotherapist, CAM practitioner and researcher
- Alan Mills - practitioner
Ms Tuson described the background of the Centre. The Centre was
set up in 1982 by Dr Lewith and a Dr Kenyon. The partners are
all medically qualified practitioners who previously worked as
orthodox GPs and hospital doctors. They also use a range of qualified
CAM practitioners alongside the partners to complete the range
of therapies they can offer. They have built up their reputation
so that they now have 4000 patients on their current database
and the doctors see up to 20 patients a day from across the British
Isles and Europe. They also have a smaller sister clinic in Upper
The conventional medical background of the doctors and practitioners
is an important element to the Centre as it gives the public confidence
in their abilities and improves relationships with local GPs,
resulting in more referrals. It is also important that all the
practitioners are multi-skilled and are not limited to the use
of one CAM therapy so that they often use a mixture of therapies
in one treatment plan.
They have their own dispensary and qualified nurses who provide
advice and support for patients. This is part of the Centres emphasis
on a team based approach. They have a nurse advice line for patients
with worries as well as a web-site with information on treatments.
The fact that they have the phrase 'for the study of' in their
title means they get numerous phone calls from people who do not
realise they are a clinical practise. The reason they keep this
title is because historically they did a great deal of training
and research from the Centre. However they do not currently offer
training courses but they keep their title because providing information
is part of their mission.
A survey of the Centre which was published in the BMJ shows most
patients come with very long term problems (average duration 10
years). Currently patients most frequently present with the following
conditions: irritable bowel syndrome, migraine, eczema, non-specific
allergy, back pain and chronic fatigue. The staff continuously
audit their practice, and results for 1999 show impressive outcomes
for a lot of patients suffering from chronic conditions such as
IBS and ME.
The Dorset NHS Contract
The Centre for the Study of Complementary Medicine is primarily
a private practice but it has a history of providing NHS care
too. Until recently this was provided under the fund-holding scheme
for local fund-holding practices. Other practices in the area
were able to refer patients through the Health Authority, and
these patients had to meet stringent criteria. This system led
to a difference in availability between those practices which
were fund-holding and those which were not. The abolition of fund-holding
has meant that patients in the Southampton area can usually obtain
referral to the Centre if their GP thinks it would be the best
treatment for them.
As well as their relationship with the local PCGs the Centre has
a separate NHS agreement with the Dorset Area Health Authority.
This is a unique contract within the NHS for CAM services. It
operates in two parts. The first is an integrated medicine unit
which operates for one day per month at a GP practice in Dorset.
GPs in this clinic and in other local clinics are able to refer
patients with any of six specific conditions to this clinic. These
conditions are: chronic fatigue syndrome, IBS, migraine, child
behavioural problems, eczema and non specific allergy. There is
a waiting list of around three months for this clinic; at times
this has been as long as nine months. Prescriptions are limited
to what is available on the NHS unless patients are willing to
pay for medicines themselves.
The second contract with the Dorset Area Health Authority allows
patients to travel to the Centre in Southampton for their treatment.
Last year this resulted in 600 consultations. This system provides
for the same six conditions as the first contract although there
is some flexibility. This service is quite popular with GPs as
they can send patients who are difficult and who they have been
unable to help. This is a more comprehensive contract as the range
of treatments they can provide at the Centre is greater and the
nurses and dispensary can be used. The contract is very easy to
administer as it provides for 6 appointments for the specified
condition with the only formality being a letter of referral.
The contract also requires a letter of progress be sent to the
referring GP. The six appointments can be extended if the GP writes
to the Health Authority for permission. The Centre makes a conscious
effort to make sure GPs are always kept up to date about their
patients' progress and treatment. This contract has allowed interested
GPs to become fully informed about the Centre's methods and they
see this as being of long term benefit to the NHS.
The Committee were then introduced to a patient who had received
treatment at the Centre and had the opportunity to ask questions
about how they had viewed their treatment and what they felt about
The Committee were given the opportunity to participate in or
watch demonstrations of the Alexander Technique and Acupuncture,
and to ask questions of the practitioners involved.