Complementary medicine: changing attitudes: The Laing Chair of Complementary Medicine: synopsis of inaugural lecture, 8 December 1993

Abstract

It used to be (and still is) called fringe, quackery or even medical fraud. Alas, the terminology has become somewhat kinder, and we now speak of alternative heterodox, unproven or complementary medicine (CM). More than 150 different remedies (none of which ever really qualified as an ‘alternative’ to orthodoxy) have been counted within CM; they may be sub-divided into a drug category (i.e. herbalism), physical remedies (i.e. acupuncture), dietary approaches (i.e. macrobotics) or cognitive treatments (i.e. healing). This list makes it obvious that complementary therapies are highly heterogeneous. Yet there are some common denominators: an all encompassing theory (sometimes more a philosophy than a theory) the view of health as a balance of forces within the body and healing as the restoration of this balance, the holistic approach, and the emphasis on each individual’s own responsibility for health. It is noteworthy that the latter two characteristics are, of course, an integral part of (good) orthodox medicine. Being more critical in describing CM, one can also point out that it often lacks an adequate theoretical basis, its diagnoses are usually not in line with science, and it has failed to demonstrate clinical effectiveness convincingly. CM may thus be defined as those branches of the art and science of health care that are not in accordance with current medical thought, scientific knowledge or university teaching. A most striking feature is CM’s immense and continuously growing popularity. In Europe ‘natural medicines’ increase each year by 3.5%. In the UK this figure amounts to 6%. In the US, the consultations to providers of CM have long outnumbered those to primary health care physicians.1 Common, chronic and self-limiting conditions are among the ailments seen most often by practitioners of CM, but there are, of course, important exceptions such as cancer or AIDS. Many British GPs now feel that the integration of some aspects of CM into their surgery would be desirable and helpful for their patients? characteristically the younger doctors are more open minded than the older generation. There seems to be a fascinating paradox: no one doubts that today’s modern, orthodox medicine is more successful than any of its predecessors in diagnosing, treating and preventing disease. Yet the public chooses complementary medicine in vast numbers. Why? There must be many reasons, ranging from dissatisfaction with high-tech medicine to a fascination with mysticism, from grabbing ‘the last straw’ to looking for more empathy, to falling victim to the Barnum-Effect or the Health Information Fatigue Phenomenon. Whatever the reasons are (and no doubt they need to be researched in much more detail), they represent a severe criticism to the content and style of today’s medicine. Orthodoxy might be well advised to try and learn a lesson from the apparent success and obvious popularity of CM. As the quantity of CM grew, quality often fell behind. The fact that just about anybody in the UK, regardless of professional background or training, can set up as a complementary practitioner has alarmed many mainstream doctors. Therefore, the recent British Medical Association report3 rightly demands registration, control, com-