Complementary medicine: New approaches to good practice

Abstract

The Prince of Wales, when President of the British Medical Association (1982-1983), first identified the need for the Association to recognise the risks inherent to the doctor/patient relationship from the increasing specialisation of medicine and the consequent damage to extending our understanding of the healing process. He suggested that orthodox medicine may not have all the answers. A report from the British Medical Association Board of Science and Education Alternative Therapy, published in 1986, discovered many unscientific, unsubstantiated claims for alternative therapies. That 'many alternative approaches to medicine do not base their rationale on theories which are consistent with natural laws as we understand them' was thought to preclude research protocols being developed. However, the quality of time and the personal focus provided by alternative therapists were thought important in producing positive results for the patient. By 1992 the enormously increased use of alternative therapies by the population of the UK and the parallel interest of general practitioners in the use of alternative therapies in addition to orthodox approaches produced a demand for a second BMA report. This was Complementary Medicine: new approaches to good practice(1993), t This focused not on the efficacy of treatments but on the need for statutory regulation; standards of admission to training; a register of practitioners with an acceptable code of ethics enabling doctors to refer patients in the secure knowledge of accepted standards of clinical practice; and behaviour by complementary practitioners. The move to seeing these therapies as complementary rather than the alternative to orthodox medicine was reflected in this widely read and influential report. Clearly there is a very positive approach now towards complementary medicine, both by those who wish to provide services and those who wish to purchase them for patients under the NHS. However, there are still many important questions to be answered about which services should be purchased, why they would be of value to patients, and how their use and outcomes of treatment can be monitored and audited. We need many more pilot trials and sound research projects in both general practice and in hospital situations. Orthodox practitioners require much more information on when and how to refer patients for particular types of treatment, and on obtaining training for themselves and their practice staff. Clearly there is increasing demand by patients for complementary treatment and we must aim to provide this on a rational basis according to standardised protocols and outcomes measures. This will require much more investment in research and information for purchasers, practitioners and provider helath organisations. t Complementary Medicine: new approaches to good practice available from BMJ Bookshop, BMA House, Tavistock Square, London WC1H 9JP Orders tel: 071 383 6185 Price: £7.99 (BMA members £7.49)