Complementary and alternative medicine.

Chronically embedded in the tension between Royal patronage and scientific reasoning, the UK debate about complementary and alternative medicine (CAM) is heating up. Currently the Academy of Medical Sciences is developing a 'CAM policy paper', the King's Fund is trying to reach a 'consensus on appropriate research methods' in CAM, the Arthritis Research Campaign is 'reviewing the role of CAM in the management of rheumatic diseases', and the Prince of Wales Foundation for Integrated Health are about to publish guidelines on the role of CAM in mental health. In November 2007, the Lancet (again) published several critical comments on homeopathy and, in December 2007, the government's most senior scientist, Sir David King, warned that homeopathy 'is a risk to the population'. 1 Patients are being systematically misled 2 and remain confused: of the 21 questions most frequently asked by consumers to NHS Direct, six related to CAM. 3 Even GPs are often uncertain how to advise their patients, and decision makers or regulators struggle when forced to decide what the NHS should pay for. If the NHS's commitment to evidence-based medicine is serious the criteria for NHS funding are clear. Firstly a treatment should be demonstrably effective. Secondly it should be reasonably safe. Thirdly it should be affordable. Fourthly it should compare favourably in the aforementioned domains with other therapeutic options. 4 But this is merely theory; in practice, things can turn out to be a little more complex. My team and I have extensively reviewed the effectiveness and safety of CAM. work into a nutshell by selectively listing those interventions which are backed by positive and sound evidence. The result is a meagre list of 20 treatments with several notable surprises. For instance, acupuncture, which is often promoted as a panacea, is effective for some conditions but not for others. Many popular CAM treatments are absent from Table 1, simply because of a lack of compellingly positive evidence. Kava, a herbal anxiolytic, is clearly effective but is probably not safe, and Bach Flower remedies might be safe but are not effective. 5,6 Other excluded treatments are homeopathy, craniosacral therapy, spiritual healing, and dozens of herbal medicines. Perhaps the most remarkable 'absentee' is spinal manipulation; it has been shown to be as effective (or Conventional Treatment Condition Cost options Acupuncture Nausea/vomiting Cbc Pme Osteoarthritis Cbc Pme African plum (Pygeum africanum) Benign prostatic hyperplasia Moderate Pse Aromatherapy/massage Cancer palliation Cbc Pse …