Pins and needles: the politics of (alternative) healthcare
Wednesday, May 27th, 2009
The Daily Mail ran a story this week on the National Institute for Clinical Excellence’s (NICE) decision to make a range of complimentary and alternative medicines (CAM) for people with non-specific back pain available on the NHS . A few years ago, the prospect of state funding for therapies such as acupuncture, chiropracty and osteopathy was almost unimaginable; it now seems that practitioners of CAM have gained both legitimacy and power in the wider dominance of ‘orthodox’ medicine.
The Daily Mail is not pleased by this turn of events. It described alterative therapy practices as ‘mumbo jumbo’ medicine, and referenced ‘experts’ from conventional medicine who condemned NICE’s decision. No ‘experts’ from the CAM world were invited to comment, leaving the article feeling somewhat one-sided. I imagine that a number of readers were left outraged by the health watchdog’s actions. How can NICE continue to refuse the funding of ‘proven’ interventions for cancer and Alzheimer’s, whilst sanctioning the use of taxpayers’ money on ‘fooling’ people into believing they are getting better? (the Daily Mail’s words, not mine!)
As NICE points out in its recent report on the matter, a lack of evidence doesn’t equate with evidence of ineffectiveness. Nevertheless, NICE will not approve NHS funds for interventions without a sound evidence base, and research points to the efficacy (and dare I say it, cost effectiveness) of many alternative therapies in the treating of back pain. A couple of trips to an acupuncturist or osteopath can work out far cheaper than a MRI scan, for example. A major stumbling block for CAM in the past has been a lack of funding to support the large quantitative trials needed to evaluate interventions, although some CAM practitioners have argued that alternative therapies cannot be measured in the same ‘scientific’ way as orthodox medicine and instead require a more qualitative approach to research. Either way, NICE’s decision is surely good news for patients who have, in the past, been forced to pay privately for services that GPs argued should be available to all.
Listening to an osteopath on the television this morning defending NICE’s decision, I was struck by how far the CAM community has come in terms of identifying itself with conventional medicine. The osteopath commented that a few years ago CAM was ‘a bit wacky’, but codes, regulation, accredited training had changed that. The CAM field is by no means a homogenous one, and I can’t help but wonder whether there is a feeling in some quarters that uncomfortable compromises were struck in order for CAM practitioners to ‘professionalise’ and secure legitimacy in the UK healthcare system.