The Other Medicine: Programme Four

Transcript: First, Do No Harm

First broadcast on BBC Radio 4
Tuesday 12/10/04 2100-2130

PRESENTER:
ANNA FORD

CONTRIBUTORS:
GUANG XU
EDZARD ERNST
HUGH MACPHERSON
PETER HOUGHTON
SIMON MILLS
KATJA SCHMIDT
NANCY HOLROYD DOWNING
PETER FISHER
HELEN COOK
MICHAEL BAUM
GEORGE GEORGIOU

PRODUCER:
RAMI TZABAR


MONTAGE
So far I’ve had no bad experiences with herbal medicine at all.

Hospitals are filled with patients suffering from adverse reactions from conventional interventions. We get 2,000 deaths per annum from non-steroidal anti-inflammatories.

There’s an elderly woman who had breast cancer which was being treated with carrot juice and she was bright orange. I think she’d reached the point where she thought she ought to abandon alternative medicine.

FORD
Complementary and alternative medicine, or CAM, is often marketed by practitioners as the safe and natural option. Patients have told me "well if it doesn’t do you any good, it won’t do you any harm." But is this true? Can CAM be said to have fewer side-effects and less incidents of toxicity than conventional medicine? In this programme, we’ll explore the possibility of harm in complementary medicines, from the advice practitioners give to some of the remedies themselves.

ACTUALITY - DR GUANG XU’S CLINIC
[Knock, knock]
Take a seat please.

FORD
At the Traditional Acupuncture Centre in London, which also offers herbal treatments, Elisabeth has made an appointment to see Dr Guang Xu, a practitioner of traditional Chinese medicine about a skin problem.

ACTUALITY - DR GUANG XU’S CLINIC
So I get red - sore red areas here between the eyebrows and on my cheeks. And they’re like little spots that move around, they almost - it sort of moves around. And I think it’s hormonal because it’s always worse before my period.

Why don’t you try antibiotics as well, why do you want to have herbal treatment?

I did go to the doctor and I got something called MetroGel, which is an antibiotic I believe. And I used that for four days and it just seemed to get worse - it got worse and worse and really angry looking and it became very, very itchy and I couldn’t stop scratching my face.

GUANG XU
In China it takes five or six years full-time to train as a doctor who can prescribe herbal medicine. So we have to know every single herbs, how much dose we could use and then in the prescription we would use 5, 10, sometimes up to 30 different ingredients in it and which herbs can be mixed together and which herbs are not allowed to mix together and which herbs can reduce the other herbs side effect. We also should check the patients on a regular basis, so if there’s any sign of side effect we would pick up on time and before it gets too bad.

FORD
Traditional Chinese medicine has become incredibly popular in Britain over the last decade, as more non-Chinese patients have sought it out to treat conditions that Western medicine hasn’t touched. However, government agencies are concerned about the quality and safety of the largely untested ingredients in Chinese medicine, which can include not just plants but minerals and even animal extracts.

ELISABETH
A lot of ingredients go into the preparations and I’ve no idea what they are, they look strange, they smell strange and they’re pretty disgusting but because I’ve been recommended them I’m prepared to give them a go. So far I’ve had no bad experiences with herbal medicine at all.

FORD
Traditional Chinese medicine, like many forms of CAM, is based on such ancient and natural practices that most patients assume they are safe. But is that really the case?

ERNST
Not only do people perceive it as less risky but it definitely is less risky, absolutely.

FORD
Edzard Ernst is Professor of Complementary Medicine in the Peninsular Medical School at the Universities of Exeter and Plymouth. Compared to CAM, he says, orthodox medicine has a poor safety record - thousands die in our hospitals every year from drug overdoses, MRSA and surgical complications. But is this a fair comparison?

ERNST
Very few people die on the table of an acupuncturist or chiropractor and quite a few people die on the table of the surgeon. But the absolute risks are a very unfair comparison. What we really should compare is the risk benefit ratio. Now if something has no benefit then even a slight risk weighs very heavily but if some other therapeutic intervention has the potential to save your life then enormous risks are acceptable.

FORD
How do you know that CAMs - complementary medicines - aren’t dangerous given that there’s so little research about it?

ERNST
That’s a very good question. How do we actually know that people aren’t dying from batch flour remedies? If they were we would hear about it. But some other therapies are associated with risk - sticking a needle into a patient certainly carries a risk and manipulating the neck of a patient definitely does. So I think we have to distinguish between some complementary therapies which are plausibly, even though we don’t have the evidence, plausibly almost entirely safe and other therapies, like chiropractic herbalism, where we feel it is perhaps associated with risk and it is predominantly, in my view, these therapies that we should investigate systematically.

FORD
It’s true that acupuncture and chiropractic do have the potential to cause harm. But are patients aware of this? Hugh MacPherson trained in acupuncture in London and China and has worked at the York Clinic of Complementary Medicine for more than 20 years. He surveyed his own patients and was surprised by the results.

MacPHERSON
My experience of patients coming to see me is they tend to be very trusting and don’t expect acupuncture to be unsafe, they don’t expect risks, they don’t expect cross-infection and they assume, for example, that all acupuncturists use disposable needles, once and once only, and so forth. So there’s a sense - an assumption that because it’s alternative - and it’s involving natural medicine where there’s nothing added to the body or taken away as there would be say with drugs and surgery - then acupuncture has to be very safe. That’s their assumption. I think the conclusion increasingly has come in that competent hands acupuncture is safe, if people aren’t properly trained then it is not safe, there are dangerous conditions - dangerous situations that can be caused by acupuncture, for instance a pneumothorax - if someone’s inappropriately needling they can puncture the lungs. Now that is definitely bad practice and anyone who has a decent training would never ever allow that to happen.

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