FORD
A product of its time, Hebden Bridge offers visitors a cosy retreat into the counter-culture revolution of the 1960s. And that’s what’s driven the CAM movement ever since, says historian Professor Roger Cooter of the Wellcome Trust Centre for the History of Medicine at University College London.

COOTER
There’s always two elements to it, which is partly I don’t like your authoritarianism in this surgery, telling me about some particle of my body gone wrong, I do want to take some control of it, know more about it, be empowered by knowledge and to varying degrees I think a kind of anti-science, anti-materialist approach, which has been there right through from the 19th Century.

FORD
Given that advances in orthodox medicine during the 20th Century were quite phenomenal, I mean let’s just start at penicillin, then why should we also at the same time have this growth in an interest in things away from scientific medicine?

COOTER
Well it has a lot I think to do with political economy and the cost of medicine but really the critique of monopoly power in medicine built up that power during that golden age from penicillin to thalidomide or from insulin to thalidomide, when it comes down with a bit of a crash. So in the ’60s there were a number of scandals of medical ethics, of testing cancer on geriatric patients without their consent, the huge expense of cost of treating people and the arrogance of a profession that was so highly invasive, so highly technologised that all patients were totally alienated. So it isn’t as if the triumphs, which many people wouldn’t deny, of scientific medicine caused it, it was part of a much broader cultural movement against that kind of monopoly, that kind of authority which could be increasingly found within an atmosphere where you wanted to bring down those with too much power.

PATIENT
Well I know that antibiotics don’t work, that it suppress symptoms, but for deeper problems that the West medicine doesn’t have a cure for there are other methods of treating. So particularly something like a back ache, there’s not very much in the West - Western medicine other than some sort of painkillers that will help someone, whereas there are a lot of things that one can do for oneself or through an alternative practice that will heal the problem.

PATIENT
I was recovering from a slipped disc and he was introduced to me as a back specialist and he helped me a great deal. And then it developed from there and I was at the time travelling a lot and getting very run down and I think for me that’s the great learning from him is firstly that everything is connected, where you think you have a pain it’s actually originating from somewhere else. And secondly, most things you can do something about and you can help yourself before you get ill.

LEWITH
I think there’s certainly a pull factor away from orthodox medicine and the perceived lack of sympathy in orthodox medicine towards CAM. But most of CAM use is a push factor.

FORD
George Lewith practises acupuncture, herbalism and homeopathy in Southampton, where he’s also a CAM researcher. He believes CAM offers something positive that patients really want from their healthcare system and increasingly feel they can’t get elsewhere. And he says they may continue to use CAMS even though their symptoms are not always improved.

LEWITH
CAM has something to offer them and when they receive CAM, even though it may be directed, acupuncture may be directed at a painful knee or a painful hip, and their pain doesn’t seem to improve they still want to go on having acupuncture because it somehow improves their general wellbeing, it makes their problem easy to bear, it’s something they will even pay for, although when we actually measure out CAM in terms of pain it doesn’t necessarily seem to be helping their pain. So there’s something there, it’s about their quality of life, their feeling of wellbeing, perhaps a sense of coherence but the behaviour is very clear - people will go on having CAM and seek CAM but of their own volition, without any coercion because it offers them something that conventional medicine doesn’t.

FORD
Michael Baum is a cancer specialist and Emeritus Professor of Surgery at University College London. Over 30 years he’s seen how desperate some of his patients are for reassurance, often turning to complementary and alternative approaches.

BAUM
As a good doctor we teach our students to recognise the need of patients for spiritual solace. The patient may be aware of this aching hole, facing death, not believing in God or not being a member of a religious community and then they’ll be sucked in to these new-age belief systems which are really a replacement for spiritual solace and spiritual support. So they will learn that somewhere, it’s usually a long way away in some exotic place, there is a miracle cure. And so they will go seeking the miracle cure. I have enormous sympathy for these individuals but I have no sympathy at all for these charlatans who offer miracle cures.

FORD
So far we’ve heard some of the charges levelled against orthodox medicine, but do those criticisms hold up and is medicine in the orthodox field changing?

GOLDACRE
My name’s Dr Ben Goldacre, I’m a doctor working in a hospital and I write a column called Bad Science for the Guardian about pseudo science in all forms of life, but particularly alternative therapies and the cosmetics industry. What I find slightly odd about alternative medicine is the way that it often involves going on the attack on mainstream medicines, so they’ll say mainstream medicine is paternalistic or it’s controlling, it’s all about drugs, it’s about treating symptoms and not underlying causes, which is obviously completely fallacious. An alternative therapist will give you something for pain and a mainstream doctor will give you something that will treat the underlying cause. As a young doctor I often go out of my way to try and involve the patient in the treatment decisions that are being made but sometimes you’ll say to them this is what the diagnosis might be, these are the treatments that we could offer you, what do you think is best? And they look at you blankly and amazed, as if to say well you’re the doctor, you make the decision. And I think one of the difficult things is that as the face of medicine changes it’s very difficult to choose how to be with patients.

PATIENT
I was really lucky actually because I happened to have a consultant who was very open-minded, not blinkered like a lot of them are. I told him I was having acupuncture, I thought it was only right that I should, thinking he would poo poo it or you know… and his reaction was - Oh great. I also had a bad back at the initial stages of pregnancy and I mean a real bad back, I could hardly - well I couldn’t get out of bed and I thought I was going to be spending the duration of the pregnancy in bed. So I did go to see a chiropractor and he sorted my back out and the next time I went to the consultant he was amazed at how much more mobile I was - I hopped up on to the bed and everything - and yet another doctor, another consultant who was in the room at the time, said - How did your back get better? Did you see an osteopath? And I said no, I saw a chiropractor and his reaction was - Oh a quack. So I knew there was no point talking to that man about it. And that just shows you two consultants and different attitudes.

JEWELL
There’s an extraordinary dual standard here that medicine in order to be justified, in order to get on to the market, in order to be sold, in order to get it … has to pass a whole lot of really stringent tests. But if you want a little bit of osteopathy, which is regulated, I mustn’t be rude to the osteopaths, but it doesn’t have to - the treatment itself doesn’t have to pass those tests at all and it’s a dual standard.

FORD
Dr David Jewell is a GP and editor of the British Journal of General Practice. He’s cheerfully old school in his utter scepticism of the efficacy of CAMS but thinks he can guess why orthodox practitioners may sometimes end up recommending them.

JEWELL
I’ve worked alongside people who practise conventional medicine, known lots of people including my own next door neighbour who’s a very keen homeopathic doctor, and the only acceptable position for a sceptic is to say well if you can prove to me that it’s worthwhile doing we’ll take it up and use it.

FORD
And yet do you find it surprising that according to a recent survey I think 50% of GPs admit that they will now refer their patients to an alternative practitioner?

JEWELL
I find it slightly depressing but I don’t find it very surprising. I mean they may do it for all sorts of reasons - they may do it because they don’t wish to take up a very negative position, they may do it simply because they’re asked to. They may do it, as some people say, because they don’t want to get to the point of saying I have nothing further to offer to patients, that becomes a really difficult position to get to. And so complementary medicine does offer a range of things that they can then fall back on, as it were, when they don’t think any of their conventional remedies are working.

GOLDACRE
When you go and see a doctor these days they’re more likely than not to say - Well we don’t really know what it could be but we’ll try these tablets, they might work, they might also have all of these awful side effects. Whereas an alternative therapist will say - Oh there’s an imbalance in your chi, you’re deficient in selenium you need to eat more spinach. And they’ll say - That’s what’s wrong with you, this is the treatment, take it. And are paternalistic and didactic in exactly the way that they’re accusing mainstream medics of being.

BAUM
There is an extraordinary paradox - in the days when doctors were much more certain and confident about what they were doing they were respected more by their lay-people and seldom challenged. And it’s very perverse that these days when the vast majority of doctors are taught from day one of their undergraduate curriculum to recognise uncertainty and live with uncertainty and that on the basis of uncertainty we can make progress the profession has lost the respect of the lay-public. And so we do have peddlers of alternative medicine who can fill that gap and say - Well the doctors are uncertain, I’m not. I have learnt to live with uncertainty, I train my students - postgraduate and undergraduates - the necessity, the virtue, the beauty of the uncertainty principle, without which no progress is made.

FORD
So with nearly 20 million visits to a complementary therapist taking place every year, there’s little doubt CAM is popular. But what about the evidence that it works? Do the research results agree with the punters? And how do you measure success? Next week we’ll explore the debate about the science behind complementary and alternative medicine, and look at some of the implications of this patient led movement.

LEWITH
It’s not a new gene, it’s not a new antibiotic, it’s not Professor Fleming finding penicillin in St. Mary’s outside Paddington, drifting in through the London air, it’s very different. And it’s about this battle, this process of who owns health.

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Content last updated: 08/09/2004