Transcript: A Marriage Made in Heaven?

First broadcast on BBC Radio 4 
Tuesday 26/10/04 2100-2130

PRESENTER:
ANNA FORD

CONTRIBUTORS:
DAVID REILLY
SARAH BUDD
MIKE O’FARRELL
BEN GOLDACRE
SCOTT MIDDLETON
ANGIE BUXTON KING
EDZARD ERNST
KATE MACKENZIE
MICHAEL FOX
SUE MORRISON
JUSTINE SMITH
PETER HAIN
PAUL DIEPPE

PRODUCER:
RAMI TZABAR


FORD
Over the last five programmes we’ve explored various issues central to the debate surrounding the increased use of CAM - complementary and alternative medicine: its popularity, the debate about evidence behind it, the questions of safety and regulation. CAM, say some, is now poised to create a revolution that may be as fundamental a change to healthcare in this country as the creation of the NHS was over half a century ago.

Integration is the buzz word. The coming together of orthodox and complementary therapies to create a holistic system for the benefit of patients. It sounds wonderful but is it possible? Already pockets of integrated care exist around the country such as the four NHS homeopathic hospitals. But how well do these schemes integrate themselves into mainstream medicine and what does integration mean anyway?

PATIENT
Well when I heard about the place I went to my own doctor and she says - Well homeopathic - some of us believe in it and some of us don’t - she says - it won’t do you any harm - she says - it might do you good.

FORD
In Glasgow, the Homeopathic Hospital houses a 14-bed in-patient unit and a busy outpatient service. About 400 patients are admitted annually, most referred by specialists and GPs.

The hospital is run by Dr David Reilly.

REILLY
It’s a place that cares for patients, it does it on the NHS and it has a model of care that’s I think that’s quite cutting edge. We have all orthodox trained people - so you’ve got doctors and nurses, physiotherapists, occupational therapists - who’ve gone on and developed other skills and studied other healing disciplines that would include both what would be seen as complementary medical approaches and mind body medicine and holistic orientations. And the remarkable thing is the extent to which we get such great results from that.

PATIENT
They work with conventional medicine, I mean you come in they don’t take you off of your drugs - that was my decision because of illnesses I’ve had previously and because of what drugs - the drugs have done. And with the help of the remedies and the staff, also the acupuncture, and they do what they call like your addiction points, which helps with withdrawals I suppose, I’ve managed to cut down over half of my medication, my conventional medication.

REILLY
What happens is you start breaking the cycles of multiple specialists, multiple investigations and multiple referrals.

FORD
Whilst the hospitals have been in existence for nearly 60 years, until recently providing CAM services within the NHS has often been down to the determination of individuals such as Sarah Budd. A midwife at the Derriford Hospital in Plymouth, Sarah started offering acupuncture for pain relief in pregnancy and labour 18 years ago.

BUDD
I started using it on the labour ward with success and colleagues from the maternity community service were asking me if I could help them with some of their patients with problems like backache and sickness in pregnancy. I’d had a full traditional Chinese medicine training in London over three years part time and I’d also followed that up by a visit to China to do further training, so I felt well I’ve got the theory I’ll give it a go. And the results were very satisfactory and even I was very surprised at how good it was. We’ve treated over 5,000 women here now in Plymouth with antenatal problems - mostly morning sickness and backache - but we have a wide range of other conditions, such as constipation, varicose veins, headaches and migraines, pelvic pain needing admission to hospital.

PATIENT
If I’ve got a headache I’ll take a paracetamol - that kind of thing. Won’t avoid painkillers normally but obviously because of the pregnancy I really didn’t want to do that. I was told they wouldn’t hurt the baby but I didn’t want to take the risk, I didn’t want to take the risk with the pregnancy being quite early on and 15 weeks of taking painkillers wasn’t an option as far as I was concerned. But the acupuncture was fantastic, it was brilliant.

The first time didn’t - I got a little bit of a relief but it was for a short period but then after the second time, that was weekly at first, and it was brilliant, from week to week it - the relief was there.

BUDD
Obviously acupuncture training costs quite a lot of money so once you have your midwife trained in acupuncture then you’re not particularly looking at any greater cost.

PATIENT
From my experience with the pelvic pain I would say that they tend to see it as a last resort, it should be offered as strongly as the painkillers are.

FORD
The number of acupuncture services free at the point of delivery is increasing. But it’s not a given that all practitioners are happy about the prospect of working in the NHS. According to Mike O’Farrell of the British Acupuncture Council, many have concerns about how NHS bureaucracy might change the way they work.

O’FARRELL
The statements like I don’t want to work in the NHS, well you don’t have to. Where I put the needle, who’s going to tell not to do that and I said that isn’t going to happen. There are those members and there are many of them and they’re concerned that regulation is going to mean audit and bureaucracy. There’s those things and of course there’s the overriding concern that anyone has in any profession which is one of reluctance to change. The only data I can offer is that we have out of our 2,400 members we’ve got about 150 currently working in the NHS, either in primary care trusts, in acute trusts, in mental health trusts, in maternity care and in palliative care. None of those to my certain knowledge have been told how to practise acupuncture. The only thing they’ve been asked to do is to ensure that - particularly if they’re working in a GP’s surgery, in a GP practice - that perhaps they restrict their treatment per patient to half an hour. Well that’s still significantly more than the patient gets from a GP.

FORD
These genuine concerns have to be addressed but doubts over further integration don’t just come from CAM. Despite increased interest in the role of complementary therapies from the medical profession, some, like writer and doctor Ben Goldacre, point out that the boundaries of the NHS couldn’t envelope the luxuries of time and care that CAM offers in the private sector, however attractive that might be.

GOLDACRE
There’s no way that alternative therapies will ever be accepted into the mainstream, not because of any kind of ideological objection that empiricists like me might have to alternative therapies but simply because you can’t do alternative therapy on the NHS. Alternative therapy is about people paying money to have somebody spend a lot of time listening to them talk about their problems and however much I might think that’s a great way to spend your time as a healer, however much I would love to do that in my own practice, it’s simply not possible on the NHS.

    next > Page 1 of 3