Publication of the report received coverage in the London Times, June 23, under the banner, "Doctors recognise role for alternative medicine -- About-turn by BMA on complementary therapies it once dismissed."
While the report's title is Complementary Medicine, the term used in the report is "nonconventional therapies," or what they call the "discrete clinical disciplines" of osteopathy, chiropractic, acupuncture, homeopathy and herbalism (in order of popularity in Britain).
One of the advisors to the BMA's Board of Science and Education was Professor Thomas W. Meade, director of the Medical Research Council, Epidemiology and Medical Care Unit, London. If Dr. Meade's name sounds familiar, it's because he was the principal investigator of a British study1 that revealed chiropractic care more effective than hospital outpatient care in Great Britain (see "British Researchers Show Chiropractic More Effective", July 4, 1990 issue of "DC").
Publication of Complementary Medicine is an indication of the significant increase in interest by both the public and medical doctors in nonconventional therapies. For example, in 1985, the Consumers Association reported that one out of seven of their 28,000 members had visited a "nonconventional therapist." In 1991, the number had jumped to one out of four (25 percent).2
It's interesting to note that this trend in Britain mirrors the same trend in the United States. The January 28, 1993 issue of the New England Journal of Medicine published a survey revealing that U.S. citizens are spending an estimated $10-14 billion annually on nonconventional health care, or one-sixteenth of the total U.S. health care market.
Most interesting in the BMA's report, was the great amount of interest general practitioners (GPs) had in nonconventional therapies and specifically chiropractic. Some of the more enlightening information included:
A comprehensive study presented in 1986 in the British Medical Journal presented a random sample of 200 GPs.3 "In the survey, 38 percent of respondents claimed to have received training in some form of complementary medicine, principally in the form of weekend courses; a further 15 percent wished to arrange training." The reports adds that "there were high levels of acceptance of these therapies, especially for spinal manipulation, which was acknowledged as useful or very useful by 89 percent of respondents, followed by hypnosis (79 percent), acupuncture (67 percent), homeopathy (47 percent), healing (46 percent), and herbalism (23 percent)." In addition, "70 percent (of the GPs) thought that the 'most acceptable techniques' -- acupuncture, spinal manipulation, homeopathy, and hypnosis -- should be available on the NHS (National Health Service)."The two areas that appeared to be holding back the acceptance of nonconventional therapies in the U.K. are the perceived lack of information and the lack of research. Part of the research issue was attributed to the fact that the scientific journals within each profession are not read by those outside the profession. Indeed, the Meade et al., study was the only chiropractic research cited in Complementary Medicine.
A larger survey was conducted by the General Medical Services Committee in February, 1992. Questionnaires were received from 25,458 GPs, (70 percent of the of the GPs in the United Kingdom. When asked if chiropractic services should be included in GP surgeries (offices), 21.4 percent said "yes," 42.4 percent said "no," and 36.2 percent had "no strong view." One of the reasons speculated for the large number of undecided is the "lack of reliable information" on chiropractic.
Another survey published in the July 16, 1992 issue of Doctor showed that "90 percent of respondents (GPs) believed that acupuncture was effective, and similar high levels of support were accorded osteopathy (84 percent), hypnotherapy (81 percent), homeopathy (80 percent), and chiropractic (78 percent)."
The demand for "nonconventional therapies" has become so pressing, and the available information so sparse, that the Council on European Communities has charged its Council on Science and Technology (COST) to conduct a five year study. This study would examine the "medical, social, cultural, psychological, legislative, and economic implications of nonconventional therapies across Europe." The goals of the COST project are to:
- "facilitate competitive and fruitful research activities by the examination of literature sources, the setting up of literature data banks, and the possibility of co-ordinating existing literature sources;
- "document the levels of pre-clinical and clinical research for individual nonconventional procedures by means of critical reviews of available data;
- "develop and evaluate procedures for demonstrating the efficacy of individual nonconventional procedures and establish an appropriate advisory service for researchers in the field;
- "perform clinical studies into the effects, clinical efficacy, and safety of nonconventional therapies; and
- "investigate the alleged working principles attributed to many nonconventional therapy forms."4
The BMA report reveals that organized medicine in Britain no longer dismisses the contributions of nonconventional therapies, yet finds it unacceptable to allow the unrestricted practice of nonconventional therapies irrespective of training or experience. In this respect, Complementary Medicine supports the conclusion of another recently released British publication, Report of a Working Party on Chiropractic, which called for statutory regulation of chiropractic in the United Kingdom (see June 18, 1993 issue of "DC").
The publication of Complementary Medicine gives momentum to the movement in the U.K. for the registration and regulation of chiropractic in Great Britain.
- Meade TW, Dyer S, Browne W, Townsend J, Frank OA: Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ, 1990;300: 1431-7.
- Consumers Association, Report on Regulation (unpublished, 1992).
- Wharton R, Lewith G: Complementary medicine and the general practitioner. BMJ, 1986;292: 1498-500.
- Unconventional Medicine: An International Collaborative Research Project. Research Council for Complementary Medicine, COST Project B4(RCCM, London, 1992).