NHS approves alternative therapies

[Brett m]

Saw this on the Healthypages home page:
http://www.massageplanet.net/newsitem.php?news=6035

It relates to NICE approving various alternative therapies to alleviate back pain.

This is the story from timesonline:
http://www.timesonline.co.uk/tol/life_and_style/health/article6368290.ece

This is the good news (from the timesonline):


But this is the big question:


More money needs to be put into research into what is going on in "healing." At present it's hard to fund high quality research into any area that is not going to benefit the sales of a drug. If it's hard to fund such research it's going to be hard to produce well designed trials to test alternative therapies.

There is some hope here. More complicated delivery of more highly engineered drugs is coming up with some unexpectedly poor results, with no significant difference to controls. There is increasing interest in what is actually going on in the placebo effect.

Still very interesting news!

Norbu

 

[AMPhoto]

Hi Norbu,

Forgive an old cynic - I see the profit-driven drug companies doing whatever they need to to hang on to their profits. If this includes paying some professor to rubbish anti-drug therapy they can do this easily. In fact it happens all the time.

If you can gain access to the booklet (forget who publishes this, but all universities have copies) which shows the available major research grants you will find its mostly drug companies dolling out the cash.

When I did my post-grad research at Durham I was amazed at the long reach of the pharmaceutical companies.

Some charities are also in there, supported by, you guessed it, drug companies.

David

 

[Xzara]

LOL, I love that quote:



Shows some ignorance on somebody's part somewhere. Even if they were using toothpicks, they would still be stimulating the meridian points, just like tapping with EFT/FreewayCER etc. It's not necessary for it to be actual needles sticking into the skin. So it wasn't "placebo" or a dummy treatment, it was a real meridian treatment, just using different tools.



All Love and Reiki Hugs

 

[--------------]

It depends which paper you read as to what the experts are saying. It's reported in the Nursing Times to the Guardian ... selection of links below.

It also ties into my Open University Course on Complementary Therapies as we're looking at Integrated Medicine at the moment!

http://news.sky.com/skynews/Home/UK-News/Backache-NHS-Watchdog-Nice-Approves-Alternative-Treatment-For-Back-Pain-Including-Acupuncture/Article/200905415289225?lpos=UK_News_Third_Home_Page_Article_Teaser_Region__7&lid=ARTICLE_15289225_Backache%3A_NHS_Watchdog_Nice_Approves_Alternative_Treatment_For_Back_Pain_Including_Acupuncture
http://www.channel4.com/news/articles/uk/back+pain+nhs+to+offer+acupuncture+/3173257
http://news.bbc.co.uk/1/hi/health/802787.stm
http://www.guardian.co.uk/society/2009/may/24/back-pain-sufferers-acupuncture-nhs
http://www.timesonline.co.uk/tol/life_and_style/health/article6368290.ece
http://www.nursingtimes.net/whats-new-in-nursing/acute-care/nice-endorses-acupuncture-for-lower-back-pain/5002049.article

 

[rahuhzun]

Have you seen the details of the design of this trial? If the trial merely swapped one tool for another being used by an experienced acupuncture practitioner then would you agree that it would be an unnecessary risk to use an acupuncture needle and that NICE should only approve acupuncture using toothpicks?



But what is a placebo exactly? Perhaps we should just accept that mumbo jumbo heals

Norbu

 

[Donald]

I'm not saying it doesn't happen but I think we should take a balanced view with respect to the empirical process. If the results of clinical trials are going to be taken seriously they are only going to be run under tight protocols. This is an expensive process and is only done when a hypothesis for the effect of an intervention is based on a plausible causal explanation based on the existing body of research and theory. Now I'm not saying that this is a perfect process by any means but, at least in terms that our society recognises, it is more reliable than any other method we have come up with so far. I have a good friend that is a medical writer and I have every confidence that, while he uses the skill of the written word, his integrity in reviewing trials is unquestionable. For a pharma company to get strong endorsement for their products they need to get well respected medical writers to report the findings of their trial data. Good medical writers do not tell lies despite there being pressure for them to do so. If they do, their credibility soon becomes subject to question and pharma companies then don't have much use for their opinions.



Would you include the work funded by the Wellcome Trust in your suspicion? I'm not suggesting that the empirical process is anything but a slow process but work done on CBT and MBCT has been paid for by the Wellcome Trust and this work, I believe, will be seen in future as a major turning point in mainstream understanding. This work is significant because it has built a bridge across a gulf, where psychiatry previously did not accept that mind training could benefit well-being; now it does. Of course some aspects of spiritual practice or alternative therapies may continue to be untestable and some may be shown to be little more than mumbo jumbo, but some will be better understood and this will benefit many (e.g. MBCT). I just think that the world of alternative therapy will have more to loose in the long run by not recognising the value of the empirical process.

Norbu

 

[Piggy]

Hi,

Drugs companies use every tool they can, including Medical Writers.
Sales of drugs are not dependant upon Medical Writers, though.

Take the latest drug to hit the headlines - Alli. Its a horrible anti-fat medication, designed to stop the body from absorbing fat. Its been used at full-strength as a prescription-only medication for ages.

Trials of this drug as a prescription-only medication showed that it worked - under controlled conditions.
One step away from that is GPs precribing this med. Clearly in the real world there is less control put on patients and how they use the drug.
However, the trials looked good on paper, and were obviously endorsed by someone for the med to be allowed onto the prescription list.

When it was released for over the counter (OTC) sale a few weeks ago, we (the public) were repeatedly told by the media that it would only be sold to very overweight/obese people.

Within three days a whacking great TV advert appeared for Alli. This has been repeated several times that I've seen.
Pharmacies were also issued, on request, with big posters for their windows. And the drug hasn't even been properly trialled in its OTC form. Neither the posters nor the ads were targetting very overweight/obese customers.

I don't have the time to reply properly to your post - apologies for that, but I'll certainly do a search on The Wellcome Trust and report back, with refs.

David

 

[offegorub]

No I haven't gone into the details.
However, I agree that if they're going to swap needles for toothpicks it shouldn't be called accupuncture, because that wouldn't be accupuncture. However, it would still be a valid way of stimulating the meridian points and so they've had the same effect just substituting one meridian based therapy for another (or they've in fact created a new one with toothpicks, perhaps they should call it pickupuncture! )


Placebo is what scientists call it when someone shows positive healing from what they believe can have no scientific basis. They agree that placebo exists, they agree that it does have a healing effect. What they can't agree on it how it's working. So, in effect, the scientists are happy to admit that something they don't understand does actually work.

But of course they wouldn't admit to that openly.

All Love and Reiki Hugs

 

[Crissa]

Now there's a thought!



From a scientific perspective I think a better definition of placebo would be an effect that is observed but not explained by means of a body of theory. This doesn't mean that a body of scientific theory never will be established to explain the processes that result in observed placebo effect.





I don't think that this is really the case. I understand the issue with using placebo's is more about ethics.

I'd just like to point out that I believe that being scientific is in the interests of all. It is, after all an assessment of the the merits of various forms of treatment for back pain that has lead to NICE decision that it is better to use alternative therapies (where there is no medically identifiable cause) on the basis that they are more cost effective and that may be because they are more cost effective placebos.

Norbu

 

[Poopypuss]

Hi again,

Thanks for replying previously BTW. I have a
bit more time now.

Now, you said:

"I'd just like to point out that I believe that being scientific is in the interests of all".

And if it was a level playing field, and if science was as scientific as scientists make out, then I'd agree.

But when I see, first hand, material openly plagiarised by colleagues who are also PhD Candidates. When I hear a Prof say he's going to give an "opposing" Uni candidate a hard time because I (as his student) had a hard time with his oppo in a Viva. When I read "research" and try to duplicate the equipment and methodology - and it plainly can't possibly work - this is at post-doctorate level BTW, and a Paper has already been published describing this research in a prestigious Journal - and when I talk to the techs (in a Gold Standard Uni Workshop) who make the experimental equipment, I have the sneaking suspicion that much research is not really scientific at all.

Anyhoo....

I've done a brief search on Google Scholar and Turbo 7.
Both go deep-web evidently, but certainly Google Scholar I can trust.

Here's what I came up with, relating to the Wellcome Trust:
http://www.wellcome.ac.uk/About-us/History/WTX052938.htm

Actually I came up with a whole lot more. But if you are seriously interested in looking at this, that ref is the one to chase.

Wellcome have a big pharm/profit interest.


David

 

[Dersilbhild]

Dear David,

I don't think I've suggested that drug companies are free of commercial interest and that this distorts the direction of research. Neither have I suggested that researchers are free from human weaknesses. I'm not trying to defend the negative influence of personal interest or commercial interest.

What I have said is that the scientific process is one that is valuable and that it is the best one that society has come up with to test the efficacy of a therapy. And that this process has led to the widespread use of CBT and increasingly MBCT in depression related illness. This has only been possible through clinical psychological research. Actually I think it is ironic that some of the money that has paid for this research originally came from drug companies.

It is through establishing the efficacy of a therapeutic approach across a population in a clinical trial that large scale decisions are made by managers in the Health Service. In the case of alternative therapies for back pain this has resulted in demonstrating that allopathic approaches to dealing with this problem (where a medial cause has not been identified) are not cost effective. NICE has recommended that alternative therapies are more cost effective. Is that a bad thing?

I, for one, hope that more money will go into researching alternative therapies. Do you think this would be a bad thing if there was better understanding of healing in terms that would persuade NHS managers to spend more public money on alternative approaches and reduce the use of drugs in therapy?

Norbu

 

[orvbodjc]

Hi,

What you said (asked) was:
"Would you include the work funded by the Wellcome Trust in your suspicion? "

I would, and searched out a ref to show that this was indeed the case.

I think it would be an excellent thing if the drug companies pumped more money into complimentary medicine research - but lets be honest - this isn't going to happen if there is the slightest chance that it will affect their sales. NICE has said one thing - an "expert" has said something else. Its pretty easy to see how this game is played.

Major Universities depend upon grant funding for most of their research. The grants are paid, directly or indirectly, by vested interests.

I know empirically that much complimentray therapy works. I also know empirically that much of our NHS medication, taken by millions on a regular basis, is either not needed, wrong for the patient, or needed but in smaller doses. But me knowing something is not going to change things.

Professor Pali Hungin (Dean of Medicine) has been quoted as saying " despite billions being spent on pharmaceutical research, most new preparations perform little beyond placebo, which in itself appears effective in 20-80% of sufferers"
Dec 2006 - Talk in London - The Patient with Nothing Wrong: The Rising Tide of Functional Illness in Society.

There is a wealth of information out there to support this.
Read the Paper Listening to Prozac but hearing Placebo (Kirsch and Saperstein) for example, and then search their refs - the list just goes on and on.

Then there are the Talks and Meetings which GPs and Nurse Practitioners have to attend to keep their CPD up-to-date. Each one is sponsored or part-sponsored by - guess who?
Then there are International Conferences which are subsidised - again - who do you think does that?

So I guess I'm saying I agree with you about the research aspect, as long as its done properly, but I don't believe it will make too much difference to the status-quo. The drugs people just have too much money, power and influence.

Sorry to sound so negative. Maybe someone else has a plan of how this could be changed?

Good discussion.

David

 

[iveexusfiapimkezt]

Dear David,

I don't disagree with most of your rant, if you'll forgive me for describing it like that, all I'm saying is that I believe the tide has turned with the research done on CBT and MBCT (much of which happens to have been funded by the Wellcome Trust). I will just like to mention again that this work has resulted in the NHS paying for people to learn to meditate and now main stream Psychiatry is now prepared to discuss the idea that mind can effect neurophysiology as well as the other way round. This I, would argue, is a massive step forward.

When it comes to other ways that things can change, I believe that cost will be a major factor that will lead to more new (expensive) treatments failing to be NICE approved as they will show poor value for money. Then there is the general change in popular opinion, belief, understanding etc that I believe is very much part of a widespread process of change.

I guess, I'm saying, rant away but ranting isn't going to solve the problem either! I'm aware of many of the kinds of obstacles you describe. However, there are some very good people working in these areas (I'm not talking about my medical writer friend) who are having to be very careful about slowly pushing back the frontiers of clinical science. They need to maintain the highest level of credibility in this field. And when these researchers produce their work there is increasing interest as with MBCT.

On the other hand, tarring all science and clinical research with the same brush only brings resistance. Sometimes with a dismissive and angry response, which may also be combined with ridicule at alternative therapy mumbo jumbo.

Norbu

 

[The One With Three Eyes]

Hi Mark,

The NHS is not paying for people to meditate except in a few instances. It is not widespread practice as far as I can see - happy to be corrected on this if wrong though.

Mainstream psychiatry has known and accepted for many years that the mind can affect neurophysiology. If not they haven't been keeping up with their reading, because there is a large body of research which shows this. There is, of course some territory protectionism going on between psychiatry (who treat medically and surgically), and psychologists (who tend to treat a little more holistically). Most of the research has been undertaken by psychologists I believe.

See this thread
http://www.massageplanet.net/forum/showthread.php?t=64366

It'll be interesting to see how NICE reacts to new, expensive treatments proving poor value for money. My guess is that it won't make much difference. It certainly hasn't so far.

Rant is perhaps a little strong - but I do feel very strongly about the duplicitous treatment of our medical system by vested interests.

Research certainly has its place, but sometimes its also good to know your enemies.

David

 

[Tessa]

I don't believe you are correct. I don't think there is even a model of "mind" outside it being generally considered to be an epiphenomenon in mainstream psychiatry. Things are, however, changing...

I'd just like to quote this from the forward of "Mindfulness-Based Cognitive Therapy for Depression" (Segal, Williams, Teasdale, 2002).



Time will tell.

Norbu

 

[Myhoo]

Just wanted to say I've really enjoyed reading this thread!

Back in 2005/2006 I wrote my social anthropology dissertation on the uses of complementary therapies in the context of UK palliative care services (I was working in a hospice at the time which used a lot of complementary treatments for it's patients, to alleviate pain and stress and improve quality of life).

Whilst mine was not an empirical based study (I was conducting ethnographic research) I had the chance to read a lot of the available empirical papers, the arguments against and counter-arguments etc and found the contentions between the medical professions and complementary/alternative medicine really fascinating.

I am a bit rusty, but I remember some studies identifying different factors which play a role in placebo responses, the response is very subjective and depends upon a number of variables so it's very, very difficult to isolate these in clinical trials especially in complementary medicine... from what I understand, randomised controlled trials used to test drugs are designed to eliminate subjective variables and 'placebo' responses to prove it is the drug creating the healing effects and nothing else, however in complementary medicine it is these subjective variables which will have an impact on the efficacy of a 'placebo' response and therefore could impact on the results of treatment if treatment relies on subjective variables (this of course depends on your view of 'placebo' responses and how much a part they play in any given therapy). It's not impossible to empirically test, but it is difficult to produce results that will not be questioned by the scientific community. I would also like to see more study go into unravelling the 'placebo' effect itself, as it is quite effective and can often even be improved by manipulating the variables to suit the person being treated.

On another note, I agree with the post above that mentioned the apparent scepticism and animosity of medical professionals being linked to ethics in medicine. I remember one quote by a doctor in response to a study on the impact of positive thought on breast cancer survival rates (I think the study was by Spiegel et al, it was a very sound preliminary research paper from what i could see). This doctor argued about how we only ever say these things in connection to diseases that we do not understand, or that have no cure or clear pathology.... she was saying something like "well we do not say we can 'think' ourselves better when we have illnesses like syphillis or tubercolosis, with clear causes that we understand".

There are other issues raised by medical professions too regarding the raising of false hopes of a cure, that patients might be led to reject tried and tested medicines that are proven to work.... also ethical issues with providing a 'treatment' that they know has no actual 'effect' in itself as such although the patient is told it will have an effect (interestingly, some countries do have medical professionals who will try using placebo 'sugar' pills quite frequently to treat minor ailments but I think this is not the case in the UK... also interesting how homeopathy is quite highly regarded by medical professionals in Germany although other countries will reject the same evidence of it's efficacy).

It was very interesting conducting anthropological research into these issues. Anthropology by it's nature rejects the idea that everything can be tested empirically... empirical testing is good and important, but in Anthropology it is just a small part of the bigger picture because in anthropology the world ceases to be an objective place! So my own study was more focused on the attitudes, beliefs and values of patients and professionals in the Hospice context and not so much looking for 'proof' that therapies worked, it was more focused on the uses of the therapies in the context of treating people with medical conditions that were terminal and unlikely to improve.

Anyway, my rambling's over...

 

[Mistress Mayhem]

Perhaps, our culture is caught by the illusion of the independent existence of the "object" like no other culture in history to date.

Every culture has to establish systems of probity. While there are faults with the illusion of objectivity (testable by classical empiricism), it does at least break the stranglehold of kinship, lineage, and projections of self of the personality of patriachal leader of traditional societies even if it is not free from bias manipulated by those who hold power. Like democracy it is a blunt instrument but I believe it is the best instrument by which authority may be tested socially that humanity has developed to date.

And the fact is that the epistemology of classical empiricism is an important tool to influence power in our society, so that is why we need to know how to understand it and use it effectively.

Norbu

 

[m_s2k7]

I completely agree! But would be very interested to see more 'integrated' research into this subject, using a variety of methods alongside empirical study to really thrash out what the variables are and how they interact and influence treatment outcomes, also more dialogue with practising therapists as to why some studies fall short and what they make of the experiment conditions and research outcomes.

 

[Adian]

Hi CG,

This won't happen unless the scientists pay for their own research. As I previously stated on this thread, the research pot-of-gold is controlled by drug company interests. And while they may be willing to fund some research, the vast majority of the money will always tend to go towards propping up vested interests.

David

 

[partly cloudy]

If you want to know how medical research is funded in the UK have a look at the Medical Research Council.

Myarka.