The lurking fear in Tredinnick's Integrated Health Care debate

Last week I mentioned that David Tredinnick, Conservative MP for Bosworth, was being a bit silly in the lead up to his adjournment debate on integrated healthcare.  At the time I boldly suggested that if Tredinnick was the best ally alternative health had in the Houses of Parliament then it was in a great deal of trouble.  Sadly I may have been too confident.  The transcript of the debate is now available and Tredinnick’s contributions are as fanciful as you would expect.  However, it is not these that cause me concern, the man is not a credible figure and his voice carries little wait in tilting the healthcare debate one way or another, it is Anne Milton, the Under Secretary of State for Public Health, whose replies are troubling in many respects.  Readers may be interested in her pronouncements about ‘service providers’, and changes to the structure of NHS healthcare, which suggest some hard questions about their commitment public healthcare need to be asked of the new government.  My focus though, as usual, will be on those replies more pertinent to quackery and its regulation.  While Milton is clear and sensible on the need to defer to NICE and the evidence base, especially in these uncertain economic times where finite NHS resources are already strained and further threatened by the enthusiastic swishing scalpels in the Treasury, there are nevertheless some arguments that offer succour to alternative practitioners.

From her second paragraph:

My hon. Friend may be interested to know that although I trained as a nurse and worked in the NHS for 25 years in conventional medicine, my grandmother trained at the homeopathic hospital in London, and was herself a homeopathic nurse. Later, she became a Christian Scientist. I am therefore not without my own roots in alternative therapies. My hon. Friend may also be interested to know that my grandmother never, until her death at the age of 89, took any conventional medicine.

While this may be an opening gambit of flattery, designed to lessen the rejection of Tredinnick’s ideas, the claim about her grandmother does not seem particularly appropriate.  While good health, of the sort that lets you live until 89, may not require conventional medicine so much as luck, in both genes and environment, it is undeniable that many lives are saved by its use.  To imply by anecdote, not the most reliable of measures, that homeopathy may allow one to live long in the absence of accepted healthcare is unbecoming of a health minister upon whose decisions the health of millions rests. Worryingly the following paragraph suggests the the Minister may indeed have some mistaken opinions about the benefits of an agitated sugar pill.

My hon. Friend raised the issue of homeopathic hospitals and his concern about them. I understand that there are five such hospitals in the United Kingdom, based in London, Bristol, Tunbridge Wells, Liverpool and Glasgow. However, the Tunbridge Wells homeopathic hospital stopped providing services in March 2009 owing to the primary care trust’s decision to end funding. All the hospitals have experienced a reduction in the number of referrals over the past three years, and it has been claimed that all of them are now in a precarious position as a result of such significant funding losses. That is a matter of concern, given that they have clearly offered valuable treatments to patients.

I would like to know the evidence that showed clear benefit from these relics.  It certainly isn’t in the Science and Technology Committee report on homeopathy, which the Minister claims to be considering:

I note my hon. Friend’s comments on the Lords [sic] Science and Technology Committee report on homeopathy, and I am aware that it caused quite a lot of concern. It was published on 22 February, and we are still considering it and will formally respond in due course. He raised considerable concerns about the report, and highlighted the low cost of many alternative therapies and the important contributions they make. He also made reference to experiences from around the world-he mentioned Australia in particular, and also the USA-and he made an important point about the open-mindedness of some countries to alternative therapies.

In considering outcomes, patient-reported outcome measures must be an important factor. As my hon. Friend rightly said-and as I mentioned-individuals’ own experiences are very important, and if we want to achieve the best outcomes, one step we must take is to ask the patient whether they actually got better.

In conclusion, I wish to thank my hon. Friend for his contribution to the debate and to suggest that perhaps the picture is not as bleak as he fears-I noted a certain weariness in his voice; he feels that he has raised this issue on so many occasions and it has fallen on deaf ears.

I do not expect the government to fundamentally disagree with the reports recommendations, that would be a foolish fight to choose given homeopathy’s many vociferous critics, however the comment about patient-reported outcome measures intrigues.  As mentioned in the previous post on Tredinnick, these are the brain child of Boo Armstrong, ex-writer for an AIDS denialist magazine and former Chief Executive of the Prince’s Foundation for Integrated Health (FIH), and a rather curious thing for the Minister to pick up on.  While an inherently weak form of evidence that NICE would not normally consider, they are amenable to misinterpretation by those seeking to attribute what most would consider human bias to unscientific modalities, or magic if you prefer.  One wonders who briefed Anne Milton before this debate and why she considers that alternative therapies are not as threatened as Tredinnick fears?

Perhaps the answer to this lies in the new government’s views on regulation:

The issue of regulation was raised, and it is a thorny one. When I was a shadow Health Minister, I met on numerous occasions psychologists, psychotherapists and counsellors who were very concerned about the regulation of their professions. Across the professions allied to health care, there are those who are keen on regulation and those who feel regulation would be wrong and would be unable to deal with the intricacies of their work. There is no doubt that vulnerable people are often preyed upon by unskilled and unscrupulous practitioners, and I think that professions wanting to achieve the highest standards will welcome proper regulation. The issue for Government is always whether statutory regulation is the most appropriate way of dealing with that risk, or if a lighter-touch approach would be more appropriate. That is why, as I understand it, last year the Department of Health, along with devolved Departments, consulted on the regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine. As my hon. Friend will be aware, the consultation closed in November, and more than 6,000 responses were received. The high response rate is a testament to the strength of feeling about public access to complementary and alternative medicines; I am sure I am not alone in having received a huge number of letters on the subject.

The consultation examined in detail the options for regulation, including alternatives to statutory regulation. Once the Government have considered the consultation responses, we will make clear the next steps in the regulatory process. In acknowledgment of my hon. Friend’s keen interest in the matter, I am very happy to keep in touch with him about it. In the meantime, the Complementary and Natural Healthcare Council [CNHC] provides for voluntary registration for practitioners from nine complementary therapy disciplines. I appreciate that my hon. Friend feels that that is not sufficient, but that is in place for the moment while we consider the consultation that has taken place and make a decision on what the next steps should be.

While there is no firm commitment to any particular position here there are two things the Minister needs to consider.

1) ‘light touch’ regulation does not work.

The CNHC have declared that they will ignore complaints from some members of the public, and have been utterly ineffectual in what little concerns they have considered. Not only that they have had to tolerate some outrageous conspiracy theories and false accusations widely circulated by email.

2) Statutory regulation does not work.

Consider the Chiropractors, The General Chiropractic Council (GCC) are supposed to be the statutory body that regulates Chiropractic.  However, since one of the GCC affiliate associations decided to unsuccessfully sue Simon Singh, the profession has found itself under considerable scrutiny, with many of its members subjected to professional standards complaints.  The GCC have been obstructive, inconsistent, dishonest and completely ineffectual in dealing with these.

The regulation of quackery requires some fresh thinking and if the government chooses either of the options above then there will only be chaos from quacks and complaints from skeptics.  Whatever their choice it looks like the eternal battle between reason and woo will continue.  With the collapse of the FIH, quackery is in search of new allies and its former employees may already be making contacts.  As the governments ideologically enthusiastic and economically necessary cuts bite, the temptation to favour cheap placebos may lead many astray.  Anne Milton may not yet have chosen her side, but her lack of commitment is telling, the dark mutterings of the deluded are being listened to if not yet obeyed.