'This house believes that complementary medicine does more harm than good'

Professor Michael Baum: for the motion

Professor Baum began by defining what he thinks patients with life threatening diseases need.  He said  'patients need to get better and that is where medical science leads the way. 

Once they’re getting better they need to feel better, and that’s where complementary medicine has its role... and finally patients with life threatening disease need to live better, and to help them live better they need some kind of spiritual support, and in this area, this grey area. For the secular amongst us I believe the arts play in that role, and for the religious amongst us I believe the faith communities plays that role.  I also believe it is a plausible hypothesis that helping patients with their spiritual concerns and making them feel better through complementary care may indirectly help them get better'.

He added that in the 1990s he had been instrumental in getting art therapy introduced to the Royal Marsden Hospital.  His objection is to 'alternative' therapies which claim to treat major disease.  'I have a series of horrific photographs of patients with advanced breast cancer, horrible ugly stinking ulcers which would shock you and each one of these had chosen to have natural cures'.  He says of websites which promote curing cancer by diet and vitamins alone 'this is cruel, this is evil and this should be illegal'.   He adds that homeopathy is sometimes promoted for 'all sorts of lethal diseases'.  Hence Professor Baum has come to the conclusion that CAM does more harm than good.

 Professor George Lewith: against the motion

Responding, Professor George Lewith first talked about risk: 'Distorting the reality and deliberately misleading patients is bad stuff and there is good and bad in complementary and conventional medicine.'  However it was misleading to draw a line portraying complementary medicine as unsafe and unproven and conventional medicine as working smoothly. 'If you look at some studies from the US, they suggest that the death rate from adverse reactions to some drugs is greater than the death rate from cancer'. 

He criticised Professor Baum and others for implying that complementary medicine was not even worth researching. 'Michael and some of his colleagues have argued that we should stop teaching complementary medicine in some of the modern universities like Westminster and Thames Valley, and secondly that we shouldn't invest in research.  We won't get any further unless we do invest in research'.

He argued that although there are problems with complementary therapy safety and some herbs in particular have been rightly withdrawn, the risks often tend to get overstated. 'I remember having a debate about ten years ago about acupuncture.  It was very dangerous, very harmful. Now we've now got prospective studies with over half a million acupuncture consultations, we know it's safe. 

'Simon [Singh's] been on about how dangerous chiropractic is.  Now just because stroke has sometimes happened after manipulation doesn't mean the two are causally linked.  There's good evidence that the incidence of stroke is the same whether visiting a GP or a chiropractor with the same problem.'

He believes that some opponents of complementary approaches don't present a balanced view to patients, who sometimes respond by pursuing alternative health options in secret because they can't talk to their main healthcare provider about it.

He added that what patients want to do is 'trade off' and get the best of both methods.  He agreed with Professor Baum that mistreating cancer with alternative medicine was suicidal, but argued that 'right wing oncologists', not miracle cure websites were the main reason for abandonment.  

'I just systematically reviewed 26 papers looking at why people use CAM for complementary medicine and we focused very clearly on abandonment. We didn’t find a single case in 26 papers, not one case which someone had gone to have their alternative cancer treatments because of what they read on the web, that is pure fiction, it is not supported by systematic science, it is scaremongering.'

He pointed to places where there's a growing evidence base for complementary approaches. 'CAM helps with a range of illnesses, there’ve been some good systematic reviews of irritable bowel, depression and back pain'

He believes that RCTs can't work in acupuncture because there's no good placebo.  'What we know about acupuncture and pain is it doesn’t matter necessarily where we put the needle, but when we put the needle in, for chronic arthritic problems, painful conditions like migraine, we get twice the effect that you do without using that method.  Now there are two conclusions from that, one conclusion might be that acupuncture doesn’t work, the other conclusion, probably a more reasonable one, given that it’s twice as effective as conventional medicine, is that we don’t have a very good placebo and that it's very difficult to design a placebo in acupuncture'.

Simon Singh: for the motion

Simon Singh, by contrast argued that newer acupuncture trials showed smaller and smaller effects.  He added 'But the really important point here is, is this as good as it gets for my opponents? - acupuncture for pain and nausea is as good as it gets.  We’re going to acupuncture for everything from depression, to hay fever, high blood pressure, solving liver disease, mental problems, rheumatism, diabetes and so on.  All these treatments are claimed for acupuncture, but there's virtually zero clear evidence.  So in that case I would say for the majority of conditions acupuncture does more harm than good.

He went on to say that there's no compelling evidence for 'spiritual healing, homeopathy, crystal therapy, magnet therapy, reflexology, reiki and many others'.

He argued that while these do no direct harm, they may be used as an alternative to proper treatment, or lead to a delay in seeking proper treatment.  For instance, he said 'only three per cent of homeopaths in a 2002 survey believed that the MMR vaccine was good for children.'

David Peters: against the motion

David Peters said that healthcare costs were spiralling because of chronic disease coupled with longevity. 'It has industrialised in the face of this onslaught. Michael's a very experienced and caring doctor and I don’t believe he is typical by any means of what’s happened to doctors in industrialising processes. But I think many begin to downgrade the time spent on compassion'. 

Summing up, he said: 'If you believe complementary practitioners are all conmen with an anti-science agenda, then actually campaigns are justified.  I’m not going to get into conspiracy theory, but whose interest is it to entirely ration healthcare according to what you can force through the randomised controlled trials designed for drugs.

They’re designed for looking at mass effects, they’re designed - in general and with success - to tell us what happens when an enormous number of people are treated by a single drug.  It’s very hard to research something complex in that way.  If we insist in national healthcare working that way, what we'll get from the NHS is a drug service. 

'Complementary medicine has its place but if we support those who practice it badly, fraudulently, carelessly, in an unregulated way without being properly educated, then we will end up with a system where complementary medicine is no longer available to us, I don’t think we want that.  In its essence complementary medicine does far more good than harm, but it has to be done in context, it has to be done well, if and ideally it has to find its way into integrated relationships with mainstream medicine. 

Integrated medicine is not 'what works mixed with what doesn’t work', as Michael suggests.  We have a problem with all kinds of medicine, part of it works and part of it doesn’t but we often don't know the odds. 

We need integration because we have the crisis of cost, care and profession.  We need medicine which begins to create health, not just wage war against disease.  Somewhere in there there may be some very interesting and important knowledge to be gaining by diving in deeply to research.  So I oppose the motion that complementary medicine does more harm than good.'