Head To Head: Should NICE Evaluate Complementary And Alternative Medicine?

Demand for complementary and alternative medicine is high despite limited evidence. In this week's BMJ, researchers go head to head over whether the National Institute for Health and Clinical Excellence (NICE) should review these therapies.

NICE was set up as an independent body by the UK government in 1999, charged with getting the best from NHS resources. It examines the value of treatments and decides whether they should be used in the NHS.

Around half of general practitioners provide access to complementary medicine, and two thirds of Scottish general practitioners prescribe herbal or homoeopathic medicines, so a thorough review by NICE would benefit the NHS and patients, argue Professor Linda Franck and colleagues.

Some people within conventional medicine remain deeply convinced that alternative medicine cannot have any possible benefit, but this is all the more reason that these therapies should be rigorously evaluated, they argue.

They believe that failure to evaluate complementary therapies also leads to health inequalities because of uneven access and missed opportunities. For example, as complementary therapies are often relatively cheap, if shown to be effective they could save money currently spent on costly drugs.

Complementary and alternative therapies deserve a full evaluation from NICE and, if the evaluation is favourable, they should be adopted either on their own or integrated with conventional medicine, they conclude.

But Professor David Colquhoun argues that NICE cannot afford to re-examine evidence that has shown little benefit.

He points out that NICE already have alternative treatments in several of their reports and, in all these cases, they have found no good evidence for anything more than placebo effects.

And it is not necessary to take the word of sceptics about the lack of evidence. The more honest advocates of complementary and alternative medicine admit it themselves, he adds.

None of this is intended to deny the important role of supportive and palliative care for patients for whom that is the best that can be done, he says. But there is no need to subscribe to the early 19th century pseudoscientific hocus pocus of homoeopathy to treat sick patients sympathetically and holistically.

And there is no need for NICE to spend time and money coming to that conclusion when it has more important things to do, he concludes.