Response to Doctors’ Campaign Against Alternative Therapies Eileen Marshall Margaret Williams 24th May 2006 Members of the ME community may have read a letter that was published in The Times on 23rd May 2006 from a group of eminent (ie. so-called “establishment”) physicians and scientists who are strongly opposed to what they call “unproven or disproved treatments” that are now being encouraged for general use in the NHS. According to the BBC, this letter was sent to the head of every single Primary Healthcare Trust in the UK – almost 500 of them -- urging them to “review practice in your own Trust with a view to ensuring that patients do not receive misleading information about the effectiveness of alternative medicines. We would ask you to write to the Department of Health requesting evidence-based information for trusts and for patients with respect to alternative medicine”. The letter asked the recipients “to join us in representing our concerns to the Department of Health” and stated: “There are two particular developments to which we would like to draw your attention. First, there is now overt promotion of homeopathy (sic) in parts of the NHS (including the NHS Direct website). A recently-published patient guide, promoting the use of homeopathy (sic) is being made available through Government funding”. The letter continues: “Secondly, there has been a concerted campaign to promote complementary and alternative medicine as a component of healthcare provision. Treatments covered by this definition include some which have not been tested as pharmaceutical products”. It goes on: “At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence. Our ability to justify to patients the selection of treatments is compromised if we abandon our reference to evidence”. The timing of this letter was significant, because it appeared on the very day the HRH The Prince of Wales was to address the World Health Assembly (and his support for alternative and complementary medicine is well-known, as is the fact that members of the Royal Family have used such interventions for many years: indeed, it is said that the Queen never travels without a homoeopathic medicine chest). Apart from the signatories’ notable lack of rejoicing about the fact that in many instances homoeopathy actually works -- which means that patients benefit from it – even if the way in which it works remains undetermined (and something that is of benefit to patients ought surely to be the raison d’etre of such eminent medical and scientific persons), the argument promoted for the non-use of therapies that work requires scrutiny. The letter makes it clear that in the delivery of healthcare, the signatories urge reliance on nothing but “evidence-based” interventions and that they believe such interventions are those that use “pharmaceutical products”. Here, once again, seems to be the voice of HealthWatch, a campaigning organisation that was set up to serve the interests of the pharmaceutical industry and which has an established track record of militant opposition to alternative and complementary medicine and to the extermination of its practitioners (see for example Hansard (Lords) 28th April 1993:364-382 and Hansard (Lords) 10th May 1995:66-68). Despite furious denials from one of its founders (the President of HealthWatch, Nick Ross of CrimeWatch fame), its own early literature is very clear about its objectives, and it is an irrefutable fact that it has in the past accepted money from both the pharmaceutical and health insurance industries. Some of the signatories to the letter to The Times are, or certainly were, members of HealthWatch, whose other members of relevance to the ME community include Professor Simon Wessely and Dr Charles Shepherd. Professor Michael Baum, the lead author of the letter, was a major player from its foundation in 1985, while Professor John Garrow was a member of its Committee and held the post of Hon Secretary, whilst Professor Lewis Wolpert could fairly be described as an adherent of the “Wessely School”. If “acceptable” therapeutic interventions must be based on “solid evidence”, why does this concept not apply in ME/CFS, where the only interventions that are offered (sometimes under duress) and indeed permitted are antidepressants and behavioural modification programmes, including graded exercise regimes, which have been shown to be ineffective and sometimes dangerous. In this case, the very limited and equivocal “solid evidence” consists of only five RCTs and it is unknown how many participants actually had ME or in fact had some other form of “medically unexplained” fatigue. These RCTs delivered only modest and time-limited benefit, yet the UK Government has been happy to pour at least £11.1 million into these unsuitable interventions that cannot credibly be described as “evidence-based”, since ‘double-blind’ psychotherapy is impossible (ref: Clinical trials in psychiatry: background and statistical perspective. Tony Johnson (MRC Biostatistics Unit, Cambridge, UK): Statistical Methods in Medical Research 1998:7:209-234). It will be recalled that this is the same Tony Johnson who is currently assisting Simon Wessely with the MRC PACE trials. It is alternative and complementary interventions which are the very ones that often deliver benefit to the unfortunate and much-abused ME/CFS patients, yet here we have yet more confirmation of the influence of powerful vested interest groups whose aim seems to be to deny and prevent such benefit. Since doctors no longer swear the Hippocratic oath, some of them seem to have forgotten that the aim of medicine is to prevent, not compound, suffering.