MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Dear edzard

I am sending you Richard Eaton’s excellent update on developments around complementary medicine. As you will know, the College is supportive of an integrated approach that offers each patient the best of both worlds – conventional and complementary. In both worlds it is important that treatment and advice offered is safe, appropriate and evidence based…

Thank you for your continued support of the College of Medicine.

With best wishes,

Dr Michael Dixon
Chairman
College of Medicine

I received this via email today, and of course I was interested. The ‘excellent update’ turned out to be truly amazing. For reasons that will become clear when you read on, I will abstain from any criticism – but I urge you to read it in full and perhaps let me know what you think by posting a comment:

START OF QUOTE

The Charity Commission’s Consultation: The use and promotion of complementary and alternative medicine – Making decisions about charitable status, (13.03.17):

The deadline for responses to the Charity Commission’s Consultation about the charitable status of CAM expired on 19th May (see the May edition of this blog). Many responses were filed, including by The Complementary & Natural Healthcare Council (CNHC) and by The College of Medicine.

Confusingly, the Commission’s Consultation Document expressly provided (in the section What the Commission is not consulting on at page 5) that:

‘…This consultation is not about…whether or not CAM therapies in general, or any particular CAM therapies, are effective…’

Yet logic dictates that the effectiveness of CAM and, therefore, the reliability of the evidence for it, will clearly feature significantly in the Commission’s deliberations as it assesses the extent to which CAM is of benefit to the public for charitable purposes.

The submission by The College of Medicine included the following:

‘…the continuing appetite of the public for access to CAM both in the private sector and through NHS organisations, should offer the Commission at least some reassurance that CAM has overall, a beneficial impact for those who use it…’

and further that:

‘…Whilst an RCT can be regarded as the highest level evidence, this type of study is not always the most suitable for assessing the benefits (efficacy/effectiveness) of CAM. Other research designs such as observational studies, surveys and qualitative methods can provide high quality information. In addition, RCTs invariably require very large budgets to underpin their delivery and CAM has not on the whole been the recipient of sufficient grant funding to enable large RCTs to be performed…’

The outcome of this important Charity Commission Consultation is awaited. It will be of huge significance to charitable organisations using or promoting CAM and to CAM practitioners and patients.

The Exclusivity of the Randomised Controlled Trial – the debate:

There is a continuing debate about the exclusivity of the Randomised Controlled Trial (RCT). Research articles about the RCT may be found here [Getting off the “Gold Standard”: Randomised Controlled Trials and Education Research: PMCID-PMC3179209] and here [Fool’s gold, lost treasures, and the randomised controlled trial-PMID: 23587187].
Further observations on the efficacy of the RCT may be found in the (free) April 2017 Newsletter published online by the Alliance for Natural Health International.

The Human effect and its desirability:

Also relevant to the debate about the evidence-base for CAM is the desirability of the Human effect. The Smallwood Report (The Role of Complementary and Alternative Medicine in the NHS: 2005), at page 23, makes the following observation:

‘…While some critics have derided the use of CAM treatments, claiming the success of some therapies to be purely based on a placebo effect, CAM proponents see what Dr Michael Dixon calls the “human effect” as desirable in itself…’
(Dixon & Sweeny, 2000 and see the BMJ book review here)

National Institute for Health & Care Excellence: CAM Updates

Practitioners of complementary and alternative medicine (CAM) may recall my November 2016 blog which referred to confirmation by the National Institute for Health and Care Excellence (NICE) that it had decided to retain its guideline on improving supportive care for adults with cancer, thereby ensuring that, for the time being at least, selected CAM therapies will continue to be available within the NHS in England & Wales. This guideline has been given the new title of End of life care for adults in the last year of life: service delivery and is currently “in development” with a publication date of January 2018 when it is hoped that CAM therapies will continue to be retained.

In the meantime, Further NICE guidelines have been published covering the planning and management of end of life and palliative care for infants, children and young people (aged 0 – 17 years) with life-limiting conditions. These aim to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives. Recommendations include (paragraph 1.3.25) consideration of non-pharmacological interventions for pain management including music and physical contact such as touch, holding or massage. These Guidelines will next be reviewed in December 2018.

As mentioned in my blogs posted in September 2016 and February 2017, NICE Guidelines regarding the assessment and management of low back pain and sciatica in people aged 16 or over (published in November 2016) have stopped recommending acupuncture. The removal of acupuncture from the guidelines conflicts with research published (in January 2017) by MacPherson H, Vickers A (and others) in The National Institute for Health Research Journals Library: Programme Grants for Applied Research, Volume 5, issue 3 (“Acupuncture for chronic pain and depression in primary care: a programme of research”), which concludes as follows:

‘…We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence…’

These Guidelines will next be reviewed in November 2018 when, again it is hoped, acupuncture will be reinstated and that Alexander Technique together with other beneficial CAM therapies will be included.

Professional Standards Authority: Accredited Registers Programme

Practitioners will already be aware of the Accredited Registers Programme which is overseen by the Professional Standards Authority for Health and Social Care (PSAHSC). This programme aims to provide assurance to the public, care commissioners and patients who are seeking health practitioners (including complementary therapists) who are not regulated by statute. The President of the Federation of Holistic Therapists (FHT), Jennifer Wayte, has suggested that:

‘…By signposting the Accredited Registers programme in relevant Guidelines, NICE would help to ensure better safety and standards of care…’ (International Therapist Journal, Issue 117 at page 17: Summer 2016).

Commissioning cost-saving CAM: The future for Integrated Medicine

In March 2016, The Kings Fund published its report Bringing together physical and mental health: A new frontier for integrated health about which a discussion can be viewed here and a blog by the FHT may be read here. In the News & Analysis section of its Health and Wellbeing Board Bulletin (06.06.17), The Kings Fund also highlighted the article published in The Lancet on 23.05.17 titled Forecasted trends in disability and life expectancy in England & Wales up to 2025: a modelling study which concludes:

‘…The rising burden of age-related disability accompanying population ageing poses a substantial societal challenge and emphasises the urgent need for policy development that includes effective prevention interventions…’

In the light of this and having regard to research such as that relating to the worsening mental well-being of year 10 school children, practitioners and their patients could lobby relevant Government departments, NICE and the PSAHSC regarding the potential of CAM as a cost-saving contributor to preventative and integrated medicine. In his Economic Outlook published in The Sunday Times on 23.04.17 (Business Section, page 4), Economist David Smith predicted frightening health spending as doubling from (roughly) 7% of gross domestic product to over 12.5% over the next 40-50 years and that social care costs will also double to 2% of GDP. Health spending policy makers and Clinical Commissioning Groups would do well to keep these (long-term) numbers in mind when assessing the potential of CAM and integrated medicine.

Further information about integrated and complementary medicine may be found in the Elsevier publications Advances in Integrative Medicine and the European Journal of Integrative Medicine and by accessing British Medical Journal (BMJ) articles such as Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour (as amended), which concludes:

‘…The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence…’

For further research and debate about the cost-effective integration of CAM into the NHS, please refer to the February 2017 issue of this blog.

Adopting a business approach to practising CAM

Turning to a very different topic, my message to Practitioners and especially to those who are in the process of starting or establishing their CAM practice, is that adopting a business approach to practice management is crucial. By doing so and without compromising their professionalism, practitioners can help to defend their freedom to practice.

The past year has been challenging for practitioners. It looks like next few years will be even more so as those working in the health and social care sectors continue to assess the implications of ‘Brexit’ and how these may affect their freedom to practise and their patient’s right to receive a CAM treatment of their choice.

As ever, much of the popular press continues to present an unbalanced and misrepresentative view of CAM. For instance, I have yet to see popular print or broadcast journalism properly cover The World Health organisation Traditional Medicine Strategy 2014 to 2023: Strategy Document which states (at page 19; note: italics added by me):

‘…As the uptake of T&CM (Traditional and Complementary medicine) increases, there is a need for its closer integration into health systems…’

(refer to my November 2016 blog for more information).

Contrast this with the column in the Times Newspaper (by a Times leader writer and columnist) on Tuesday 13th December last year, captioned:

‘…Prince Charles’s homeopathy fad is joke medicine…’

I suggest there has never been greater need for practitioners to ‘fight their corner’, including by effectively organising the management of their practice and promoting the health benefits of their treatments.

To this end, I suggest that practitioners need to accept that running a CAM practice is, in essence, the same as trading in any (small) business. The knowledge, experience, professionalism and ethical standards of a qualified, insured and properly regulated CAM practitioner are acknowledged and to be congratulated. Nevertheless, now more than ever, practitioners need to embrace business processes.

The following are some straightforward business processes that could assist your business and thereby enhance the health and care of your patients.

Business planning will help you to prepare for most eventualities, including when, like most businesses, your practice encounters financial losses or failures. Don’t delay taking good business advice and realise that it is sometimes what you don’t want to hear that constitutes the most valuable advice.

Remember, “people buy from people” so you need to build good rapport with your patients. Listen to what they have to say about you and how you provide your practice specialism(s). If appropriate, adapt the structure and delivery of your business to their needs and requirements. Give them the opportunity to provide feedback [maybe use: surveymonkey]

While established practitioners may have the well-deserved and hard-earned luxury of relying on ‘word of mouth’ recommendations to find them new clients, this will rarely be an option for a new practitioner. So, whether you are practising alone or in association with other practitioners, for instance at a Health Centre, do not wait for patients to find you. You need to go out and find them. Recruit them by actively promoting yourself and your expertise.

Join local and national business support organisations such as the Federation of Small Businesses and the Chamber of Commerce. Always attend their meetings, networking events and, if appropriate, Trade Shows. As the contacts you make get to know and to trust you, they are likely to seek your professional help for themselves and their family and possibly for their colleagues and employees, too. Encourage this by offering to give a presentation [maybe use: presentme] about your practice to local businesses, to community groups and to the employees and students of local colleges and universities. Introduce them to your practice.

Sign-up to (often free) supportive online business newsletters and memberships like enterprisenation.

Using, among other things, the feedback from your patients (see above), prepare a patient database and create a Marketing Plan and a Business Plan, including a cash-flow forecast. You will have a much better chance of achieving your business goals if you first write them down.

Ask yourself: when and why did my patients seek my services and how can I keep in touch with them? Distribute print or e-newsletters [maybe use constantcontact]. Write articles about your practice and its treatments for professional journals and general healthcare-focused magazines. Produce a well-designed, good quality brochure and publicity material, both in print [see, for instance, moo.com] and also online.

Make use of social media platforms. Although new practitioners are likely to be familiar with how this is done, it’s possible this may not be the case with established practitioners. Record a video about you and your business and post it on YouTube. Link this to your Twitter and Facebook accounts. Your “followers” might then “comment”, “like” or “re-tweet” to their “followers”, thereby promoting your professional status and practice. Create, or, if you already have one, keep updated a (free) LinkedIn business account profile.

A website that is well designed and informative is a vital marketing tool. It is a worldwide ‘shop window’ as it informs your patients (existing and prospective) about you, where you are located, what you do and when you do it. If, when starting your business, you cannot afford a professionally built site, then build you own (maybe try wordpress].

Keep your cyber security under constant review and seek advice and support from websites like cyberware and getsafeonline. Your business will be processing your patients personal and health information/patient records, so ensure that you comply with data protection legislation including the new General Data Protection Regulation.

There are other business processes that could assist your practice, especially if you decided to diversify into the manufacture and sale of CAM-based products (e.g. first-aid kits, aromatherapy oils/preparations, books/course material, meditation audio-packs, therapy tools and devices) or to associate your business with other health professionals (e.g. at a veterinary practice, NHS Practice or Hospital, as appropriate for your specialism).

I hope that you have found this focus on the business aspects of practising CAM useful and thought provoking. My further thoughts can be found as either a paperback or as an e-book (the latter including hyperlinks to business and CAM websites) and at the amazon.co.uk bookstore. Information about business guides for complementary medicine may be found online.

I anticipate that, in the coming years, the freedom to practise CAM (whether or not independently of the conventional medicine sector or as a contribution to the provision of integrated healthcare and medicine) will depend upon the adoption of a business-focused approach by practitioners.
Established practitioners might be prepared to mentor new members to help them to adopt this approach.

Veterinary CAM Practitioners: Review of guidance by the RCVS

The Royal College of Veterinary Surgeons has announced a review of its position statement and guidance regarding the prescribing of CAM by its members (see my November 2016 blog). A campaign by is underway by www.vets4informedchoice.org to:

‘…raise the awareness of the Evidence Base (or lack of) for many current Veterinary Practices, enabling animal owners and guardians to make considered responsible choices without pressure from the Veterinary Industry…concerns over frequent and unnecessary Vaccination, Corporatisation of Veterinary Clinics, Pressure Selling of products and services, etc, are widespread and growing…’

A facility is available on the campaign website to sign-up to join the campaign and to get regular updates.

Therapy Expo 2017 and RCCM Membership

Therapy Expo returns to Birmingham’s NEC on 22nd – 23rd November. Conference information and booking details can be found here. Have you thought of becoming a member of the Research Council for Complementary Medicine? CAMRN membership ‘is free and provides members with access to the CAMRN research network, which provides regular email messages about conferences, events, projects, funding, new research and dissemination of members queries and requests’.

Department of Health Policy Research Programme Project – The effectiveness and cost effectiveness of complementary and alternative medicine (CAM) for multimorbid patients with mental health and musculoskeletal problems in primary care in the UK: a scoping study (The University of Bristol):

On 13th July this year, I received a circulated email from the Senior Research Associate at The School of Social and Community Medicine (University of Bristol) advising as follows:

‘…We are pleased to be able to let you know that our project ‘SCIM’ – “The effectiveness and cost effectiveness of complementary and alternative medicine (CAM) for multimorbid patients with mental health and musculoskeletal problems in primary care in the UK: a scoping study” has now finally been approved by the funders and the final report is available on their website. I have also attached our Executive Summary. I hope you find it interesting and please do get in touch with any feedback…We may well be in touch again over the summer as we progress with this piece of work and look for collaborators and input from the wider CAM, primary care and research communities…’

(The Executive Summary may be found here).

This is great news. Many congratulations to Professor Deborah Sharp and to her colleagues. There will, of course, be more about this project in my next blog (November 2017). In the meantime, CAM practitioners and others will no doubt welcome the opportunity to provide feedback and to respond to a request for further input to this project.

Professor George Lewith

Finally and most importantly, I add my belated (following its inexcusable omission from my blog in May) expressions of sadness and shock to those of countless others at the untimely and sudden death of Professor George Lewith for whom numerous obituaries have been recorded, including by the College of Medicine, the University of Southampton and The Research Council for Complementary Medicine. All practitioners, patients, students and researchers of CAM and orthodox medicine owe him so much. Along with those of many, my thoughts are with his family.

RICHARD EATON

1st August 2017

END OF QUOTE

Who is Richard Eaton?, I asked myself after reading this. The answer is here:

Richard Eaton LL.B (Hons) whose professional background is as a barrister (Bar Council – Academic Division) – now retired – and as a lecturer in law, believes that the future for practitioners of complementary and alternative medicine in private practice lies within well-managed Health Centres. He formerly owned and managed, together with his wife Marion Eaton LLB (Hons) Reiki Master Teacher, the Professional Centre for Holistic Health in Hastings, East Sussex. He now provides consultancy services through his company, Touchworks Ltd, including in relation to the practice management of CAM.

SAY NO MORE!!!

 

10 Responses to Richard Eaton’s excellent update on developments around complementary medicine

  • Well, this confirms my experience with lawyers, and barristers in particular; they know nearly nothing about everything but believe otherwise. They are not critical thinkers and once they believe something to be true, ……………….it is. That his wife does magic and his blind acceptance of it only makes him the same as her, a fool.

    A tax lawyer lives across the street from me, and he is typical, in my experience, in that I could not ever like him one percent of the amount he likes himself, not that he is a likeable character anyway. Such a shame; the last two families in that house are wonderful people with whom we still have the closest relationships (virtually family), but they aren’t lawyers.

    Sorry Prof, to turn this into an anti-lawyer rant, but that behaviour is characteristic of every lawyer I’ve ever met. It is a pity they aren’t good at their jobs either. If a doctor gave the same expectation and delivery of results, modern medicine would not exist.

    (Bytheway, I’ll be in Totnes in four weeks. What a scary thought. 🙂 )

    • @FC: Wow that one strikes the target! Perspicacious (though perhaps landing in minor proximity to the ‘fallacy of the composition’) none the less a statement in need of stating.
      As my attorney says: it’s not IF you’ll need a lawyer it’s when”….it’s better stated: “it’s not THAT you should hate lawyers it’s too what extent you need to”.
      At least in Mr. Eaton’s case he helps give us the answer: a whole lot.

  • Their submission to the Charity Commission’s consultation on CAM charities is a remarkable piece of special pleading and wishful thinking:

    Whilst an RCT can be regarded as the highest level evidence, this type of study is not always the most suitable for assessing the benefits (efficacy/effectiveness) of CAM. Other research designs such as observational studies, surveys and qualitative methods can provide high quality information. In addition, RCTs invariably require very large budgets to underpin their delivery and CAM has not on the whole been recipient of sufficient grant funding to enable large RCTs to be performed. In addition, just because there is an RCT showing benefit or dis-benefit the quality of the RCT has to be considered. Not all published RCTs meet now well-defined quality standards even when published in what might be regarded as high ranking journals. Finally, to a large extent patients must be the final arbiter. CAM is mainly but not exclusively available through private means in the UK. However, over the last few years it has become more widely available in NHS settings which in itself this speaks to the likelihood that a certain level of evidence has been met.

    They don’t expound on why they believe RCTs are not always the ‘most suitable’ for CAM, of course.

    Needless to say, I anticipated and, I think, refuted, all their excuses in my submission.

    Overall, their response is rather short at essentially just three pages – it’s almost as if they’ve given up trying.

  • Mr Eaton is a specialist in FBWW: fairytale based wishful writing!

    • Naturally he is. CAM is the very stuff of fairytale based wishful thinking.

      That is not the worst of it though. There is a much darker side to the wishful nonsense.

      Eaton’s blog in May quotes the Alliance for Natural Health approvingly: Brexit can “offer an unparalleled opportunity to create a dynamic, diverse hub of integrated healthcare products and services that not only transform patient choices, but would dramatically reduce the burden on an overwhelmed National Health Service”

      The ANH is an anti-vax outfit. One of their senior staff was photographed together with Andrew Wakefield after the surreptitious screening of his film in London earlier this year.

      If the College of Medicine sees the ANH as an ally, it’s a scandal that it should have charitable status.

  • This blog entry reads like a master list of logical fallacies. Very apparent are the “appeals to popularity”, “the appeals to poverty” and coursing throughout the entry (especially in the veterinary medicine section) is an overarching sense of “mental projection” where the groups see the natural world they way they want it to be and not the way nature really is.

    Why don’t we have issues with “CAE” complementary and alternative engineering? You know when it comes to things like rockets and skyscrapers the standards of the groups involved are a bit more unyielding when it comes to science.

    In the veterinary profession there is a group proposing the feeding of “Raw Diets” if have taken the next step and proposed them to start marketing and selling “Raw Water” . Great marketing except if you ask the millions with no potable water.

  • What I find at the same time interesting, and ominous, is how Mr. Eaton perhaps inadvertently, reveals the one true driving force behind sCAM, that of monetary interests. He goes on at length trying to justify the promotion of CAM as a business – instead of proving its worth as in terms of efficacy.

    • I thought the Charity Commission consultation was a plea for arguments as to why CAM deserved charitable status. Surely, rationalisation of the business case flies in the teeth of that idea?

  • I have read Advocate Eaton’s article, promoted by Dr Dixon, in the original. It comprises more logical fallacies than you could shake a stick at.
    This might be thought an ‘ad hominem’ fallacy itself, but I am not attacking Mr Eaton, just his highly imaginative, wrong, even foolish, advocacy, and the concepts he is associated with.

    I agree with Mr Eaton’s view that the Commission’s statement the that the consultation “…is not about whether CAM therapies are effective’” is incoherent with their aim to determine whether the charities do ‘benefit the public’ – but thereafter we enter the all too familiar world of obfuscation, fantasy and fallacy.

    Referencing the College of Medicine’s (sic) assertion that there is ‘continuing appetite of the public for access to CAM’ – this is of course irrelevant, ‘argumentum ad populum’, and a red herring.
    The obsession of so many camists and their supporters that RCT’s are ‘not always the most suitable for assessing effectiveness of CAM’ may be true, but applies also to regular medicine, and is a red herring.
    Dr Dixon’s ‘human effect’ simply represents the fact that humans can effect one another. That is also called TLC, ‘non-specific effects’ and might be termed ‘placebo effects’ in some writings. Hardly novel, certainly not unique to CAMs, and therefore an irrelevant red herring in discussion about the value of CAMs and their supporting charities.

    All therapies have effects in two domains: (i) As a result of human relationships (placebo, TLC, ‘human’) and (ii) As a result of the specifics of the therapy (medicine or surgery, or, in the case of camistry: pins, pummelling, provision of preternatural power etc.). The question for the Commission is not whether humans should be nice to one another, but whether charitable support for the use of the specific treatment has any benefit. And to date, none has been shown, or the treatment would be ‘medicine’ and the Commission would not be assessing its benefit.

    Mr Eaton refers to CAM’s ‘contribution to preventative and integrated medicine’. The oldest trick in the camists’s book – conflating two mutually exclusive concepts. ‘Preventative medicine’ seeks to prevent pathology by applying rational evidence-based methods. ‘Integrated medicine’ seeks to damage ‘medicine’ by conflating its methods with CAMs (for which there is no plausible reproducible evidence of benefit), and reducing ‘medicine’ to a state wherein camistry becomes accepted. Totally ignoring the fact that ‘medicine’ has grown out of, and now away from, ancient anachronistic or imaginative practices which cannot comply with modern standards of evidential basis. They are ‘condimentary’ – they might give a nice flavour, but have no substance.

    Mr Eaton then creates the false dichotomy (black and white fallacy) suggesting camists need ‘freedom to practice’.
    No one is seeking to remove their freedom – but the rest of us must be free to say “You do what you want, but do not harm the systems we have built up in ‘medicine’.”
    Mr Eaton goes on to misrepresents the problem for camists: “There has never been greater need for practitioners to fight their corner.” Camists are not in a corner. They have faith in different systems. End of. But of course, Mr Eaton is promoting his other interests as a business development consultant. Fact. No ‘attack’ here, no ‘ad hominem’.

    The kitchen of medicine is a hot place, and rightly so. The heat of scientific inquiry can be intense, but cooling it down with the balm of baloney just to satisfy those who cannot stand the heat, will damage all of us who hope for improved treatments and real benefits as time passes. There is no substitute for reality, and those who find that difficult, should leave the kitchen.

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