MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The PGIH (currently chaired by the Tory MP David Tredinnick) was founded in 1992 (in the mid 1990, they once invited me to give a lecture which I did with pleasure). Its overriding aim is to bring about improvements in patient care. The PGIH have conducted a consultation that involved 113 SCAM-organisations and other stakeholders. The new PGIH-report is based on their feedback and makes 14 recommendations. They are all worth studying but, to keep this post concise, I have selected the three that fascinated me most:

Evidence Base and Research

NICE guidelines are too narrow and do not fit well with models of care such as complementary, traditional and natural therapies, and should incorporate qualitative evidence and patient outcomes measures as well as RCT evidence. Complementary, traditional and natural healthcare associations should take steps to educate and advise their members on the use of Measure Yourself Medical Outcome Profiles (MYMOP), and patient outcome measures should be collated by an independent central resource to identify for what conditions patients are seeking treatment, and with what outcomes.

Cancer Care

Every cancer patient and their families should be offered complementary therapies as part of their treatment package to support them in their cancer journey. Cancer centres and hospices providing access to complementary therapies should be encouraged to make wider use of Measure Yourself Concerns and Wellbeing (MYCaW) to evaluate the benefits gained by patients using complementary therapies in cancer support care. Co-ordinated research needs to be carried out, both clinical trials and qualitative studies, on a range of complementary, traditional and natural therapies used in cancer care support.

Cost Savings

The government should run NHS pilot projects which look at non-conventional ways of treating patients with long-term and chronic conditions affected by Effectiveness Gaps, such as stress, arthritis, asthma and musculoskeletal problems, and audit these results against conventional treatment options for these conditions to determine whether cost savings and better patient outcomes could be achieved.

END OF QUOTE

Here are a few brief comments on those three recommendations.

Evidence base and research

NICE guidelines are based on rigorous assessments of efficacy, safety and costs. Such evaluations are possible for all interventions, including SCAM. Qualitative data are useless for this purpose. Outcome measures like the MYMOP are measures that can and are used in clinical trials. To use them outside clinical trials would not provide any relevant information about the specific effects of SCAM because this cannot account for confounding factors like the natural history of the disease, regression towards the mean, etc. The entire paragraph disclosed a remarkable level of naivety and ignorance about research on behalf of the PGIH.

Cancer care

There is already a significant amount of research on SCAM for cancer (see for instance here). It shows that no SCAM is effective in curing any form of cancer, and that only very few SCAMs can effectively improve the quality of life of cancer patients. Considering these facts, the wholesale recommendation of offering SCAM to cancer patients can only be characterised as dangerous quackery.

Cost savings

Such a pilot project has already been conducted at the behest of Price Charles (see here). Its results show that flimsy research will generate flimsy findings. If anything, a rigorous trial would be needed to test whether more SCAM on the NHS saves or costs money. The data currently available suggests that the latter is the case (see also here, here, here, here, etc.).

Altogether, one gets the impression that the PGIH need to brush up on their science and knowledge (if they invite me, I’d be delighted to give them another lecture). As it stands, it seems unlikely that their approach will, in fact, bring about improvements in patient care.

10 Responses to The ‘All-Party Parliamentary Group for Integrated Healthcare (PGIH) have just published a new report – and it’s full of surprises

  • The report is found on the icamhub.com website. It is run by a company called Integrated Healthcare Partnership Limited. The company various different services including –

    Public & Parliamentary Affairs
    Public Relations and Media
    Event Management
    Business Support and Service Delivery
    Crisis & Reputation Management

    The sole director of the company is Matthew Williams who certainly did used to work for Tredinnick. It’s not known if he currently does. In some industries the obvious conflict of interest would be an issue.

    The sources of some elements of the report are very obvious. The whining about the ASA, suggesting MYMOPs, etc can be tied to organisations if not individuals. Some organisations have stated that they contributed. That 113 figure has been reported as the number of contributed organisations in some places but it seems more likely most of the number are individuals.

    Much of the report reads as a “wish list”. Some elements are the usual bogus justifications (eg CAM is “integrated” into healthcare in India) for CAM.

    The Alliance for Natural Health also released a report not so long ago https://www.anhinternational.org/resources/documents/anh-intl-blueprint-for-health-system-sustainability/

    • interesting!
      thanks

    • Their being members of this group is a red flag as regards their intellectual credentials.

      It doesn’t take too long for ANH to claim that prescription drugs are a leading cause of death. They cite Peter Gøtzsche.

      Gøtzsche claims that in the USA prescription drugs are the third leading cause of death after heart disease and cancer. He claims that 100,000 people die every year due to incorrect use of drugs and another 100,00 die who use drugs correctly. (Our prescription drugs kill us in large numbers. Pol Arch Med Wewn. 2014; 124 (11): 628-634)

      2016 CDC figures show 161,374 accidental deaths as being the third leading cause of death in the USA after heart disease and cancer.
      https://www.cdc.gov/nchs/data/hus/2017/019.pdf

      For 2016, National Highway Traffic Safety Administration (NHTSA) data shows 37,461 people were killed in motor vehicle crashes.

      CDC figures for deaths related to prescription opioid misuse from 1999 to 2017 were 218,000 – being five times higher in 2017 than in 1999.
      https://www.cdc.gov/drugoverdose/data/prescribing.html

      These figures can be compared with another recent study examined by David Gorski at Science Based Medicine. This study found 123,603 deaths associated with adverse effects of medical treatment from 1990 to 2016.
      https://sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s-2019-edition/

      Gorski compares those figures with another study by Martin A Makary and Michael Daniel which estimated 250,000 to 400,000 deaths per year due to medical errors.

      Some of CDC’s accidental deaths will be drug overdoses due to medical error and personal misuse. The figures of Peter Gøtzsche and Makary and Daniel are huge by comparison. Suspiciously so to my eyes. Is the CDC underestimating or Gøtzsche, Makary and Daniel overestimating deaths due to medical/prescription drug use?

      ANH quote a controversial claim as if it were the gospel truth.

  • Did you really mean Price Charles?

    It is rather hard to see how a group of parliamentarians belonging to All-Party Parliamentary Group for Integrated Healthcare could have come out with a reports saying SCAM? DON”T DO IT. . Still it would be nice to see some critical thinking.

    I live in Canada and am not familiar with the group but it seems to me that their name alone should a red flag to other legislators and policy advisors but I suppose that is too much to hope for.

  • I’m not sure that the PGIH’s aim is to bring about improvements in patient care. It seems to be more of a talking shop that uncritically promotes CAM and Tredinnick’s pet obsessions. It is worth pointing pointing out that All Party Parliamentary Groups (APGs) are informal bodies. They have no official standing (although some APGs are influential and well regarded). They are not Select Committees. They receive no (direct) public funding. Where the resources to put run the initial consultation and write report came from is unknown.

    It is worth reading this blogpost from Andy Lewis http://www.quackometer.net/blog/2017/05/david-tredinnick-standing-again-as-mp-for-homeopathy.html that mentions the initial consultation. Alas, the Society of Homeopaths has removed/hidden their submission that is linked to in the blogpost.

    • “I’m not sure that the PGIH’s aim is to bring about improvements in patient care.”
      neither am I – but this is what they state.

  • We must also be clear that in the UK ‘Integrated Care’ is a term regularly used over a long period to imply the integration of primary care (registered medical practitioners working in primary care settings such as GPs); with secondary care (carried out by specialists in hospitals and other facilities by doctors with higher qualifications as specialists – including public health); with tertiary care – carried out by specialists in facilities with special and particular facilities, often at regional if not national level, and sometimes referred to as ‘centres of excellence’ – and with social care (often in patient’s own homes or other local facilities.)

    Such integration is the policy (as is use of the term) of the government and its departments, all healthcare institutions (except the ‘College of Medicine and Integrated Health’), Medical Royal Colleges, Royal Colleges of Nursing, Midwifery, Dentistry, medical trade unions (BMA, HCSA, MPU etc), professional medical associations (BMA again) and everybody except for those individuals and groups who wsh to see CAM modalities ‘integrated’ in some way with the regular healthcare being carried out by everybody else.

    Any MP is entitled to organise an ‘All-Party Parliamentary Group’ to focus on an issue dear to their heart – providing they do invite all MPs to join. Such groups are autonomous and certainly have no official status or funding.

    The use by this group of the term ‘integrated healthcare’ is misleading, and they seem not to now use the term ‘complementary and alternative medicine’ (CAM), but rather make their objectives more acceptable to the unwary and vulnerable they wish to dupe by giving the impression that ‘complementary care’ has advantages.

    Indeed such care might provide benefit – for patients suffering from delusions about the nature of nature, who fail to critically consider the motives of those promoting implausible modalities which rely on undeclared placebo responses, and for those suffering from emotional deficit which has not otherwise been adequately attended to.
    But they should be cared for by practitioners with integrity, acting honestly, obtaining fully informed consent and basing their recommendations on genuine evidence. Not by quacks and charlatans.

    Most of us have ‘moved on’. A shame Mr Tredinck’s group have not. Fortunately, most of his colleague’s hold him in little regard. Unfortunately, there are some ‘regular’ practitioners of all sorts who derive satisfaction from taking advantage of the vulnerable and gullible and seek to have CAM available for NHS patients. This undermines the serious professional intent of the vast majority of the rest of us, acts as a drag anchor on attempts to advance and improve evidence-based healthcare and is to be deprecated.

    The costs are incalculable because the cost of ‘satisfaction’ (which is the earnest desire of the group of patients Mr Tredinick, quacks and camists identify), is infinite and cannot be determined. As Sir Michael Jagger so wisely pointed out.

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