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Health, Sports & Psychology

Princes and placebos: A Brief History

Updated Tuesday, 14th September 2004

Freelance journalist Jane Feinmann reviews the history of changing attitudes to alternative medicine.

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Prince Charles Copyrighted  image Icon Copyright: BBC

What we know today as complementary and alternative medicine (CAM) has roots going back 5,000 years to Chinese (traditional Chinese medicine), Indian (Ayurvedic medicine) and similar healing traditions in cultures across the planet. For thousands of years, these diverse medical traditions had in common a belief in the energy of the body and the need for harmony between mind, body and spirit. The role of the 'doctor' was to facilitate the healing process by identifying and removing obstacles to health. Therapies addressed the underlying cause of the disease by encouraging lifestyle changes, self-care and preventive strategies, rather than simply suppressing symptoms.

If this all sounds rather familiar, that's probably due to an extraordinary full circle that has taken place over the last century. Throughout most of the 19th century, good doctors used the same skills as today's herbalists, osteopaths and dieticians; they were generous with time and empathy, and relied on a good bed-side manner. Prayer was important, as was "a change of air"; more dubiously, so were lots of laxatives and bleeding and leeches. Right up until the early 20th century, sick people relied on much the same kind of therapies as their ancestors.

The last century, however, particularly the decades following the Second World War, brought significant change. As GP and journalist, James Lefanu noted in his book The Rise and Fall of Modern Medicine, from the 1950s, a series of medical breakthroughs seemed to prove beyond doubt that previous attempts at healing were nothing more than mere quackery. These triumphs included: the discovery of penicillin, leading to today's antibiotics; cortisone (a powerful anti-inflammatory medicine); streptomycin (a powerful antibiotic that beats tuberculosis); insulin (to treat diabetes) and chlorpromazine (an anti-psychotic which controls schizophrenia). There were also huge strides forward beyond the pharmaceutical industry. Open heart surgery, hip replacements, kidney transplants, intensive care and successful vaccination programmes both saved and improved the quality of countless millions of lives.

It's no surprise that so much power to alter human destiny would lead, as Lefanu suggests, "to the resultant abandonment of homely remedies such as massage, manipulation and dietary advice, only for them to be taken up by alternative practitioners". And this was exactly what happened - with a dramatic explosion in the growth of 'alternative' therapies throughout the second half of the 20th century. Alongside modern medicine, CAM began to develop as an entirely separate discipline - contemptuous of the achievements of mainstream medicine, while at the same time being dismissed by mainstream practictioners as at best ineffective, and at worst fraudulent. For most people, getting the best from mainstream and alternative medicine was a delicate operation: those who did try to use both services learnt that in order to avoid criticism, the best strategy was to keep quiet about the use of the alternative therapies.

Exactly when all this started to change is open to debate. A turning point seems to have been December 14, 1982 when Prince Charles, recently installed as President of the British Medical Association, was guest speaker at its 150th anniversary dinner. A long-term user of homeopathy and increasingly excited by complementary therapies, Prince Charles was characteristically blunt in putting forward his case to a medical profession which, two years previously, had (in a British Medical Journal editorial), dismissed CAM as "a flight from science".

Prince Charles demanded that doctors end their "hostility to the unorthodox" and accept that there were alternatives to "the objective, statistical, computerised approach to healing the sick". While fully recognising "the enormous benefits brought by modern medical science", Prince Charles said he was concerned at the "frightening" dependency on drugs, which were costing the National Health Service (in 1982) £2 billion a year. "By concentrating on smaller and smaller fragments of the body, modern medicine perhaps loses sight of the patient as a whole human being, and by reducing health to mechanical functioning it is no longer able to deal with the phenomenon of healing," he said.

Six months later, Prince Charles made the same case when opening the new premises of the "alternative" Bristol Cancer Help Centre - commenting: "I think it is only right that a patient should be free to try a different form of treatment if he or she feels little progress is being made in, for instance, what could be referred to as a drug-based treatment."

Prince Charles Copyrighted  image Icon Copyright: BBC

It was an important point. For despite the massive success of modern mainstream medicine, significant under-performance has persisted into the 21st century - namely, its failure to have an impact on long-term chronic conditions. One in five people in the UK has tried at least one form of complementary therapy, with one in ten GPs actively involved in providing it. The health problems which are most likely to attract people to complementary therapies, according to a detailed study of complementary medicine use in the United States, published in May 2004 by the National Center for Complementary and Alternative Medicine, are: back, neck, head, or joint aches, colds, anxiety or depression, gastrointestinal disorders or sleeping problems - almost all of which are conditions poorly managed by Western medicine.

The study also identified the type of person most likely to use CAM. She is a woman with a higher than average educational level who may have been hospitalised in the past year and has probably a higher than average commitment to keeping well: she is more likely to have given up smoking, for instance.

It gradually dawned on the medical profession that CAM was here to stay. The BMA's first response to Prince Charles' challenge was Alternative Therapy, a report published in 1986, acknowledging a widespread interest in CAM but dismissing it as "medieval" dogma in contrast to progress in "scientific" research in medicine. Six years later, a second report, entitled Complementary Medicine - New Approaches to Good Practice, heralded an astonishing about-turn. This new 160 page report recognised that: "the demand for non-conventional therapies had become so pressing that organised medicine in Britain could no longer ignore its contribution". At the same time, however, the BMA set in motion a further chapter in the history of CAM by insisting that it was "unacceptable" to allow the unrestricted practice of non-conventional therapies, irrespective of training or experience.


The result was a move, led by osteopathy and chiropractic, for CAM to be regulated by law in exactly the same way as mainstream medicine. By 2000, osteopathy and chiropractic were subject to 'statutory regulation' - making it a criminal offence to practice either therapy without being a member of each profession's statutory register. Acupuncture and herbal medicine are due to follow this route by the end of 2005.

As the BMA commented at the time: "People want to know what works and what doesn't. It is sensible if the NHS is going to share treatment and management of patients that there should be good information about therapies available for health care workers and patients. The BMA believes that only those therapies that are adequately regulated should be available on the NHS."

Also in 2000, the House of Lords Science and Technology Committee published a report of its enquiry, investigating mainstream medicine's charge that CAM was largely unproven and over-reliant on the placebo response. In view of its popularity, the Committee reported, the NHS could not allow complementary and alternative therapies to sit on the sidelines of publicly funded health care simply because "theories about their modes of action are not congruent with current scientific knowledge". It called for more 'high-quality' research, "taking into account the fact that many practitioners believe that conventional research methods are not suitable tools with which to investigate their therapies".

The House of Lords' report was addressing the fact that complementary therapies have proved difficult to fit into a framework of randomised controlled trials, the benchmark of scientific medicine which was being widely debated throughout medicine. "The over-emphasis on technical effectiveness has sidelined medicine's interest in our innate capacity for natural recovery and made us less curious about how to catalyse resilience", argued David Peters, Professor of Community Care at Westminster University in his book Understanding the Placebo Effect in Complementary Medicine.

Last year, the Department of Health announced a £1.3m programme to begin a - so far, modest - attempt to build a new type of research capacity in British universities, with the specific aim of bridging the credibility gap around CAM. Instead of subjecting therapies to randomised controlled trials, the emphasis would be more on finding out how and why they were effective.

The aim is not to open the floodgates to all complementary therapies. By no means can all complementary therapies claim to have proved they are any more than mere quackery. And as Cancer Research UK recently pointed out: "There is a tendency to believe that complementary medicines are always harmless. This is not the case". What is clear, however, is that people with health problems in the 21st century will increasingly have unprecedented access to both modern Western medicine and a range of safe and effective traditional therapies. And the clever way to proceed is to use the two types of medicine in conjunction - so that both become truly complementary.

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