Policy and Research

Chronic conditions work programme

The Foundation has identified six long term chronic conditions - allergies, back pain, depression, irritable bowel syndrome, obesity and stress - with which the current conventional approach to health and massively overburdened NHS are struggling to cope. These conditions affect the lives of millions of people throughout the UK.

We are starting to develop a set of practical proposals for dealing with these six common chronic conditions. We will be looking at how everyone in society can play a part in avoiding and tackling these problems. Our proposals will be not just for healthcare professionals and health policy makers, but for teachers, employers, parents, communities, and most importantly, for individuals themselves.

As many long term conditions are preventable but few are currently curable, radical thinking is required to achieve our objective to improve the lifestyles of those who suffer from or are at risk of developing these chronic conditions. The emphasis must be on maximising quality of life and wellbeing, and preventing deterioration of the individual's condition. This calls for people to be given resources, information and support to take greater responsibility for managing their own health and wellbeing, which is at the heart of an integrated approach.

We will work with a broad range of partners to develop proposals that will help to create supportive environments and remove barriers so that it is easier for people to make healthy choices.

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Research and evidence

The integrated health debate is often framed as a clash between supporters of a ‘conventional’ route to health and those who advocate a ‘complementary’ path. In this caricature, conventional paths to health are backed up by evidence, while complementary paths have far less evidence in their favour.

We welcome research into the safety and effectiveness of all healthcare treatments, therapies and interventions. We recently ran a conference with the King's Fund to begin to identify the most appropriate methods for assessing complementary therapies.

Randomised controlled trials (RCTs) are the gold standard of medical research, and although the individualised treatments typical of complementary therapy make traditional RCTs more complex to design, there are still ways to create studies that will give credible results. Qualitative studies which look at the effect on the whole person are also an important part of the picture.

However science is increasingly revealing the physiological basis for non-specific effects and we believe that research should focus on both the specific and non-specific effects of different therapeutic interventions. Those who write off non-specific effects as ‘just placebo’ are missing an opportunity to learn about the human body’s 'self-healing' mechanisms.

There are some complementary therapies and remedies with strong evidence to support their use in certain conditions – acupuncture for osteo-arthritis of the knee for example, or St. John’s Wort for moderate depression.

Supporters of complementary medicine often assert that there are many orthodox medicines and practices that have not been subjected to evidence-based assessment, and indeed the publication British Medical Journal (BMJ) Clinical Evidence agrees that 46% of commonly used orthodox treatments have no data as to their effectiveness with another 10% unlikely to be beneficial – or even likely to be harmful.

So the picture is less clear-cut than it is sometimes portrayed, but what is certain is that levels of funding for medical research need to be far greater so that we can all be clearer about what works and how, as well as what doesn’t work. Less than one third of one per cent of the funding available in the UK for medical research goes to research into complementary therapies. With such a small amount of money available for this research, it is very hard to establish an evidence base for complementary therapies particularly as RCTs are extremely expensive to conduct. There is also a clear financial incentive for pharmaceutical companies to fund research into drugs rather than into complementary therapies, which often can not be patented.

But when you consider that as many as one in five people in the UK have used a complementary therapy, this low level of funding is clearly disproportionate. Many people, especially those living with chronic conditions, will take the reasonable view that since medical science does not have a simple fix (or in many cases, any fix at all), they need to look elsewhere for solutions - or at least for approaches that will improve their quality of life.

Until we have more answers from research, their choices will be hit and miss. Without good information, there's a risk of each potential user of complementary therapies having to start from scratch in making judgements about what would best suit their situation.

More well designed studies and trials will help a mass of people who want to take an integrated approach to their health. Where a complementary intervention is unlikely to improve a condition, good quality research and evidence may save people from wasting time and money. Where the efficacy of a complementary therapy for a specific illness or condition can be demonstrated, there's a much stronger chance that the therapy will become available on the NHS – which means that people who currently can't afford complementary treatment will have the same access to better health and wellbeing as those who can afford to pay.

We would also welcome a greater balance between research into treatment and research into prevention. Funders of research need to acknowledge the enormous significance of influencers on health such as lifestyle, diet and socio-economic status. A new range of outcome measures will be required to capture the impact of these broader factors on the whole individual.

The power of placebo

Doctors speak the language of science and rightly demand proof that a treatment is effective, but equally many acknowledge that it’s hard to measure the effect of a feeling like hope on the human body. At the heart of the double blind RCT methodology - the ‘gold standard’ of scientific experiments - is a tacit admission that something else is at work; that the mind can influence the outcome.

Researchers are now investigating how to produce a placebo effect without giving a placebo. This is sometimes called a ‘context effect’ – the impact of everything else apart from the medical intervention. This could include the physical setting in which healthcare is given, the conversations between doctor and patient, even both people’s sets of expectations.

Complementary therapists often see the healing environment as being part of the treatment – in other words, they deliberately seek out context effects. It’s vital that research in this area helps us to distinguish between context effect and treatment so that we can harness this knowledge and make the most of both.
There is a wealth of evidence of the link between our emotional and social condition and our health, but no universal explanation of how the healing context and environment (including the relationship between patient and practitioner) help to make patients better.
The study of human healing should start by asking what facilitates or disrupts the recovery process in individuals. It should gather knowledge from a rich variety of sources – research into placebo, the new science of psychoneuroimmunology, psycho-social studies, spiritual practices, art, architecture and complementary therapies.

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House of Lords summary report

In November 2000, the House of Lords Science and Technology Committee published its report on Complementary and Alternative Medicine. The report considered issues relating to public health policy and patient safety arising from the widespread and increasing use of CAM, not only in the , but also throughout the developed world. It made a number of recommendations relating to regulation, evidence base, adequate sources of information, training for practitioners and the NHS provision of these treatments.

The Foundation has recently reviewed the recommendations of the Lords report and has identified areas where progress has been made and further work still needs to be done. Our work in this area is progressing through our regulation and policy programmes.