Dear Editor
I am surprised by glaring omissions in your article, Ethical problems
arising in evidence-based complementary and alternative medicine by Ernst,
Cohen and Stone. Their paper undoubtedly presents an outdated picture of
the development of complementary and alternative Medicine (CAM) in the UK
at this time
The authors state “that providers of CAM are often not medically
trained” and that “their understanding of anatomy, physiology, pathology
and other disciplines of Western Science may be limited…” It goes on to
say, “ Unlike the situation of widespread licensure in the US for
chiropractors, acupuncturists, massage therapists and to some extent
naturopathic physicians, most CAM professions in the UK are not
statutorily regulated (the only two exceptions in the UK are chiropractors
and osteopaths.)”
The authors fail to report that statutory regulation of the UK herbal
and acupuncture sectors is now imminent. There is no mention that in 2,000
the House of Lords Select Committee on Science and Technology published a
report on CAM [1] and that this report specifically called for the
statutory regulation of the acupuncture and herbal medicine sectors. Nor
do the authors refer to evidence given to the Select Committee (Sections
5.51 and 5.52) by the Under Secretary for State for Public Health, Yvette
Cooper, who told the Committee that on safety grounds, the Government had
specifically identified acupuncture and herbal medicine as therapies that
it would like to see achieve statutory self-regulation. She also pointed
out (Section 5.44) that the 1999 Health Act now provided a fast-track
route for the statutory regulation of a health profession previously only
achievable by cumbersome primary legislation.
The article also omits to mention that in 2001, the Government
responded to the Select Committee Report recommending that herbal medicine
and acupuncture should as soon as possible seek statutory regulation under
the Health Act 1999 [2] and that the following year the Department of
Health set up two independent committees, the Herbal Medicine Regulatory
Working Group (HMRWG) and the Acupuncture Regulatory Working Group (ARWG)
to give detailed consideration of how statutory regulation of acupuncture
and herbal medicine could best be achieved. Both Committees met regularly
throughout 2002/3 and published their recommendations in September
2003.[3,4] Having considered these two reports, the Government is set to
publish, any day now, a public consultation document seeking views on
aspects of the statutory regulation of herbal and acupuncture
practitioners in the UK. Following a thirteen-week consultation period,
the Government will once again take stock before finally consulting on
draft legislation that will eventually lead to legislation laid before
Parliament. Although there is no firm timetable, we anticipate the
statutory regulation of UK herbalists and acupuncturists to pass into law
in 2006. I submit that all this presents a very different picture to the
one painted by Ernst, Cohen and Stone.
As for training, it is accepted by the herbal profession that
herbalists of all traditions require a good standard of western medicine
including pharmacology. The Core Curriculum published in the HMRWG report
is a detailed account of this training, which is overseen by the
Accreditation Board of European Herbal Practitioners Association.
Traditional acupuncturists too must be trained in conventional western
medicine so that they can recognise the limits of their competence and
know when to refer. Several British Universities currently offer degree
training in these disciplines and such training has now been available for
the past decade. The UK leads the world in the development of CAM and its
level of acceptance surely does not so much represent a “challenge to
healthcare professionals of all disciplines” as Ernst et al assert, but
rather a golden opportunity to integrate the best of orthodox and CAM for
the benefit of millions of patients who clearly wish to access both
modalities.
References
(1) House of Lords’ Select Committee on Science and Technology,
Session 1999-2000. 6th Report. Complementary and Alternative Medicine. The
Stationary Office, 2000.
(2) Department of Health. Government Response to the House of Lords Select
Committee on Science and Technology’s Report on Complementary and
Alternative Medicine. The Stationary Office, March 2001.
(3) Recommendations on the Regulation of Herbal Practitioners in the UK A
Report from the Herbal Medicines Regulatory Working Group, published on
behalf of the HMRWG by the Prince of Wales’s Foundation for Integrated
Health, 2003.
(4) The Statutory Regulation of the Acupuncture Profession, the Report of
the Acupuncture Regulatory Working Group, published on behalf of the ARWG
by the Prince of Wales’s Foundation for Integrated Health, 2003.
Dear Editor
I am surprised by glaring omissions in your article, Ethical problems arising in evidence-based complementary and alternative medicine by Ernst, Cohen and Stone. Their paper undoubtedly presents an outdated picture of the development of complementary and alternative Medicine (CAM) in the UK at this time
The authors state “that providers of CAM are often not medically trained” and that “their understanding of anatomy, physiology, pathology and other disciplines of Western Science may be limited…” It goes on to say, “ Unlike the situation of widespread licensure in the US for chiropractors, acupuncturists, massage therapists and to some extent naturopathic physicians, most CAM professions in the UK are not statutorily regulated (the only two exceptions in the UK are chiropractors and osteopaths.)”
The authors fail to report that statutory regulation of the UK herbal and acupuncture sectors is now imminent. There is no mention that in 2,000 the House of Lords Select Committee on Science and Technology published a report on CAM [1] and that this report specifically called for the statutory regulation of the acupuncture and herbal medicine sectors. Nor do the authors refer to evidence given to the Select Committee (Sections 5.51 and 5.52) by the Under Secretary for State for Public Health, Yvette Cooper, who told the Committee that on safety grounds, the Government had specifically identified acupuncture and herbal medicine as therapies that it would like to see achieve statutory self-regulation. She also pointed out (Section 5.44) that the 1999 Health Act now provided a fast-track route for the statutory regulation of a health profession previously only achievable by cumbersome primary legislation.
The article also omits to mention that in 2001, the Government responded to the Select Committee Report recommending that herbal medicine and acupuncture should as soon as possible seek statutory regulation under the Health Act 1999 [2] and that the following year the Department of Health set up two independent committees, the Herbal Medicine Regulatory Working Group (HMRWG) and the Acupuncture Regulatory Working Group (ARWG) to give detailed consideration of how statutory regulation of acupuncture and herbal medicine could best be achieved. Both Committees met regularly throughout 2002/3 and published their recommendations in September 2003.[3,4] Having considered these two reports, the Government is set to publish, any day now, a public consultation document seeking views on aspects of the statutory regulation of herbal and acupuncture practitioners in the UK. Following a thirteen-week consultation period, the Government will once again take stock before finally consulting on draft legislation that will eventually lead to legislation laid before Parliament. Although there is no firm timetable, we anticipate the statutory regulation of UK herbalists and acupuncturists to pass into law in 2006. I submit that all this presents a very different picture to the one painted by Ernst, Cohen and Stone.
As for training, it is accepted by the herbal profession that herbalists of all traditions require a good standard of western medicine including pharmacology. The Core Curriculum published in the HMRWG report is a detailed account of this training, which is overseen by the Accreditation Board of European Herbal Practitioners Association. Traditional acupuncturists too must be trained in conventional western medicine so that they can recognise the limits of their competence and know when to refer. Several British Universities currently offer degree training in these disciplines and such training has now been available for the past decade. The UK leads the world in the development of CAM and its level of acceptance surely does not so much represent a “challenge to healthcare professionals of all disciplines” as Ernst et al assert, but rather a golden opportunity to integrate the best of orthodox and CAM for the benefit of millions of patients who clearly wish to access both modalities.
References
(1) House of Lords’ Select Committee on Science and Technology, Session 1999-2000. 6th Report. Complementary and Alternative Medicine. The Stationary Office, 2000.
(2) Department of Health. Government Response to the House of Lords Select Committee on Science and Technology’s Report on Complementary and Alternative Medicine. The Stationary Office, March 2001.
(3) Recommendations on the Regulation of Herbal Practitioners in the UK A Report from the Herbal Medicines Regulatory Working Group, published on behalf of the HMRWG by the Prince of Wales’s Foundation for Integrated Health, 2003.
(4) The Statutory Regulation of the Acupuncture Profession, the Report of the Acupuncture Regulatory Working Group, published on behalf of the ARWG by the Prince of Wales’s Foundation for Integrated Health, 2003.