House of Lords - Science and Technology - Sixth Report

House of Lords

Science and Technology - Sixth Report


Here you can browse the report together with the Proceedings of the Committee. The published report was ordered by the House of Lords to be printed 21 November 2000.

CONTENTS

REPORT

SUMMARY

CHAPTER 1: INTRODUCTION

What is Complementary and Alternative Medicine?

Growing Use of CAM in the United Kingdom

British Surveys

Table 1: Use of CAM in the United Kingdom
United States Surveys

Table 2: Use of CAM in the USA
Reasons for Accessing CAM

Survey Data

Table 3 :Reasons for Using CAM
Other Possible Explanations
Approach of This Report

Conduct of this Inquiry
CHAPTER 2: DISCIPLINES EXAMINED

Definitions of the Various CAM Therapies

Box 1: Short and Simplified Descriptions of CAM Disciplines
Differing Philosophies
CHAPTER 3: PATIENT SATISFACTION, THE ROLE OF THE THERAPIST AND THE PLACEBO RESPONSE

Patient Satisfaction
Patient Dissatisfaction
The Role of the Therapist
Placebo Effect
CHAPTER 4: EVIDENCE

Evidence for Efficacy?
Evidence for Safety

Patient Satisfaction As Evidence For Efficacy
Evidence About Mechanisms of Action
CHAPTER 5: REGULATION

Current Regulatory Status of CAM Professions

Box 2: Status of Some CAM Voluntary Professional Bodies in the United Kingdom.
Box 3 : General Statutory Regulation of CAM

Weaknesses of the Current Situation
Features of an Effective Regulatory System

Box 4: Modern Principles of Statutory Self-Regulation in the Health Field
Regulatory Options

Voluntary Self-Regulation

Box 5: Features of an Effective Voluntary Self-Regulatory Body
Statutory Regulation
Routes To Statutory Regulation

Own Act
Health Act 1999

Box 6 : Criteria for petitioning to come under the Council for Professions Supplementary to Medicine or its successor
Box 7 : Criteria for a Group to be Considered a Profession
Which Therapies Would Benefit From Statutory Regulation?

Acupuncture
Herbal Medicine
Homeopathy
Single Umbrella Regulatory Body?
Regulation of Conventional Healthcare Professionals Practising CAM
Regulation of Herbal Products
CHAPTER 6: PROFESSIONAL TRAINING AND EDUCATION

Standards of CAM Training Courses

Training in Statutorily Regulated CAM Therapies
Training in Non-Statutorily Regulated CAM Therapies

Current Status of Training
General Conclusions
Continuing Professional Development
Validation of Training
What Should CAM Training Courses Include?

Basics of Biomedical Science
Research Methods
Limits of Competence
Familiarisation With Other CAM Therapies
A Core Curriculum?
National Occupational Standards
Training Conventional Medical Practitioners in CAM

Familiarisation for Medical Students

Box 8 : Extracts from Reports of GMC Visits to United Kingdom Medical Schools 1998-99
Postgraduate Familiarisation for Doctors
Training for Medical Practitioners
Nurses, Midwives and Health Visitors

Familiarisation
Training
Conclusion
CHAPTER 7: RESEARCH AND DEVELOPMENT

Priority Areas For Research

Should Specific Therapies be Prioritised?
Research Methods

Randomised Controlled Trials (RCTs)

Box 9: Issues to Consider When Designing RCTs for CAM Therapies
Qualitative Research

Box 10: Some Forms of Qualitative Research: Their Advantages and Disadvantages for CAM Research
Research Outcome Measures
Which Research Method to Use and When
Expertise on Grant-Awarding Boards
Environment and Infrastructure for Research

Research Education
Attracting Mainstream Investigators
Research Funding Sources

The Government

Box 11: Government Funding Options
The Medical Research Charities
Commercial and Industrial Companies
Pump-Priming and Ring-Fencing

The Lessons of NCCAM
Attitude of UK Research Funding Bodies
Co-ordinating the Development of CAM Research
CHAPTER 8: INFORMATION

Information for Healthcare Professionals

The Dissemination of Research Findings
Information for Patients
Media Coverage of CAM
The Internet
Advertising CAM

Table 4: Complaints Against Advertisements
An Overarching Information Body?
CHAPTER 9: DELIVERY

Current Patterns of Delivery
Methods of Delivery

Box 12: Methods of Delivery Within the NHS
Integrated Healthcare

Primary and Secondary Care
Primary Care Groups
Gatekeeper Role of GPs
Criteria for NHS Provision

Figure 1: Factors Affecting PCG Decision Making on CAM Provision

SUMMARY OF RECOMMENDATIONS
APPENDIX 1
Difficulties of Randomised Controlled Trials
APPENDIX 2
Features of the General Osteopathic Council and the General Chiropractic Council
APPENDIX 3
Visit to Mr Simon Mills' CAM Practice, Department of Complementary Medicine, University of Exeter; and the Centre for Complementary Health Studies, University of Exeter On 22/23 March 2000
APPENDIX 4
Visit to the Marylebone Health Centre, 12 April 2000
APPENDIX 5
Visit to the University of Southampton Medical School and the Centre for the Study of Complementary Medicine, Southampton, on 9 June 2000
APPENDIX 6
Special visit to the Glasgow Homeopathic Hospital by two members of the Sub-Committee on 24 August 2000
APPENDIX 7
Sub-Committee 1
APPENDIX 8
List of Witnesses
APPENDIX 9
Acronyms

Note
Written and oral evidence received by the Committee is published in two separate volumes (HL Paper 48 and HL Paper 118).

In the text of the Report:
Q refers to a question in oral evidence;
p refers to a page of written evidence printed in HL Paper 118; and
P refers to a page of written evidence printed in HL Paper 48.

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