by     JOHN KAPP

Paper for Liberal Democratic Party for integration into their Health Policy 27.9.07
22, Saxon Rd, Hove BN3 4LE, East Sussex   Tel: 01273 417997

1 Synopsis
This paper supports Prince Charles’ call for the integration of the best of complementary therapy into conventional medicine in his keynote address to the World Health Organisation conference of health ministers in May 2006. As reported in the media, it attracted opposition from the medical establishment with many prominent medics writing jointly to the chief executives of all 467 NHS Trusts, telling them not to spend public money on un-evidenced treatments.

While this sentiment is unexceptionable, what they went on to say was that the NHS should not pay for complementary therapy, such as homeopathy, the cost of which is relatively trivial. Their objection was really a smokescreen to protect drug treatment in the NHS, worth £7bn pa. This diverted attention away from conventional medicine’s secret; which is the shakiness of the evidence base and the lack of safety of drugs. Adverse drug reactions are now estimated to cause 200,000 deaths pa in UK, making that the number 1 killer, killing even more people than heart disease. (1)

The proposed solution is an integrated service, offering patients the choice of free complementary therapy on the NHS as an alternative to free drugs. This is in line with the government’s objective of promoting self-responsibility by offering patients choice in a patient-centred NHS. Many patients would choose complementary therapy rather than drugs, which would save the NHS money, as it is generally cheaper and more effective, and is without side-effects and adverse reactions (see appendix for examples)

2 The problem – unsafe drugs
The issue of unsafe drugs is known as ‘iatrogenic’ or doctor-induced illness. This is the awful ‘secret’ of the NHS. It was first shown on TV 7 years ago (2) but its figures have never been denied by the Government. Books have been written about it also. (3) This secret is like an unexploded bomb in the heart of society. The purpose of this paper is to defuse it by bringing it out in the open and addressing a solution.

Despite this media exposure, it is still a ‘secret’ because of the enormity of its consequences. They are so awe-full that they cannot be collectively contemplated. They have therefore been repressed into the ‘too difficult’ box in people’s mind, (as was drink-driving, smoking kills, climate change) Politicians, doctors, drug company chiefs have a vested interest in the status quo. The public are subconsciously afraid to rock the boat because they are dependent for their health on modern medicine.

Everybody knows that prescription drugs sometimes give people unpleasant side-effects, and may get them hooked. What they don’t know (or have repressed if they did) is that drugs can cause what are known as ‘adverse drug reactions’ (ADRs) which can permanently maim and kill people. A favourite phrase in the media is ‘what is the body count’, to question the relevance of an issue. With ADRs, the body count is literally ‘awesome’.

Because it has been kept secret and unaddressed, the problem has been growing ever larger for the whole of the last century since drugs (manufactured chemicals, such as the first one, aspirin) were produced. The issue has now grown to be the leading cause of death in the western world. It kills even more people than heart disease and cancer. The number killed each year by ADRs is approximately 800,000 in USA and 200,000 in the UK. (1)

In the UK, this number is 400 people (equivalent to a ‘Shipman’) every day. Of course, they were not killed by intention, but by mistake, but they are just as dead. One drug alone (Vioxx) caused 300,000 heart attacks and killed 140,000 people worldwide, before being taken off the market in 2004. (4)

No drug can be trusted as being safe, because the method of approving drugs has been shown to be fatally flawed, on two counts. First, testing procedures. Under the Medicines Act 1968, all drugs have to be tested first on 2 sorts of animals, say rodents and monkeys. This law is counterproductive, and should be changed, because humans are not like animals in their reaction to drugs.

For example, the drug TGN1412 passed all its animal tests, and was proved to be safe for monkeys at 500 times the human dose. (4) However, when it was first given to humans, all 6 men who trialled it in Sept 2006 were fighting for their lives in intensive care, and one was permanently maimed, losing his fingers and toes. (5)

Secondly, drug company trial reporting has been shown repeatedly to be untrustworthy. For example, trial data showed that Seroxat made some children suicidal, but this was not disclosed, and the drug was given to children for years. It was only after many had committed suicide that this concealment came to light, and it was subsequently withdrawn for children. Many similar stories are recounted in the literature, collectively showing that the evidence base for drugs is fatally flawed (6,7)

3 What solutions are offered by other parties?
The NHS is the Conservative’s number one priority, according to a recent leaflet (8) In it David Cameron says that he ‘will create a panel of medical experts to decide where funds are needed rather than where the politicians want it.’

That is exactly what politicians of both parties have been doing for the last 60 years. They have left the health of the nation to the medical experts, and given them £trillions of taxpayer’s money to get on with it. That is the policy which has caused the above mentioned problem of unsafe drugs (iatrogenic) David Cameron’s policy will perpetuate the problem, not solve it.

In the last 5 years Labour has doubled the amount of taxpayer’s money put into the NHS to £90 bn pa, but the nation is not healthier, but sicker. Conventional medicine cannot even keep its staff healthy. The average sickness rate is around 5%, 1 in 20 being off sick at any time, mostly with stress-related illness. If conventional medicine worked, doctors would be the healthiest people in society. In fact, they are the sickest, having approximately a decade shorter expectancy of life, and above average drug and alcohol dependency.

The Department of Health has proliferated quangos beyond count to solve its problems, but they have not delivered. Although accountable in name to the Secretary of State for Health, in practice they act in a free for all, unaccountable way, having a jamboree at taxpayer’s expense.

For example, Connecting for Health has been working for several years on a project called ‘Do Once And Share, DOAS’ which is a national database for unscheduled care. It contains at least 85 personal questions and breaks into many sub questions. It will be filled in by receptionists taking telephoned inquiries from patients for urgent care. It will be accessible by any health or social care worker in the country on a ‘need to know’ basis. It will soon become the latest database of the surveillance society that we now live in. As forecast by George Orwell in ‘1984’ -. ‘Big Brother is watching You’.

4 Do the Government want a patient-centred NHS?
This was a Conservative policy from the 1990s from which Labour adopted parts. They have parroted the words ’patient-centred’ constantly for the 10 years since they came to power. However, they have done nothing to implement that policy, and done much to stifle the efforts of those trying to implement it, thereby reinforcing its provider-centred nature.

For example, the Conservatives took the first practical steps towards a patient-centred NHS by creating fundholding, and Community Health Councils (CHCs) in the 1990s. Labour abolished fundholding on coming to power in 1997. They abolished CHCs in 2003, creating in their place Patient and Public Involvement (PPI) Forums, and the national quango to support them, the Commission for PPI in Health (CPPIH)

Through the PPIFs, some 5,000 patient representatives have been trying to get the NHS to be more patient-centred. They have not succeeded, but they have ruffled the feathers of the experts (clinicians) The Government therefore decided to further disrupt patients’ efforts by abolishing their organisations again. In 2006 the PPIFs and CPPIH were due to be abolished in March 2007, but they could not get the legislation through in time, so that is delayed until March 2008, under the Local Government Bill. Then Local Involvement Networks (LINks) are supposed to take over, but there will probably be a gap, as nothing has yet been done to create LINks.

The above shows that both Conservative and Labour policies on health are centralist, keeping the same socialist model (paternalist) as at its nationalisation in 1948, and its provider-centred nature,. All other nationalised industries (except social care) were privatised in the 1980s and 1990s. This changed them from being run for the benefit of the staff, to being run for the consumers, with dramatically beneficial results to society.

Health and Social Care are the only remaining dinosaur residue of those 60 year old socialist policies, but they take a quarter of taxation and employ over 2 million staff. They are a 20th century anachronism which are serving our society exceedingly ill (literally) It is time that they were made fit for the future in the 21`st century by making them truly patient-centred. It is the only sector of society not to be consumer-centred, and it is as bad for the staff (killing doctors) as it is for the patients.

5 The solution – integration of complementary therapy into the NHS
There are 2 health services in the UK of roughly equal size. First the provider-centred National Health Service (NHS) This is really a national sickness service, because only 4% of its £90bn pa budget is spent on health (wellness and the prevention of illness) and 96% is spent on the treatment of sickness.

Second, there is the patient-centred ‘alternative’ health service, offering complementary and alternative medicine (CAM) This is a true ‘health’ service, in that it promotes wellness and the prevention of illness. It empowers and educates people to take responsibility for their own health, and support their own natural self-healing capacity (immune system) Its practitioners already outnumber those in the NHS. They became CAM therapists because they found CAM treatments which helped them overcome their own illnesses, and became trained so that they could help others.

The evidence for the efficacy of CAM is demonstrated by the fact that it is the fastest growing industry in the western world. In UK, this is despite playing uphill against a free NHS. The active ingredient in most CAM is meditation, which has been shown in many clinical studies to be healing. It is accepted by the National Institute for Clinical Excellence (NICE) as an alternative to antidepressants.There is no recorded case of anyone ever being maimed or killed by CAM.

CAM is holistic, meaning that it recognises that bodily health depends on a healthy mind, soul and environment, and that the cause of chronic disease originates there. CAM helps the client to find and eliminate the cause of their disease, thus allowing their body to heal itself. The political problem for society is that CAM has to be paid for by the client, so only the wealthy can afford it. Polls show that 3 out of 4 people want it to be provided free on the NHS, so in a truly patient-centred NHS, with patient choice, it has to be provided.

Due to patient pressure, CAM is creeping in, with half of GP practices offering some form of it. However, it is seldom free to the patient because most Primary Care Trusts (PCTs) will not fund it. This is because official policy says that there is no evidence for it. In fact, there is ample evidence for it going back thousands of years (eg meditation, yoga, acupuncture, massage) The true test of efficacy is the market. If CAM did not work, people would not spend their own money on it, which they do.

6 How would integration of CAM work?
The government has already put in place the mechanism for paying for patients’ choice in the Payment By Results legislation, which came into effect in April 2006. Under it, general practitioners (GPs) are supposed to hold the budget for each and every one of their patients.

In a patient-centred NHS the patient would tell the GP the treatment that he/she chooses, and the GP would commission and pay for it out of the budget under Practice Based Commissioning. (PBC) Through their PCTs, GPs can contract under Service Level Agreements (SLAs) with Alternative Providers of Medical Services (APMS) who could be providers of CAM, such as meditation, yoga, acupuncture, massage etc

The main obstacle to this is the General Medical Council’s (GMC) resistance to CAM. Doctors can still be struck off the register for putting their patients in jeopardy by referring them to ‘charlatans of quack remedies’. This 19th century notion should be discarded, to remove the fear among doctors of losing their livelihood. The worst that can happen if GPs refer their patients to quack CAM therapists is nothing. Nobody has ever been harmed by CAM, unlike prescribing drugs.

Of course good clinical governance requires that all patients are treated with safe and effective methods. This should be applied equally to all publically funded treatments, whether conventional, or CAM. We have seen above, however, that at present clinical governance is applied hypocritically. It is used to outlaw CAM, which is safe, effective and never hurt anybody, but is not applied to drugs, which kill 400 people every day.

Conclusion outcome of 60 years of paternalistic, provider-centred, NHS which knows best? The ‘Prozac nation’ (9) in which the cure is often worse than the disease, and which kills both patients and doctors.

For the patients the outcome is: Being unwittingly prescribed unsafe drugs that cause many (around 1 in 5) to become permanently addicted. Many (perhaps 1 in 30) to be permanently maimedkilled.

For the doctors, the outcome is: a system which has reduced a once great profession of healing to pill pushers for the drug companies. Doctors are forced to break their Hippocratic oath (do no harm) and become Shipmans, wittingly or unwittingly. The price they pay for this is burnout, above average drug and alcohol dependency and dying prematurely, a decade earlier than average.

Many people in society have rumbled the system, and take responsibility for their own (and their family’s) health under self-care. If they can afford it, they invest in CAM to keep well and prevent illness in themselves and their families.

However, the majority of the population cannot afford CAM. The biggest health inequality is the haves, who prevent ill health with CAM, and the have-nots, who cannot afford CAM, and are given ‘hobson’s choice’ of free, but unsafe drugs, which often do them more harm than good.

8 Recommendation
Change the 60 year old (1948) political message from the State:

  • ‘We will care for you from the cradle to the grave however you treat or mistreat yourself’ to
  • ‘You are responsible for your own, and your families’ health, and we will assist you in this’.

This will require the re-education of the nation, starting with NHS staff, who can then re-educate their patients. The word ‘doctor’ comes from latin ‘doctare’ meaning ‘to teach’. Teaching health (rather than sickness) can be done by creating an integrated health and social care service incorporating CAM therapists, by:

  • getting the GMC to relax its Victorian rules forbidding doctors to refer to quacks,
  • encouraging GPs to get their PCTs to contract with CAM providers as APMSs
  • giving all patients the choice of free conventional or free CAM

This will relieve the present excessive pressure on the NHS by adding a million extra trained staff to the NHS workforce, as called for by Wannless. It will give existing NHS staff free CAM to de-stress and heal themselves, and learn what a patient-centred service really is. They can then teach their patients how to take responsibility for their own health (self-care) The outcome of this change will be a healthier nation, at lower cost to the taxpayer.

9 Appendix Examples of cost savings with CAM treatments
a) A 40 year old woman with breast cancer could be offered drug Herceptin costing £10,000. This might give her a remission to carry on as before for 5 or 10 years, but the cancer might then return because the cause has not been addressed.

Alternatively she could be offered season tickets for 1 hour yoga classes at £7 per hour 3 times per week for a year, costing the PCT a total of £1,100 for 150 classes. This would educate her to take responsibility for herself, and change her life style. This could enable her to find and eliminate the cause of her cancer, and live healthily for another 40 years. If she chose the yoga option, the saving to the PCT would be £8,900, plus the saving of not having to treat a recurrence of her cancer 5 or 10 years later.

b) An 85 year old woman with terminal cancer could be offered palliative chemotherapy costing £3,000, which might shrink her tumour and extend her life, but give her distressing side-effects.

Alternatively she could be offered half hour sessions of reflexology and/or aromatherapy and /or reiki healing 3 times per week. This would cost the PCT £20 per session or £800 in total for 40 sessions over 3 months. This would calm her anxiety and enable her to reflect on her life, considering her regrets, forgivenesses and goodbyes It might enable her to die at peace, and her relatives to know that she had had a good death.

If she took the alternative option, the saving to the PCT would be £2,200, and less stress on the staff.

10 References
1 Book Death by Medicine by Gary Null
2 TV Channel 4 documentary ‘Why doctors make mistakes’ Nov 2000
3 Book Secrets of the Drug Industry by Brian Hubbard, published by What Doctors Don’t Tell You. 2002
4 See European Doctors website
5 Northwich Park, Parexcel, reported on TV ‘Dispatches’ 29.9.06
6 Book Food is better medicine than drugs by Patrick Holford and Jerome Burne.
7 Book The Great Cholestrol Con by Dr Richard Kendrick about statins.
8 Conservative ‘In Touch’ leaflet, Sept 2007
9 Speech by Health Secretary Patricia Hewitt to Mental Health conference, May 06

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