I’ve just come back from chairing a debate on the motion “A treatment should have to be scientifically proven to be available on the NHS”for the Guild of Health Writers (http://www.healthwriters.com/).  It was an eminent panel and an equally eminent audience of doctors, researchers, journalists, editors, writers, complementary therapists – and many who had feet in more than one camp. Unsurprisingly it turned into an absorbing debate.  Not too heated, yet a great deal of passion was on show and a lot of ground was covered.

It is an area I’m really interested in and have written about at some length but the debate did make me think some of the issues again.  Perhaps the most important was the notion that evidence is a slippery beast.  No one, neither on the panel nor in the audience, were arguing against going with the best evidence.  But the deciding just what is the best evidence is not easy.  There is the modern discipline of Evidence Based Medicine (http://www.bmj.com/cgi/content/full/312/7023/71 is a good starting point) which is the current medical paradigm, but there is leeway within that and there is also a view that EBM itself is too rigid.  One of the arguments that emerged was the fear that good practice might be discarded if it didn’t conform to the type of evidence that fitted into EBM.

And then there was the thorny problem of how evidence is gathered and evaluated.  A significant amount of clinical research is funded by the drug companies who stand to make money if the drugs turn out to be effective.  (That's not to say that the results are tainted in any way but it does leave the system open to accusations of bias at the very least.) There is nothing like the same amount of money available for research into complementary medicines so there is not the same body of evidence available.  No-one argued that complementary should not be researched but there is an important issue here, how to fund it?  And what about outcome measures; when is a treatment deemed to be successful?  If a patient gets well that’s a very clear outcome, but how do you evaluate improvements in chronic conditions?  There is the notion of qalys - quality of life years - which are valued currently at around £30,000 but they are far from perfect. 

Overall, I was struck by the very large amount of brain power that has gone into this subject yet there are still very big questions to resolve.  There remains a great deal of uncertainty around medicine and treatment and healing and health care.  That’s probably not a bad thing – uncertainty fosters inquiry – but it is not easy for either doctors or patients to live with.  Contributors from both sides of the debate referred to the realities of being a doctor facing a patient and trying to do the best for them.  The information they have about the efficacy of treatments is incomplete to say the least.  They are constantly using their judgment to navigate through poorly charted waters.  And I thank Hippocrates that they do and they are good at it.

But it was the final comment made yesterday evening that has stuck with me.  Right at the end a young woman spoke up, I’m paraphrasing so I hope she’ll forgive me if I get this wrong.  She is a medical student and reading between the lines she also has an interest in complementary therapies.  Addressing both the medical doctors and complementary therapists in the room she almost pleaded “why can’t we work together to help our patients live better?”.