Personalised medicine is transforming the way we care for people living with long-term conditions like diabetes and cardiovascular disease. But as we understand more about what works well and what doesn’t, it is creating space for wider consideration of alternative therapies, including non-pharmacological interventions such as aromatherapy, acupuncture and meditation.
Increasingly, doctors are prescribing therapies that fall outside of mainstream healthcare, supported by a growing body of evidence that they are effective. At the same time, patients are becoming more receptive to alternatives to medication as they become better informed about the benefits.
So-called social prescribing is a good example. Backed by the NHS, social prescribing enables GPs, nurses and other primary care professionals to refer people with long-term physical or mental conditions to a range of local, non-clinical services to support their health and wellbeing. Social prescribing can include walking, volunteering, arts activities, group learning, cookery and healthy eating advice. Wellbeing is supported by building social connections and increasing activity levels.
Another example is pulmonary rehabilitation, which is effective in supporting people with a lung condition. PR involves specially designed exercises, backed by advice from professionals about managing their condition. The therapy is becoming more widely available to patients, although access remains limited.
There is no universally agreed definition of complementary and alternative medicines. Although ‘complementary and alternative’ is often used as a single category, it is helpful to make a distinction between the two terms:
- When a non-mainstream practice is used together with conventional medicine, it is considered complementary.
- When a non-mainstream medicine is used instead of conventional medicine, it is considered alternative.
Some complementary and alternative medicines or treatments are based on principles and an evidence base that are not recognised by the majority of independent scientists. Others have been proven to work for a limited number of health conditions. For example, there is evidence that osteopathy and chiropractic practices are effective for the treatment of lower back pain.
Despite growing interest, the availability of complementary and alternative therapies on the NHS is limited. NICE has approved a limited number of such therapies. Examples include the Alexander posture technique for Parkinson’s disease, and ginger and acupressure for relieving morning sickness. In August 2020 NICE recommended acupuncture as an option for some people with chronic primary pain, provided it is delivered within certain, clearly defined parameters.
This does necessarily mean that alternative therapies are not effective. One of the biggest barriers is the absence of any evidence, rather than conclusive proof that something does or does not work. According to the King’s Fund, the independent health think tank, there are still weaknesses in the evidence for social prescribing even though it is, undoubtedly, a positive experience for many. Many studies are small scale, do not have a control group, and focus on progress rather than outcomes.
So, even as consensus emerges over the desirability of improving access to alternative therapies, the absence of a deep evidence base is likely to remain an obstacle for some time to come.
By Martin Barrow.
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