Health: Cancer

Lord Colwyn Excerpts

Thursday 11th November 2010 Lords Chamber

[Lord Colwyn]

My Lords, despite the fact that successive Governments have generally maintained funding, modern medicine is, I believe, experiencing an economic crisis that has brought changes that have alienated patients and eroded the job satisfaction of physicians. It has become too expensive. The resultant managed care system is making the lives of both patients and doctors difficult. One of the attractions of medicine as a profession was the promise of autonomy. Today, few doctors can succeed in solo practice and most must work in group practices or corporate settings, where they are told how many patients to see in an hour, which treatments are authorised and which are not.

The very success of modern scientific medicine has been partly responsible for this situation. Eliminating infectious disease—the major killer of the early 20th century—has left us to deal with chronic degenerative illness. The success of medicine has also contributed to the ageing of the population. Of course, medical expenses increase the more elderly people that there are.

Another reason for the expense of conventional medicine is its extreme dependence on technology. Medical technology is inherently costly, and unless we change that dependence, there is little hope of cutting costs. Another powerful economic force impacting on medicine is the still-growing consumer movement that is demanding low-tech options for preventing and treating illness. Consumers are very clear about their desire for natural, complementary and alternative therapies. This is not a passing fad but, rather, a sociological trend with deep roots and a great economic significance.

Patients want greater empowerment in medical intervention and they want doctors who share their views about health and healing. They want doctors and specialists who have time to sit down with them and help them understand the nature of their problems rather than just promote drugs and surgery as the only possible treatment. They want doctors who are aware of nutritional influences on health and who can answer questions about the complex array of dietary supplements and natural therapeutic agents in health food stores. They want doctors who are sensitive to mind-body interactions, who are willing to look at patients as mental-emotional beings as well as physical bodies and who will not laugh at them for inquiring about Chinese medicine or therapeutic touch.

Those are all reasonable demands. A problem is that medical schools are not training doctors in the ways that consumers want and many patients are turning elsewhere. At a time when healthcare institutions are economically pressed, medicine cannot afford to ignore where the market is moving.

It is possible to teach both patients and practitioners about the strengths and indications of standard medicine without in any way rejecting its real achievements. Alternative, complementary medicine is a rich mixture of wisdom and folly. A few alternative therapies are dangerous, more are ineffective and still more are unproven, but many conventional practices are also unproven and many are dangerous as well as ineffective and costly. The use of complementary medicine in the treatment of cancer has attracted particular attention because of the fear among oncologists, radiologists and cancer surgeons that patients may be denied effective and potentially life-saving treatment because of a reliance on unproven fringe techniques. This issue arouses strong feelings among orthodox and complementary practitioners and their patients.

A 1984 study by Cassileth et al found that, in their beliefs about illness and treatment, cancer patients using complementary medicine differed substantially from patients using only conventional therapy. Patients using complementary medicine were more likely to believe that their cancer was preventable, primarily through diet, stress reduction and environmental changes. They were also more likely to believe that disease in general is caused mainly by poor nutrition, stress and worry. Almost 100 per cent of the patients interviewed believed that they should take an active role in their own health as compared with 74 per cent of patients having conventional therapy only.

The challenge is to sort through all the evidence about all healing systems to extract those ideas and practices that are useful, safe and cost-effective. Then we must try to merge them into a new comprehensive system of practice that has an evidence base and addresses consumer demands. The most appropriate term for this system is “integrative medicine”. That term is neutral, accurate and acceptable in academic discussion and it avoids the misleading connotations of “alternative medicine”, which suggests a replacement of the standard system, and of “complementary medicine”, which suggests retention of standard therapies as central and primary.

Integrative medicine is not simply concerned with giving physicians new tools such as herbs in addition to, or instead of, pharmaceutical drugs; rather, integrative medicine aims to shift some of the basic orientations of medicine towards healing rather than symptomatic treatment, towards a closer relationship with nature, towards a strengthened doctor-patient relationship and towards an emphasis on mind and spirit in addition to body. These shifts should make for better medicine in addition to greater satisfaction for patients. I should declare that I am president of the All-Party Parliamentary Group for Integrated and Complementary Healthcare.

Integrative medicine offers the promise of restoring values that were prominent in medicine of the recent past, cutting healthcare costs, improving health and renewing consumer confidence and satisfaction. I hope that my noble friend will confirm that the White Paper will enable and promote patient choice, and that cancer patients and those patients who wish to access complementary therapies will have that access and will not be discriminated against in any way.