Kat - You look at whether we can look at complementary medicine in a scientific way. Can you tell me what your book is about, and what gave you the idea to write it?
Toby - The book is not about whether complementary medicine works, but how do we know whether it works or not. I think that this is a more important question. At the moment, we have no real way of testing these methods to see if they do what they claim they do.
Kat - What first got you interested in this question?
Toby - I first became interested when an old cat of mine became ill. I took him to the vets and was told that his kidneys had failed. Rather than have him put to sleep, I decided to take him to a homeopathic vet. Homeopathic remedies don't contain any active ingredients, so I knew that my cat wasn't going to be in any harm. The homeopathic vet asked me if the cat had lost his fur at any time, to which I said yes. The vet called this 'angry kidneys'. If my cat took some pills for the next few weeks, I was told his fur would start to fall out again as the 'anger' from the kidneys was drawn out. This is indeed what happened and the cat went on to live another year rather than the two weeks predicted by the first vet.
This anecdotal evidence tells us absolutely nothing. We couldn't take half a cat and give that the homeopathic remedy while leaving the other half as a control. This problem stuck around in the back of my head. As I started talking to professors and doctors that had looked into it, I realised that all the arguments for and against complementary medicine are based on whether they work or not. No-one understands how to look at and test them properly.
Kat - We have Professor Fran Balkwell in the studio. Would you please tell us how you would test a drug in a clinical trial?
Fran - For a cancer drug, the first thing you do is a phase 1 clinical trial. That is done on patients for which there is no other option. Their cancer will be very advanced and there will be no other treatment for them. At this stage of the trial, you look for how toxic the drug is and not whether it has any effects. At phase 2, you try to give the drug the best chance of working. Scientists will look for responses such as tumours shrinking. If there is an effect at phase 2, you move onto phase 3, which is randomised. You give one group the best treatment currently available and you compare it with the new drug that you're testing. After testing it on a large number of people, the results will indicate whether the drug is really having an effect.
Kat - So that's the scientific view. Toby, how do you propose this model be used to test complementary medicines?
Toby - I think it is best to use an example like physiotherapy first. It is widely used and has good effects. If you try to treat physiotherapy as a cancer drug, you immediately run into some problems. Firstly, the treatment is individualised. If the physiotherapist applied the same treatment to everybody, it wouldn't work. They apply the same principles, but it is dependent on how quickly the patients get better, their particular problem and their own musculature. Secondly, part of the role of the physiotherapist is to develop a relationship with the patient. If they develop a good relationship, chances are that the patient will get better more quickly. The patient is more likely to do their exercises than if they don't like their physiotherapist. This interaction of individualised treatment and the relationship automatically makes things complicated. This is not to say that it couldn't be put through clinical trials, it is just that it is not as simple as testing a straightforward drug. This is the same for testing things like acupuncture and reiki. No useful results will come out of it. What we need is a new type of protocol that takes into account the treatment as a whole.
Kat - Do you think that complementary medicines are just placebos?
Toby - Any doctor will admit that the placebo is an important part of the healing process. It has even been enshrined in some versions of the Hippocratic Oath, which says that 'a kind word and a bit of care can be as effective as the pharmacist's drug or the surgeon's knife'. We can't discount the placebo. It definitely makes people feel better. Placebos can come in the form of pills that have nothing in them, or there can be a context placebo effect. This can be when people feel better by, say, going to the doctors. Just doing something about your illness can make people feel better.
Andrew - We have some medical students that have to spend a day outside of the health service in an area concerned with health care. Many visit the local Chinese doctor and other complementary medicine practitioners. What they all say is that the practitioner was a very good psychologist, very good with the people that came in, good a dealing with stress and good at giving their time.
Toby - Yes, I think that some of the treatments have genuine therapeutic effects, even if some of the others are crazy. In most of them, it is something about that relationship. I think everyone involved in health care might be able to learn something from this.