If you visit an alternative health centre you may find yourself being offered cures for everything from AIDS and cancer to headaches and warts. Homeopathy, iridology, hypnotherapy, reflexology, aura readings, aroma therapy, acupressure, oxygen therapy, past life regression therapy and Indian head massage are just a small fraction of the alternative therapies on offer today. There is only space here to look briefly at a few of them.

There are about 50,000 practitioners of alternative medicine in the U.K. today (compared with about 36,000 ordinary doctors), and the industry has a turnover of about two billion pounds a year (1). Use of alternative medicine has doubled in the last seven years. There is a great deal of coverage, mostly uncritical, in our popular newspapers and magazines.

The difference between Complementary and Alternative therapy - These two terms are often used interchangeably, but there is a difference. According to the National Centre for Complementary and Alternative Medicine, complementary medicine is used together with conventional medicine, while alternative medicine is used in place of it. Complementary therapies, although they do not cure, could be helpful to some patients and are recommended by some doctors: for example stress management, massage, or some other relaxation technique to reduce discomfort following surgery.

ALTERNATIVE THERAPIES

Richard Dawkins defines alternative medicine as

‘that set of practices that cannot be tested, refuses to be tested or consistently fails tests.’

It is difficult to know what to believe about alternative medicine, because the experts themselves seem to disagree. And if the experts disagree, what are we supposed to believe?

How many of us know what a busy spleen does for a living?

As John Diamond puts it: the alternate therapists have ‘one massive advantage working in their favour: most of us have not the faintest idea how medicine works. Come to that, most of us have a pretty feeble idea of how our body works’. (2)

Diamond reported how, in an episode of the BBC’s game show The Generation Game contestants were asked to place stickers naming various bones and organs on the bodies of a couple of bathing-suited models. Both teams scored zero. Most of us, it seems, are not in a position to question the treatments or therapies which are meted out to us, whether orthodox or alternative. So we tend to follow our instincts, to take things on trust, and to put our faith in the expert - but which expert?

   
A Feel-good Factor? - some advantages of alternative therapies - Instinctively many people prefer ‘natural’ remedies, herbs, massages, ‘whole-body’ techniques etc. There’s a feel-good factor about it. We are treated as real people and are encouraged to involve ourselves in the whole process. The emphasis is more on prevention than cure.

Moreover alternative treatments can reduce hospital waiting lists, and lead some people away from a dependence on anti-depressants, sleeping pills and other drugs. These are positive aspects not to be brushed aside.

The ordinary doctor’s surgery, on the other hand, may have a ‘feel-bad’ factor! You often have to wait ages in the surgery before you are seen, and then you may be fobbed off with antibiotics or some other drug by a tired and stressed doctor. Unlike the ‘natural’ remedies, the conventional drugs are seen as ‘chemicals’ (from a test tube) and artificial, impersonal, sometimes even dangerous, and as more likely to have side effects. No wonder so many people embrace the alternative treatments.
 
     
    The picture, however, is not quite so simple - Firstly the distinction between ‘natural’ and ‘chemical’ substances is questionable. Many plants, which are by definition ‘natural’, are also extremely poisonous (see box); and every single plant, and even our whole bodies, are made up of chemicals. Moreover, scientific medicine has got nothing whatsoever against herbs or other plants. Many tried and tested medicines are in fact plant based. (Aspirin, which is made from willow bark, is a well-known example.) All that the scientists ask is that any herbal treatment should be rigorously and scientifically tested before being proclaimed a medicine.
     
What is ‘natural’?
Aconite, part of the buttercup family and found in some gardens, was once used to poison wolves (hence the common name wolfs bane). Deadly nightshade, part of the potato family and growing both wild and in gardens, is also highly poisonous from top to bottom, especially the roots. Hemlock, a pretty plant related to parsley and the carrot, is one of the most poisonous, and was used to execute criminals in ancient Greece. What could be more ‘natural’ than the plants in your garden?
 

The pretty but extremely poisonous water hemlock plant.
     

So, for the love of all that’s good
and great, please don’t say:

   
     

"It’s made of chemicals so it must be bad"

   

or

   

"It’s natural so it must be good"

   
     
Secondly there is more to conventional medicine than over-worked doctors dishing out antibiotics.    
Achievements of conventional medicine
Once modern scientific medicine began to take root in the 19th century its achievements have been monumental. Bacteria, anaesthetics, X-rays, antibiotics, vitamins, vaccinations and a great deal more were discovered. Deadly diseases such as smallpox, tuberculosis, cholera, polio, tetanus, typhoid and many others have been all but conquered in many parts of the world. These achievements have of course gone hand in hand with better hygiene and sanitation.
   
Vaccinations have led to the dramatic decline of a number of diseases.
 
Despite these wonderful achievements, however, conventional medicine cannot provide cures for AIDS, advanced cancers and even the common cold.

On the plus side, however, the lives of AIDS sufferers can be greatly prolonged and improved, and cancer can often be cured with early diagnosis. We have made enormous strides in our knowledge about the prevention and the nature of these diseases.

   
The question to ask
There is one important question to ask about a particular alternative medicine or therapy. Can it be shown to be effective, using controlled, double blind studies? If it can, then it should be included in mainstream or orthodox medicine, and should no longer be called ‘alternative’.

But if the scientific research shows that a particular treatment has no beneficial effects, then we should at least be wary of it. If it appears to work for you, that’s fine; but make sure to put your critical thinking cap on, before throwing away money on ‘snake oil’, squid’s cartilage or other miracle or untested cures! (Snake oil has become a widely used term by sceptics to refer to any dodgy or unproven cures.)

 
The double-blind method
This is a way of avoiding bias during research. For example ten participants are given a homeopathic pill, and another group of ten are given a different, non-homeopathic pill which looks the same. Neither the experimenter nor the subjects know who gets the homeopathic pill and who gets the blank pill. (See also
    Richard Dawkins defines alternative medicine as ‘that set of practices that cannot be tested, refuses to be tested or consistently fails tests.’
The risks
Sometimes a person’s faith in alternative medicine may be so unshakeable that tragedy can result. A couple decided to protect their child from ‘suppressive’ conventional medicine. They did not immunise him against a number of common childhood diseases and never took him to a GP when he was ill. Instead they persevered with homeopathic treatment. When he died he had a swollen stomach, swollen testicles and an enlarged liver. Professor Peter Clayton, from Great Ormond Street Hospital commented: ‘If medical advice had been sought the outcome would have been different.’ (3)
   
So if you are having alternative treatment for a serious condition, the advice which any good doctor would give is to seek conventional treatment at the same time.    
When reliance upon alternative medicine becomes government policy its dangers become even more apparent. South Africa has an AIDS epidemic, with 18.8% of the population affected, and in some regions over 30%. (UNAIDS Global Report, 2006). Approximately 1,000 South Africans die of AIDS every day, and there are 1,200,000 orphans as a result of the disease. Yet a South African Minister of Health , as recently as 2003, was advocating a diet of beetroot, olive oil, garlic and potatoes as a remedy, while down-playing the usefulness of anti-retroviral (ARV) therapy. A healthy diet is of vital importance, but not as a cure for HIV/AIDS, and not as an alternative to the life-saving ARV drugs.    
HOMEOPATHY

CURE-ALL OR SNAKE OIL?

Greek: homo = same, path = disease

Homeopathy, founded by the German doctor, Samuel Hahnemann, in 1755, is one of the most popular and also one of the most controversial of the alternative medicines. Every year about 470,000 people in Britain spend £25m on homeopathic remedies, and it is said to be favoured by the royal family and by celebrities such as David Beckham and Geri Halliwell. A former British Government minister (Peter Hain) claimed that it had cured his baby son of eczema. In any high street chemist you will probably find pulsatilla, nux vomica, rhus tox and other exotically named medicines on the shelves.

Samuel Hahnemann Judged by the standards of his day Samuel Hahnemann was a sensible doctor, ahead of his time. He had a strong dislike for medical practices such as blood-sucking leeches, purging, burning, and the use of poisons such as arsenic and mercury. He was also (unlike his medical contemporaries), kind to mentally ill people and did not allow corporal punishment at the asylum of which he was in charge.

 
The two main tenets of homeopathy are:

  • Like cures like - for example pollen to treat asthma.
  • Only an infinitesimal amount of the medicine is needed - in fact the more diluted the potion the more powerful it is.

A further principle is that the remedies are tailored to the needs of the individual. A homeopath will assess not just the physical cause of the illness but the emotional state of the patients, as well as their personality and temperament, before deciding upon the remedy. This is part of its appeal.

   
The most expensive water in the world?
Homeopathic remedies are diluted so much that in many cases not a trace of the original substance remains - not even a single molecule, and yet it is still claimed to be effective! This was not a problem for Dr. Hahnemann - molecules were still waiting to be discovered in his day. But it is this aspect which scientists have found most troubling. If there is no molecule of the original ingredient left in the water, then surely that’s all it is - water! Homeopaths do not deny this, but claim that the water somehow retains an imprint or memory of the herb’s or mineral’s vital essence.

If this were true, it means that water would retain a memory of almost every different chemical on the planet, given that it is endlessly recycled; and that for every glass of tap water we drink, we would probably be receiving homoeopathic treatment for virtually any condition you care to mention! Scientists, however, do not recognise this capacity of water to become imprinted or to memorise in this way.

What the evidence shows Over the past 150 years a great many scientific studies have found homeopathic remedies to be ineffective, except as a placebo (see box below). A few have had positive results, but these could not be repeated.

In October 2005 Prince Charles released his own report which was sympathetic to homeopathy.(4) He argued that people using homeopathic remedies had fewer consultations with GPs, and took half as many drugs. In purely economic terms this represents a significant saving for the health service.

    The Placebo Effect
If a sample of patients take a blank pill with no medication in it, but think it is a medicine, and begin to feel better more quickly than a sample who took no pill, then this is referred to as the placebo effect. It has also been found that large pills work better than small ones, coloured ones better than white ones, and that doctors with white coats and stethoscopes are more effective that those in ordinary clothes. Simply having faith or belief in the treatment is an important factor and can influence the result.
A large scale double-blind study
A recent large scale study was carried out in Switzerland and published in the Lancet (official magazine of the British Medical Association). The study, using the double-blind method, looked at 110 trials using homeopathic remedies and 110 using conventional medicine. The two samples of patients were as well matched with each other as possible - for example the two groups had similar illnesses or medical conditions. Again, the conclusion from all the data was that homeopathy had no more than a placebo effect. (5)

An editorial in the Lancet was titled The End of Homeopathy. It argued that the negative results of the Swiss study were not at all surprising; what was surprising was that we were still debating the issue after 150 years and after so many studies which have come to the same conclusion. ‘For too long a ….laissez-faire attitude has existed towards homeopathy. Now doctors need to be bold and honest with their patients about its lack of benefit.’

Despite the many negative findings, the popularity of homeopathy continues to grow, and millions of people continue to swear by it. There is no shortage of anecdotal evidence of people making remarkable recoveries.

 

It is important to keep bearing in mind, however, that:

  • the placebo effect has been proved many time
  • we recover anyway from most conditions, with or without treatment
  • anecdotal evidence can be very unreliable. (See Glossary)
   
“The art of medicine consists in amusing the patient while nature cures the disease.” Voltaire, philosopher (1694-1778)    
     
ACUPUNCTURE    
Latin: acus = needle, pungere = to prick

The Emperor Huang-di
About 4,700 years ago the Chinese ruler Huang-di is said to have introduced writing, the bow and arrow, the pottery wheel, the breeding of silkworms and acupuncture, among other things. (In Britain at the time we were busy building Stonehenge, but our inventions and discoveries were no match for those of the Chinese.) About 2,000 years later Huang-di’s thoughts on medicine were collated into a text called the Su wen - the most ancient medical text in the world. Among other things it describes the method of healing, using needles, known as acupuncture.

Acupuncture is an alternative treatment which has more scientific support than any of the others. Although there have been a number of scientific studies which have concluded that acupuncture has no benefit for patients beyond a placebo effect, there is also some evidence which suggests that its benefits can be real, above and beyond placebo. As we shall see, the evidence is not clear cut.

   
Some of the main tenets of acupuncture:

  • We have a theoretical substance or energy called qi (pronounced chee), which flows through our bodies by means of pathways called ‘meridians’.
  • There are twelve main meridians (some say 14), which correspond to the months and animals of the Chinese Zodiac or calendar.
  • Diseases occur when the qi does not flow properly, as a result of blockages in the meridians.
  • There are traditionally 365 points (known as acupoints) along the meridians, one for each day of the year, although some modern practitioners say there are more than this.
  • Very fine needles, traditionally of gold or silver, are inserted into selected acupoints along these meridians and twiddled about rapidly between the fingers. The needles unblock the flow of qi, bringing the body back into balance, and thus bringing relief from pain as well as healing.
  • Each meridian is thought to correspond in some way to a particular organ such as the heart, the kidney or the lungs. So if you have a breathing problem, the needles are inserted at points along meridians which are linked perhaps to the lungs and the nose. (Like homeopathy, the treatment is not standardised but tailored to the needs of each individual, looking at the ‘whole person’, including personality, temperament etc.)
  • An ill person is thought to be out of balance with nature and in particular when the two opposing forces of yin and yang do not balance each other. Yin is supposed to be the feminine, passive and accepting side, while yang is the male, aggressive and forceful side. When the qi can flow freely again, balance and harmony in the body is restored, and the patient gets better. (Sometimes yin and yang are thought of as light and darkness)
  • The colour, shape and coating of the tongue, as well as the pulse are also part of the diagnosis and are thought to indicate problems in the internal organs. (Different pulses on the body for each internal organ.)

(When pressure is applied to the acupoints without using needles, for example with the thumbs, this is known as acupressure. Its methods and principles are otherwise the same as acupuncture.)

Medicine in ancient China
Dissection of the human body was forbidden in ancient China, diseases were not systematically described or classified, and evidence was not collected and studied. As a result there was no knowledge of cells, nerves, hormones, the circulation of the blood and so on. Concepts such as meridians, acupoints, or the balancing of yin and yang are not based on any physiological evidence, and are considered by most modern scientists to be imaginary.
From this very brief synopsis we can see what a huge gulf there is between traditional Chinese acupuncture and modern scientific medicine. The concepts, diagnosis and the treatment, could come from different planets!

We cannot blame the ancient Chinese for not having a modern scientific approach! For their time they were way ahead. But what is surprising is the extent to which these same ideas have survived into the modern era. For many there is a certain mystique about the ancient - if it has come down to us from the mists of time it must be good. The phrase ‘ancient wisdom’ trips off the tongue.

   
But does it work?
As with all alternative medicine, no matter how strange it seems, we have to ask: what does the evidence show? How effective is it? How important is the placebo effect? What do ‘double blind’ trials show?

In a television programme about acupuncture in January 2006 a girl was seen lying on an operating table in a Chinese hospital having heart surgery. A number of needles were sticking out of her body and she was still awake and not in pain. The film gave the impression that the needles were responsible for the analgesia (insensibility to pain).

Upon further investigation, however, it turns out that the patient was also receiving three conventional sedatives - midazolam, droperidol and fentanyl, along with a large amount of local anaesthetic injected into her chest. Why were these drugs not mentioned in the film? (The acupuncture may of course have also contributed to the analgesia, but from this film it was impossible to judge.) Which all goes to show how careful we have to be with the mass media!

   
Scientific support
There have been studies, however, which have found that the insertion of needles in the body can cause relief from pain. For example, in 2005 a large scale study in Munich, Germany and a separate one in Britain found that acupuncture could bring relief from headaches and painful osteoarthritis in the thumbs. (6)

In October 2010 Edzard Ernst reviewed all the available evidence (between 2000 and 2010) regarding 12 different rheumatic conditions. Only for osteo-arthritis, low back pain and lateral elbow pain did he find evidence of pain relief. (7)

A promising area of research is the use of brain-scans while the acupuncture is being carried out. The British study found that during acupuncture, two regions of the brain were activated - the opiate centre and the ipsilateral insular - parts which could possibly be involved in pain modulation.

Would randomly inserted needles have the same effect?
The intriguing question is whether the needles have to be inserted in the acupoints along the meridians, or whether they can be inserted anywhere, at random. The German study is one of several which have looked at this. Not only were the needles inserted randomly (i.e. completely ignoring the supposed meridians along which the qi is said to flow), but fewer needles were used, and they were inserted less deeply than in traditional acupuncture. This fake acupuncture had a beneficial effect equal to the real acupuncture.

The doctor and journalist Ben Goldacre quotes another large-scale study, involving 1,162 patients suffering from chronic back pain: there was no statistically significant difference between the proper, genuine acupuncture and the fake “bung a needle in, anywhere you fancy, with a bit of theatrical ceremony” acupuncture.

 
Electrical stimulation
Dr. G. A. Ulett has been studying acupuncture for more than 35 years. He has found that, although the needles do activate areas in the brain important in pain control, electrical stimulation was as effective - with or without needles. He also dismissed the meridians, the qi, the acupoints etc. as based on fantasy and superstition. Ulett used specific electric currents to stimulate motor points and nerve junctures, which evidently cause the release of chemicals such as endorphins, which are known to help in pain control and healing. He found this ‘neuro-electric stimulation….to be a potent technique giving lasting relief from chronic pain with a reduced dependency upon medication.’ (8)
   
Conclusions
From the welter of conflicting evidence, the following conclusions could perhaps be drawn:
  • Acupuncture can produce some relief from pain and some curative benefits beyond the placebo effect, although the extent of its anaesthetic potential is still hotly debated.
  • Needles inserted randomly (i.e. ignoring the so-called meridians and acupoints) and fewer in number can have the same beneficial effect as those inserted in the normal way.
  • It follows from this that the existence of meridians, acupoints, the flow of qi etc. are unlikely, rooted as they are in ancient Chinese superstition and numerology.
  • Electrical stimulation of certain points (unrelated to acupoints) may also be effective.
  • The placebo effect plays an important part (i.e. in addition to the other possible benefits) - which is not denied by acupuncturists.
  • No link has been established between specific pulses and specific internal organs, or between the state of the tongue and the internal organs.
   
     
REIKI    
Reiki is a Japanese technique for stress reduction and healing. The word comes from two Japanese words - Rei meaning ‘God's wisdom’ or ‘ higher power’ and ki which is ‘life force energy’. It was popularized by Mikao Usui (1865- 1926), and has also become popular in the west. After fasting and meditating for several weeks, Usui began ‘hearing voices’ giving him ‘the keys to healing.’

Topping-up our ‘life force energy’ (or ‘ki’) The ki is similar to the qi (chee) in acupuncture, but Reiki differs from acupuncture in the following ways: (i) the laying on of hands is used, not needles; (ii) the ki (or ‘life force energy’) flows within, into, and out of the body but not along meridians or any other specific channels; (iii) the idea is not to unblock the flow of ki, but to channel the ki of the universe, via the healer, into the patient.

If our life force energy is low, we are more likely to get sick or feel stress; but when re-channelled into us we will be ‘rebalanced’ and will feel better. (‘attunements’ and ‘harmonies’ are also often-used terms, which may explain why the therapy is popular with New Age followers.)

 

The patient lies down and should feel as comfortable as possible. There is no need to remove any clothing as Reiki will pass through anything, even plaster casts. The practitioner places his or her hands non-intrusively in different positions, covering the whole body. (Physical touch is not always necessary since ki can flow from the body of the healer into the patient via the air.)

What the apprentice learns
For an apprentice to become a master can cost £5,000 or more. During the training they will learn how to call up the universal life force, how to heal an emotional or spiritual illness, and how to heal someone who isn't present (!). The Reiki Handbook (1992) states that reiki can be used to treat brain damage, cancer, diabetes and venereal diseases. If the healing fails, however, it is because the patient is resisting the healing energy. So it is quite easy for the therapist to pass the buck if it isn’t working.

 
There is no scientific evidence to support the concepts upon which Reiki is based. Like most alternative therapies it is harmless in itself and may make you feel better if you believe in it (the placebo effect). The cost of Reiki in Britain is about £30 for an hour, but could be as much as £50 or as little as £20; usually a series of sessions would be recommended. The only serious harm which could arise is when patients with serious but treatable illnesses have such faith in it that they avoid conventional doctors.    
THERAPEUTIC TOUCH
(also known as HEALING)
   
Like acupuncture and reiki it involves improving the flow of energy (qi) in the body, but unlike the other two, there is no physical contact with the patient. It can be used on adults, children, infants, pets and even plants. Practitioners believe:

  • that each living thing has a ‘life energy field’ which extends outside the surface of the body and can generate an aura (see pictures below)
  • the palms of the hand are chakras and can channel this healing energy
  • The energy fields of the healer and the patient interact, and the healer can transfer some of her or his own energy to the patient.

The patient is normally horizontal during the treatment, and the session is usually accompanied by the dimming of lights, the burning of incense, and soothing music. The healer begins the assessment by passing his or her hands a few inches above the latter’s body, scanning it from head to toe. The patient’s hands are sometimes placed next to each other, thumbs touching, and palms down. The healer 'feels' various energy sensations such as tingling, heat, cold, heaviness, or a ‘drawing feeling’. This allows her to determine the type of imbalance which is present - loose congestion, tight congestion, localized imbalance, obstruction, energy deficit etc.

The therapists moves their hands in a circular sweeping pattern as though massaging the air. This restores the energy field to a state of balance or harmony by moving excess energy to areas of low flow.

Like other pseudo-scientists, some TT practitioners claim that it is based upon scientific principles, including quantum physics, and dress it up in suitable jargon: “The principles upon which this technique is based include acceptance of the Einstein paradigm of a complex, energetic field-like universe (i.e. the existence of a Life energy flowing through and around all of us). Further, if life is characterized by an interchange of various qualities of energy, it can be assumed that any form of obstruction - either within the organism or between the organism and the environment - is contrary to Nature's tendencies…” (9)

 
What would a scientist make of this?
  • Einstein did not have a paradigm which included the notion of ‘a Life energy flowing through and around all of us.’
  • Scientists do refer to interchanges of different types of energy, for example kinetic energy into electrical energy, or electrical energy into heat or sound energy, but I don’t think that this is quite what the TT writer had in mind.
  • The blockage or obstruction of an air passage or of an artery is certainly unhealthy. If you had such a blockage you would be well advised to get it removed urgently - and not by someone massaging the air over your energy field! Scientists do not recognise blockages in the flow of energy fields.
   
Robert Todd Carroll points out, moreover, that obstructions are not necessarily unnatural. ‘…. for most organisms the environment is mostly obstruction. This may not be healthy, but it is certainly natural. In any case, what does it mean to say that it is unhealthy to go contrary to Nature's tendencies? Are the hurricane, the tornado, the volcano, the flood, the lightning bolt and the earthquake contrary to Nature's tendencies? How could they be, since they are part of Nature.’ (10) We could also ask: is it natural for the male lion who joins a new pride, to kill every single cub in his new family? What appears to be a profoundly unnatural act is in fact very much part of nature, and has the effect of spreading the gene pool, which helps to ensure the survival of the species (whether we humans like it or not!)    
     
CHAKRAS AND AURAS    
In Hinduism, the New Age movement and some alternative therapies, a chakra is a point or a source of energy or ‘life force’ located in the body. There are seven primary chakras, each associated with different parts of the body, emotions, thoughts, health etc. Some believe that chakras give rise to auras.

The aura is an ‘energy field’ that is believed to surround all living things including insects, and which have different colours which reveal our emotions, character traits, spiritual health etc. It is a little like having a glow (more than one) all around us. For example, a dark brown aura may indicate common sense, a pale green aura may indicate spiritual advancement, and so on. You need, of course, to be very well trained or spiritually advanced to be able to detect and read a person’s aura.

There is no scientific basis whatsoever for either chakras or auras. There are such things as ganglia (singular: ganglion) i.e. nerve centres or nerve junctions in the body. But these ganglia bear no relation to the imagined chakras.

   

What might a person’s aura look like to the trained observer?
Unfortunately there is no standardised version. Observers from different therapies or traditions do not always agree with each other on what it would look like - which raises the question as to whether it is more likely to exist subjectively, in the observer’s mind, rather than as an objective reality. The picture on the left is one version. Another may be a more uniform glow of one colour, right round the body, with another layer of a different colour outside that one.

 
Fortunately it is relatively easy to test scientifically the accuracy of the Reiki and TT claims. When tested, Reiki and TT practitioners have always failed to tell which arm or leg or other part of the body of the volunteer is injured or diseased. TT therapists have also tried their hand (so to speak) at the James Randi $1,000,000 challenge. None were able to tell the difference between volunteers who were ill and those who were healthy. (11)

The NHS and alternative treatments
In May 2006 a group of 13 eminent British doctors and scientists wrote to every NHS Trust in the country to urge them to stop spending money on ‘unproven or disproved treatments’ such as homeopathy and reflexology, while lack of funds was forcing hospitals to deny patients access to life-saving drugs, and in some cases to sack nurses.

They said that they were happy for the NHS to offer the treatments once research has proven them effective, but that very few had reached the required standards. ‘If people want to spend their own money on it fine, but it shouldn’t be NHS money.’ (12)

QUESTIONS

CONTENTS

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