Health: A natural health service: Registration for osteopaths, a professorship in complementary medicine, acupuncture on the NHS: attitudes to alternative therapies are changing radically. A report by Annabel Ferriman

'ALL professions are conspiracies against the laity,' said the playwright George Bernard Shaw, in a phrase that resonates with all supporters of complementary medicine.

Last week the Queen gave Royal Assent to a Bill that will turn practitioners of osteopathy, once a fringe group derided by conventional medicine, into a fully-fledged profession. For the first time, it will be illegal for peo-

ple with only a passing acquaintance with the subject to put up brass plates and call themselves osteopaths.

It is a sign of the times. It demonstrates just how far yesterday's 'quacks' are becoming today's establishment, and how fringe ideas are being transformed into modern orthodoxy. The passage of the Osteopaths Bill is just one of many signs of change. Last month the British Medical Association, which had previously condemned the use of alternative practitioners as a 'return to primitive beliefs and outmoded practices', published a report which finally recognised that such therapies were here to stay. Exeter University will be welcoming the country's first Professor of Complementary Medicine in the autumn.

Why have things changed? Why are doctors now accepting that not all fringe therapists are rogues and charlatans, and calling for them to be registered and regulated, partly for the sake of the respectable practitioners?

One reason is that doctors have become less sceptical about the therapies. By referring some patients to alternative practitioners,

they have discovered that their techniques can work and that their behaviour is not always bizarre and outlandish.

Doctors have also started to explore many of the therapies for themselves by making use of the numerous courses in complementary medicine available to them. More than 1,000 have trained in acupuncture and an equal number in homeopathy. More than 600 doctors and dentists are now members of the British Society of Medical and Dental Hypnosis.

But the most important reason why the medical establishment has dropped its vociferous opposition to alternative medicine is that it has no choice. The number of people now consulting alternative practitioners - about 1.5 million a year - is so high that doctors can no longer dismiss it as a passing trend. To try to stem the tide would make King Canute look like a man of modest ambition.

One of the thousands of patients who visited a homeopath last year is 33-year-old Esther Kaposi, a communications consultant from north-west London. She had been waking every morning feeling exhausted. 'I felt permanently as if I were about to get the flu. I did not want to go and see my GP because it did not seem serious enough.'

A friend suggested that Esther should see a homeopath. 'I'm very glad I went. He said I was suffering from a low-level virus, prescribed some remedies and within a couple of weeks I was feeling much better. It really made a difference. Whatever your beliefs, if someone does something that makes you feel better you cannot argue with it.'

Many explanations have been put forward for the explosion of public interest in alternative medicine. Some have attributed its upsurge in the Eighties to the influence of Margaret Thatcher, and her emphasis on self- help and individual responsibility, rather than collective care as exemplified by the NHS.

Others have said it is because modern medicine has raised expectations it cannot fulfil. It has given us the belief that we need never suffer pain, tiredness, skin blemishes or other disorders, but has not provided the remedies to fulfil that promise. It is for these chronic conditions, such as arthritis, asthma, eczema, hay fever and stress that people turn to alternative medicine, rather than for the acute and potentially fatal 'blue light' conditions.

Then there has been the widespread horror at the side-effects of modern drugs, such as steroids, amphetamines and tranquillisers. Finally, there is the perception that conventional doctors do not treat you as a whole person, but as a collection of symptoms.

With its growing popularity, there have come demands that some complementary therapies should be available on the NHS. At present, only homeopathy is integrated into the health service. Treatment is available at five homeopathic hospitals in London, Glasgow, Liverpool, Bristol and Tunbridge Wells, which accept referrals from across the country.

Many complementary therapists would like to offer their services through the NHS - partly so they can reach the very poorest in society (though many now forgo fees if they feel the patient cannot afford them), partly to make a more secure living. Some believed the establishment of the GP fund-holding system in 1991 would signal a new era. Under the scheme, GP fund-holders are given large budgets with which to buy hospital care for their patients. As long as they do not exceed their budget, they can refer them to whatever hospital or specialist they think most suitable.

Some have seized the opportunity to do something different. One practice in Plymouth, for example, is using part of its budget to refer patients with backache, tennis elbow and post-operative pain to a local acupuncturist, Adrian White, chairman of the British Medical Acupuncture Society.

'Because we are out in the sticks, I only charge pounds 15 for a 30- to 40-minute session,' he says. 'It's also cheaper than sending someone to the pain clinic at the local hospital.'

Most GP fund-holders are not turning to complementary therapists, however, because they believe their budgets are intended to buy standard hospital treatments such as cataract and hernia operations, not the strange and fanciful offerings of complementary therapy.

'Where you have to choose between two groups of bone tweakers, osteopaths and orthopaedic surgeons, one is kosher and the other is not,' says Stephen Henry, chairman of the National Association of Fund-Holding Practices. 'If I spent my budget on people who swing pendulums or shine lights through black boxes, I would not be approved of.'

While GP fund-holders are thus not proving to be the champions of complementary medicine, some health authorities are turning out to be more amenable to public demand. Dorset health authority has put aside pounds 50,000 so that local GPs can refer four groups of patients to the Centre for the Study of Complementary Medicine in Southampton.

If a new age is indeed dawning for alternative treatment on the NHS, what therapies can we expect to see on offer? What conditions do they treat, and how do they work? Here is a guide to eight of the most popular.

ACUPUNCTURE

Acupuncture is the grandfather of complementary medicine, having been practised in China for more than 3,500 years. Practitioners treat patients by sticking needles into their skin and manipulating them at particular points. These acupuncture points lie on invisible energy channels called 'meridians' which are thought to be connected to internal organs.

The ancient Chinese believed that we are born with a finite amount of energy (called chi) circulating in our bodies. The needles stimulate points on the meridians to unblock trapped energy, speed it up if it is flowing too slowly, or slow it down if it is racing too fast. By inserting and manipulating needles in energy points (of which there are thought to be 2,000), the acupuncturist can correct the imbalances that affect the functioning of our internal organs. These, in turn, affect our health.

Traditional acupuncture is a preventive therapy for maintaining health and is usually practised in conjunction with the full range of traditional Chinese medicine. But acupuncture is also used for temporary pain relief, and for anaesthesia during surgery. It burst upon the Western medical consciousness when the New York Times columnist James Reston received acupuncture treatment after an emergency appendix operation in China in the early Seventies. It has steadily grown in popularity ever since. A low-frequency electrical current is sometimes now used instead of needles.

Acupuncture is mainly used to treat painful conditions such as arthritis, back pain and rheumatism, but practitioners also treat people with allergy, anxiety, bronchitis, digestive problems, insomnia, stress and tiredness. Scientists believe acupuncture works partly by releasing into the blood endorphins, the naturally occurring opiates that reduce pain.

For a register of acupuncturists contact: Council for Acupuncture, 179 Gloucester Place, London NW1 6BX (071-724 5756).

AROMATHERAPY

Aromatherapists treat patients with concentrated oils, extracted from plants. Both the ancient Chinese and Persians used the techniques. These 'essential oils' can be inhaled, added to baths or used in dressings applied to affected areas, but the most common method is for them to be massaged into the body.

The oils are extracted from a huge range of plants, including camphor, cedarwood, eucalyptus, fennel, geranium, lavender, marjoram, peppermint and tea tree. Practitioners believe these plant extracts have medicinal properties. They are thought to work both by penetrating the skin and by their smells sending messages to the brain. Many have antiseptic qualities, and some are thought to be effective against infections caused by bacteria or fungi.

Most patients appreciate the oils for their calming effect and the general sense of wellbeing they promote. They are used for many conditions, including constipation, depression, digestive problems, poor circulation, headaches, migraine and tension.

For more information contact: International Federation of Aromatherapists, Department of Continuing Education, Royal Masonic Hospital, Ravenscourt Park, London W6 0TN (081-846 8066).

HERBAL MEDICINE

The origins of herbal medicine pre-date recorded history. Archaeologists have found bunches of medicinal herbs among the fossilised remains of our Neanderthal ancestors. It was the usual form of medical treatment in the West until the 18th century. Even now, many medical prescriptions are based on plant materials. The Institute of Medical Herbalists, founded in the 19th century, has had to resist many attempts by orthodox medical pressure groups to have herbal medicine banned.

Modern herbal medicine combines a holistic philosophy with the exclusive use of plant material. It claims to treat the patient as an individual, not just a collection of symptoms. A practitioner will ask the patient about his medical history, diet, exercise and lifestyle. He or she will also examine the patient before prescribing a suitable preparation.

Herbal medicine uses whole plants, parts of a plant (leaves, stems, flowers, fruit, root or seed) or extracts of plants. A prescription may take the form of a tincture, lotion, cream or ointment. Some may be taken with boiling water as a herbal drink. More than 2,000 medicinal plants are used to produce the remedies, including arnica, basil, camomile, elder, fennel, feverfew, garlic, lemon balm and mint.

Interest in herbalism has increased over the past 20 years as the public has become worried about the side-effects of powerful modern medicines. Herbalists believe their medicines can benefit people who are suffering from a wide range of illnesses including arthritis, migraine, digestive problems and skin disorders.

For more information contact: National Institute of Medical Herbalists, 9 Palace Gate, Exeter, Devon EX1 1JA (0392 426022).

HOMEOPATHY

Homeopathy is a relative newcomer to complementary medicine when compared to the ancient arts of acupuncture and medical herbalism. It was developed in the early 19th century by a German physician, Samuel Hahnemann, who saw it as a gentler alternative to the orthodox practices of the day, which included bloodletting and purging.

Patients are given a minute dose of a substance which, in large amounts, would produce the symptoms from which they are suffering. The symptoms themselves are thought to promote healing. Contrary to all the principles of modern medicine, however, homeopaths believe that the more dilute the dose, the more powerful it is. Hahnemann's ideas were based on an ancient principle dating back to the Greek civilisation of the fifth century BC - that 'like cures like'. The word homeopathy means 'like disease'.

Homeopathic remedies are made from plants, mineral and animal substances. The active ingredients are extracted by first soaking the substance in alcohol. They are then diluted many times over, sometimes a thousand or a million-fold. The mixture is shaken vigorously after each dilution, a measure designed to increase its potency.

In the final homeopathic remedy, there are often very few, if any, molecules of the original substance left. Many scientists consequently believe these remedies cannot be effective in themselves. They claim that, if patients recover, it is because of the placebo effect - the belief that the remedy will cure them. But homeopaths hotly contest that claim and maintain that the remedies work because 'footprints' of the original extract can be found in the final dilution.

Homeopathic remedies are thought to be suitable for a wide range of complaints including coughs, colds, stomach problems, hay fever, back pain, depression, eczema, arthritis and migraine.

For more information contact: Faculty of Homeopathy, 2 Powis Place, Great Ormond Street, London WC1N 3HT (071-837 2495). The Society of Homeopaths, 2 Artisan Road, Northampton NN1 4HU (0604 21400).

HYPNOTHERAPY

Hypnotherapists induce a trance-like state in their patients to try and improve their health. In this state, the conscious mind is sufficiently relaxed for the therapist to communicate suggestions to the subject's unconscious, without resistance from the conscious mind. The therapist tries to bring about physical or mental changes in the patient.

Hypnotherapy is used to treat skin disorders, migraine, peptic ulcers, irritable bowel syndrome and other disorders increased by stress. It can also help people to give up smoking and fight drug and alcohol problems.

For more information contact: British Society of Medical and Dental Hypnosis, 17 Keppel View Road, Kimberworth, Rotherham, South Yorkshire S61 2AR (0709 554558).

OSTEOPATHY AND CHIROPRACTIC

Osteopaths and chiropractors manipulate the skeletal-muscular system of the body, usually by hand. Osteopathy - developed by an American doctor, Andrew Taylor Still (1828- 1917) - deals with the body's whole framework of spine, bones, joints, muscles, ligaments and other supportive soft tissues. It aims to restore proper movement and functioning to this system by means of manual pressure and articulation.

Osteopaths believe that one of the main reasons why we suffer from structural problems is that we stand upright, rather than walking on four legs like most mammals. The force of gravity is particularly severe on the vertebrae of the spine and the cushioning discs between them. Poor posture makes mechanical problems more likely. By manipulation and massage, osteopaths can restore normal function.

The first school of osteopathy opened in Britain in 1917 and there are now about 2,000 registered osteopaths practising in this country. The Osteopaths Bill, which had its third reading in the House of Lords last week, aims to regulate the profession by making it illegal for anyone to use the title unless they are on a Register of Osteopaths. They must either have worked for many years as an osteopath, or completed a recognised course of training.

Chiropractic was founded by Daniel David Palmer in the United States in the 19th century. It was based on the premise that 'nerve flow' led to disease. Like osteopathy, it seeks to treat patients by manipulation of the spine and musculo-skeletal system, but it makes greater use of X-rays and conventional diagnostic methods than osteopathy. There are about 800 chiropractors working in Britain.

Osteopaths and chiropractors can help people with spinal problems, such as low-back and neck pain, which account for half their workload. Other disorders they treat include tension headaches, sports injuries to muscles or joints, the onset of osteoarthritis and backache brought on by pregnancy.

Cranial osteopathy is used for head and facial pain. This involves applying gentle pressures to the head and upper neck, to remove stress patterns and restore mobility.

For more information contact: General Council and Register of Osteopaths, 56 London Street, Reading RG1 4SQ (0734 576585). Cranial Osteopathic Association, 478 Baker Street, Enfield, Middlesex EN1 3QS (081-367 5561).

REFLEXOLOGY

Reflexology is a technique applying pressure to one part of the body, usually the feet or hands, to effect changes in another part. It is supposed to relax muscles and stimulate the body's natural ability to heal itself.

Reflexologists believe the feet are a mirror of the body, with different parts of the sole relating to certain parts of the body such as the heart, lungs and stomach. Massaging one section of the foot can heal a corresponding part of the body.

The technique is thought to have originated in China about 5,000 years ago, and shares some of the assumptions of acupuncture - principally that illness occurs when certain 'energy channels' in the body become blocked. Practitioners say it can help people who suffer from back pain, migraine, period problems, sinus problems and stress.

For more information contact: British School of Reflexology, 92 Sheering Road, Old Harlow, Essex CM17 OJW (0279 429060).

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