Live and let heal

What is the difference between consulting a "real doctor" and knocking at the door of an "alternative practitioner"? One answer is that when you visit the doctor you know that he/she has undergone a lengthy training, is subject to professional control, and, in the event of anything going wrong, may be disciplined by the General Medical Council. You may know very little about the alternative practitioner. He may have qualified by part-time study, and know little about the pharmacological properties of the substances he is using, and there may be nobody to whom you can complain should the need arise.

In this extremely readable and well-researched study of the issues surrounding complementary medicine, Julie Stone and Joan Mathews give a very good account of the background to the regulation of complementary therapies and the modern discussion of how far the state should go in regulating the terms under which people may seek treatment. The philosophical issues are profound. In one vision, it is legitimate for government to protect people from what may be seen as valueless or even harmful recourse to therapies outside the bounds of what we take to be scientifically efficacious. In this view, not only drugs marketed by pharmaceutical companies but also all other substances taken for a therapeutic purpose, such as herbs, should be subjected to the same regime of testing and control. At the same time, there would be control, or even outlawing of therapies seen as worthless because they cannot be shown to be beneficial or because they are not backed by explanations which satisfy a mechanistic scientific model.

This will be too paternalistic for most people, and indeed the attitude of the United Kingdom Government towards complementary medicine has been described by the authors as "benevolent neutrality". Yet further regulation of complementary medicine is likely as the political demand for this grows. Revelations that imported traditional Chinese remedies have been adulterated with harmful substances hardly help, particularly when "ethnic medicine" is increasingly being used by those outside its traditional constituency. In these circumstances, further regulation is probably inevitable, although the authors of this book hope that this can be achieved through voluntary self-regulation rather than through legislative professionalisation.

There is a great deal of fascinating detail here about the forces at play in the regulation debate. Whether or not one's sympathies are with complementary medicine and its practitioners, it is clear that whatever is done to regulate these therapies, there will always be those who will wish to pursue a cure by the route which they see as attractive, irrespective of the professional status of the practitioners. Complementary medicine will therefore thrive, whatever is done to restrict it or to question its efficacy. It should not be driven underground.

Ultimately, the issue is one of freedom. Should people have the right to resort to measures which prevailing opinion rejects? The liberal answer must be a positive one, but at the same time an effort might be made to ensure that in this pursuit people are informed as to the qualifications of those who offer them help, and are given some means of complaining. The existing legal framework is ill-suited to this purpose, and the authors make useful proposals for ways of improving the protection of the public through voluntary regulation by practitioners themselves. Their suggestions are judicious and balanced, and should, if implemented, achieve the necessary balance between freedom and regulation. Yet at the same time, there are those who would argue that the public needs much greater protection, even if this protection may have the effect of stifling such traditional healing techniques as herbalism. This argument may be heard in Europe, and its effect is chilling - for all sorts of reasons.

Alexander McCall Smith is professor of medical law, University of Edinburgh.