Accredit where it's due

January 19, 1996

Therapists are persuading universities to set up degree courses in complementary therapies. But critics are accusing them of trying to get recognition via the back door. Aisling Irwin reports.

This is a tale of the 20th century university's slide back into the unempirical infertility of its medieval past. Alternatively, it is a tale of the flourishing of the modern university to embrace ideas it had previously shunned.

This is a year in which you can enrol for a BA in therapeutic massage or an MSc in acupuncture validated by the University of Wales, which is also considering validating a degree in homeopathy.

This is a time when, under the orders of the British Holistic Medicine Association, complementary health therapists are persuading universities to set up degrees in their subjects.

That world is obsessed with two words: validation, for example by turning courses into degrees; and accreditation, enabling practitioners to become members of professional bodies. As was reported after a BHMA meeting a year ago, the association does not appear to distinguish between the widely different therapies lodged together under the title of complementary medicine. The message was: it does not matter what the therapy is - get it validated. Once it is part of the establishment, irritating questions about whether or not it works will be less potent. Degrees will relax the outside world's concern that therapists should be qualified. And students will be able to get grants.

The degrees have multiplied: a BSc in herbal medicine at Middlesex has entered its second year. Several homeopathy colleges are trying to develop degrees. Acupuncture may soon be available as a degree from the University of Westminster.

"Universities are making a presumption that each therapy is an effective treatment," says Thurstan Brewin, chair of HealthWatch, a charity that campaigns for consumer health care information.

"It is quite wrong for universities to make presumptions of that kind. If you are a university you should not be tied to a theory - you should be doing your best to investigate its claims." Otherwise, it is "like the Treasury calling itself the ministry of monetarism ," he says.

Free from his criticism are the university departments that investigate complementary health - such as the one at Exeter University.

But is anyone else, apart from Dr Brewin's pressure group, worried about degrees in bodies of "knowledge" whose investigation may turn out to be like grasping jelly.

Yes: perhaps surprisingly, there are critics inside complementary medicine. "Practitioners recognise that validation is a way of getting recognition of some of these therapies thorough the back door," says Jonathan Monckton, director of the Research Council for Complementary Medicine.

David Peters, senior lecturer in complementary therapy studies at the University of Westminster, is worried that competition between complementary courses is mounting. "Someone has suggested to me that the training market is saturated. So only the best courses will survive: best equals validated as a degree."

Monckton and Peters fear that a degree will falsely be regarded as a licence to practise. This is likely in a world that has been criticised for the paucity and laxity of its professional bodies (anyone can set up as a medical herbalist, for example, although there is a voluntary professional body and plans for another).

"When you put someone through a BSc in herbal medicine how do you know they are ready to practise?" asks Peters, who is both a medical doctor and an osteopath. "When you are training you are making someone ready for clinical practice. Universities don't do that." They leave it to bodies such as the General Medical Council.

Without statutory frameworks to regulate practitioners, the universities are "potentially exposed", says Simon Mills, of the centre for complementary health studies at Exeter University.

He says that "universities are being driven to do courses which in wiser times they would not have done: "Those in herbal medicine have been trying their luck, frankly. They have been scouring campuses searching for anyone on the campus who might have a cultural background that would make them sympathetic."

These people are certain to be rejected by medical schools, says Mills, which, quite rightly according to him, would tell them to take a running jump. How, asks Peters, could a medical school accept that a herb works by "organ-balancing" And how could a science faculty take on a course in homeopathy (as opposed to an investigation of it), when it appears to clash with most of modern chemistry?

This need for cultural meshing leads to major problems, they say: the degree courses in complementary medicine run the risk of ending up in social science faculties where there is no science back-up.

To be schooled properly in herbalism, for example, you need to practise physiology, pharmacology, toxicology, botany and microscope work, says Mills. "If you were to ask me, as someone with a medical background, are [herbal medicine degrees] equivalent to a medical education I would have to say that the case remains unproven."

But at Middlesex University, where the herbal degree is in the faculty of social work and health science, admissions tutor Ellis Snitcher is robust in defence of its scientific foundations and its clinical training. "We have labs for both practicals in science subjects and clinical training," he says. During the four-year course students learn physiology, anatomy and pharmacology. Third- and fourth-year students will go to Whittington hospital in North London for their clinical training. The degree is accredited with the National Institute of Medical Herbalists.

On equalling the competence of medical students, Dr Snitcher says: "I don't anticipate that problem at all. We are linked with some very highly placed members of the medical profession as external examiners."

Mills helped to validate a degree in phytotherapy (herbal medicine)at the School of Phytotherapy in Sussex, on behalf of the University of Wales. He praises its clinical programme and theoretical element but says that the college is in the middle of nowhere, isolated from outside influences.

The need for outside influences is of great concern to Dr Peters. "Complementary medicine lives within its own little subculture and it is not curious about what others say about it. At a degree level you can't just be inward looking. You must look at the historical, anthropological cultures in which it developed and look at the substantial critique from outside."

Snitcher says his students are encouraged to be questioning. And the academics are trying to build up a research programme in the department.

So, if there has been plenty of hard work to make some of these degrees sufficiently tough, which subjects should be allowed degree status and which should be rejected? Therapeutic massage? Westminster's BA in the subject is only for nurses, topping their diplomas up to degrees by teaching level three courses. Natural health sciences? Peters's department is setting up a BSc in it which will tackle everything from anatomy to psychology, he says. Acupuncture? Homeopathy? "You can't give a scientific explanation of homeopathy or acupunture," says Peters. "Why make homeopathy a BSc? If you do then you've got to make it extremely self-critical."

But an MSc in homeopathy is not offensive, he says: "It's much more like an art than a science. A masters degree will be based in clinical practice."

For acupuncture, he says it is easier to make an interface with science. Creating a truly academic degree seems close to Peter's heart. He was pleased recently at a meeting on academic legitimacy, where he expected to be "kneecaped" for raising these issues. Instead he says he received widespread praise.

But back in the sober world of HealthWatch, Dr Brewin wrote some time ago to the Committee of Vice Chancellors and Principals to warn it of the planned onslaught on universities. He has not received a reply. Degrees in such subjects, he says, mark our descent from rationality back to magic.

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