Ambiguity over alternative medicine funding in Wales

On the 1st of December 2010, I sent Freedom of Information Act requests to all seven of the Local Health Boards in Wales;

  • Cardiff and Vale University Health Board
  • Cwm Taf Local Health Board
  • Aneurin Bevan Local Health Board
  • Hywel Dda Local Health Board
  • Powys Teaching Local Health Board
  • Betsi Cadwaladr Local Health Board
  • Abertawe Bro Morgannwg University Health Board

I posed these questions to them:

“Does your Health Board fund the use of any complementary or alternative medicine?”

and

“Please provide me with details of which complementary or alternative medicines you fund. How much is spent on them per annum?”

Of these seven health boards, three provided me with concrete information about whether they funded complementary/alternative medicines and if so, how much was spent on them. Aneurin Bevan Local Health Board released detailed information about which CAMs they funded and how much was spent on them. I shall come back to them later.

Two of the health boards, Powys Teaching LHB and Cwm Taf LHB, told me “[This health board] does not fund the use of any complementary or alternative medicines.”

The remaining four health boards were a little more ambiguous with their responses. Repeatedly, I was informed that information about the funding was not held by the health board.

Betsi Cadwaladr LHB responded by saying “Unfortunately we do not hold this information as the Health Board does not fund or provide complementary of alternative medicine.” Hywel Dda LHB were similarly ambiguous in their response – “I regret to inform you that the information you requested is not held by this organisation. The Health Board does not support the prescribing of complementary/alternative medicines.”

On the face, this might seem like a good thing – they’re not funding or don’t support the prescribing of these unproven therapies. However, upon re-reading of these responses, both responses start; the information simply isn’t held by the health boards. Therefore, there could quite easily be funding for CAM therapies that they just don’t know about. I would have liked to have thought that the health boards know exactly what their money is being spent on.

Back to Aneurin Bevan LHB, who provided me with detailed information on which therapies they fund. They did inform me that whilst they do not have formal agreements in place for specific funding of complementary or alternative medicines, GPs “may prescribe any medication under their terms of service that have been approved by the Department of Health. They also told me that it “is not possible to identify all alternative medicines prescribed by GPs due to the way in which the prescribing data is captured.” However, they undertook an analysis of information that they did have. Here is that information:

Nutritional Supplements

Glucosamine preparations – £121,000

Melatonin – £37,000

VSL #3 Probiotic Food Supplement – £4,000

Homeopathic preparations

Abrotanum Oral Drops – £156

“Herbals”

Nytol Herbal Tablets – £121

Kalms Herbal Sedative – £7

St. John’s Wort – £41

In total, £162,325 is being wasted on treatments with little or no evidence base to support their use.

Glucosamine supplements have been studied to no positive avail. A BMJ meta-analysis of 10 trials concluded “Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.”

Evidence for St. John’s Wort is ambiguous. The Cochrane Collaboration reviewed the evidence for it and concluded “Overall, the St. John’s wort extracts tested in the trials were superior to placebo, similarly effective as standard antidepressants, and had fewer side effects than standard antidepressants. However, findings were more favourable to St. John’s wort extracts in studies from German-speaking countries where these products have a long tradition and are often prescribed by physicians, while in studies from other countries St. John’s wort extracts seemed less effective.” So there could be a cultural bias leading to more positive results for it.

The final two health boards in Wales are Cardiff and Vale University Health Board and Abertawe Bro Morgannwg University Health Board. Both fund complementary and alternative medicines, but neither provided me with details about how much money is spent on them, even after clarification from myself.

Cardiff and Vale UHB provide “limited complementary therapy modalities … for example Acupuncture as part of physiotherapy management to provide pain relief and massage techniques in the mental health service.” However, because this is provided as a package of care as opposed to stand alone therapies and no dedicated funding is provided, they cannot provide me with any details about funding.

Abertawe Bro Morgannwyg UHB informed me that they provide acupuncture and “this is provided within the physiotherapy service. This is part of the whole package of treatment following assessment by the physiotherapists. There are no separate acupuncture clinics and referrals for acupuncture alone are not accepted. Therefore as stated in our original response there is no ‘dedicated funding’ for complementary therapies and therefore we would not hold separate financial information for this.”

To conclude, it appears that the main problem with the health boards is the way in which prescribing data is captured. Aneurin Bevan LHB said it themselves – “It is not possible to identify all alternative medicines prescribed by GPs due to the way in which the prescribing data is captured.” Perhaps there needs to be a new method of capturing prescription data, to ensure that this information doesn’t fall through the cracks as it appears to be doing now.

3 Responses to “Ambiguity over alternative medicine funding in Wales”

  1. Adam February 3, 2011 at 10:27 am #

    Hm. Glucosamine is a tricky one.

    It’s certainly true that the evidence for it is weak. However, it’s not non-existent. There is some evidence, albeit far from convincing, of a beneficial effect of glucosamine.

    I had a bit of a problem with the BMJ meta-analysis you cite, as the ITT analysis they used may not give the full story. See the rapid responses to that article for my detailed thoughts on it. There are a few other criticisms from others there as well, although I’ve not read them carefully enough to know whether those criticisms are justified.

    Anyway, it’s probably fair to conclude that the evidence for glucosamine is limited, but does that make funding glucosamine any worse than funding a great many conventional treatments? I wonder how much was spent on antibiotics for viral infections, for example? No doubt there are many other conventional treatments that wouldn’t stand up to any reasonable cost-benefit analysis.

    The point is that when you are faced with something like glucosamine, where the evidence is not good enough to say that it definitely works but also not good enough to say that it definitely doesn’t work, making decisions about funding is not simple.

    That’s a very different matter to something like homoeopathy, where the evidence that it’s a total crock of shit is compelling.

    • Rhys Morgan February 3, 2011 at 11:07 am #

      Hmm… OK. Glucosamine, as far as I can tell, has been extremely ambiguous with regards to evidence tipping regularly between “Yes, it works.” and “No, it doesn’t work.” The example I referred to was the most recent meta-analysis I found on PubMed.
      Of course, I would disagree with antibiotic use for viral infections. It’s a dangerous and expensive placebo. However, I doubt we’ll ever know the true cost, due to doctor/patient confidentiality. It might be worth looking into though, for anonymised patient data…
      The point “No doubt there are many other conventional treatments that wouldn’t stand up to any reasonable cost-benefit analysis.” I would agree with. And I would also agree that they should not be funded on the NHS – unless no other treatment exists for the condition.

    • Taron June 24, 2011 at 11:48 pm #

      All of my questions settled—tanhks!

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