title: The paradox of non-evidence based, publicly funded complementary alternative medicine in the English National Health Service: An explanation.
abstract: Despite the unproven effectiveness of many practices that are under the umbrella term 'complementary alternative medicine' (CAM), there is provision of CAM within the English National Health Service (NHS). Moreover, although the National Institute for Health and Care Excellence was established to promote scientifically validated medicine in the NHS, the paradox of publicly funded, non-evidence based CAM can be explained as linked with government policy of patient choice and specifically patient treatment choice. Patient choice is useful in the political and policy discourse as it is open to different interpretations and can be justified by policy-makers who rely on the traditional NHS values of equity and universality. Treatment choice finds expression in the policy of personalised healthcare linked with patient responsibilisation which finds resonance in the emphasis CAM places on self-care and self-management. More importantly, however, policy-makers also use patient choice and treatment choice as a policy initiative with the objective of encouraging destabilisation of the entrenched healthcare institutions and practices considered resistant to change. This political strategy of system reform has the unintended, paradoxical consequence of allowing for the emergence of non-evidence based, publicly funded CAM in the NHS. The political and policy discourse of patient choice thus trumps evidence based medicine, with patients that demand access to CAM becoming the unwitting beneficiaries.
authors.affiliation: Law Department, Queen Mary University of London, Mile End Rd, London E1 4NS, United Kingdom. Electronic address: maria.sheppard@qmul.ac.uk.
authors.forename: Maria K
authors.initials: MK
authors.lastname: Sheppard
mesh_terms: D002755:Choice Behavior; D000529:Complementary Therapies / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D005380:Financing, Government; D006291:Health Policy; D006801:Humans; D057285:Precision Medicine / Q000191:economics; D012648:Self Care; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*; D006113:United Kingdom
keywords: Choice policy; Destabilisation; English National Health Service (NHS); Non-evidence based complementary alternative medicine (CAM); Patient choice; Patient treatment choice