Keeping healthy on a minimum wage

equivalent to paroxetine, 10 costs only 82p, compared with £1.62 for paroxetine.His case studies suggest that complementary and alternative programmes can lead to savings in direct costs, but these savings will be greatly diminished or abolished when set against the overall costs of providing these services.The provision of specific complementary and alternative interventions by members of existing primary healthcare teams might offer scope for cost savings in such settings.The report concludes that complementary and alternative therapies should be targeted at the "effectiveness gaps" of conventional health care, 11 particularly in managing chronic pain and mental disorders, and in palliative care.We think this is a useful concept but were perplexed by Smallwood including asthma, for which conventional treatment is generally effective and safe.Despite its limitations and the likelihood of bias in its conclusions, we believe that the Smallwood report fulfills a useful political function.It should promote more investment in research on the cost effectiveness of complementary and alternative treatments.Nevertheless, the report's principal recommendation-that NICE (the National Institute for Health and Clinical Excellence) carries out a full assessment of the cost effectiveness of these therapies-is ill advised.A more sensible recommendation to NICE would be that, in developing the scope of new guidelines on chronic conditions, the institute pays greater attention to reviewing complementary therapies.Therapists with particular expertise in complementary and alternative treatments for each specific condition should be invited to join guideline development groups.These groups can wrestle with the philosophical and methodological dilemmas over what study designs should be included in the evidence base of the guidelines.Uncertain evidence of effectiveness does not preclude a positive recommendation in a guideline, and original modelling of cost effectiveness can be part of guideline development. 12astly, those making decisions about integrated medicine in the NHS should consider each complementary or alternative therapy on its merits, using a broad range of appropriate scientific evidence including data on cost effectiveness.Such decision making, if done transparently, may change the public perception of scientific medicine for the better.