Many of our recommendations make reference to the way we have organised therapies into three separate groups in the Report. These groupings are outlined in detail in Chapter 2 but for ease of reference a short synopsis of our grouping system is as follows:

• The first group embraces what may be called the principal disciplines, two of which, osteopathy and chiropractic, are already regulated in their professional activity and education by Acts of Parliament. The others are acupuncture, herbal medicine and homeopathy. Each of these therapies claims to have an individual diagnostic approach and are seen as the 'Big 5' by most of the CAM world.

• The second group contains therapies which are most often used to complement conventional medicine and do not purport to embrace diagnostic skills. It includes aromatherapy; the Alexander Technique; body work therapies, including massage; counselling, stress therapy; hypnotherapy; reflexology and probably shiatsu, meditation and healing.

• The third group embraces those other disciplines which purport to offer diagnostic information as well as treatment and which, in general, favour a philosophical approach and are indifferent to the scientific principles of conventional medicine, and through which various and disparate frameworks of disease causation and its management are proposed. These therapies can be split into two sub-groups: Group 3a includes long-established and traditional systems of healthcare such as Ayurvedic medicine and Traditional Chinese medicine. Group 3b covers other alternative disciplines which lack any credible evidence base such as crystal therapy, iridology, radionics, dowsing and kinesiology.

2. More detailed quantitative information is required on the levels of CAM use in the United Kingdom, in order to inform the public and healthcare policy-makers, and we recommend that suitable national studies be commissioned to obtain this information (para 1.21).

3. Diagnostic procedures must be reliable and reproducible and more attention must be paid to whether CAM diagnostic procedures, as well as CAM therapies, have been scientifically validated. We agree that this is an issue that should always be kept in mind when doing research in this area (para 4.16).

4. In our opinion any therapy that makes specific claims for being able to treat specific conditions should have evidence of being able to do this above and beyond the placebo effect. This is especially true for therapies which aim to be available on the NHS and aim to operate as an alternative to conventional medicine, specifically therapies in Group 1. The therapies in our Groups 3a and b also aim to operate as an alternative to conventional medicine, and have sparse, or non-existent, evidence bases. Those therapies in our Group 2 which aim to operate as an adjunct to conventional medicine, and mainly make claims in the area of relaxation and stress management, are in lesser need of proof of treatment-specific effects but should control their claims according to the evidence available to them (para 4.18).

5. We recommend that if a therapy does gain a critical mass of evidence to support its efficacy, then the NHS and the medical profession should ensure that the public have access to it and its potential benefits (para 4.37).

6. We recommend that, in order to protect the public, professions with more than one regulatory body make a concerted effort to bring their various bodies together and to develop a clear professional structure (para 5.12).

7. We recommend that each of the therapies in Group 2 should organise themselves under a single professional body for each therapy. These bodies should be well promoted so that the public who access these therapies are aware of them. Each should comply with core professional principles, and relevant information about each body should be made known to medical practitioners and other healthcare professionals. Patients could then have a single, reliable point of reference for standards, and would be protected against the risk of poorly-trained practitioners and have redress for poor service (para 5.23).

8. It is our opinion that acupuncture and herbal medicine are the two therapies which are at a stage where it would be of benefit to them and their patients if the practitioners strive for statutory regulation under the Health Act 1999, and we recommend that they should do so. Statutory regulation may also be appropriate eventually for the non-medical homeopaths. Other professions must strive to come together under one voluntary self-regulating body with the appropriate features outlined in Box 5, and some may wish ultimately to aim to move towards regulation under the Health Act once they are unified with a single voice (paras 5.53 and 5.55).

9. We recommend that each existing regulatory body in the healthcare professions should develop clear guidelines on competency and training for their members on the position they take in relation to their members' activities in well organised CAM disciplines; as well as guidelines on appropriate training courses and other relevant issues. In drawing up such guidelines the conventional regulatory bodies should communicate with the relevant complementary regulatory bodies and the Foundation for Integrated Medicine to obtain advice on training and best practice and to encourage integrated practice (para 5.79).

10. We encourage the bodies representing medical and non-medical CAM therapists, particularly those in our Groups 1 and 2, to collaborate more closely, especially on developing reliable public information sources. We recommend that if CAM is to be practised by any conventional healthcare practitioners, they should be trained to standards comparable to those set out for that particular therapy by the appropriate (single) CAM regulatory body (para 5.83).

11. We recommend that the MCA find a mechanism that would allow members of the public to identify health products that had met the stringent requirements of licensing and to differentiate them from unregulated competitors. This should be accompanied by strong enforcement of the law in regard to products that might additionally confuse the customer with claims and labelling that resemble those permitted by marketing authorisations (para 5.93).

12. We strongly recommend that the Government should maintain their effective advocacy of a new regulatory framework for herbal medicines in the United Kingdom and the rest of the European Union, and urge all parties to ensure that new regulations adequately reflect the complexities of the unregulated sector (para 5.95).

13. We are concerned about the safety implications of an unregulated herbal sector and we urge that all legislative avenues be explored to ensure better control of this unregulated sector in the interests of the public health (para 5.97).

14. We support the view that any new regulatory regime should respect the diversity of products used by herbal practitioners and allow for simplified registration of practitioner stocks. Nevertheless, any such regime must ensure that levels of quality and assurance of safety are not compromised (para 5.98).

15. Establishing an independent accreditation board along the lines of the British Acupuncture Accreditation Board is a positive move. Other therapies with fragmented professional representation may wish to use this as a model (para 6.20).

16. We recommend that CAM training courses should become more standardised and be accredited and validated by the appropriate professional bodies. All those who deliver CAM treatments, whether conventional health professionals or CAM professionals, should have received training in that discipline independently accredited by the appropriate regulatory body (para 6.33).

17. We suggest that the CAM therapies, particularly those in our Groups 1 and 2, should identify Continuing Professional Development in practice as a core requirement for their members (para 6.34).

18. We consider that it is imperative that higher educational institutions and any regulatory bodies in CAM liaise in order to ensure that training is adequate for registration. If extra training is required after academic qualification to ensure fitness to practise, this should be defined by the appropriate professional body, which should then implement appropriate mechanisms in order to see that this objective is achieved (para 6.40).

19. We recommend that training in anatomy, physiology and basic biochemistry and pharmacology should be included within the education of practitioners of therapies that are likely to offer diagnostic information, such as the therapies in Groups 1 and 3a. Although it may be useful for other therapists to understand basic biomedical science, there is no requirement for such in-depth understanding if the therapy being practised is to be used as an adjunct to conventional medicine (para 6.43).

20. We recommend that every therapist working in CAM should have a clear understanding of the principles of evidence-based medicine and healthcare. This should be a part of the curriculum of all CAM therapy courses. An in-depth understanding of research methods may be even more important for those therapies that operate independently of medical supervision, and which attempt to make a diagnosis and to cure complaints rather than for those which offer relaxation or aim to improve the general quality of life of patients. Therefore training in research and statistical methods may be particularly appropriate for practitioners of therapies in Groups 1 and 3a. But we consider that an understanding of research methods and outcomes should be included in the training of all CAM practitioners. It is important that all of those teaching these courses should understand these principles (para 6.49).

21. We recommend that all CAM training defines limits of the particular therapist's competence as clearly as possible in the state of current knowledge. Training should also give students clear guidance on when a patient should be referred to a primary care physician or even directly to secondary hospital care (para 6.52).

22. We recommend that all CAM therapists should be made aware of the other CAM therapies available to their patients and how they are practised. We do not think it should be assumed that CAM practitioners competent in one discipline necessarily understand the others (para 6.54).

23. We conclude that there should be flexibility for training institutions to decide how to educate practitioners. It is the relevant professional regulatory body of a specific CAM therapy that should set objectives of training and define core competencies appropriate to their particular discipline, and we so recommend. We do not advocate a blanket core curriculum (para 6.61).

24. We recommend that, whether subject to statutory or voluntary regulation, all healthcare regulatory bodies should consider the relevance to their respective professions of those elements set out in paragraph 6.55 (para 6.62).

25. We recommend that therapies with a fragmented professional organisation work with Healthwork UK to develop National Occupational Standards, and we encourage the Department of Health to further support Healthwork UK's activity with such therapies; we believe that this would be of long-term benefit to the public (para 6.70).

26. We recommend that familiarisation should prepare medical students for dealing with patients who are either accessing CAM or have an interest in doing so. This familiarisation should cover the potential uses of CAM, the procedures involved, their potential benefits and their main weaknesses and dangers (para 6.77).

27. We recommend that every medical school ensures that all their medical undergraduates are exposed to a level of CAM familiarisation that makes them aware of the choices their patients might make (para 6.79).

28. We recommend that Royal Colleges and other training authorities in the healthcare field should address the issue of familiarisation with CAM therapies among doctors, dentists and veterinary surgeons by supporting appropriate Continuing Professional Development opportunities (para 6.85).

29. The General Osteopathic and Chiropractic Councils, and any other regulatory bodies, should develop schemes whereby they accredit certain training courses aimed specifically at doctors and other healthcare professionals, and which are developed in conjunction with them. Similar schemes should be pursued by dentists and veterinary surgeons (para 6.95).

30. We recommend that the UKCC work with the Royal College of Nursing to make CAM familiarisation a part of the undergraduate nursing curriculum and a standard competency expected of qualified nurses, so that they are aware of the choices that their patients may make. We would also expect nurses specialising in areas where CAM is especially relevant (such as palliative care) to be made aware of any CAM issues particularly pertinent to that speciality during their postgraduate training. The Royal College of Nursing and the UKCC, as they do not provide CAM training themselves, should compile a list of courses in CAM that they approve, in order that nurses who wish to practise in this field can obtain guidance on appropriate training (para 6.106).

31. To conduct research into the CAM disciplines will require much work and resources, and will therefore be time-consuming. Hence, we recommend that three questions should be prioritised and addressed in the following order:

• To provide a starting point for possible improvements in CAM treatment, to show whether further inquiry would be useful, and to highlight any areas where its application could inform conventional medicine does the treatment offer therapeutic benefits greater than placebo?

• To protect patients from hazardous practices - is the treatment safe?

• To help patients, doctors and healthcare administrators choose whether or not to adopt the treatment - how does it compare, in medical outcome and cost-effectiveness, with other forms of treatment? (para 7.7)

32. We recommend that CAM practitioners and researchers should attempt to build up an evidence base with the same rigour as is required of conventional medicine, using both RCTs and other research designs (para 7.26).

33. To achieve equity with more conventional proposals, we recommend that research funding agencies should build up a database of appropriately trained individuals who understand CAM practice. The research funding agencies could then use these individuals as members of selection panels and committees or as external referees as appropriate (para 7.45).

34. We recommend that universities and other higher education institutions provide the basis for a more robust research infrastructure in which CAM and conventional research and practice can take place side-by-side and can benefit from interaction and greater mutual understanding. We recommend that a small number of such centres of excellence, in or linked to medical schools, be established with the support of research funding agencies including the Research Councils, the Department of Health, Higher Education Funding Councils and the charitable sector (para 7.57).

35. Bodies such as the Departments of Health, the Research Councils and the Wellcome Trust should help to promote a research culture in CAM by ensuring that the CAM world is aware of the opportunities they offer. The Department of Health should exercise a co-ordinating role. Limited funds should be specifically aimed at training CAM practitioners in research methods. As many CAM practitioners work in the private sector and cannot afford to train in research, we recommend that a number of university-based academic posts, offering time for research and teaching, should be established (para 7.67).

36. We recommend that companies producing products used in CAM should invest more heavily in research and development (para 7.81).

37. We recommend that the NHS R&D directorate and the MRC should pump-prime this area with dedicated research funding in order to create a few centres of excellence for conducting CAM research, integrated with research into conventional healthcare. This will also help to promote research leadership and an evaluative research culture in CAM. Such funds should support research training fellowships and a limited number of high-quality research projects. This initiative should be sufficient to attract high-quality researchers and to enable them both to carry out large-scale studies and to continue to train CAM researchers in this area within a multi-disciplinary environment. We believe ten years would be sufficient for the pump-priming initiative as, for example, in the case of some MRC programme grants and various training and career development awards available in conventional medicine. The Association of Medical Research Charities may also like to follow this example (para 7.102).

38. We recommend that the NHS Centre for Reviews and Dissemination work with the RCCM, the UK Cochrane Centre, and the British Library to develop a comprehensive information source with the help of the CISCOM database, in order to provide comprehensive and publicly available information sources on CAM research, and that resources be made available to enable these organisations to do so (para 8.21).

39. We see the NHS as the natural home in the United Kingdom for reliable, non-promotional information on all types of healthcare; providing such a home is particularly important for CAM, where the diversity of opinion and organisations make it almost impossible for individuals to gain an overview. Consequently we support the plans of the Department of Health to make information on CAM available through NHS Direct, and we urge that they be carried out in the very near future. We recommend that the information should contain not only contact details of the relevant bodies and a list of NHS provision of CAM in each local area, but also some guidance to help patients (and their doctors) evaluate different CAM therapies (para 8.31).

40. We are aware that the National electronic Health Library and NHS Direct Online plan to have information available about CAM in the future and we support these plans and recommend that they are carried forward (para 8.48).

41. We recommend that CAM regulatory bodies, whether statutory or voluntary, remind their members of the laws concerning false claims in advertisements and take disciplinary action against anyone who breaks them. Information leaflets produced by such bodies should provide evidence-based information about a therapy aimed at informing patients, and should not be aimed at selling therapies to patients (para 8.57).

42. We recommend that those practising privately-accessed CAM therapies should work towards integration between CAM and conventional medicine, and CAM therapists should encourage patients with conditions that have not been previously discussed with a medical practitioner to see their GP. We also urge CAM practitioners and GPs to keep an open mind about each other's ability to help their patients, to make patients feel comfortable about integrating their healthcare provision and to exchange information about treatment programmes and their perceptions of the healthcare needs of patients (para 9.20).

43. We recommend that all NHS provision of CAM should continue to be through GP referral (or by referral from doctors or other healthcare professionals working in primary, secondary or tertiary care) (para 9.37).

44. We recommend that only those CAM therapies which are statutory regulated, or have a powerful mechanism of voluntary self-regulation, should be made available, by reference from doctors and other healthcare professionals working in primary, secondary or tertiary care, on the NHS (para 9.46).