APPEARANCES in headlines, as in life, can be deceptive. Take this week’s front page Times story: “NHS told to abandon alternative medicine”. At first glance it was a title fight between the Prince of Wales and a group of doctors. In one corner, His Royal Organic-ness was declaiming the benefits of complementary therapies. In the other corner, the Science 13, a squad of top medics, were decrying homoeopathy as an “implausible treatment”.

So, yet another bruising bout between conventional and alternative medicine? Not really. This fight was actually about rationing.

The Science 13 told 476 acute and primary care trusts — and I paraphrase — that it was bonkers for the NHS to be paying for alternative treatments that don’t work at a time when access to drugs proven to save lives is denied on the ground of cost.

It had particular resonance for me. I have just recorded the last programme for Radio 4’s Inside the Ethics Committee series, in which our ethics panel considered the case of Richard, whose bowel cancer had already spread widely when he first had it diagnosed. He wanted to have a new drug called Avastin, which would have extended his life by as much as five months. But the cost was £18,500 and his PCT refused. Was it ethical to withhold treatment but equally, in a world of finite NHS resources, was it ethical to deny others good health because of the cost of treating Richard? Five months of life for Richard or a few hip replacements or lots of osteopathy. Choose now.

Of course, such decisions are impossible. None of us wants to be responsible for them or even to admit that rationing is necessary. So we devolve this nasty work to NICE (the National Institute for Clinical Health and Excellence), the NHS rationing body, and to PCTs. Then, usually when we are faced with the heart- breaking testimony of real people whose lives are affected, we reject carefully considered decisions in favour of ad hoc gestures.

As the British Medical Journal notes this week, appeals have been made against almost a third of NICE recommendations, resulting in four reappraisals.

But, as some gain, others lose, usually the chronically ill, whose stories are not media-friendly. It is those with chronic disease that have perhaps most to gain from complementary therapies.

For if being better is no longer an option, merely feeling better acquires great value. Have some doctors lost sight of this, perhaps because they have failed here? A sober, considered debate about rationing has never been more badly needed.

Inside the Ethics Committee is on Radio 4, Wednesday, 8pm, and repeated on Saturdays, 10.15pm

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