GPs offering complementary therapies
My recent blog on HolisticDoctorOnLine has created quite an uproar of comment, especially on Ecadamy, a business networking forum, where it was entitled "Critics of complementary medicine are arrogant and close-minded".
As the subject of evidence-based medicine is relevant to animal health also, I have copied it in full here:
At last! some rare signs that I am not alone!
I have found two posts on the PULSE website that make my heart sing.
A recent survey of 200 GPs shows that 56% either provide or recommend (like me) complementary therapies.
I insist on calling them complementary therapies rather than "alternative" as is used on the site – it is essential that science and therapies work hand in hand to help people through illness to wellness and a degree of self-healing.
Acupuncture was recommended by 40%, homeopathy by 11%. The summary does not discuss osteopathy, which I feel is also more commonly recommended (as those GPs with a purely left-brained mindset can see how it "could" work so more likely to recommend it than, say, homeopathy).
The comments on the page are, unfortunately, back to the traditional arrogant scientific view of "it’s just the placebo effect" and "poor deluded patients, imagining an effect".
Then, amongst the links to the debate to ban all complementary therapies on the basis of lack of evidence-base (you mean, like appendicectomy and paracetamol?), I found the most wonderful article by Dr Michael Dixon from Devon – a fellow – thinker, he has put into words exactly my thoughts.
What a man; like myself he thinks that, maybe, "Critics of complementary medicine are arrogant and close-minded". I had noticed this myself; my patients are so relieved when they find they can talk openly with me about their use of herbal and homeopathic medicine. If at least 60% of the general population use or have used complementary therapies, it suggests to me that the scientists are in the wrong for ignoring and trivialising this.
I would like to point out here that I have spent 4 years in pure scientific research in physiology and pharmacology, and have been trained in the "art" of pulling apart scientific papers, as well as having been on the receiving end. With that experience behind me I feel that a.) evidence based medicine is an appropriate way to distinguish between two drugs to be used for the same problem. b.) No amount of large trials will convince the sceptical scientists that complementary therapies work (as I have already seen that they/ we can pull apart any research anyway). c.) As complementary therapies work at least partly at a holistic level involving the individual in self-healing, randomising patients will not demonstrate an effect anyway – this does not mean the placebo effect (as scientists devalue anything with that term) but the self-healing effect, which should be made use of by each of us in health care (patients and therapists alike).
Dr Dixon’s post is so close to my feelings, I copy it in full below (and wish there was a facility on Pulse for me to register my support for him).
Critics of Complementary medicine are arrogant and closed-minded:
07 Jun 07
Pressure groups such as Sense about Science are too quick to condemn complementary approaches to treatment, argues Dr Michael Dixon
Is it bad medicine to treat some NHS patients using complementary treatments? ‘Yes!’ says the powerful pressure group Sense about Science. But is science – or indeed sense – on its side?
Many complementary approaches do have a good evidence base. St John’s wort for moderate depression or acupuncture for osteoarthritis of the knee are just two examples. In fact, there is better evidence for these than for many conventional treatments in daily use.
It has been estimated that at least 75% of conventional primary care lacks the support of double-blind placebo-controlled trials. For symptoms such as tiredness, back pain or irritable bowel syndrome, there is often no good evidence-based treatment. So why discriminate between the conventional and the complementary, providing both are safe, when neither has the evidence base that Sense about Science demands?
That question is particularly relevant in long-term disease – by definition incurable – where patient perception of improved well-being and function is the desired outcome. Why should we accept Sense about Science’s restricted, even arrogant, interpretation of science and healing? It is the science of ‘scientists’ and technicians, of a regimented world far from frontline general practice where a symptom may be a metaphor for the real problem and where beliefs, background and culture are major factors in the treatment’s success.
Its science excludes feelings and suffering. It ignores the patient as an individual. It dismisses empathy, hope and our ability as self-organising beings to heal through the mind. It is a dehumanised vision designed to turn GPs into evidence-based robots.More than 50% of GPs now refer patients to complementary practitioners or practise it themselves, and 75% of patients want to receive complementary medicine on the NHS. Real science should explain that, not condemn it. What we need is a science that goes deeper, using a more pragmatic and applied research methodology, and taking in the entirety of a patient’s treatment rather than dissecting it – a science that gives practitioners and commissioners a better idea of what works and what does not. Otherwise science and patients will go in opposite directions and both will suffer.
The trouble with Sense about Science is that its science is inhuman and its sense fails to resonate with the common sense of ordinary patients. Its self-appointed experts are dominated by emotion. They use personal invective – I have the scars to prove it. Sometimes this emotion is fear – that complementary medicine will take away money from specialist treatments. The reality is the opposite. Complementary medicine used wisely for long-term diseases should enable the right patients to be looked after cost-effectively in primary care, reducing secondary care referrals, drugs and other costs and leaving more money for conventional but costly treatments where they are needed.
I discovered complementary medicine because conventional medicine held insufficient answers. Last week I had failures and successes – a patient whose arthritis had been quiescent for a year on a herbal medicine, another whose frozen shoulder had been helped by self-administered acupressure, a third who had avoided a diagnostic laparotomy by using a complementary diet and a fourth with cancer who felt that creative visualisation and a diet had helped. All these treatments were sustained by the patients themselves and cost the NHS very little.
Fortunately we live in a primary care-led NHS, which respects patient choice. Long may that remain the case.
Dr Michael Dixon is a GP in Cullompton, Devon, visiting professor at the University of Westminster and a trustee of the Prince of Wales Foundation for Integrated Health