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Rapid Responses: Rapid Responses published:
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Is history static?
- Peter Morrell (15 September 2000)
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Ayurveda-a Great Science.
- B M Hegde (16 September 2000)
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PHYTOTHERAPY : COMPLEMENTARY MEDICINE OR MEDICINE?
- Fabio Firenzuoli (20 September 2000)
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More pragmatic trials are needed.
- Andrew Thornett (22 September 2000)
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On Integration and Mainstreaming of Complementary and Alternative Medicine
- Opher Caspi (30 September 2000)
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Them 'n Us
- John P Heptonstall (2 October 2000)
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Alternative therapies
- Badal Pal (22 November 2000)
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A comment from the author
- Andrew Vickers (28 November 2000)
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Re: A comment from the author - rebutted
- John P Heptonstall (30 November 2000)
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Re: A comment from the author
- Peter Morrell (1 December 2000)
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University
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Sir, I think many practitioners and historians of complementary medicine would disagree [to state it at its mildest] with Andrew Vickers when he calls these disciplines "a static historical tradition" [1] and also when he claims that 'integration' "means that similar clinical, scientific, and regulatory standards are being applied across all forms of health care" [1] These same standards maybe comprise a bench-mark they are all moving towards, but for those therapies progressing more like tortoises than hares, they still have a very long way to go. In what sense is any form of therapy static? It has its great figures who come along and donate their skills and expertise to the stream of its tradition and so it swells out into an ever-widening river of ideas and techniques. This account clearly applies to homeopathy and acupuncture, for example, neither of which can be accurately described as 'static'. They are anything but static. Can he therefore, clarify what he means by this term? As regards integration, it seems that most complemetary therapists would lament integration as a process better described as the robbing of a set of techniques in isolation from their underpinning paradigm, and that this is not integration but 'appropriation' or even 'misappropriation'. Maybe he could also comment on that claim. Sources [1] Recent advances: Complementary medicine, Andrew Vickers, BMJ 15 Sept, 2000; 321: 683-686 |
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B M Hegde, Vice Chancellor Manipal. India
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Sir, While it is gratifying to note that complementary systems of medicine are gaining respectability, it is a pity that the most ancient of all medical wisdoms, Ayurveda, is missing from even the list, although Yoga is mentioned; the latter is only a wing of Ayurveda. While there have been many Ayurvedic medical schools giving scientific training, lasting as long as the modern medical training does, in many countries outside India, there is a new school even in London's Thames Valley University. The most important aspect of this method of health care is that it looks at the patient as a whole, in addition to his environment. Healthy diet, yogic exercises, and change of mode of living are the main pillars of Ayurveda, in addition to herbal drugs. Ayurveda believs that the whole need not necessarily be the sum total of the bits and, therefore, stresses on the whole extract being administered in place of the so called "active ingredient". While there are many drugs being marketed after careful toxicologic studies and efficacy trials in Japan, Germany and the USA, the area of chronic diseases all over need the effective Ayurvedic methods. Whereas there is no doubt that for emergency treatment modern medicine has no equals, less expensive but effective methods of palliation are available for chronic illnesses in Ayurveda. More research needs to be done here to get this system into the mainstream of complementary medicine. Efforts are on in this direction. Prevention of diseases is Ayurveda's forte. This includes the highest technology of eradication by vaccination of the only disease, small pox. Edward Jenner's vaccination methods were supported by Dr. T.Z.Holwell, a Fellow of the London Royal College of Physicians, in his report to the College in the year 1747. Holwell studied the efficacy of Ayurvedic vaccination technics over a period of twenty years in "The Bengall" and wrote in his report that "the method has the field record of success and antiquity.." The original report has been traced to the archives of the Royal Society, which had sent many scholars to study the science and technology in India in the eighteenth century. Health care delivery would be less expensive if complementary systems get scientifically evaluated to be included with mainstream medicine. |
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Fabio Firenzuoli, Service of Phytotherapy Empoli, Italy
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Administration of a herbal extract, validated through the rules of common scientific research, and having established qualitative characteristics, should not be considered complementary therapy but part of medicine. From many years herbal extracts (Aesculus hippocastanum, Valeriana officinalis, Centella asiatica, Crataegus monogyna, et cet. ) are registered in many national and international Pharmacopeias and commonly sold in chemists’s shops (1). To consider whether or not a therapy is complementary is often just relative to the clinical pattern of a pathology and not due to the origin of the substance used ( vegetal, synthetic or semisynthetic): in a patient affected by cancer, preoperative antibiotic therapy become complementary to the surgical therapy, while in a child affected by recidivant tonsillitis, sometimes surgical tonsillectomy is complementary to an immunostimulant therapy wiyh Uncaria tomentosa. In medium or light depressive syndromes, a treatment with a Hypericum perforatum extract may be considered a first line therapy and not just a complementary treatment. Particularly in reference to the St. John’s wort extract pharmacological research confirms a superior activity of the herbal extract vs. single chemical components (2), and even WHO and EMEA guidelines confirm the possibility to register a phytotherapeutic extracts, that is characterized by more chemical components of vegetal origin (3); otherwise it is well known that for other drugs of vegetal origin the best pharmacological activity is got through extraction of a single chemical component like morphin from Papaver somniferum or taxol from Taxus brevifolia. An important problem is instead self-therapy with herbal drugs. In spite of the fact that for at least three years in Italy, phytotherapy has been part of an institutional public Hospital, our survey showed that 10% of people use herbal drugs, of these, 55% practice self-therapy and 85% do not inform their doctor, resulting in serious risks for health due to interactions with synthetic drugs, collateral effects, improper substitution of well established therapies, et cet.); for these reason we claim urgent educational initiatives in the media and for professional care-givers. The problem now as ever is not to decide what is conventional and alternative: there is only medicine that has been adequately tested and medicine that has not, that is reasonably safe and effective or not (5). We must only decide which type of therapy works better following the rules of evidence based medicine because there exists only one type of medicine. Firenzuoli F, Gori L, Corti G.
Bibliography 1. Firenzuoli F. Fitoterapia. Masson, Milan, 1998 2. Calapai G, Crupi A, Firenzuoli F.: Effects of Hypericum perforatum on levels of 5-hydroxytryptamine, noradrenaline and dopamine in the cortex, diencephalon and brainstem of the rat. J Pharm Pharmacol 1999, 55: 723- 728. 3. Firenzuoli F, Gori L.: Guidelines in phytotherapy. Fitoterapia 1999, 70 (I): 119-120. 4. Firenzuoli F, Gori L, Corti G, et al.: Most common interferences between herbal drugs and synthetic drugs. National conference on “Herbs- drugs interferences”. Florence, June 3rd, 2000. 5. Angell M, Kassirer JP.: Alternative Medicine – The Risks of Untested and Unregulated Remedies. N Engl J Med 1998;339: 12, 839-841. |
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Andrew Thornett, Clinical Research Fellow University of Southampton, SO14 0YG
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Vickers has demonstrated the increasing acceptance of complentary medicine by medically trained professionals. This has resulted from the increasing interest in complementary medicine in the community at large. The authors have also explained how research into the complementary therapies has shifted towards pragmatic trials. These trials involve exploring efficacy, side-effects, patients preferences and costs in the setting in which the treatment would normally be used. In these studies, less importance is attributed to whether the treatment itself is directly responsible for any benefits seen, but outcome instead depends upon the therapeutic relationship, the environment, patient and doctor views of the treatment on offer, and therefore outcome will be subject to the biases and predjudices that we all possess. Such studies can be very useful for the assessment of treatments for either short-lived minor illness that will often resolve spontaneously or for long-term illness that is difficult to treat with conventional therapies, where symptom resolution is particularly important. Placebos and expectancies play an important role in the outcome of such treatments and therefore should not be controlled for in their assessment. We do not fully understand the factors that are important in pragmatic trials. One example relates to patient preferences for treatment. As doctors, we often view the patients' choice as choosing one of a number of treatment options. However, patients may prefer to receive several treatments simultaneously even if there is no objective evidence for additional benefit in randomised controlled trials. 1. Vickers, A. Recent advances: Complementary medicine. BMJ 2000; 321: 683-686 2. Crow, R., Gage, H., Hampson, S., Hart, J., Kimber, A., Thomas, H. The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review, Health Technol. Assess., 1999; 3 (3). |
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Opher Caspi, Research Assistant Professor Program in Integrative Medicine, University of Arizona
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Vickers's clinical review on recent advances in complementary medicine [1] is yet another example for the mainstreaming, and not integration, of Complementary and Alternative Medicine (CAM). Time indeed is changing, but what to? The complexity of the integration of allopathy and CAM is self- evident. Vickers relates only to one aspect of this process i.e., the acceptance of a unified set of standards for the scientific testing of both systems of healthcare. This unfortunately is incorrect, as different regulatory standards apply to pharmaceuticals vs. nutraceuticals. Furthermore, it is truly misleading as integration according to the dictionary includes "the incorporation of equals into society" [2]. Let's be honest about it: there is no equality in medicine; never was and probably never will be! Adding one or more CAM modalities to the already existing partially proven allopathic therapeutic menu (therefore the term complementary), while purposely ignoring their philosophical frameworks, best illustrates this inequality. The recent approval of acupuncture by the British Medical Association [3] is by no means an overarching endorsement of traditional Chinese medicine as a legitimate alternative system. It is simply an acknowledgment of the accumulation over time of good enough evidence and large enough body of literature that shows the effectiveness of acupuncture in some conditions. This is, to borrow a metaphor from the word processing world, a "cut and paste" approach. It results in assimilation rather than in creation of a new emergent property. Combination medicine is not integrative medicine! Whereas I agree with the rest of Vickers' general analysis of the current state of affairs, two other crucial aspects related to the future shape of CAM deserve further discussion. These are health services research and medical education. Those of us who care for the future of CAM, should take responsibility for their incorporation into our grand scheme. Health services research - At present the vast majority of the research effort related to CAM goes into biomedical research in the form of 'treatment x for disease y'. Almost no systematic research is taking place in relation to the delivery, organization and financing of different integrative healthcare models. Likewise there is not much research on the appropriateness, quality, availability and cost of CAM modalities within the current healthcare system. At the time when there is much interest in marketing marketing, ignoring that line of research would be undoubtedly counterproductive in the long run, the reason for which is simple: dollars are easier to measure and relate to than healing. Only by combining both lines of research, the biomedical that looks mainly at mechanisms of effect, and health services that looks mainly at modes of delivery, will we be able to facilitate true integration above and beyond the mere expansion of therapeutic tools. Medical education - Tallying up the number of CAM courses given in medical schools is probably the most misleading indicator for integration. It may create an illusion that CAM already made inroads into the temples of medical establishment. The truth is that CAM education is currently an optional dessert rather than a main course. I am not asserting that that is not a good start, especially when we all remember the still too recent ban on any form of CAM. I am simply asking myself what is next? Without shifting the medical education paradigm from one of disease to one of humanism; from one of cure to one of healing; from one of knowing to one of not so much knowing, no real integration will be feasible. The real opportunity that exhibits itself now is expanding the horizons of medicine beyond the domain of therapeutics. It is truly unfortunate that a statement regarding the mission of the medical profession like the one that Dr. Relman, the former editor of the New England Journal of Medicine, expressed during a debate on the future of medicine "Medicine cannot be expected to make unhappy people happy, or frightened people calm" is still the prevailing paradigm in the halls of learning of tomorrow's healthcare providers. [4] By their nature, review articles deal with the past. We, on the other hand, ought to look at the future: what will follow the current trend of mainstreaming? Issues related to CAM implementation cross continents and cultures. Now more than ever, in a time of globalization and semi- openness, there is a need for an international multidisciplinary task force (possibly under the auspices of the United Nations through the World Health Organization) that will develop an agenda for the CAM field in its entirety for years to come. That agenda will layout a proactive plan that deals with what is needed and is critical for the further development of CAM as a legitimate and integral part of healthcare. The National Institute of Health National Center for Complementary and Alternative Medicine's strategic plan is one example for such a plan. [5] By executing that agenda we all would be actually writing up the future review on recent advances in CAM. References: [1] Vickers A. Recent Advances: Complementary medicine. BMJ. 2000;321:683- 6. [2] Merriam-Webster's Collegiate Dictionary. 10th edition. Springfield, MA: Merriam-Webster, Inc., 1993. [3] Board of Science and Education. British Medical Association. Acupuncture: efficacy, safety and practice. Amsterdam: Harwood Academic,2000. [4] "Is integrative medicine the medicine of the future?" A debate between Arnold S. Relman, MD and Andrew Weil, MD. University of Arizona, Tucson, Arizona, USA. April 9, 1999. A short version of the debate can be found in Dalen JE. Arch Int Med 1999;159:2122-6. [5] http://nccam.nih.gov/nccam/strategic/ Opher Caspi, MD
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John P Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre West Yorkshire
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Editor Clearly Andrew Vickers voices an educated opinion about the potential for 'integration' of CAM practices into his medicine; I say 'his' because the very rapidly emergent complex of interventions - which one may call 'modern medicine from the public perspective' - is the reality. This is where Western Medical (WM) practices and CAM practices are widely available and subject to public choice, we already have a 'public medicine' and this is not 'his medicine'. 'His medicine' would be an amalgam of WM and CAM, where CAM must wait until WM research and analytical principles have been applied to ensure CAMs become 'biomedicalised' so they fit nicely under the control and manipulation of WM practitioners like himself. Not only is this a far cry from the ideal 'integration' desired by CAM practitioners and public alike, but it would require the public to wait until WM gurus decide which CAM to interfere with, and when if ever to indulge that decision, before moving towards unanimous public need - CAM provision paid for with public tax dollars with equal funding, if not more (as CAM is so varied as to include forms of complete medicine, partial and even purely palliative forms of medicine). The public, as CAM practitioners, also values research - whilst not forgetting that some CAMs, such as Traditional Chinese Medicine (TCM), already boast thousands upon thousands of excellent contemporary research papers from countries such as China - a world power with some of the finest academic and scientific gurus. Most objective observers would expect research into a CAM must ensure compatibility with that CAM doctrine and common practice, yet what tends to flood the volumes of Cochrane and Pubmed are poorly concocted WM hybrids that bear little if any resemblance to the original CAM perspective. One finds many examples of such grossly inadequate papers with titles such as 'the CAM that doesn't work as well as its practitioners and patients believes it does'. These are usually written by a small cohort of 'WM rapid-research gurus' and litter Cochrane and other WM-based centres of storage. I do not believe that the public or majority of CAM practitioners wish to 'amalgamate' or 'integrate' with WM; WM is seen more and more as just another alternative - one with potential devastating consequences for vast numbers as well as hope and healing for others. When WM doctors strike, people who would have died live; if CAM practitioners were to strike, people who would have lived will probably die as they have to return to their doctors. Who would dispute this? Patients become the victims of bad medicine, not the medicine or practitioner. The modern patient is much wiser now that statistical information is readily available from many sources about risks and benefits. 60% of patients in the USA and 40% in Europe turn to CAMs whilst the remainder still visit their WM alternative, an alternative which has little evidence of efficacy or safety. That is their democratic right. The most important development that would provide for their democratic right to choose would be to open funding, on an equal footing, for all CAMs required by the public. Wasting time and money on a pie-in-the-sky research process, or a process of 'integration' which as described by Vickers ought really to be called 'plagiarism', which has yet to prove the worth if its own WM guru-led systems belies the true need of the public. WM seems to be suffering a major identity crisis. CAMs are now preferred by vast tracts of humanity despite WMs massive budgets, haughty towers, endemic professionalism and national edicts which preserve drugs budgets over required public funding. Many WM practitioners are clammering to study (often in short bursts which says something about the mentality of these practitioners and their true desire to learn) CAM practices to supplement their failing methods. How many TCM practitioners, Homeopaths, or Ayuvedic practitioners feel the need to supplement with WM practices to achieve cures and healing for their patients - very few I think. The main drive to require additional WM education in CAMs comes from the WM establishment - as though a Frenchman needs German to achieve proper communication. Many CAMs have an innate ability, through centuries of practice and perfection of scientific arts, to communicate adequately with human physiology to achieve cures and healing - WM often gets in the way of this success. That is not to say that WM with CAMs could not work, merely that it will only work if WM accepts its role as just another CAM and throws off the unseemly arrogance which shouts aloud, like the child who wishes to hurt its guardians, that its demise would result in greater disaster than relief. The record to date suggests this might not be the case. Governments should break the strangle hold WM has on public finance and begin to fund, adequately and according to public wishes, CAMs as mainstream practice. In time, all forms of CAM medicines (including WM) can sit and discuss priorities for research funding, according to public need. Only when equal status is achieved for all doctrines will the public receive best practice from its healers and politicians, and decisions on important areas of scientific progress, such as research, will be resolved without fear or favour. Regards John H. |
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Badal Pal
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Sir - I read with interest the two recent articles(1,2) in the BMJ on complementary therapies which left me confused regarding the value of acupuncture for pain relief. In the first paper(1) acupuncture was said to be useful, and evidence based whilst in the second article (2), acupuncture was dismissed. I have introduced acupuncture in my rheumatology clinics as one of the last resorts to treat non-inflammatory painful conditions where conventional treatment has failed, or when drugs have become unacceptable due to adverse reactions, as in the elderly from non-steroidal anti-inflammatory medications and narcotic analgesics. Many patients seem to find this helpful as an adjunct to other interventions, and accept acupuncture especially when they realise there are no alternatives left for them. In this situation the value of acupuncture is self-evident but difficult to prove on randomised trials. However, a recent randomised controlled study has just done that( which Ernst has overlooked) showing benefit of acupuncture in osteoarthritis of the knee(3), in addition to several other papers cited by Vickers (1). It is also notable that the National Institute of Health in the United States of America(4), and more recently also the British Medical Association have approved acupuncture for pain relief.(5). Many clinicians may be planning to offer acupuncture facilities in their services now or in the future. Should they follow recommendations given by the NIH and the BMA or should they heed Ernst's proclamation that acupuncture has no role to play , and abandon their plan? Dr.Badal Pal,
Reference: 1.Vickers A. Recent Advances: Complementary medicine. BMJ 2000,321:683-686. 2.Ernst E. The role of complementary and alternative medicine.BMJ 2000;321:1133-1135. 3.Berman BM, Singh BB, Lao L, Langenberg P, Li H et al: A randomised trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatolgy 1999,38:346-354. 4.NIH consensus conference. Acupuncture. JAMA 1998;280:1518-24. 5.Board of Science and Education, British Medical Association. Acupuncture: efficacy, safety and practice. Amsterdam:Harwood Academic,2000. |
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Andrew Vickers, Author of Recent Advances paper Memorial Sloan-Kettering Cancer Center
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Apparently, I "purposely ignor[e] [CAM's] philosophical frameworks". And "integration [is] a process better described as the robbing of a set of techniques in isolation from their underpinning paradigm". Also: my medicine "would be an amalgam of WM and CAM, where CAM must wait until WM research and analytical principles have been applied to ensure CAMs become 'biomedicalised' so they fit nicely under the control and manipulation of WM practitioners like [me]." Please, please, go back and read the original article. I say absolutely nothing about how CAM should be integrated. Nothing in my article suggests that CAM practices need to be practised in any particular way. I must be especially emphatic that I did not, and have not ever, suggested that CAM needs to be biomedicalised / teased apart from its philosophical framework. In the unit at which I work now, we have two traditional acupuncturists (one of whom is Chinese) who practise pretty much the same at this hospital and in their private practice. I don't get involved in telling them how to treat patients, or what for. I have previously gone on the record with my views on this subject (Vickers AJ. For pluralism in medicine. Complementary Therapies in Medicine 1998;6:169-71) The comments of Morrell, Heptonstall and Caspi are deeply saddening. It suggests that some advocates of CAM are so quick to temper, so sensitive to the possibility of outside influence that a straightforward descriptive article making no recommendations as to practice becomes a "them and us" with its author automatically characterised as "them" (I am said to be a doctor hoping to subjugate CAM). Such overt defensiveness does not bode well for the future of health care. |
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John P Heptonstall, Director of the Morley Acupuncture Clinic and Complementary Therapy Centre West Yorks
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Editor I sympathise with Dr. Vicker's comments, he cannot be too comfortable with the replies of Morrell, Caspi and myself - the truth often hurts. I did not recognise 'temper' in any of the three responses, merely clear views adequately represented. I will only speak for my speciality, TCM - acupuncture & moxibustion. Yes, Vickers is ignoring the philosophical framework encompassed by TCM - the origin and driving force for safe, efficacious acupuncture. Vickers mentions acupuncture only in the context of 'pain control', this is anathema to TCM. Using acupuncture for 'pain control' is analagous to using a hammer-blow to shatter and quieten the alarm which is warning of internal disorder - this is an abuse of acupuncture and can only lead to a dramatic increase in adverse reactions; these are already being recognised, particularly amongst patients of 'medical acupuncturists' who are most likely to provide symptomatic 'pain control acupuncture' as opposed to acupuncture for correction of systemic disturbance for which a proper understanding of TCM is essential. The 'Integration' described by most 'medical' commentators, is little more than 'robbing a technique' (to use Vicker's terminology) from TCM - the essential underpinning paradigm; the irony is that so many commentators do not seem to recognise the importance of TCM in this regard, clearly they have not taken the time to study and understand its complexity and necessity for safe, efficacious acupuncture; I believe this will be disasterous for patients who receive 'acupuncture' as opposed to 'TCM-based acupuncture & moxibustion'. Vickers uses the following phrases to describe important values held by patients, researchers and clinicians to explain where 'conventional' and 'complementary' medicines meet:- Patients care about 'clinical relationship' Researchers care about 'control of bias' Clinicians hold critical 'clinical competence' From my perspective, as a TCM specialist, I prefer to believe that Patients most care about 'sound improvements in their conditions' Researchers care about 'developing interventions that provide for what patients most care about' Clinicians hold critical 'competence in providing for patients' needs' If one wishes to integrate, one must recognise these differences in perspective; perhaps difficulties in reflecting the real needs of patients, researchers, clinicians and purchasers. The use of 'conventional' to mean allopathy, and 'complementary' to mean every other form of medicine, drives a wedge through the 'integrative approach'. 80% of the global population do not use, or have access to, allopathy; they use their own traditionally valued 'conventions'. Using the term 'conventional' to mean allopathy is incorrect and arrogant, it leads to division not integration, which serves only allopathy, and those who gain from non-integration or integration on their own terms eg. a CAM as a substandard verison of it's original state 'integrated into allopathic practices'. Introducing biomedicalised versions (after discarding age-old experience, convention and modernisation) of traditional medicines will increase allopathy's already horrendous record as the 3rd biggest killer after cancer and heart disease. Vicker's Review, he admits, is based on the 'major source', the Cochrane Library'; how can any serious researcher ignore 99% of the world's data on the TCM technique acupuncture, yet achieve some kind of consensus on the issues he does? He says that much of the evidence for CAMs 'involves small numbers of patients and is of poor methodological quality'; then goes on to say 'high quality systematic reviews of complementary medicine have been published recently' - how does one develop useful systemtic reviews from poor quality studies? In computer terms one would expect GIGO, and that is what I perceive to be the case for systemtic reviews on acupuncture - examples at his references 5, 6, 7, 8. TCM requires funding in the West; its practitioners require research facilities, and its techniques must be followed as per TCM principles - that is the only way to 'prove' acupuncture. Acupuncture is not a 'pain killer' per se, it kills pain safely and effectively when targetted systemically, and is efficacious in many and varied conditions as the WHO recognised through its list of recommendations for acupuncture dated 1981; used naively it can kill pain symptomatically, ignore systemic problems and becomes a dangerous option. If Vickers cannot understand or come to terms with this he is out of touch with reality, along with many other well-published commentators. I suggest he asks the 'traditional acupuncturists in the unit he now works' for advice on this matter if his desire is for integrity in integration, safety and efficacy for patients. My 'overt defensiveness' is essential if patients are to be protected from 'medical acupuncture for pain control' and incessant inaccurate reflections on what acupuncture is, and what it can and cannot do. Regards John H. |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University
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Sir, It is reassuring, if somewhat sanctimonious, to be told that Andrew Vickers is not so keen to misappropriate CAM modalities and ignore their philosophical aspects, and thus I am willing to admit to a slight misinterpretation of his position. However, it is worth saying, that from an historical angle that is precisely what has been done in the past with CAM techniques and therefore the 'misinterpretation' seems perfectly justified, based as it is upon past patterns of behaviour. Afterall, when leopards do change their spots, it is noteworthy. I do not therefore regard my comments as remotely sad or disheartening. They spring from clear knowledge of the way CAM therapists have consistently been treated by the orthodox for over a century. Apparently oblivious of this history, Vickers seems content to draw his own conclusions regardless. Yes, there is a 'them and us' in medicine and this again is well known to anyone who has studied the history of CAM modalities - a history of almost continuous hostility, friction and abuse from orthodoxy. Again, when the bullying stops, it still takes a long time to convince the victim that it has truly stopped and the bully has stopped being a bully. Is that truly the case? I think that is a fair account of how the 'them and us' attitude has arisen and perhaps why he thinks CAM sympathisers might be 'quick to temper'. In the light of his own intemperate remarks, I think that comment is a little rich. If he wishes to understand 'such overt defensiveness', rather than just pompously condemn it, then perhaps he should study the history of these modalities more carefully, himself. Or does he still think history is static? A point he has declined to address. I think it was Hegel who said we never bother to learn from history. That 'does not bode well for the future of healthcare' either. |
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