Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Integrated medicine: Give Us Research!
- Michael Loren (19 January 2001)
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Reductionism and ComplexityHome Ad
- H Bernard Lewis (20 January 2001)
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Integrated medicine - a short road to betrayal
- Roger A Fisken (20 January 2001)
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CAM = COST
- Paul Lee (21 January 2001)
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integrated medicine
- Liam Farrell (21 January 2001)
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Integrated Medicine fills the gaps of Defensive Medicine
- Dan Michaeli (21 January 2001)
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Re: Integrated medicine - a short road to betrayal
- Anthony Campbell (21 January 2001)
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Humility and glass houses
- John Hopkins (21 January 2001)
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Integration or assimilation?
- John P Heptonstall (21 January 2001)
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Is ‘Integrated medicine’ an imperialistic concept?
- Wainwright Churchill (21 January 2001)
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Integrated Medicine means Doctors in Charge
- David St George (22 January 2001)
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Missing the point?
- Carl Ringwood-Walker (22 January 2001)
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Re: Integrated medicine - a short road to betrayal
- Thomas M Walter (23 January 2001)
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Re: Integrated medicine - a short road to betrayal
- Rory Orr-Sabard (23 January 2001)
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Integrate what?
- Janet Richardson (23 January 2001)
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Integrated medicine
- A Karperien (24 January 2001)
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The science of the art of medicine
- Michael Sharpe (24 January 2001)
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No common language available yet
- Chuanfang Lee (24 January 2001)
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Integrated medicine
- Roger Clarke (25 January 2001)
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Re: Re: Integrated medicine - a short road to betrayal
- Peter Morrell (25 January 2001)
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no such thing as complementary or alternative medicine
- Charles Essex (26 January 2001)
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Re: no such thing as 'evidence-based medicxine'?complementary or alternative medicine
- John P Heptonstall (27 January 2001)
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Science-based Medicine & the "Trip to Stonesville"
- Robert Imrie (29 January 2001)
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Misleading terminology
- Tim Blowfield (29 January 2001)
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Re: Science-based Medicine & the "Trip to Stonesville" - In Defense of Andrew Weil
- Wainwright Churchill (30 January 2001)
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Weil's Non-Science Based "Medicine"
- Paul Lee (1 February 2001)
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Re: Re: Re: Integrated medicine - a short road to betrayal
- Anthony Campbell (2 February 2001)
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Re: Re: Re: Re: Integrated medicine - a short road to betrayal
- Peter Morrell (4 February 2001)
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Pathological Science
- Alan Shortt (4 February 2001)
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Re: Re: Re: Re: Re: Integrated medicine - a short road to betrayal
- Anthony Campbell (6 February 2001)
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Study of anthroposophical practices
- Gene Feder (23 February 2001)
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Integrated medicine: Finding the Time
- N W Read (27 February 2001)
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A new integrated medicine, not integrating alternatives to medicine.
- Vivian S Rambihar (28 February 2001)
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An Alternative Integrated Medicine
- T Chalder (1 March 2001)
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The reality of holism
- Peter Morrell (16 March 2001)
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Re: integrated medicine
- John P Heptonstall (19 June 2001)
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Patient's welfare needs help from everywhere
- R D Prabhu (3 October 2001)
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Re: Integrated medicine - a short road to betrayal
- Mark P Guthrie, Spokane, WA 99205 USA (18 January 2002)
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Integrating systems of medicine
- Vaishnavi K (23 May 2004)
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Re: Integrating systems of medicine
- Milind A Patil (28 July 2004)
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The 'Obi' Protocol For 'Medically Incurable Cancer' : A Celebration Of Pure Hope
- Joseph . C . Obi (29 July 2004)
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Michael Loren, Assistant Professor of Pediatrics, University of Kansas
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Patients may be running to the alternative therapist. But we still need to have scientific data to back up what we do. This problem is especially dangerous in the United States: The FDA does not regulate Herbal or Diet supplements. Research in alternative therapy should be more than window dressing before we "integrate." |
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H Bernard Lewis, Research Physician SIMBEC Research
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Editor:- Today I read with great interest your 'Editor's Choice on
'Restoring the soul of medicine; also the other articles and letters in
the same issue along the same line.
It seems to me that the debate flounders because our language in discussing such matters is so deeply affected by a discredited philosophical dualism of 'mind/body' instead of regarding the world as a collection of events; the living brain consists of some of the events that constitute the universe and our 'mind' is just a term for some of those events. Looking at medical science from this perspective reductionism as a means of trying to understand the world has produced a measure of understanding, but to increase our grasp of complexity then the fruits of reductionism need to be viewed in the terms of context which does not involve unverifiable and vague concepts such as 'holism' Further progress in neuroscience allied to a new language to speak of mind/brain events should eventually make it clearer the way that emotions, whether negative or positine, can influence systems such as the immune and endocrine ones. This may bring greater clarity to our thoughts on these matters. Dr H. Bernard Lewis
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Roger A Fisken, Consultant physician Friarage Hospital, Northallerton, North Yorkshire
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Given the tide of political correctness, sackcloth-and-ashes and plain kookiness which seems to have been engulfing the BMJ in recent years I am not surprised by the theme of your current issue. I am, however, appalled: if we get into bed with alternative medicine we are not only betraying our scientific heritage but we are also a short step away from betraying our patients. It has taken hundreds of years to pull medicine away from the quagmire of superstition, witchcraft, mumbo-jumbo and sheer quackery and turn it into something resembling a scientific pursuit. Now all of that progress appears to be in danger of being thrown away because we are too gutless to stand up to the criticism of scientific rationalism which is being offered to anyone who will listen. Only this week I have had to rescue a man from the ministrations of his daughter, who informed me that she had changed him on to the "homoeopathic equivalents" of frusemide and an ACE inhibitor, with the result that he was admitted to hospital in severe heart failure. The likes of Charcot, Semmelweiss, Koch and Thomas Lewis must be revolving at high speed in their last resting places if they can see what we are allowing to happen. Look: there is no necessary opposition between scientific medicine and humane, holistic clinical practice and the best clinicians throughout history have been skilled at combining both elements. To suggest that one cannot be a good scientist and a caring, compassionate doctor is utter, drivelling nonsense. The bottom line is that the laws of physics and chemistry are the same the world over and that because of a rigorous application of these laws and of the principles of the Enlightenment we now know that malaria is not caused by bad air or curses, that mental illness is not a sin and that we can prevent outbreaks of typhoid by good public health measures and vaccination rather than by sacrificing goats at midnight. |
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Paul Lee, Physiotherapist in private practice Klinik for Fysioterapi, Rolighed 22, 4180 Sorø, Denmark
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Complementary and Alternative Medicine (CAM) cannot do what it claims to do, and is anything but what it claims to be. It claims to be holistic, but in fact treats specific symptoms using specific therapies. In that sense it is no different than many accepted forms of treatment for illnesses without cures. It claims to treat the cause of disease, but treats the symptoms. It claims to be without side effects, without proving this to be the case, or for that matter, being able to prove its claims of efficacy. It claims to be better than Evidence-Based Medicine (EBM), but does not produce any proof for this claim either. CAM is a misleading, oxymoronic misnomer, consciously or unconsciously created to give a false impression, get political clout and win undeserved confidence and respect. Although it lacks convincing proof of efficacy, it seeks to win acceptance without meeting the usual criteria demanded of EBM for gaining and deserving the acceptance it seeks. It is not "Complementary" to EBM, but is "Competitive" to it. When practitioners of so-called "alternative medicine" speak of evidence-based medicine, they usually do it derogatorily, thus revealing their true motives. Any talk of cooperation is a smoke screen for a Trojan horse mentality. They would love nothing better than to see CAM replace EBM. It is not "for" medicine, but is usually "Opposed" to the practice of EBM. The opposition to EBM is often bitter, outspoken, derogatory and nasty. There can be no question as to the real intent of the practitioners of CAM and the enormous industries supporting them: the total eradication/domination of EBM. But just as long as they can get their fingers in Federal moneys, they'll be quite satisfied to work alongside EBM. It is not an "Alternative" to EBM, but is used "Supplementary" to it. Users of CAM nearly always use it in addition to EBM. And when they don't, they still resort to EBM when all else (CAM) fails. It would be more correct to use the term COST (Competing, Opposed, and Supplementary Therapies) than CAM. It is C ompeting with EBM.
As such it is an unnecessary additional "cost". The National Center for Complementary and Alternative Medicine (NCCAM) seeks approval for something that will be an enormous, extra burden for taxpayers. Let people that want it pay for it themselves. If its efficacy ever gets proven, then it'll cease to be COST and it becomes EBM. Legislators should be aware that CAM is a deceptive, misleading, oxymoronic misnomer, both as regards its intent and its efficay. They need to start thinking in terms of COST, instead of CAM. Then they'll realize that when they take money from EBM research and use it on unproven methods, they are throwing taxpayer's money out the window to the hungry ducks (quack, quack!!) below. This money would be better used to perform real research and to treat critically ill patients, such as cancer victims, with EBM. It should not be taken from them and wasted on unproven remedies. Which brings up a dilemma. The above describes what should and should not be done ideally. But the game of reality is something else, and requires different rules. We have to compromise for the sake of a higher purpose than only preserving scientific integrity. The public needs to be protected from deception and endangerment. This is the consumer protection advocate's dilemma. The very existence of government-funded research of CAM modalities is used by their proponents to legitimize their methods. The questions of final results, as well as proofs of efficacy and safety, do not concern them. They will often hypocritically use any excuse to make it appear that their method is legitimate, accepted, and confirmed by science, even though they use any available excuse to denigrate scientific endeavors at the same time. The poor ethics revealed by a lack of willingness to be held accountable for misleading statements and the poor, and sometimes dangerous, results of therapy, is reason enough to justify making an exception to the principle of "The burden of proof is on the claimant." The concern for protection of the public is a higher concern than a firm stance on this point. Therefore the research should be done, in spite of the fact that such research will be used as propaganda, regardless of the outcome. Making an exception for this reason does not negate the validity of the principle. But dishonesty and/or lack of integrity demand that the rules of the game be changed. Since many CAM practitioners refuse to respect the rules of the game, we must counteract their negative influence by playing differently than we usually would. Otherwise they will run circles around us, treat us as naive, and continue to deceive the public. Some unproven therapies may actually be useful, but lack proof of efficacy, simply because the research hasn't been done yet. As long as this is the case, CAM practitioners will be able to use this excuse to try and justify their use of many worthless and even dangerous methods. Therefore the research needs to be done. They should have this last excuse removed from them. They will then no longer be able to claim ignorance as an excuse. While it is not possible to prove that an unworkable modality works, it may at times be possible to prove that it doesn't work. Emily Rosa, with her debunking of Therapeutic Touch at a school science fair, showed that it doesn't always have to be expensive, time consuming or done by trained scientists. But, unfortunately, it is not always that simple. Proving the efficacy of a modality is the responsibility of the claimant. Experience has shown that the exponents of many CAM modalities are not interested in attempts to disprove their pet methodology. Even though disproving it is not the responsibility of skeptics, if it can be done relatively easily, it would be in the best interests of the public that it be done. It is, after all, skeptics that are interested in debunking false and/or unproven claims. But, it is questioned, why do it, since the true believers just "ignore the data anyway?" Casting pearls before swine has always been an exercise in futility. The thing we need to be aware of is that it is not for their sake it needs to be done. No, among the general public there are a lot of sensible, but scientifically ignorant people. It is for their sake the research needs to be done. Many of them are in a vulnerable situation. What they end up believing is dependent on who gets to them first: the quacks with their emotionally very appealing anecdotes, or the skeptics with their solid, logical facts, which effectively inoculate the potential victims from being infected with nonsense. Time passes while we refuse to do the research. Meanwhile the quacks are getting their message out to the public. Once infected with alt med nonsense, they become immune to cognitive dissonance. Some of them are then unreachable for a few years, others for the rest of their lives, and still others even more permanently: they die as a result of our hesitation. It may be that history will show that we were correct in stating that we were not obligated to do the research, since the burden of proof was on the claimant. But we lost the battlefield to the quacks, simply because we didn't show up. We spoke to the quacks (who would not listen). and neglected to protect the public (who needed our help). The quacks won and the public lost. Paul Lee, The Quack-Files: http://www.geocities.com/healthbase |
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Liam Farrell, GP Crossmaglen, Ireland
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Dear editor, I am a firm believer in integrated medicine. After each consultation I give my patients a Teddy-Bear to cuddle and play them a tune on the banjo Yours DR Liam Farrell |
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Dan Michaeli, Chairman , Board of Directors Clalit Health Services Israel
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The trend of superspecialisation in medicine has many outcomes one of which is the lack of security of the physicians and their patients in the management of their needs. It is true that modern medicine is more "technocratic" but it is also very defensive. By this I mean that too often doctors refer patients to "specialists" for consultations because they are not sure anymore in their ability to assume full clinical responsibilty. It is a result of a double edged development. On the one hand patients are not as ready as in the past to accept what their doctors tell them as "dictates", and many times for good reasons. On the other hand the increase weight of litigations put physicians in a very defensive attitude. The result is that the physician hesitates to take care of the patient without "consultations" and at the same time the patient receives this message and translates it to a lack of confidence on the part of the physician.
The patient needs to have confidence and needs the doctor who is not a technician but a "healer". This he finds in those who practice alternative/complementary medicine. They at least are ready to give the patient this feeling of security we have forgotten to produce. A great part of this process is due to the disappearance of the master-teacher in the education and training of young doctors. I believe that the present trend is a symptom and a result of the needs of the patients to resume their confidence in their healers and of the physicians to regain this role. But in the long run this will not be enough and the real task is of our medical schools. We need to re-establish the role of the master-teachers and not leave the student to try to "integrate" pieces of information from diverse "specialists" and sources of information attempting to become a healer and not just a technician-doctor... The challenge is for the medical educators ! |
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Anthony Campbell, Retired Consultant Physician, Royal London Homeopathic Hospital
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I think there is often a measure of uncertainty in many people's minds about some of the forms of complementary/alternative medicine they are either attacking or commending. In the case of homeopathy, in particular, it's really impossible to understand the subject in any depth unless you view it from a historical perspective. This is because it developed in the early nineteenth century and hasn't really changed much since then. There are a number of myths about homeopathy that are often repeated both by critics and defenders. In an attempt to clarify things for anyone interested, I've made an electronic book - Homeomythology - available on the Net, in which I look at the subject in what I hope is an objective way. It can be found at: http://www.cix.co.uk/~acampbell/freethinker/altmed/homeomythology/ |
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John Hopkins, General Practitioner Darlington
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Sir, As Roger Fisken points out, there is no reason why scientific medicine and humane holistic practice cannot be combined. And, in a week when Princes of the Realm and Lords Chief Justice appear to have joined the many who criticise doctors for lacking the common touch, one might ask if these institutions are best placed to throw stones. John Hopkins |
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John P Heptonstall, Director of the Morley Acupuncture Clinic and Complementary Therapy Centre West Yorkshire
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Editor I believe that the quote "Integrated medicine (or integrative medicine as it is referred to in the United States) is practising medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment" would be seriously questioned by many CAM practitioners, especially those who recognise that 'alternative' often means just that, and 'complementary' may mean for example Homeopathy WITH Reflexology whilst excluding 'orthodox treatment' that may have already proved of little use to the patient. The reason 60% of Americans and 40% of Europeans are using CAMs INSTEAD OF 'orthodox' treatments is that the latter fail to address so many health problems whilst the former obviously manages to address them. Any other explanation would suggest that so many patients are DELUDED and should not believe that the CAMs they embrace work better than any 'orthodox' alternative. Many of us see daily that GPs and Specialists are incapable of meeting the medical needs of many patients, not because they have insufficient time or manpower but because they are incapable of achieving a result, one that is achievable by the CAMs the patients choose. Unless this point is made by CAM professionals the system (eg. HoL) will remain ill-advised by medical interests which constantly make it appear that CAMs have nothing to offer that is superior to 'orthodoxy' other than listening, time etc. That is patently untrue. Ultimately we are talking about medical provision which is under 'orthodox' medical control to the massive exclusion of patient rights and beliefs. Patient's rights and beliefs ought to take precedence, even to the exclusion of a profession's beliefs, in any democratic society. Regards John H. |
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Wainwright Churchill, Traditional Chinese medicine acupuncturist and herbalist London
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At the beginning of their article [1], Lesley Rees and Andrew Weil state: ‘Integrated medicine (or integrative medicine as it is referred to in the United States) is practising medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment.’ At the end, they say: ‘Integrated medicine is good medicine, and its success will be signalled by dropping the adjective [‘Integrated’].’ Their definition of ‘Integrated medicine’ (IM) is good, making clear that Integrated medicine should not be identified with Complementary and Alternative Medicine (CAM) insofar as IM adheres to the biomedical paradigm. This distinguishes it from systems of medicine with their own paradigms, such as Traditional Chinese Medicine (TCM) or Ayurvedic Medicine. What is objectionable is that Rees and Weil do not consider the implication of their goal of dropping the adjective ‘Integrated’ if the IM project is successful. This would mean that, in our society, ‘medicine’ would be firmly identified with only one paradigm, that of biomedicine. What is to happen to, for example, the noun ‘Medicine’ in ‘Traditional Chinese Medicine’ or ‘Ayurvedic Medicine?’ Are these systems to be regarded as invalid paradigms, useful only insofar as they supply biomedicine with a few additional techniques or insights, but not meriting the designation ‘medicine’ in their own names? I would suggest that Rees’ and Weil’s proposal could be interpreted as being imperialistic. I suggest an alternative to the concept of ‘Integrated medicine’, one that I think is much more relevant to the way medicine will actually develop in our culture as an increasing percentage of the population utilise CAM. That is the concept of ‘Pluralistic Medicine’. ‘Pluralistic’ implies that more than one medical paradigm has validity, and conversely that no individual paradigm can legitimately claim a monopoly on the ‘truth’, or to serve as the sole basis of all medicine. This, in fact, goes along with the insights of philosophers of science such as Thomas Kuhn, who made clear in The Structure of Scientific Revolutions [2] that all paradigms are based on assumptions (which themselves cannot be tested) that are inextricably linked with their insights and praxis. Thus, no paradigm can lay claim to revealing the 'truth'. Kuhn maintained than no individual paradigm can answer all questions put to it, and showed that different paradigms are ‘incommensurable’, meaning that the statements and insights of one paradigm cannot be translated into another. No paradigm can legitimately claim to be the basis with which to judge the validity of another. A medical approach, such as Rees’ and Weil’s ‘Integrated medicine’, by being based on the biomedical paradigm, cannot – in principle - deliver the insights and praxis of another paradigm such as TCM. (It could only do so if non-biomedical and biomedical paradigms were entirely commensurable.) Integrated medicine therefore cannot legitimately assert that it can deliver all that is good with both current biomedicine and CAM in an integrated, self-consistent whole, nor that as a system it has found ‘all that is true and useful’ with non-biomedical medical systems, improved insofar as they are now explicated within a biomedical theoretical framework. Integrated medicine, whether it keeps or abandons the adjective ‘Integrated’, can only ever be one more paradigm among many, without all the answers or a monopoly of the truth. In the light of his excellent books, such as ‘Spontaneous Healing’ [3], which could well serve as inspiration for a ‘Pluralistic Medicine’ project, I am surprised that Andrew Weil is promoting the monolithic concept of ‘Integrated medicine’ which grants the biomedical paradigm a privileged position over other medical paradigms, aiming to supplant all alternative systems by claiming for itself exclusive rights to the term ‘medicine’. I would be very interested to know what Andrew Weil and Lesley Rees propose should be the standing of non-biomedical systems of medicine, such as TCM or Ayurvedic Medicine, once ‘Integrated medicine’ has finished assessing them and appropriating the bits it finds useful, whence in Integrated medicine’s mature form, the adjective ‘integrated’ can be discarded. Citations [1] Lesley Rees and Andrew Weil. Integrated Medicine. BMJ 2001; 322: 119-120 http://www.bmj.com/cgi/content/full/322/7279/119 [2] Kuhn, T. (1996). The Structure of Scientific Revolutions. Chicago and London: The University of Chicago Press. [3] Weil, A. (1997). Spontaneous Healing. London, 1997. Warner Books. |
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David St George, Director Centre for Integrative Sciences in Complementary and Alternative Therapies (CISCAT), London
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Rees and Weil’s editorial on integrated medicine gives a rather one- sided view of the topic. It talks about selectively incorporating “elements” of complementary and alternative medicine into “comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment”. It also identifies a need for “physicians with the biomedical knowledge” to be able to distinguish between the multiple options of complementary therapies. This comes across as orthodox biomedical “cherry picking” from the complementary field, in order to supplement conventional treatment. It also implies far greater knowledge and certainty about the relative merits of different complementary therapies than currently exists, or which will exist for some time to come. It is precisely because of the limitations of biomedical knowledge and treatment that doctors (particularly GPs) began to open the door to complementary practitioners. During the late 1980s and early 1990s, some GPs and complementary therapists developed pragmatic forms of collaboration, which represents “integration” on a more equal professional footing. In these arrangements, GPs often referred patients to complementary therapists for their opinion and advice, rather than with certainty that a particular therapy would help the patient. Also, they found that complementary therapists could make an important contribution to patient care, even in the absence of a clear-cut orthodox medical diagnosis. The picture that emerged from these arrangements is very different from Rees and Weil’s image of “doctors in charge”. When such inter-professional collaboration has been developing at the grass roots for so long and in an unsung way, why has the BMJ now dedicated an issue to “integrated medicine”? Surely not because one of the elite bodies of the medical profession (the Royal College of Physicians) is finally taking complementary medicine seriously. Nor because an organisation locked into the heart of the British establishment (the Foundation for Integrated Medicine) has been campaigning for its own medically dominant brand of integration. The expansion of complementary therapies over recent decades has been widespread, consumer driven and at the grass roots. We are now witnessing the establishment finally waking up to the potential threat from alternative healing practices if they continue to flourish unchecked. Come on BMJ, get real! Despite the pious claim to be “restoring the soul to medicine”, what your theme issue really signifies is orthodox medicine’s attempt to shore up its monopoly by bringing the complementary therapy professions under its wing. |
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Carl Ringwood-Walker, Nurse researcher/PhD student Wrexham Maelor Hospital
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Dear Editor, I am dismayed at the responses of so many medical practitioners still apparently unable to see that those engaged in serious and professional research/practice into various complementary therapies do so with the very best of motives. We surely all want to see our patients receive the best possible care to ensure the best possible outcomes? There seems to be reference only to 'complementary therapy as though it were a single discipline rather than a wide array of practices of which many are rapidly establishing credence among not just the public and whole time complementary therapists, but also an increasing number of doctors who do recognise that conventional medicine cannot always provide the best outcomes. For goodness sake, wake up and realise that CAM is not something to be dismissed as quackery like so much black magic; it is here to stay, and the sooner it receives the complete backing of the medical fraternity and appropriate regard in the race for research funding the sooner we can all work in harmony - for the ultimate good of those we profess to care for.Let well conducted research provide the evidence for or against the variety of CAM treatments on offer; let there be a genuine attempt to combine allopathic and complementary medicine to achieve the greatest synergistic effect. |
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Thomas M Walter, Asst. Lecturer, Dept. of Medicine, Government Medical College(for Alternative Medicine). Palayamkottai, Tamilnadu, India.
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I just read the article, "Integrated medicine - a short road to betrayal". I was really shocked to read the article. It is always advised to have a complete idea about the field before making any comments. I have done my Doctor of Medicine (M.D) in Herbal Pharmacology. I have three years Research experience in Experimental Pharmacology. I have fully evaluated a new Herbal and a Metal drug using Scientific parameters. I have done all the tests extensively ( Bio-chemical, Pharmacological, Microbiological, Phyto-chemical,Toxicological and Clinical studies. I am ready to show all the necessary documents). A lot of research is being done on the alternative drugs and the results prove to be highly effective and encouraging without any side-effects. Alternative medical systems have got the solution for the dreaded diseases like AIDS etc. Alternative Medical Systems are fully scientific and no one can charge it as baseless etc. We are not going to discover anything new. It is only going to be the rediscoveries of what is said in the Traditional literatures perhaps in the modern/scientific terminologies. Our ultimate aim is going to be one. i.e. providing a healthier life for all. We(the People of Alternative Medical Systems) only opt for a peaceful, understanding and co-operative working atmosphere. If such an atmosphere prevails wonders can be explored from the Alternative Medical Systems. Then we will find a Wonderful,Natural,innovative and a Eco-friendly Road. |
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Rory Orr-Sabard, Clinical Director Marriott Street Clinic, Northampton
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Sir, I quote from your recent correspondence: "I am, however, appalled: if we get into bed with alternative medicine we are not only betraying our scientific heritage but we are also a short step away from betraying our patients. It has taken hundreds of years to pull medicine away from the quagmire of superstition, witchcraft, mumbo-jumbo and sheer quackery and turn it into something resembling a scientific pursuit." It is true that many of those (and I include myself) who practice and research into alternative medicine are not medical doctors. It is also true that many of us not only adhere to the principles of true scientific enquiry but also are familiar with the history of the development of medical science. There are a number of examples of good science, conducted by both scientists and medical doctors, peer-reviewed and published in respected medical and scientific journals which should also be included under the umbrella heading of alternative medicine, and I offer just three examples: 1] Dr Harold Saxton Burr (PhD), a neuro-anatomist at Yale University School of Medicine for over 40 years, developed a practical, safe and consistently reliable (over 95%) electro-metric test for cervical cancer in the 1940's. 2] Dr Robert Becker (MD), an american orthopaedic surgeon, artificially induced limb regeneration in frogs and demonstrated de- differentiation of cancer cells all the way back to primitive cells in the 1970's. 3] Dr Bjorn Nordenstrom (MD), Professor of Diagnostic Radiology at the Karolinska Institute in Stockholm, and pioneer of the percutaneous x- ray guided needle biopsy technique, has been reversing otherwise intractable terminal lung cancer in his patients for over 30 years. These are important, validated and practical scientific breakthroughs which should, by now, be taught as part of orthodox medicine and be routinely employed to save lives. If orthodox medicine shuns the brightest and best innovators from within its own ranks it is little wonder that so little progress has been made in the treatment of the major causes of death amongst its unwitting patients. It should therefore come as no surprise that the tired, sick, bereaved, frightened and gullible public - our mutual patients - , are increasingly turning to " superstition, witchcraft, mumbo-jumbo and sheer quackery ". Yours sincerely, Rory Orr-Sabard
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Janet Richardson, Director of Integrated Health Development Oxford Brookes University
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It is common to talk about integrating complementary and conventional therapies. The assumptions being that the practitioners are keen to be part of the NHS, and that limited availability within the NHS produces inequity in healthcare provision. The questions then are which therapies should be integrated and how should they be integrated? Complementary therapies are currently delivered within the NHS through a variety of models including primary care, hospitals, and by conventional healthcare staff who have completed additional training and extended their skills (Fulder 1996, Coates and Jobst 1998). The extent to which different models have been compared and contrasted, however, is somewhat limited and the most appropriate mechanisms for delivering complementary therapies within the NHS have not yet been established. Furthermore, there are diverse definitions of 'integration'. For example one definition might be to place the patient at the centre of a package of care that combines different but appropriate therapeutic modalities, delivered within the context of their own theoretical perspectives. Another definition is that 'integration' is simply about taking the best bits of complementary and alternative medicine and placing them in the NHS. But if we have limited research evidence about the effectiveness of the 'best bits', and have not fully explored the fundamental underpinnings, similarities and differences of conceptually diverse therapies, how can we 'integrate' appropriately? There are no simple answers to this. What may be missing from the debate about complementary therapy and its integration into orthodox healthcare is dialogue about the fundamental principles of complementary therapies. What do the common principles within complementary therapies have to offer?' How different and diverse are they? How do they contrast with conventional Western medicine? But also can they provide a deeper understanding of human nature, health and illness? And can they enhance our ability to provide a therapeutic context for our conventional health care? Two issues need to be explicit. The first is that any attempt to integrate a complementary therapy should be clear about the therapeutic approach, parameters, context, strengths and weakness of the initiative when reporting the outcomes. The second is to continue to facilitate dialogue about the fundamental principles of complementary therapies. So how can we consider these issues when planning the education of healthcare practitioners? The 'familiarisation' courses suggested by the Select Committee may quickly become a feature of all pre-registration medical and nursing training. However there is a danger that such courses will only skim the surface and fail to do justice to some of the therapies. Yet perhaps at this level, the best we can do is to present an overview of a range of complementary therapies, raise awareness about safety, regulation and evidence, and talk of the challenges the different philosophical perspectives present. In contrast, at the post-registration level, different professional disciplines can come together to learn new therapeutic techniques, whilst exploring and debating the contribution of different philosophical perspectives. The integration of complementary and alternative approaches within conventional healthcare, and the development of multi-disciplinary education that incorporates such therapeutic approaches will require careful planning. The context and cultural development of complementary and alternative approaches, requires further dialogue and debate. If these issues are neglected as we hurry to incorporate different 'techniques' into our conventional practice, we may simply be left with additional tools that we are ill equipped to use. References Coates J.R. & Jobst K.A. (eds) (1998) Integrated Healthcare: A Way Forward for the Next Five Years? The Journal of Alternative and Complementary Medicine 4(2), 209-247. Fulder S. (1996) The Handbook of Alternative and Complementary Medicine. Oxford University Press. Dr Janet Richardson
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A Karperien, Human Reproductive Unit Cold Lake, Alberta
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Inasmuch as medicine is defined as "the art of preventing or curing disease", all successful preventative or curative techniques are that art. The source of a treatment can't matter. Consider, for instance, the medicinal value of mould. It follows that any new or old medical technique can only be measured by its successfulness, according to the same rigorous standards in all cases. In fact, throughout history, medicine (and disease) have always evolved. It has not changed that each treatment, regardless of its source, eventually stands or falls on its own apparent merit. What has changed is our ability to apply rigorous standards when determining such merits. This suggests, therefore, that the NIH is doing a wonderful thing in embracing opportunities to define and refine medicine. The tragedy is not that science is soon going to elucidate the merits and demerits of so many therapies yet untested. The tragedy is the drawing of a line in the sand of society, a line separating people educated in universities from people educated elsewhere. People want to be "masters of their own destiny". We make choices, act independently, try things out. We have self-help books, the Internet, distance education, and a growing trend of "choose your own health care methods". Feeding this basic human drive for independence and self- control are opportunities to choose amongst multifarious accessible and ostensibly "proven" (e.g., by testimonials) treatments. In contrast, feelings of utter dependence are fueled by prescriptions backed up by realistic but unamazing statistical likelihoods of their effectiveness. Unless the world at large can be trained in biochemistry, physiology, statistics, etc., the more formally trained medical community will have to work fast to erase a line. It is a line undoubtedly darkened by self- serving financial interests that ironically but so effectively separates "biomedicine" from "I'm a living human" medicine in the eyes of so many people. The point has to be made to the alienated public that the university-trained medical community does not consider itself an elite, know-it-all race. Perhaps the biggest tragedy of all is that it seems it all boils down not to verifiable knowledge, integrity, and respect but to the biggest sell. |
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Michael Sharpe, Senior Lecturer in Psychological Medicine University of Edinburgh
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Clearly there is a growing perception that a narrowly focussed biological approach to patients is inadequate. There is a need to address the psychological aspects of patients presentations and to provide appropriate interventions in these areas. This seems to be the argument offered for embracing complementary and alternative medicine. There is another way. There is a science of psychology and its practical application in clinical psychology and psychiatry. The problem is not that a science of the 'art of medicine' doesn't exist, but that it has become divorced from general medical practice. Liaison psychiatrists and psychologists have been addressing these isues for many years. There is a substantial evidence base of randomized trials on which to base practice (1). Some have been published in the BMJ. It is amazing to me that liaison psychiatry/ psychology was not mentioned in this special issue of the BMJ. Medicine can integrate psychological aspects of care without having to 'go alternative'. (1) Royal Colleges of Physicians and Royal College of Psychiatrists. Joint working party report: the psychological care of medical patients; recognition of need and service provision. London, Royal College of Physicians, 1995. |
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Chuanfang Lee, PhD student University of Bath
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I am currently doing a systematic review about the effectiveness of Chinese medicine for psoriasis. I have some thoughts to share. 1.Western medicine has already established comprehensive and rigorous models from animal experiments, biological experiments and clinical trials. However, Alternative medicine is more philosophical and metaphysical approached. That’s the main problem, I believe. 2.If we do believe “only” criteria used in clinical trials such as randomisation, double blinded, etc, is the best approach to assess the effectiveness of alternative medicine, then alternative medicine has a long way to go. The lack of common language to communicate both sides would prevent alternative medicine to integrate into “conventional” medicine. A common language means the same or at least similar diagnosis method, outcome measure, and the definitions of diseases, etc. In that situation, how can we talk to each other sensibly? 3.I believe it is because we have different ways of looking at the world. Nowadays many health professional use health-related quality of life instruments to “integrate” the discrepancies between self-report outcomes and clinical outcomes. “Maybe” alternative medicine has more effects in those self-report scales than traditional therapy. I mean, if we rely on HRQOL scales to judge the effectiveness of a treatment. What will it be? At least I don’t believe patients are all stupid to spend lots of money on something useless. 4.I believe if we really want to understand more about alternative medicine, in a way we need to get rid of a bit the idea of FDA or Cochrane library. They made and definitely make mistakes. It is the same as in other disciplines. Challenging an old physics theory, claiming there is something smaller than atoms, etc. The ironic is we call it “big discovery”. 5.To integrate both, building the relationship between HRQOL research and clinical indicators may be promising. However, in my study I have not found any Chinese clinical trials used HRQOL scales to discuss the “holistic” effects. I believe it is because HRQOL is rather new. The criteria in those Chinese clinical trials used different criteria from the western ones. 6.multi-ingredients Chinese medicine PG2 (Hwuan Chi) has passed the phase II clinical trial. 7.Padma 28, which was found accidentally by an Israel physician Sallon while she was in India for sanitary promotion campaign, has been used in Swiss. In Israel this drug has also been applied to treat alcoholics, intermittent claudication. 8.Genic have been proved to totally inhibit the duplication of HIV within 4-day treatment with less side effects than traditional triple therapy. This study has passed animal test and in vitro human lymph test in Germany HIV centre. 9. I totally agree "with no specific funding for research into complementary medicine, evidence will not be forthcoming." The U.S. put lots of money on it is because there is a huge market on it. Finally, a real story to share with you. I am a pharmacist (Taiwan) with western medical education and I spent two years for my MSc in medicinal chemistry. I did not believe Chinese medicine until I was “forced” by my mother to use it (with an open mind?). Until now, I still don’t understand how that practitioner (healer) used “Qi Gong” to cure my ankle problem, which was badly injured in Britain. My G.P. in Britain repeatedly said it takes more than six weeks to heal…. The GPs only asked me to rest, to rest, to rest. I rested for over three months and I still could not play badminton. Finally I was fed up with it and flew back to Taiwan. After two visits the pain and discomfort was gone! The treatment cost me £12. I also had another injury on my waist. I suffered from it for over two years. Again, after three visits it’s gone. I am not saying my experiences PROVE the effectiveness of Qi Gong because my single case does not mean anything. I am saying an open mind is extremely important to accept another possibility which we is out of our beliefs, education, experiences, or whatever. However, I did not feel any effect after three treatments of acupuncture for my spinal injury. The injury cured itself. |
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Roger Clarke, Private specialist veterinary surgeon Bundoora Veterinary hospital Melbourne Australia
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I am sure that you will receive many adverse critiques of this pseudo -editorial article. Whether you call it 'integrated medicine' ; Complimentary medicine' or Alternative medicine', much of this form of therapy is mostly unproven and unsubstantiated by scientific research. When it is given alongside / simultaneously with proven scientifically evidence based medicine, the final results are often confounded. Your editorial authors (and the Prince of Wales!) bemoan the paucity of funding for research into ‘alternative medicine’. Unfortunately there is a general paucity of funding for research that is based on sound scientific methodology. So it is not surprising that there is a shortage of money for research into complimentary or alternative 'medicine'. It has been established by surveys that these therapies are successful because they are based on public demand for a non-threatening modality of treatment when faced with the increasingly ‘cold and impersonal’ scientific approach to medicine. However, a high demand and expenditure by members of the public does not necessarily mean that alternative medicine works, just that some companies and persons are making a good living from promoting it. The article by MacLellan et al, of the Department of Obstetrics and Gynaecology, University of Adelaide, South Australia 5000, Australia, published in the Lancet, 1996 Mar 2;347(9001):569-73, and quoted by your editorial authors to substantiate their argument, puts the counter argument very well. " Extrapolation of the costs to the Australian population gives a natural expenditure in 1993, for alternative medicines, of $621 million (Australian dollars) and for alternative therapists of $AU309 million per annum. This compares to the $AU360 million of patient contributions for all classes of pharmaceutical drugs purchased in Australia in 1992/93. The public health and economic ramifications of these huge costs are questioned in view of the paucity of sound safety and efficacy data for many of the therapies and products of the alternative medicine industry.” I rest my case. Sincerely Roger Clarke |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University, ST4 2DE
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Sir, "In the case of homeopathy, in particular, it's really impossible to understand the subject in any depth unless you view it from a historical perspective." [1] It is difficult to understand exactly what Dr Campbell means by this remark. For example, many would say that any would-be practitioner would chiefly want to ensure that it works. That would be a top priority. Once satisfied that it does work, then the next priority for a busy practitioner, would be to buy one of Dr Andrew Lockie's excellent books and set about learning all about the remedies and their medical uses. Initially using specifics like Drosera for Whooping cough and Kreosotum for vaginal thrush, for example, the beginner can soon progress to the deeper and subtler aspects of practice. In this scenario, any understanding of the history of homeopathy seems to be of negligible consequence. Why does he say ‘impossible to understand the subject in any depth’? It just sounds a very strange thing to say. The vast bulk of homeopaths in the world practice it very successfully while being blithely ignorant of the history of the subject. Perhaps Dr Campbell is referring entirely to his own website, which gives the main outlines of the history of homeopathy as it has developed, but which does not give much information about the mission that Hahnemann inherited from Medieval medicine, or the social context in which he worked. Or how, single-handedly, Hahnemann ingeniously solved all the problems with Medieval medicine and in so doing stands out as the greatest physician who ever lived. Perhaps Dr Campbell means that the history of homeopathy reveals much about unorthodox medicine in general? Maybe I could tempt Dr Campbell to explain more clearly, what he means by the above remark? If, after a suitable space of time has elapsed, it is apparent that Dr Campbell does not wish to address these questions, then I shall assume that he will not mind if I have a stab at the task myself. Sources [1] BMJ letter, Re: Integrated medicine - a short road to betrayal, 21 January 2001, Dr Anthony Campbell |
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Charles Essex, consultant neurodevelopmental paediatrician child development unit, gulson hospital, coventry cv1 2hr
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There is no such thing as alternative, complementary or orthodox medicine. The current divisions are arbitrary. There are treatments, therapies and interventions that have an evidence base and those that do not. Although I think the BMJ has been drawn into giving credence to snake oil salesmen, the theme issue did illustrate several points [1]. Firstly, there are side effects for practitioners who claim to practise alternative/complementary medicine. They are at high risk of suffering from pomposity, self importance and delusions of grandeur. There was an Orwellian ‘four legs good, two legs bad’ tone to much of the writing [2]. Traditional healing good, modern medicine bad; oriental medicine good, western medicine bad; complimentary practitioners caring and holistic, orthodox doctors (apart from those who had been enlightened [3]) uncaring and not holistic. Essex’s first inverse law says that the more someone talks about being holistic, the less they are likely to be so. I can’t remember the last time one of my colleagues used the phrase ‘holistic’ but I know from doing joint clinics with them and seeing them practise that they are holistic, caring and conscientious. They don’t talk about it, they just do it. Perhaps those who are so ready to criticise and claim the moral high ground should arrange clinical attachments for themselves or their students with my colleagues. Secondly, why is there grievance by some authors that ‘orthodox’ medicine uses things that they believe are the preserve of ‘alternative/complementary’ medicine? The latter groups do not have a monopoly on viewing the person as a whole or on certain treatments. For example, extracts of hypericum perforatum from St John’s wort – which by the current artificial division is called a herbal remedy – has been found to help in depression [4]. Ideally the active ingredient will be elucidated (and toxic impurities removed); licensing trials will be done; the dosage(s) established; side effects, interactions and long term effects will be reported; and evidence based guidelines will be produced for its use. Then the NHS should fund it. There must be accountability and responsibility by those prescribing it. Currently there appears to be very little of either by those advocating ‘alternative/complementary’ therapies. Millions of pounds are wasted annually both within and without the NHS on interventions which have no proven value and whose effectiveness, interactions, long term effects, and side effects are not known. The challenge for purchasers is to ignore the orthodox - alternative/complementary division, and ask, “Where is the evidence? Show us the evidence and we’ll fund it; no evidence, no funding.” Yours sincerely, Dr Charles Essex
no conflict of interest References 1. Integrated medicine : orthodox meets alternative [theme issue]. BMJ 2000;322: [20 January] 2. Orwell G. Animal Farm. London : Penguin, 1964. 3. Essex C. Patch Adams. BMJ 1999;318:817. 4. Woelk H. Comparison of St John’s wort and imipramine for treating depression : randomised controlled trial. BMJ 2000;321:536-9. |
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John P Heptonstall, Director of the Morley Acupuncture Clinic and Complementary Therapy Centre West Yorks
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Editor If 'evidence-base' dictated all medical funding the NHS provision would reduce by perhaps 80 to 90%, is that what the good doctor ordered? Did not the last great 'snake oil salesman' begat, and put on the road to medical wizardry, John Rockefeller? Regards John H. |
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Robert Imrie, private practice
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Andrew Weil and Lesley Rees, in their BMJ editorial on “integrated medicine,” raise several interesting issues. While I have no detailed idea what Dr. Rees’s medical views are, thanks to Dr. Weil’s many popular books on the subject, his are a matter of public record. Arnold S. Relman, editor-in-chief emeritus of The New England Journal of Medicine and professor emeritus of medicine and social medicine at Harvard Medical School, discusses some of Dr. Weil’s more controversial medical convictions in the 12/14/98 issue of The New Republic. See: “Andrew Weil, The Boom in Alternative Medicine, and the Retreat from Science. A Trip to Stonesville.” This article is available on line at: http://www.thenewrepublic.com/magazines/tnr/archive/1298/121498/relman121498.html Also in December of 1998, Dr. Relman debated some of these issues face-to-face with Dr. Weil. A transcript of this debate, published in the May 10, 1999 issue of The Scientist is also available on line (at http://www.the-scientist.com/yr1999/may/bunk_p1_990510.html). These documents offer some fascinating insights into the issues currently under discussion. Here are a few comments from Dr. Weil’s various books which Dr. Relman addresses: From Health and Healing, Houghton Mifflin, 1983, 1998: "Sickness is the manifestation of evil in the body, just as health is the manifestation of holiness. Sickness and health are not simply physical states.... They are rooted in the deepest and most mysterious strata of Being." "[H]ealth and illness are particular manifestations of good and evil, requiring all the help of religion and philosophy to understand and all the techniques of magic to manipulate. Science and intellect can show us mechanisms and details of physical reality--and that knowledge is surely of value--but they cannot unveil the deep mysteries.”
From Eight Weeks to Optimum Health, Fawcett Columbine, 1997 "I would look elsewhere than conventional medicine for help if I contracted a severe viral disease like hepatitis or polio, or a metabolic disease like diabetes. I would not seek allopathic treatment for cancer, except for a few varieties, or for such chronic ailments as arthritis, asthma, hypertension (high blood pressure), multiple sclerosis, or for many other chronic diseases...." From The Natural Mind, Houghton Mifflin, 1972: “My intuitions about disease are: first, that its physical manifestations are mostly caused by nonmaterial factors, in particular by unnatural restraints placed on the unconscious mind; and second, that the limits to what human consciousness can cause in the physical body are far beyond where most of us imagine them." "Since leaving the world of allopathic practice, I have witnessed a number of impressive nonallopathic cures of ... dramatic illnesses, including cancer and life-threatening infections." … "To the straight mind nonallopathic healing sounds very mystical. Faith healing is held in contempt by most rational people, despite the abundant evidence of cures." (This evidence isn’t cited.) "Psychotics are persons whose nonordinary experience is exceptionally strong ... every psychotic is a potential sage or healer…. If it sticks to its present course, NIMH [National Institutes of Mental Health] will be the last institution in America to recognize the positive potential of psychosis--a potential so overwhelming that I am almost tempted to call psychotics the evolutionary vanguard of our species. They possess the secret of changing reality by changing the mind; if they can learn to use that talent for positive ends, there are no limits to what they can accomplish." It will be very interesting to see what, if anything, is left of scientific biomedicine should such notions be thoroughly “integrated” with it. I hope practitioners of science-based medicine reading this issue of BMJ fully understand what they are dealing with. Robert Imrie, DVM |
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Tim Blowfield, Owner North Balwyn Vdeterinary Hospital
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I do aggree with the arguements in this editorial. An issue not canvassed is the misleading terminology of many of the alternatives. An example is the naturopaths and herbalists claiming that they do not use drugs. That is just not so. Are not the potions and herbs they use just as much drugs as many in mainstream use. They may use extracts from the foxglove or willowbark. Is that less of a drug than digitalis or acetylsalacitic acid. One spectacular case I saw was a German Shepherd dog whom a 'holistic ' veterinarian had placed on both aspirin and willowbark aspirate resulting in gastric bleeding. Yes. Much research is required into the herbal remedies and it likely that new active ingredients (drugs) will be discovered. Some of these may be betetr than what we already have. But for goodness sake lets have more and better evidence not just speculation, rumour and hearsay. Tim Blowfield. B V Sc |
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Wainwright Churchill, Traditional Chinese medicine acupuncturist and herbalist London
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Dear Editor, Firstly, I’d like to thank Dr. Imrie for placing very stimulating quotations from Andrew Weil’s books on the BMJ website. Andrew Weil is an extremely important author in the field of complementary medicine. Notwithstanding my comments in my eResponse above (“Is ‘Integrated medicine’ an imperialistic concept?”) I would like to express my admiration for Dr. Weil, and gratitude for his contributions to what perhaps should simply be called ‘medicine’. I give a few reasons why his work is significant: 1) He is extremely well educated in conventional medicine, and
therefore cannot be accused of not knowing what he’s talking about.
My objection voiced before was that the thrust of Dr. Weil’s work would suggest that he respects non-biomedical paradigms, and would endorse multi-professional medical pluralism, i.e. biomedical and non-biomedical health professionals working alongside each other with mutual respect, synergistically, whereas the editorial comes down much more on the side of biomedicine incorporating CAM modalities in a system in which the biomedical paradigm alone is the basis of practice. I would suggest that anyone who is interested in Dr. Weil’s work read his books, as I think the quotations which Dr. Imrie presents should properly be appreciated in the entire context of what Andrew Weil has to say. Yours sincerely,
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Paul Lee, Physiotherapist in private practice Klinik for Fysioterapi, Rolighed 22, 4180 Sorø, Denmark
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>>Wainwright Churchill writes: Dear Editor, Firstly, I'd like to thank Dr. Imrie for placing very stimulating quotations from Andrew Weil's books on the BMJ website. >>I'd also like to thank Dr. Imrie for his contribution. He "fully understand(s) what they(he) are(is) dealing with! His websites are well worth checking out, that is, if EBM interests you: http://www.seanet.com/~vettf/Primer1.htm & http://www.seanet.com/~vettf/. Andrew Weil is an extremely important author in the field of complementary medicine. Notwithstanding my comments in my eResponse above ("Is 'Integrated medicine' an imperialistic concept?") I would like to express my admiration for Dr. Weil, and gratitude for his contributions to what perhaps should simply be called 'medicine'. >>There is nothing "simple" about it. There is a vast, irreconcilable difference between EBM and CAM, compounded by the lack of a common language (as mentioned in the previous post by Chuanfang Lee). So far, the scientific/medical community, and the alternative medicine community, cannot communicate effectively because they lack a bridge between them. This communication cannot happen until they can agree on an acceptance of the rules of logic and objective standards of proof as the bridge. The scientific community already uses these tools, while the alternative medicine community considers these tools as unnecessary, since they consider subjective anecdotes as the only proof they need. http://www.geocities.com/healthbase/dilemma.html I give a few reasons why his work is significant: 1) He is extremely well educated in conventional medicine, and therefore cannot be accused of not knowing what he's talking about. >>That's precisely what's disturbing about him: an MD who has lost touch with his scientific training, using his MD status to give credence to incredible ideas. He is not really on his way towards uniting EBM and CAM, but is on his way away from EBM. He is just like a ship that has cut its anchor rope, thrown the compass overboard, and drifts, while he promotes notions that lead others to do the same. He's simply advocating Non-Science (nonsense) Based "Medicine", and doesn't seem to consider objective evidence as being all that important. 2) His work draws on a knowledge of the history of medicine, and is not based on a parochial or narrow viewpoint. He does not ignore political and commercial considerations. >>Quite right. He is so open minded, that .......... Again, a
lack of a fixed point of reference makes it impossible to be sure of what
is really going on when a particular method is being used. This is the
danger of depending on empirical evidence alone (subjective personal
experience): the practitioner loses track of what it is that really
"works" with a treatment. The patient is deceived and the practitioner
deceives himself. This is not a professional way to act. By thus losing
touch with reality, serious illness may continue to go undiagnosed and
improperly treated, while both the practitioner and the patient put their
confidence in the undocumented treatment.
3) He has personal acquaintance with a variety of healing modalities, and their philosophies. >>And doesn't seem to be able to see why there is a difference, and that the difference is crucial if you're interested in understanding the root causes of a problem. But then, if a patient's temporary satisfaction is the only concern, then truth isn't that important. But if they have a serious illness, such as cancer, AIDS, RA, Parkinsons, MS, etc., then truth is very much important! The scientific method is the only viable way to determine the truth about the physical universe, not the least the biological and pathological sides of illness. 4) He has had the clarity to recognise many of the pivotal issues, such as the lack of regard of conventional medicine for the natural healing process. >>Nothing could be further from the truth. Rational medicine is the basis for good medical practice, and it recognizes and takes account of the natural healing process. Dr. Jacob Bigelow, M.D., elaborated these fundamental medical principles in his book "Brief Expositions of Rational Medicine", way back in 1858: http://www.geocities.com/healthbase/rational_medicine.html In the same book he thoroughly debunked one of the major delusions of his time (which is still with us): homeopathy. He also spoke clearly against a too ambitious interference with the natural processes. He is the first one to use the term "self-limiting" diseases. 5) He has had the courage to make public his convictions. >>Courage? Other less charitable words come to mind! Honesty and openness do not excuse the spread of disinformation, confusion and the sad results of a lack of critical thinking. In his case, they provide a disturbing glimpse into the metaphysical thinking of many CAM practitioners. 6) He has put energy into educating others, public and professionals alike, not least in founding a centre for Integrative medicine to train conventional doctors. >>Conventional doctors could use their time much better than to learn how to stop thinking systematically and critically! A proper resolution of the cognitive dissonance that his training should bring forth, would be to discard it immediately and to return to the scientific method as the only reliable compass to use in the search for medical truth. (remaining comments snipped for brevity) Sincerely, Paul Lee, PT
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Anthony Campbell
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Peter Morrell asks why I think it necessary to know about the history of homeopathy if one is to understand it in any depth. Certainly any doctor can read a "how to do it" book and use the remedies to treat common acute infections. Many, however, will wish to study homeopathy seriously, with a view to treating chronic diseases. It's at this point that they will encounter some pretty strange-sounding notions, and unless they learn where these come from they are likely to exlperience a good deal of confusion. This is where the history comes in. For orthodox medicine, history is something of a luxury; little that happened more than about 10-20 years ago is of much direct relevance today. With homeopathy it's just the opposite; most of the ideas, and most of the clinical observations, date from the nineteenth century. The notion that small dosese are more effective than large ones, the miasm theory of chronic disease, "laws of cure", and constitutional prescribing, for example, which understandably baffle modern newcomers to homeopathy, cannot be understood or evaluated properly unless they are seen in the context in which they first arose. In very brief outline, homeopathy originated with Samuel Hahnemann at the end of the eighteenth century and was largely a reaction against medical ideas that have now been completely forgotten and superseded. But homeopathy soon found itself in a different intellectual climate, as the work of Koch, Pasteur, Metchnikoff and others began to transform medicine in the second half of the nineteenth century. In Britain, homeopaths such as Richard Hughes and Robert Dudgeon (still among the most stimulating homeopathic writers even today) attempted to integrate homeopathy with the orthodox medicine of their day. However, homeopathy had meanwhile gone to the USA, where it became fused with mystical ideas derived from Swedenborgianism. A later Swedenborgian, James Tyler Kent, wrote extensively on this form of homeopathy and his ideas were brought to Britain by Margaret Tyler and John Weir. They soon replaced the "scientific" version of homeopathy favoured by Hughes and Dudgeon (who were now dead) and homeopathy as we have it today, at least in Britain, is largely Kentian. Before the first world war "high potencies", constitutional prescribing, and the miasm theory were largely ignored in Britain. So-called classical homeopathy is really Kentian homeopathy. I am not concerned here with the question whether this is better or worse than other forms, such as "complex homeopathy", which also exist; what evidence there is from clinical trials suggests that they all work to about the same extent. I do maintain, however, that anyone who wants to get a thorough understanding of the subject cannot afford to ignore the historical aspect. |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University, ST4 2DE
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Sir, I thank Dr Campbell for accepting my offer to discuss the history of homeopathy - few subjects are dearer to my heart. Most of the vacuous comments made in these columns in recent weeks about alternative medicine stem entirely from people who have not enjoyed the long and deep association with such healing modalities, of someone like Dr Campbell and whose views on such matters are automatically thereby elevated to higher ground and deserving of great respect precisely because of his long clinical usage of several such therapies. The ‘other voices’ rightly seem bereft of any value whatever by comparison, and in my opinion it behoves readers to avail themselves politely and with due deference of such a rare facility whenever dictated by chance. When Dr Campbell says: “with homeopathy...most of the ideas, and most of the clinical observations, date from the nineteenth century,” he might give people the impression that homeopathy is backward or frozen in time, as many before have contended, which is probably only a superficial impression he did not mean to create. The alleged ‘backwardness’ of homeopathy was largely a product of its isolation - an isolation it did not seek, but which was imposed upon it by the refusal of the dominant medical school to dialogue with it. It is also apparent that its dusty old texts are still today infinitely more useful than texts of modern medicine in ‘curing patients’, as opposed to ‘curing diseases’. However, there is real problem of translation of terms into modern parlance. What Dr Reilly [1] variously calls ‘life’s innate healing process’; ‘self-healing and holism’, ‘whole person factors’ and ‘whole person perspectives’ somewhat chime with thoughts Hahnemann expressed thus: “when a person falls ill, it is only this spiritual, self-acting [automatic] vital force, everywhere present in his organism, that is primarily deranged by the dynamic influence upon it of a morbific agent inimical to life...” [2] It is also true that the sheer incomprehensibility of homeopathy and ‘kindred medical delusions’ by the dominant medical school mostly stems from their own elopement from the main track of medical history, being seduced in the 1600s by that rough old sleuth ‘scientific reductionism’. On two points of fact that Dr Campbell mentions, high-potency Kentian homeopathy first came to Britain in three waves, first in the 1870s to Liverpool via Dr Thomas Skinner; second to 1880s Glasgow, via Dr Robert Gibson Miller, who trained with Kent in St Louis; and then by Weir and Tyler from about 1908. It is also true that Dr Dudgeon was still alive, and was even expelled from a British Homeopathic Society meeting, by Dr Octavia Lewin and Dr John Henry Clarke, for trying to argue against the use of high potencies. That would be about 1903, not long before he died. Having spoken out against the high dilutions, Dudgeon retorted: ‘quod fieri potest per pauca, non debet fieri per plura’, meaning ‘if we can do with medicines made with few dilutions, we ought not to employ many dilutions’. He was portrayed as an ‘old duffer’ standing in the way of progress. Therefore, Dr Campbell is very slightly incorrect when he says: “Before the first world war "high potencies", constitutional prescribing, and the miasm theory were largely ignored in Britain.” In fact, they were all alive and well. What is true, however, is that until around the 1950s the vast majority of homeopaths took no notice and continued to use the lower potencies like Hughes and Dudgeon before them. However, Dr Campbell is right that many of the concepts in homeopathy can best be understood from some appraisal of their historical origin. However, I did not mean to discuss homeopathy against the background of homeopathy itself, afterall they have been talking solely to each other for a century, but against the background of the whole panoply of medical history - a far grander and thus more compelling task. It has still not been sufficiently apprehended from the distance that history requires to yet integrate it successfully into a far broader context of medical reform commencing in the 17th century and enduring up to today. That is a far more interesting task than discussing the evolution of solely homeopathic ideas longitudinally and in the context of its own painful isolation. Its previous origins, its lateral affiliations and its more recent connections are also far more interesting - such as with political radicalism and religious non-conformity in the 19th century, or with other medical dissenters at any time. Today, it tends to find itself rubbing shoulders with New Agers and post-modern scholars - a motley crew indeed! The origin of homeopathy is also a point of great historical importance. My own view of the matter is that Hahnemann created homeopathy as a monument to the reforming impulse of the 1600s, but was led down a completely different track from that which spawned modern medicine. Stripping medieval medicine down to its rude undergarments, and of its thick encrustations of Christian and mystical elements [= superstitious beliefs], and finding only an ineffective form of Galenical medicine at its core, he then forged, on the anvil of reason, and from its central doctrines, the opposite axioms of homeopathy, further purified in the distillation of experimentation. Thus, contraries became similars, large doses became small doses, mixed drugs became single drugs; signatures and poisonings became provings. In the briefest terms - that is its origin. Hahnemann had no time for alchemy, astrology or signatures and expunged them all. In Hahnemann were combined a brilliant modern experimenter, a first- rate thinking mind of great erudition and incomprehensibly vast knowledge, a superb observer and cataloguer of details, a brilliant linguist and the most meticulous historian medicine has ever known. Combine all that with his personal qualities of strong independence of mind, love of arguing and overpowering adoration of truth, and you can see why homeopathy is a philosophical marvel, an historian’s dream, and a brilliant system of curative medicine that is totally grounded in experiment and clinical practice - it not only does work, but it works according to predictable and reliable principles forged, through experiment, from the useless carcass of medieval medicine - that which had been picked clean and left for dead by the vultures of so-called science. Finally, the relevance of things like homeopathy to medicine today is incalculable. Their re-emergence from the darkness, by public request, throws down the gauntlet to modern science and places the entire field of medicine at a new crossroads. Clinicians fear this unknown and irrational- seeming movement and see it as a threat to their own knowledge, certainty and dominance of medicine. It need not be so. Moreover, if Hahnemann were alive today I can guarantee he would confront his critics with the single statement - there is nothing magical in homeopathy at all - it is all pure science. And if the critics were the true scientists they claim to be, they would accept its reality on empirical grounds as a true scientific phenomenon, upon which solid base he built his entire system. Sources [1] David Reilly, Editorials, Enhancing Human Healing, BMJ 2001; 322: 120-21 [20 January] [2] S Hahnemann, Organon of Medicine, paragraph 11 |
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Alan Shortt, GP Principal Huddersfield University Health Centre
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Is it perhaps possible to have a naive arrogance that one's understanding of the world is more complete than either (a)one thinks or(b)current "scientific" knowledge supports ? My A level physics course taught me very little about Quantum Physics and Relativity but (presumably - I can't remember) focussed on a scientific middle ground based on an experience of the natural world that could be explained in terms describable by language & tangible to the senses. This was 50 years after some really brainy true scientists had explained just how complicated and crazy the world really was/is. Having taken a "trip to Stonesville" I can't help but feel that Dr Weil talks a lot of sense. The way you breathe can affect your health? Where's the controversy ? My granny could have told you this. |
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Anthony Campbell, retired consultant physician, Royal London Homeopathic Hospital
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I think the exchange of views between myself and Mr Morrell is in danger of becoming pretty esoteric and of limited interest to most readers, so this is the last time I shall contribute here (there's a lot of material on my website, http://www.cix.co.uk/~acampbell/ for anyone interested). I'm grateful to Mr Morrell for drawing my attention to the expulsion of Dudgeon from a British Homeopathic Society meeting in about 1903, something I hadn't heard of previously. I was certainly aware that feelings were running pretty high within homeopathy at this time; not long afterwards Margaret Tyler published a pamphlet, evidently attacking the prevailing homeopathic orthodoxy, and as a result she ceased to attend meetings for a couple of years. I haven't managed to find this document. I can't agree unreservedly with the depiction of Hahnemann as a scientist. Certainly he was probably the first physician to advocate the testing of drugs on healthy people, and this procedure was scientific in intention if not always in practice. His enlightened views on the treatment of the insane were also modern. However, his later insistence on vitalism as the essence of homeopathy strikes me as mystical, though admittedly this is partly an anachronism on my part. (Compare Isaac Newton's interest in alchemy.) There was a considerable shift in scientific thinking soon after Hahnemann's death in 1843. Vitalism was still a respectable scientific concept in the early nineteenth century, being entrenched at the University of Montpellier and elsewhere. The fact is that Hahnemann stands at a watershed in the development of science, and his thinking combines ancient and modern in a curious manner. For example, his belief in the infinite divisibility of matter, which underlies his potency doctrine, didn't take account of atomic theory, though this had been placed on a firmer foothold by Avogadro during his lifetime. |
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Gene Feder, Professor of primary care research and development Queen Mary, University of London
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Anthroposophic medicine is an extension of conventional medicine that aims to help people develop their latent capacities to deal with physical, psychological and spiritual aspects of illness. This integrated system of care uses a range of therapies including art, music, eurythmy (movement therapy), massage and counselling as well as anthroposophic and allopathic medicines. Rigorous external evaluation of this system has started with a recently published study.1 Five of the seven centres participating in the study are NHS general practices and the other two receive referrals from primary and secondary care. The study is qualitative in design and aims to systematically characterise the methods, organisation delivery and impact on patients of anthroposophic medicine. The study captured patient and practitioner experiences of wholeness and healing as well as those of symptoms and disease. It provides a context in which quantitative methods that are appropriately designed and targeted can now be applied. Whilst we applaud the dedication of a whole issue of the BMJ to integrated medicine, in the rush to integrate let us avoid methodological traps that reduce holistic approaches to human caring to a bag of tools for orthodox medicine. Gene Feder
Bill Gowans
1.Ritchie J, Wilkinson J, Gantley M, Feder G, Carter Y, Formby J. A model of integrated primary care: anthroposophic medicine. London:Queen Mary, University of London 2001 (available on http://www.mds.qmw.ac.uk/gp/research/anthroreport.htm) |
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N W Read, Professor of Integrated medicine Northern General Hospital, Sheffield, S5 7AU
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Integrated medicine: Finding the time. Dr Caleb Parry, eminent 18th century physician of fashionable Bath Spa, and one of the first doctors to describe thyrotoxicosis, once wrote that 'it is more important to know what sort of patient has the disease that what kind of disease the patient has'. Unfortunately, the patient has rather slipped out of focus in the enthusiasm of modern orthodox medicine for technological solutions and scientific evidence. Patients with biological disease are frequently objectified as ill stomachs, sick lungs or damaged kidneys, while the ever increasing multitude of people with 'functional' illnesses that cannot be explained by a well defined pathology and cause, often complain that doctors do not listen to them. It is the latter who make up such a large proportion of people seeking help from complementary medicine. CAM therapists do what doctors have so little time to do. They try to understand the sick person and they use techniques that relax the emotional tension that often keeps the illness going . We all know from experience in childhood that getting better is not just a matter of taking the medicine, it requires time, rest, compassion, understanding and care. Ill patients need to have faith in their carers and treatments if they are going to get well. Despite amazing achievements and dedicated practitioners, faith in orthodox medicine is at an all time low. This is no doubt exacerbated by an unsustainable caseload and a cynical media that seems intent on undermining our institutions . Integrated Medicine attempts to combine the best of both systems, but it is not just about adding a bit of acupuncture to the aspirin, it is about restoring an understanding of the patient, his or her attitudes, beliefs, personal history and life situation, to health care. Research in integrated medicine should not just investigate the efficacy of a 'complementary' set of instruments in the medical bag'. We need to understand more clearly how the disharmony caused by life situations can make people ill through, for example, long term destabilisation of the autonomic nervous system and hypothalamo-pituitary adrenal axis , and how relaxation, contemplation, confidence, and trust might work though neuroendocrine and neuroimmune mechanisms to facilitate self healing. Time is ripe for integrating the science and the humanity of health care around an understanding of the ill person. Let's hope we can find the time to seize the opportunity. Nick Read, Professor.
Centre for Integrated Medicine, Institute of General Practice and
Primary Care,
Northern General Hospital. Sheffield S5 7AU.
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Vivian S Rambihar, cardiologist The Scarborough Hospital, Toronto, Canada.
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A new integrated medicine, not integrating alternatives to medicine. Medicine is an art and a science of caring for individuals and for humanity. As such it should integrate everything that touches the health and well being of people. The dialogue on integrated medicine relates not medicine's limitations but our limitations in integrating these diverse aspects of care adequately. One response to such a difficulty is to find a better way of integration rather than to embrace non-medical practices. There are better ways of integration within mainstream science, such as chaos and complexity theory, from which is derivable a postnormal or chaos based medicine, as evidence based medicine used in context (1,2,3). Such new ideas, embraced widely across many disciplines, allow us to practice good medicine, responding to patients needs, using a medicine that works. After all, according to Angell and Kassirer, editors of the New England Journal of Medicine, there are only two kinds of medicine, "medicine that works and medicine that may or may not work" (4). This new post-normal or chaos based medicine provides better explanations of how and why things happen and how patients' beliefs and practices, however unscientific, integrate with everything else to influence health. It could be the centre of a new integrated mainstream scientific medicine. Disenchantment with the current practice of medicine or the limitations of evidence based medicine should not propel us to practice alternatives to medicine, such as an integrated medicine which includes complementary or "alternative medicine." It should instead impel us to a scientific integrated medicine - a better medicine that works, learning about everything that impacts people's health, responding better to their needs, and offering better explanations of the nature of health and disease (5). References: 1) Rambihar VS. Science, evidence and the use of the word scientific. Lancet 2000; 355:1730. 2) Rambihar VS. A new chaos based medicine beyond 2000: the response to evidence. Toronto: Vashna Publications, 1999. 3) Kernick DP. After postmodernism. Lancet 2000; 355: 149. 4) Angell M, Kassirer J. Alternative Medicine - the risks of untested and unregulated remedies (Editorial). NEJM 1998; 339: 839-41. 5. Rambihar VS. If evidence is the heart of medicine, then chaos restores its soul. BMJ Rapid Response Feb 19, 2001. VS Rambihar |
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T Chalder, Reader Guy's, King's & St Thomas School of Medicine
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The BMJ (20th January) defined 'integrated medicine' as incorporating complementary or alternative medicine into orthodox health care1. While we applaud the movement towards a more integrated approach to healthcare and welcome a scientific examination of 'complementary therapies' there is an important alternative to simply accepting the use of complementary techniques. Many researchers and clinicians have already adopted an alternative understanding of health best characterized as a 'bio-psycho- social model'2 and there is a wealth of research evidence demonstrating that a combination of biological, psychological and social mechanisms affect health outcomes in major diseases such as heart disease and cancer3. Ironically, although integrated medicine is said to be holistic, focusing on both minds and bodies, there is little evidence of holism in many complimentary and alternative approaches, which actively seek to accentuate the distinction between 'spirit' and mind. This is the same cartesian dualism that is responsible for many of the problems associated with conventional medicine4. It is true that patients are increasingly abandoning a medicine that ignores the wider view of their health but to say, in the manner of Marie Antoinette, 'if they are dissatisfied and we have nothing better to offer, then let them have their alternative medicine', has several dangers. First, it allows conventional medicine to rid itself of its 'failures' rather than learn from them. Second, it marginalises those patients who do not want 'colonic irrigation' for example, but who would like a doctor who recognises that they are more than a collection of molecules. Third, it perpetuates the myth that psycho-social features of illness and health are too 'soft' to be researchable or too complex to be integrated into treatment. We suggest that health professionals adopt the more pragmatic bio-psycho social approach to health care which would result in better health outcomes in their patients. 1. Rees L & Weil A. (2001) Integrated Medicine. British Medical Journal. 322; 119-120. 2. Engel GL. (1977) The need for a new medical model: a challenge for biological science. Science. 196; 129-136. 3. Baum A, Newman S, Weinman J, West R and McManus. (1997) Cambridge Handbook of Psychology, Health and Medicine. Cambridge University Press. 4. Helman C. (1986) Culture, Health and Illness. Doctor - Patient Interactions. Chapter 5. Wright Chalder T, Reader.
White P, Senior Lecturer.
Main CJ, Professor.
Lewin B. Professor.
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University, ST4 2DE
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Sir, "Ironically, although integrated medicine is said to be holistic, focusing on both minds and bodies, there is little evidence of holism in many complimentary and alternative approaches, which actively seek to accentuate the distinction between 'spirit' and mind. This is the same Cartesian dualism that is responsible for many of the problems associated with conventional medicine." [1] These remarks Chalder et al make, in response to Rees and Weil’s editorial [2], and concerning the term ‘holistic' seem to suggest it solely means an appreciation of body and mind or spirit. I think it is only fair to point out that this is not the usual meaning attached to this term by most CAM practitioners. The term is subtle and complex and thus deserves greater clarification. It can perhaps be better understood if compared to the inherent dualism in the scientific worldview - a worldview upon which chemical medicine very largely and unquestioningly rests. This worldview, first set rolling by figures like Galileo, holds that our world of forms is composed of objects which can be dissected into parts [reductionism], given names and that their various interactions can be accurately described by mechanisms. Science as a worldview entirely regards events through this 'conceptual filter' of reductionism, named parts and their interactions in mechanisms or causal chains. This is not the only way to view this world or the phenomena in it. It is only one method, though admittedly one that has become dominant in the last four centuries. Pre-Galileo things were viewed in a fairly as-is fashion that did not exclude some speculation and mechanism, but which was not so solely obsessed with such an approach. As scientists and medical folks are not [overtly or covertly] taught anything about holism, but only the dominant paradigm of reductionism and mechanism, it is probably a little rich for them to start pontificating upon such a theme. Only once you can get yourself conceptually free of reductionism and mechanism - by no means an easy task, because most scientists are entirely saturated in it – only then can you begin to more truly appreciate what holism really means. It is what Husserl and Hegel termed 'phenomenology', which means to try to apprehend phenomena directly [as processes], without recourse to parts, names and mechanisms. The human organism functions in a phenomenological manner - it works. Disease also simply ‘works’. As soon as you overlay this with concepts, parts, names and mechanisms, then inevitably you reduce it, distort it and simplify it. All scientific models are therefore reductions and simplifications of reality and thus omit something. Phenomenology attempts to view things more directly in their pure, holistic functioning, avoiding, as far as possible, the use of conceptual overlays like parts, names and mechanisms, with which science is so manifestly obsessed. Thus, when we look at healing modalities like homeopathy, acupuncture, nature cure, etc, we tend to find an appreciation of health and disease processes given in a descriptive, direct, as-is fashion that often spurns notions of mechanism. This is often described as soft or lateral thinking. It also describes events that occur in organs, mind, emotions, modalities, etc, without saying 'this causes that'. Thus, it cuts across the accepted pathways and mechanisms science has created and which are deemed by most educated people to be REAL, I mean real in some absolute sense, as opposed to physical or observable. The picture or model is all too often taken to be the fact. In the example of homeopathic Belladonna, the red face, the high temperature, the burning heat, the twitching of the lips, the delirious sleep with visions of monsters pouring out of the wallpaper, these are collectively mere phenomenological aspects of ‘the Belladonna state’, no- one is trying to say which parts are causes or which parts are effects in some supposed causal chains – they are simply aspects of ‘the Belladonna state’. Likewise, in the case of Pulsatilla no-one is saying that the emotionality of Pulsatilla, the desire for affection or the easy tears are in any way causes or effects of the rapidly changing symptom picture, the inconstancy, the desire for fresh air or the feeling of warmth. None of these aspects are ascribed in a causal mechanism, they are merely described as aspects of the Pulsatilla state. Similar examples of true holism can be found in all the CAM therapies. I think it is obvious even from these two examples that holism does not mean merely ‘body and mind’, it also means an abdication of all idea of mechanism, parts, names and labels and the simple and direct viewing of the organism – in health or disease – in its pure as-is state with no judgement or conceptual overlay. It also means the abandonment of mechanistic thinking as a way of looking and a way of seeing the organism – the abandonment of mechanistic thinking. I hope this clarifies the ideas Chalder et al presented, in my view incorrectly, about what is afterall a term and concept of central importance to the entire field of holistic medicine. And thus I would say they are wrong when they say: “…there is little evidence of holism in many complimentary and alternative approaches...” [1] In fact, there is abundant evidence for those eyes that can look and see without the distorting overlay of mechanistic conceptuality. Sources [1] BMJ letter, An Alternative Integrated Medicine, Chalder T., Reader Guy's, King's & St Thomas School http://www.bmj.com/cgi/eletters/322/7279/119#EL36 [2] EDITORIALS, Integrated medicine, Rees and Weil (20 January 2001) BMJ 2001;322:119-120 (20 January), http://www.bmj.com/cgi/content/full/322/7279/119 |
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John P Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre West Yorks
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Editor A few examples of patient - physician communication:-- “I know you’ve only 15% chance of improving with my medication but what else is there?” GP tries to convince a patient to take his medicine. “I’ve only 4 minutes to take your history, investigate your problem, examine you, produce a differential diagnosis and formulate a treatment plan for you so don’t be surprised if it doesn’t work first time” GP excusing his practice “You have intermittent bilateral stenosis of the left and right inguinal vascular membranes, take this prescription 3 times a day while I find a specialist who knows what it means” GP tries to cover up his lack of ability to diagnose a patient’s condition. “Why seek an alternative when we have all the answers?” GP to patient who asks for advice on the use of CAM for his problem. “Doctor, I read the other day that modern medicine is the fifth or
sixth major cause of death and injury known to man, can I trust you?” “What took you so long to get here?” CAM practitioner to patient. Regards John H. |
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R D Prabhu, Consulting Surgeon Shimoga, India
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Dear Editor, Re.: Integrated Medicine, BMJ 2001;322:119-20 (20 January) I read the letter from Roger A. Fisken on the above subject in the South Asia Edition of BMJ of September 2001. I could not resist my desire to air my views. As doctors we are concerned with the welfare of our patient. Common sense dictates that doctor try his best to bring relief to the patient irrespective of the kind of medicine. Normally, the current modern medicine is by far the best type of medical treatment; but that does not mean that it can treat anything and everything. But at times patient finds relief from alternative medicines too. Opponents of alternative medicine and integrated medicine are invariably ignorant of what they are. They believe that only scientific rationalism is acceptable and all the rest that do not fall in the parameters of this scientific rationalism have no right to exist. However, there are many things in this world that cannot be explained by the scientific rationalism of the present days. About 4-5 decades ago, British anaesthetists and surgeons ridiculed at the acupuncture. But some amongst them wanted to opine only after they see for themselves the practice of acupuncture. They visited China and were stunned to see major surgeries being performed under acupuncture anaesthesia (administered by choice of the patient). Suddenly the procedure became acceptable though the anatomy, physiology or pathology of modern medical science cannot explain acupuncture. A well-known professor of urology in India has reported about his 76 years old relative who had an advanced, ulcerated, painful and smelly carcinoma of breast. Professor’s spiritual Guru gave her "vibhuti" (sacred ash) and a "lingam". She was to drink the lingam water daily. To the disbelief of her oncologist the lesion regressed, pain reduced and ulcer started healing in a matter of weeks! Let not rationalists ridicule the old beliefs; they were relevant at that period of time. Modern medicine itself had many that appear shamefully irrational now. Take for example the extended radical mastectomy (commando operation) of the past in comparison to present breast saving procedures or total gastrectomy of the past and non-surgical treatment of the present for DU. As for betrayal, the commercial forces of health care industry are such that they influence the practitioners of modern medicine in such a way that thousands of patients are betrayed daily by practitioners of 'evidence based' practice. A scientific person needs to be humble that he does not know it all rather than be arrogant. Ancient Rigveda quotes “let noble thoughts come to us from every side”. Sincerely Prabhu |
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Mark P Guthrie, Chiropractor 4703 N Maple St, Spokane, WA 99205 USA
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First a thank you to the BMJ for printing this article on the current state of health care. Your theme is indicative of the wants of the lay public world wide. To Roger Fisken, I am deeply saddened by your comments and can only hope that your patients take your tunnel-visioned approach to health-care with 2 grains of salt. Pardon me, rather your approach to sickness-care, because nothing in your letter indicates an interest in restoration and maintenance of health, but an interventionalist attitude treating only when symptoms arise. Isn't it the goal of all health-care practicioners to guide patients to recovery and health? The vast majority of physicians in China consider it a failure in care if a patient falls ill. The Jounal of the American Medical Association has listed as the #5 cause of death in the United States the administration of correctly perscribed medication. This is more than that of all car and plane wrecks combined. Given this information, do you still wonder why 2/3-3/4 of fee- for-service patients choose complementary care as opposed to drugs-and- surgery methods? Check the track record and efficacy of pharmeceutical interventions versus those we have evoloved with nature to incorporate proper homestasis. Compassion and caring in the modern-day allopath is a white whale. If you embody these characteristics then God bless you. My self, and my family, have not met your kind in our quest for well-being. I do not condemn your profession, rather I make an argument which so many do, and which has prompted this discussion, that demands on your time and regulations by insurance dictocrats have transformed many MD's into time- constrained, care-reduced scrip-pads with not much more to offer (due to hand-tying). In conclusion, please do not hide your ignorance of the relevance of complementary therapies behind your pseudo-erudite rhetoric. We are all in this game together and our goal is to help people get better. Do your patients a favor and learn something new, look outside of your shrine of folk heroes and realize that care of the whole person, not just the symptom, just might speed their recovery and reduce the treat of harmful side-reactions. Repectfully submitted, Mark Guthrie, DC |
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Vaishnavi K, Student Government Ayurveda College, Cochin, Kerala, India-682016
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I am a medical student studying Ayurvedic medicine in India. And having read many of the responses posted here, I wonder if it is too much to ask for a little tolerance from doctors practicing 'modern' medicine. Having read a bit about history of medicine, what I derive is in that era of time, when medicine was in the developmental stages and man built his knowledge by trial and errors and observation, what must have been important to him was the RESULT of so-and-so drug acting in a particular situation. And how this medicine acted didnt probably mean much to him. And this system of medicine has stood the test of time and researches going in this field actually consolidate the fact that the system indeed has scientific basis. I don't see any reason why, as doctors, we cannot think of combining the best for the patients and in fact give them enough choices for treatment as well. The primary aim is to provide a safe effective treatment, and how will the egoistic approach - the so called modern medicine being superior to complementary medicine!; help the progress of medicine in any way? Competing interests: None declared |
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Milind A Patil, Teacher in Ayurvedic College YMT's Ayurvedic college, Kharghar, New Mumbai, India
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Dear Editor, The responses to your editorial "Integrating systems of medicine" are based on ignorance of the basic principles of alternative systems. I teach in college of Ayurveda and I know for sure that Ayurveda is the outcome of following very sound method of "science". There is a evidence in Ayurvedic texts like "Charaka Samhita" that there existed a method for arriving at scientific conclusions. So much so that, there are sound guidelines mentioned for writing a clinical trial protocol in all detail. Modern guidelines for writing clinical trial protocol match very well with those of Ayurveda. This commonness between Ayurveda and modern medicine should act as a foundation for integration of the two. As such, as modern medical concepts are advancing, they are coming closer to ancient Ayurvedic concepts of health and disease. Regards, Dr Patil Milind Competing interests: None declared |
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Joseph . C . Obi, Professor Of Complementary and Alternative Medicine (CAM) Research ; College Of Natural Medicine , Larnarca , Cyprus , European Union . (www.CollegeNaturalMedicine.org)
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Lycopene : 100mg Per Day ( Orally ) + Coenzyme Q10 : 500mg Per Day ( Orally ) + Vitamin B12 : 0.2mg Per Day ( Via A 'Metered-Dose' Sublingual Spray ) + An Exceedingly Balanced (And Sumptuously Garnished) Diet + Light Physical Exercise (Cycling 100 Yards Per Day) + NLP (Neuro-Linguistic Programming) + Natural Analgesia + Supervision . . . Competing interests: Professor Joseph Chikelue Obi MBBS MD MPH DSc FRIPH FACAM is also the Chairman of the General Wellness Assembly (GWA); an International Professional Body for Independent Wellness Consultants . He humbly invented the 'Omnipill' ; and warmly believes that Chronic Fatigue Syndrome (CFS) and Multiple Sclerosis (MS) can sometimes be adequately controlled (not cured) , using Advanced Wellness Interventions. |
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