The College of Medicine

A comment signed by Graeme Catto, Ian Kennedy and Aidan Halligan should perhaps be taken seriously.

It might taken seriously if the statement were not also signed by George Lewith (who prescribes homeopathy despite having written papers that conclude it doesn't work), Christine Glover (a homeopathic pharmacist) and David Peters (whose clinic at Westminster has used dowsing by means of a pendulum as an aid to diagnosis and treatment). If you want the evidence for these statements, you'll have to search my blog, since the BMJ's lawyers will not allow me to provide the appropriate links.

I have no doubt of the sincerity of Catto, Kennedy and Halligan, but I’m afraid that one gets judged by the company one keeps.

I continue my thoughts -

Integrative practitioners commit to spending more time and more
energy assisting transition, and benefits are seen in terms of
transitions to positive, healthier lifestyles. The route to conversion
away from self-destructive, industry-driven behaviours - fats and sugars
are cheap to add to food but increase addictive, food-driven behaviour -
can be complex and riven with emotional, physical and economic constraints
that far exceed the time and skills of many 'mainstream' medics.

Humans, being what they are, find their route to this solution
through numerous portals; some may find a GP or private doctor with the
time and motivation to counsel them accordingly, but most do not. Coming
into contact with a caring healthcare practitioner - an alternative,
functional or integrative practitioner, who spends time and engages with
the individual to reach mutually agreed decisions - can and does have
profound effects on that person's current and future health status.

To deny this option because RCTs continue to throw up spectacular
failures and few successes when applied to separated aspects of the
alternative armoury, rather than the collective experience is to deny the
powerful effects that this interaction and mutual care generates on mood
and personal belief. These benefits are dismissed as placebo by the
skeptic's, yet the same placebo-esque strategies are employed by their
colleagues on a daily basis, where time and intellect demand fast and
often abrupt communications.

Medicine is not simply the delivery of technique, it also requires
the art of support and development through a cooperative relationship
between the participants and employing different disciplines adds
substantive healing benefit to the recipient. These benefits should be
harnessed and employed as part of the therapeutic tool kit.

Unfortunately, RCTs continue to throw up spectacular failures and few
successes when applied to separated aspects of the alternative armoury,
rather than the collective experience. But to deny patients the entire
option of alternative healthcare is to deny the powerful effects that this
interaction and mutual care generates on mood and personal belief. These
benefits are dismissed as placebo by the skeptics, yet the same placebo-
esque strategies are employed by their colleagues on a daily basis, where
time and intellect demand fast and often abrupt communications. Medicine
is not simply the delivery of technique; it also requires the art of
support and development through a cooperative relationship between the
participants. Employing different disciplines adds substantive healing
benefit to the recipient. These benefits should be harnessed and employed
as part of the therapeutic toolkit.

Snyderman and Hood's proposal is that medicine - they refer to it as
prospective medicine - should become focussed on improving the functional
health of the individual. To achieve this, it requires practitioners to
employ the following four criteria:

* personalised

* predictive

* preventive

* participatory

This new medicine is then focused on systems biology rather than disease.
By altering this approach, it redefines chronic disease as a functional
alteration in the physiological network that, in turn, requires a systems
approach to clinical intervention to improve both safety and effectiveness
of therapy. , ,
Many mainstream medical colleges and scientific journals are exploring
facets of alternative medicine previously, and in some cases currently,
dismissed as quackery, and finding evidence of measurable effect. The
prestigious Nature Immunology journal earlier this year included a review
article that included the following text:

"Rather than developing new anti-inflammatory drugs, it might be more
cost-effective to devote more effort to new approaches, such as monitoring
the human intestinal microbiota and manipulating it if required through
the use of probiotics and/or prebiotics (nondigestible food ingredients
that stimulate the growth and/or activity of bacteria)."

This may be simple to comprehend to the trained practitioner, but is
likely to be non translatable to the untrained, or unqualified lifestyle
change promoter.

Chronic inflammation, at least at the molecular level, is a sine qua
non of most chronic diseases. Strategies outside of conventional dietetics
and drugs are making promising inroads into the management and resolution
of these conditions, often effectively employing principles and naturally
derived agents derided by the skeptics.

Inevitably, polarisation of opinions will reflect character,
experience and education. All sides can, at times, feel they have won a
battle but lost the war, while in most cases stridency is rarely
appreciated except by the converted. The incontrovertible truth is that
the public and the professions are voting with their feet, are happy to
wait for the evidence that satisfies the critics, and are employing the
techniques and treatments that satisfy them now.

To encourage and support a cross-discipline dialogue, to share the
best from both sides, does not do the honourable professions of medicine
and research a disservice; it positively supports the role that we play in
the management of our patients' expectations and desires. No system is
perfect, but today's predominantly reductionist approach to healthcare has
one glaring error: it does not allow for easy overview. As a result, a
sort of biological polyglot with a long-range perspective has fallen by
the wayside, bogged down with data and delivery. Yet being able to
figuratively embrace the patient and share in their needs, while
rationalising and sharing the intervention with them, requires unique
skill sets. If I hope for anything of note from the College of Medicine,
it is that the 'students' will be encouraged to step back sufficiently
from their deep analysis to see what, in many cases, is simply missed in
daily clinical care.

And that is the Holy Trinity of patient-centred outcomes:
satisfaction, functionality and cost. These aims are well met by
alternative/integrated medicine practitioners. What else do patients care
about?

[1]Braunwald E. Shattuck lecture-- cardiovascular medicine at the
turn of the millennium: triumphs, concerns, and opportunities. N Engl J
Med 1997;337:1360 -1369.

[2]Corwin RL, Grigson PS. Symposium overview--Food addiction: fact or
fiction? J Nutr. 2009 Mar;139(3):617-9. Epub 2009 Jan 28.

[3]Weston AD, Hood L. Systems biology, proteomics, and the future of
health care: toward predictive, preventative, and personalized medicine. J
Proteome Res. 2004;3(2):179-196.

[4]Snyderman R Langheier J. Prospective health care: the second
transformation of medicine. Genome Biol. 2006;7(2):104.

[5]Hood L, Heath JR, Phelps ME, Lin B. Systems biology and new
technologies enable predictive and preventative medicine. Science.
2004;306(5696):640-643.

[6]Tilburt JC, Curlin FA, Kaptchuk TJ, Clarridge B, Bolcic-Jankovic
D, Emanuel EJ, Miller FG. Alternative medicine research in clinical
practice: a US national survey. Arch Intern Med. 2009 Apr 13;169(7):670-7.

These recent exchanges will remind some readers of the Mad Hatter's
tea party (1) , when statements, sometimes abusive, were thrown back and
fore, to little effect except for the bemusement of observers. The
participants had such fixed but different views of the world about them,
without appreciating the nature and extent of those differences, that
they might have been speaking in different languages, for all the sense
that they made to each other.

Other readers will be reminded of events a century and more ago, and
wonder what we can learn from them, for the benefit of our patients, which
should always be our prime concern.

At the beginning of the last century, Bleuler and Kraepelin, well
respected physicians and psychiatrists, were working on the delineation
and diagnosis of the major psychoses. They heard what their distressed
and distracted patients said, and categorised their behaviour and
responses in an attempt to enable psychiatric diagnoses to be made as
were the diagnoses of physical diseases, on symptoms and physical signs.
They were seeking objectivity,partly in an attempt to be seen as more
scientific, by colleagues.
They heard what their patients said , but they did not listen to them.
They dismissed their patient's ramblings or outbursts as signs of disease,
without any meaning nor relevance, except in so far as they were an aid in
categorising them. They regarded their psychotic patients as being
inaccessible to reason and dialogue.

Half a century later, it was realised that many of the 'deluded' and
'psychotic' statements that generations of psychiatrists had heard as
meaningless, were often full of meaning and significance, and described
the traumas that may have precipitated and accompanied the illness. It was
necessary to listen, as well as to hear, and to be aware of the very
different nature of reality, seen from the side of the patient, or the
'other'. Many of the labels attached to behaviour and speech which
psychiatrists were used to attaching to patients, could be considered a
"vocabulary of denigration ". (2)

A quack is defined in the Oxford English Dictionary as someone who
will " puff or palm off with fraudulent and boastful pretensions..
administer quack medicines.. seek to remedy by empirical or ignorant
treatment. "

Perhaps those writers who have made accusations of quackery are
neglecting their professional duty by not asking the General Medical
Council to investigate those whom they identify ?
If they have used the word without understanding it, they have been
mischievous, to say the least.
Or is there some other explanation ?

Do contemporary critics of complementary medicine have their own
'vocabulary of denigration', enabling them to dismiss the experience and
practice of colleagues which conflicts with their own sense of reality,
and which discomforts them so much that they forgo the option of enquiring
more of what they do not understand ?
Their discomfort can be easily understood, even condoned . Worldly success
and recognition may encourage a type of self esteem which is analogous to
an inflating balloon. With his every puff it grows bigger, obscuring the
owner's view of the world. With every puff it becomes more fragile and
vulnerable to the smallest pin prick.

We must strive for a more adult debate, learning from the military,
the importance of proportionality in our responses, when challenged. And
be sensible, like Professor Colquhoun, apologising when we cross
reasonable boundaries in debate.

Professor Ernst recognises " ..outright quackery which has the
potential to kill patients ."
Perhaps a matter for the GMC ?

And yet, " adverse drug reactions have reached epidemic proportions
and are increasing at twice the rate of prescriptions. The European
Commission estimated in 2008 that adverse reactions kill 197,000 EU
citizens annually, at a cost of 79 billion euros ." (3)

No contest there, on NNK ( Number Needed to Kill ).

1 Alice's Adventures in Wonderland (1865) Lewis Carroll
2 The Divided Self (1960) RD Laing
3 The Lancet Vol 377 June 4, 2011. p1915

The spokesmen for the new College of Medicine (CoM), claim that they
alone have the gift of listening to the "people's voice" when it comes to
selecting complementary and alternative (CAM) treatments to be made
available on the NHS. I assumed therefore that they had conducted a survey
of popular opinion or even a referendum on the role of CAM in the NHS yet
I could find no reference to such work, merely assertions.

It all became
clear to me this morning what in fact they were claiming, and I even found
evidence to support their assertions. I initially assumed the people they
were talking about were the citizens of the UK but it transpires that it
was the voice of "The People" newspaper they were referring to.

For a
start if you look at "The People's" home page; http://www.people.co.uk/
you will note it is covered with images of celebrities. That accounts for
the endorsements the CoM receives. Next a quick glance at the health
section provides an insight of what kind of advice "The People" offer. For
example one click away from the home page you will find this anecdote; "I
started to get cystitis after a girl's holiday in Greece. Initially
cranberry juice worked, but over the next few months it got so bad I was
missing two days off work a week. A friend suggested Cystipret,
containing, centaury herb, loveage root and rosemary leaf. I took one
tablet a day and symptoms stopped in days." Well that's a relief, saves
the NHS the cost of a GP visit, urine culture and a proper diagnosis.

As
proponents of alternative medicine also seem to support alternative
cosmology, I thought it might be interesting to listen to "The People's"
spokesperson on astrology. I therefore looked up my horoscope provided by
a foxy looking astrologer, it read as follows:

GEMINI (MAY 22ND-JUNE 21ST)

"Many of your sign are thinking of making a change to their homes, as your
need for a firmer base comes to the fore. At last you're doing what feels
right, and not what looks right. Ring me to hear why foreign accents prove
lucky for you "

As it happens Edzard Ernst has a foreign accent and he is proving lucky
for me. Amazing!

I suggest therefore than women anticipating an elective caesarean section
to hearken to "The People's" voice before choosing the time and date of
their baby's birth making sure that the planets are in the correct
alignment.
Listen to "the People" I say, back to the golden age of magic medicine and
to hell with 100 years of clinical research!