MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

integrated medicine

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The Royal London Homeopathic Hospital, recently re-named as the Royal London Hospital for Integrated Medicine (RLHIM), has been one of the most influential homeopathic hospitals in the world. It was founded in 1849 by Dr Frederick Foster Hervey Quin. In 1895, a new and larger hospital was opened on its present site in Great Ormond Street. Many famous homeopaths have worked there, including Robert Ellis Dudgeon, John Henry Clarke, James Compton Burnett, Edward Bach, Charles E Wheeler, James Kenyon, Margaret Tyler, Douglas Borland, Sir John Weir, Donald Foubister, Margery Blackie and Ralph Twentyman. In 1920, the hospital received Royal Patronage from the Duke of York, later King George VI, who also became its president in 1924, and in 1936, the Hospital was honoured by the Patronage of His Majesty the King gaining its ‘Royal’ prefix in 1947. Today, Queen Elizabeth II is the Hospital’s Patron.

On 18 June 1972, 16 of the hospital’s doctors and colleagues on board were killed in a plane crash. During the following years, several reductions in size and income took place. From 2002 to 2005, the hospital underwent a £20m redevelopment and, in 2010, its name was changed to Royal London Hospital for Integrated Medicine.

The hospital just published a new brochure for patients. It contains interesting information and therefore, I will quote directly from this document.

START OF QUOTES

The Royal London Hospital for Integrated Medicine (RLHIM) is part of University College London Hospitals NHS Foundation Trust and accepts all NHS referrals. GP referrals are by letter or via Choose and Book. Patients can also be referred by their NHS hospital consultant.

NHS Choices provides information and an opportunity to provide feedback about our service at www.nhs.uk
….

The General Medicine Service is led by three consultant physicians. The team also includes other doctors and nurses, a dietitian, a physiotherapist, an occupational therapist and a psychotherapist. The service sees patients with chronic and complex conditions. The team is trained in many areas of complementary medicine. These are used alongside orthodox treatment, allowing them to offer a fully integrated General Medicine service. The General Medicine Service offers a full range of diagnostic tests as well as a variety of treatments and advice on orthodox treatment.

From 3rd April 2018, The Royal London Hospital for Integrated Medicine (RLHIM) will no longer be providing NHS-funded homeopathic remedies for any patients as part of their routine care. This is in line with the funding policy of Camden Clinical Commissioning Groups, the local NHS body that plans and pays for healthcare services in this area.

Should you choose you will be able to purchase these medicines from the RLHIM pharmacy, while other homeopathic pharmacies may also be able to supply the medicines. You can speak to your clinician or the RLHIM pharmacy at your next visit about this…

Conditions commonly seen include:

  • Recurrent infections, such as colds, sore throats, cystitis, thrush, chest infections and bacterial infections
  • Some persistent symptoms where tests have not revealed a serious underlying disorder
  • Asthma or chronic obstructive pulmonary disease (COPD)
  • Digestive disorders, for example acid reflux, Irritable Bowel Syndrome and inflammatory bowel disease
  • Endocrine (glandular) disorders such as under-active thyroid
  • Type II diabetes
  • Some types of heart disease, high blood pressure and palpitations (requiring no orthodox treatment)
  • Chronic headache such as migraine or tension-type headache
  • Side effects of prescribed medications

END OF QUOTES

Clearly, the big news here is that the RLHIM has been forced to stop providing NHS-funded homeopathics. This could be indicative of what might soon happen throughout NHS England.

But there are other items that I find remarkable: “The General Medicine Service offers a full range of diagnostic tests as well as a variety of treatments and advice on orthodox treatment.” Call me a nit-picker, but this is not INTEGRATED! Integrated medicine means employing both alternative as well as conventional therapies in parallel. The best of BOTH worlds and all that…

In the same vein is the statement that they treat “some types of heart disease, high blood pressure and palpitations (requiring no orthodox treatment)” I am sorry, but this again is not INTEGRATED MEDICINE! I ask myself, is it ethical to mislead patients, colleagues, NHS officials and everyone else pretending to deliver ‘integrated medicine’, while in fact all they seem to offer is ‘alternative medicine’?

The RLHIM has recently dropped the term HOMEOPATHY from its name. Soon it might have to also abandon the term INTEGRATED, because it does not seem to be able to provide a safe level of conventional medicine.

How shall we then call it?

Suggestions please!

Doctor Jonas is an important figure head of US ‘Integrative Medicine’. As we discussed in a recent post, he pointed out that many US hospital doctors fail to answer the following questions relating to their chronically ill patients:

  1. “What matters most for this patient?
  2. What is the person’s lifestyle like – their nutrition, movement and sleep?
  3. How does that patient manage their stress?
  4. Does that patient have a good support system at home?
  5. What supplements does that patient take? Has your patient seen any CAM practitioners to cope with their condition?
  6. Why do they want to get well?”

In my previous post, I tried to explain that this is embarrassing – embarrassing for doctor Jonas, I meant.

But Jonas also claims that most US hospital doctors he addressed during his lecture tour, were unable to answer these questions. And that might be embarrassing not for Jonas, but for those physicians. Let’s consider this possibility for a moment.

The way I see it, the doctors in question might not have answered to Jonas for the following reasons:

  • They felt that the questions were simply too daft to bother.
  • They were too polite to tell Jonas what they think of him.
  • They were truly unable to answer the questions.

Here I want to briefly deal with the last category.

I do not doubt for a minute that this category of physician exists. They have little interest in what matters to their patients, don’t ask the right questions, have no time and even less empathy and compassion. Yet nobody can deny that medical school teaches all of these qualities, skills and attitudes. And there is no doubt that good doctors practice them; it is not a choice but an ethical and moral imperative.

So, what went wrong with these doctors?

Probably lots, and I cannot begin to tell you what exactly. However, I can easily tell you that those doctors are not practicing good medicine. Similarly, I can tell you what these doctors ought to do: re-train and be reminded of what medical school has once taught them.

And what about those physicians who advocate ‘integrated medicine’ reminding everyone of the core values of healthcare?

Aren’t they fabulous?

No, they aren’t!

Why?

Because they too have evidently forgotten what they should have learnt at medical school. If not, they would not be able to pretend that ‘integrative medicine’ has a monopoly on core values of all healthcare. Their messages are akin to a new ‘school’ of ship-building insisting that it is beneficial to build ships that do not leak.

What I am trying to say in my clumsy way is this:

DOCTORS WHO PRACTICE BAD MEDICINE SHOULD RE-TRAIN – TOGETHER WITH THOSE PHYSICIANS WHO ADVOCATE ‘INTEGRATIVE MEDICINE‘, BECAUSE THEY BOTH HAVE FORGOTTEN WHAT THEY LEARNT AT MEDICAL SCHOOL.

Yesterday, I received a ‘LETTER FROM DR JONAS’ (the capital lettering was his) – actually, it was an email, and not a very personal one at that. Therefore I feel it might be permissible to share some of it here (you do remember Jonas, don’t you? I did mention him in a recent post: “Considering the prominence and experience of Wayne Jonas, the 1st author of this paper, such obvious transgression is more than a little disappointing – I would argue that is amounts to overt scientific misconduct.”)

Here we go:

As part of my book tour, I spent last month visiting hospitals and medical schools, talking to the doctors, nurses and students. I tell them to think of a chronically ill patient, and I ask:

“What matters most for this patient? What is the person’s lifestyle like – their nutrition, movement and sleep? How does that patient manage their stress? Does that patient have a good support system at home? What supplements does that patient take? Has your patient seen any CAM practitioners to cope with their condition? Why do they want to get well?”

Most can’t answer these questions. Providers may know the diagnosis and treatments a patient gets, but few know their primary determinants of health. They know ‘what’s the matter’, but not ‘what matters.’ …

END OF QUOTE

Let’s have a closer look at those items of which Jonas thinks they matter:

  1. What is the person’s lifestyle like – their nutrition, movement and sleep? Depending on the condition of the patient, these issues might indeed matter. And if they do, any good doctor will consider them. There is nothing new about this; it is stuff I learnt in medical school all those years ago.
  2. How does that patient manage their stress? The question supposes that all patients suffer from stress. I know it is fashionable to ‘have stress’, but not every patient suffers from it. If the patient does suffer, it goes without saying that a good doctor would consider it.
  3. Does that patient have a good support system at home? Elementary, my dear Watson! If a doctor does not know about this, (s)he has slept through medical school (where did you go to medical school Wayne, and what did you do during these 6 years?).
  4. What supplements does that patient take? That’s a good one. I suppose Jonas would ask it to see what further nonsense he might recommend. Most rational doctors would ask this question to see what (s)he must advise the patient to discontinue.
  5. Has your patient seen any CAM practitioners to cope with their condition? As above.
  6. Why do they want to get well? Most patients would assume we are pulling their leg, if we really asked this. Instead of a response, they might return a question: Why do you ask, do you think being ill is fun?

So, doctor Jonas’ questions might do well during lectures to a self-selected audience, but in reality they turn out to be a mixture of embarrassing re-discoveries from conventional medicine, platitudes and outright nonsense. “My goal is for integrative healthcare to become the standard of care…” says Jonas towards the end of his ‘LETTER’. I suppose, this explains it!

Thus Jonas’ ‘LETTER’ turns out to be yet another indication to suggest that the reality of ‘integrative medicine’ consists of little more than re-discoveries from conventional medicine, platitudes and outright nonsense.

Yesterday, I heard my ‘good friend’ Dr Michael Dixon (see here, here and here, for example) talk on the BBC about the “new thing” in healthcare: social prescribing. He explained, for instance, that social prescribing could mean treating a diabetic not with medication but with auto-hypnosis and other alternative therapies. At that moment, I wasn’t even entirely sure what the term ‘social prescribing’ meant, I have to admit – so I did some reading.

What is social prescribing?

The UK ‘Social Prescribing Network‘ defines it thus:

Social Prescribing is a means of enabling GPs and other frontline healthcare professionals to refer patients to a link worker – to provide them with a face to face conversation during which they can learn about the possibilities and design their own personalised solutions, i.e. ‘co-produce’ their ‘social prescription’- so that people with social, emotional or practical needs are empowered to find solutions which will improve their health and wellbeing, often using services provided by the voluntary and community sector. It is an innovative and growing movement, with the potential to reduce the financial burden on the NHS and particularly on primary care.

Does social prescribing work?

The UK King’s Fund is mildly optimistic:

There is emerging evidence that social prescribing can lead to a range of positive health and well-being outcomes. Studies have pointed to improvements in areas such as quality of life and emotional wellbeing, mental and general wellbeing, and levels of depression and anxiety. For example, a study into a social prescribing project in Bristol found improvements in anxiety levels and in feelings about general health and quality of life. In general, social prescribing schemes appear to result in high levels of satisfaction from participants, primary care professionals and commissioners.

Social prescribing schemes may also lead to a reduction in the use of NHS services. A study of a scheme in Rotherham (a liaison service helping patients access support from more than 20 voluntary and community sector organisations), showed that for more than 8 in 10 patients referred to the scheme who were followed up three to four months later, there were reductions in NHS use in terms of accident and emergency (A&E) attendance, outpatient appointments and inpatient admissions. The Bristol study also showed reductions in general practice attendance rates for most people who had received the social prescription.

However, robust and systematic evidence on the effectiveness of social prescribing is very limited. Many studies are small scale, do not have a control group, focus on progress rather than outcomes, or relate to individual interventions rather than the social prescribing model. Much of the evidence available is qualitative, and relies on self-reported outcomes. Researchers have also highlighted the challenges of measuring the outcomes of complex interventions, or making meaningful comparisons between very different schemes.

Determining the cost, resource implications and cost effectiveness of social prescribing is particularly difficult. The Bristol study found that positive health and wellbeing outcomes came at a higher cost than routine GP care over the period of a year, but other research has highlighted the importance of looking at cost effectiveness over a longer period of time. Exploratory economic analysis of the Rotherham scheme, for example, suggested that the scheme could pay for itself over 18–24 months in terms of reduced NHS use….

END OF QUOTES

Is there no harder evidence at all?

The only Medline-listed controlled study seems to have been omitted by the King’s Fund – I wonder why. Perhaps because it fails to share the optimism? Here is its abstract:

Social prescribing is targeted at isolated and lonely patients. Practitioners and patients jointly develop bespoke well-being plans to promote social integration and or social reactivation. Our aim was to investigate: whether a social prescribing service could be implemented in a general practice (GP) setting and to evaluate its effect on well-being and primary care resource use. We used a mixed method evaluation approach using patient surveys with matched control groups and a qualitative interview study. The study was conducted in a mixed socio-economic, multi-ethnic, inner city London borough with socially isolated patients who frequently visited their GP. The intervention was implemented by ‘social prescribing coordinators’. Outcomes of interest were psychological and social well-being and health care resource use. At 8 months follow-up there were no differences between patients referred to social prescribing and the controls for general health, depression, anxiety and ‘positive and active engagement in life’. Social prescribing patients had high GP consultation rates, which fell in the year following referral. The qualitative study indicated that most patients had a positive experience with social prescribing but the service was not utilised to its full extent. Changes in general health and well-being following referral were very limited and comprehensive implementation was difficult to optimise. Although GP consultation rates fell, these may have reflected regression to the mean rather than changes related to the intervention. Whether social prescribing can contribute to the health of a nation for social and psychological wellbeing is still to be determined.

So, there is a lack of evidence for social prescribing. Yet, this is not why I feel uneasy about the promotion of this “new thing”. The more i think about it, the more I realise that social prescribing is just good care and decent medicine. It is what I was taught at med school 40 years ago. It therefore seems like a fancy name for something that should be obvious.

But why my unease?

The way I see it, it will be (and perhaps already is) used to smuggle bogus alternative therapies into the mainstream. In this way, it could turn out to serve the same purpose as did the boom in integrative/integrated medicine/healthcare: a smokescreen to incorporate treatments into medical routine which otherwise would not pass muster. If advocates of this approach, like Michael Dixon, subscribe to it, the danger of this happening is hard to deny.

The disservice to patients (and medical ethics) would then be obvious: diabetics unquestionably can benefit from a change of life-style (and to encourage them is part of good conventional medicine), but I very much doubt that they should replace their anti-diabetic medications with auto-hypnosis or other alternative therapies.

The Society of Homeopaths (SoH) has launched a campaign to inform the public that, despite everything non-homeopaths may say and despite the undeniable facts about homeopathy, their remedies are highly effective. This article provides a detailed account of their incompetence.

I saw the image below first on Twitter. It is part of their current campaign and summarises ‘POSITIVE MESSAGES ABOUT HOMEOPATHY’ as the SoH proclaim them. Presumably, they did this piece of work to help their members finding the right arguments when defending the indefensible.

I am not usually prone to laughing fits, but this had me in stiches! It is hilarious, I think; a true masterpiece of comedy.

The masterpiece is almost too perfect to tarnish with my comments; however, I cannot resist. Sorry!

I will take the arguments in turn going clockwise and starting with

‘HOMEOPATHY MEDICINES ARE TESTED SAFELY AND EFFECTIVELY ON HEALTHY HUMANS’

Should this not be ‘homeopathic medicines’? In any case, the remedies (medicines seems too strong a word) are tested in so-called ‘provings’ – yes, safely because they normally contain no active ingredient… and effectively? I cannot see why provings might be ‘effective’; they are pure fantasy.

HOMEOPATHY MAKES A POSITIVE CONTRIBUTION TO INTEGRATED HEALTHCARE

No, as we have discussed often on this blog, adding cow pie to apple pie is not a positive contribution to anything.

HOMEOPATHY HAS BEEN AVAILABLE ON THE NHS SINCE 1948

Appeal to tradition = fallacy.

Appeal to authority = fallacy.

HOMEOPATHY PUTS THE PATIENT AT THE CENTRE OF THEIR HEALTHCARE

This too is false logic, because all good medicine puts the patient at the centre; in addition it is grammatically false English (if I as a non-native speaker may be so bold).

HOMEOPATHY IS USED BY 15% OF UK CITIZENS

I doubt it. But even if this figure is correct, an appeal to popularity is a fallacy and not a logical argument.

HOMEOPATHY IS USED BY 450 MILLION PEOPLE WORLDWIDE

I doubt it. But even if this figure is correct, an appeal to popularity is a fallacy and not a logical argument.

HOMEOPATHY IS A SYSTEM OF NATURAL HEALTHCARE THAT HAS BEEN USED WORLDWIDE FOR 200 YEARS

What is ‘natural’ in endlessly diluting things like ‘Berlin Wall’ and pretending it is a medicine? In any case, the appeal to tradition is yet another fallacy.

HOMEOPATHY DOES NOT CONTRADICT SCIENTIFIC PROGRESS, IT IS PART OF IT

This is where I almost fell off my chair; homeopathy is the opposite of progress, it is a dogma and a belief-system.

HOMEOPATHY IS HOLISTIC

All good medicine is holistic; arguably, homeopathy is not holistic.

HOMEOPATHY IS EFFECTIVE IN BOTH ACUTE AND CHRONIC ILLNESS

Yes, this is what homeopaths believe, but it is not true.

To conclude what better than quoting the person who, a long time ago, said: “HOMEOPATHS ARE THE CLOWNS AMONGST THE HEALTHCARE PROFESSIONALS” ?

 

In their now famous 1998 NEJM editorial about alternative medicine, Angell and Kassirer concluded that “It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments.”

Then and today, I entirely agree(d) with these sentiments. Years later, the comedian Tim Minchin brought it to the point: “You know what they call alternative medicine that’s been proved to work? – Medicine.”  So, comedians have solved the terminology problem, but we, the experts, have not managed to get rid of the notion that there is another type of medicine. Almost 20 years after the above editorial, we still struggle to find the ideal name.

Despite their desperate demand ‘THERE CANNOT BE TWO KINDS OF MEDICINE’, Angell and Kassirer still used the word ALTERNATIVE MEDICINE. On this blog, I usually do the same. But there are many terms, and it is only fair to ask: which one is the most suitable?

  1. ALTERNATIVE MEDICINE is strictly speaking an umbrella term for modalities (therapy or diagnostic technique) employed as a replacement of conventional medicine; more commonly the term is used for all heterodox modalities.
  2. CHARLATANERY treatment by someone who professes to have expertise that he does not have.
  3. COMPLEMENTATY MEDICINE is an umbrella term for modalities usually employed as an adjunct to conventional healthcare.
  4. COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) an umbrella term for both 1 and 3 often used because the same alternative modality  can be employed either as a replacement of or an add-on to conventional medicine.
  5. COMPLEMENTARY AND INTEGRATIVE MEDICINE (CIM) a nonsensical term recently created by authors of an equally nonsensical BMJ review.
  6. DISPROVEN MEDICINE is an umbrella term for treatments that have been shown not to work (as proving a negative is usually impossible, there are not many such therapies).
  7. FRINGE MEDICINE is the term formerly used for alternative medicine.
  8. HETERODOX MEDICINE is the linguistically correct term for unorthodox medicine (this could be the most correct term but has the disadvantage that consumers are not familiar with it).
  9. HOLISTIC MEDICINE is healthcare that emphasises whole patient care (as all good medicine is by definition holistic, the term seems problematic).
  10. INTEGRATED MEDICINE describes the use of treatments that allegedly incorporate ‘the best of both worlds’, i.e. the best of alternative and conventional healthcare (integrated medicine can be shown to be little more than a smokescreen for adopting bogus treatments in conventional medicine).
  11. INTEGRATIVE MEDICINE is the same as 10 (10 is more common in the UK, 11 is more common in the US).
  12. NATURAL MEDICINE is healthcare exclusively employing the means provided by nature for treating disease.
  13. QUACKERY is the deliberate misinterpretation of the ability of a treatment or diagnostic technique to treat or diagnose disease (quackery exists in all types of healthcare).
  14. TRADITIONAL MEDICINE is healthcare that has been in use before the scientific era (the assumption is that such treatments have stood the test of time).
  15. UNCONVENTIONAL MEDICINE is healthcare not normally used in conventional medicine (this would include off-label use of drugs, for instance, and therefore does not differentiate well).
  16. UNORTHODOX MEDICINE the linguistically incorrect but often used term for healthcare that is not normally used in orthodox medicine.
  17. UNPROVEN MEDICINE is healthcare that lacks scientific proof (many conventional therapies fall in this category too).

These terms and explanations (mostly my own) are meant to bring out clearly that:

  • none of them is perfect,
  • none has ever been clearly defined,
  • none describes the area completely,
  • none is without considerable overlap to other terms,
  • none is really useful.

My conclusion, after pondering about these terms for many years (it can be an intensely boring issue!), is that the best solution would be to abandon all umbrella terms (see Angell and Kassirer above). Alas, that hardly seems practical when running a blog on the subject. I think therefore that I will continue to (mostly) use the term ALTERNATIVE MEDICINE (consumers understand it best, in my experience) … unless, of course, someone has a better idea.

I have been alerted to the fact that my former medical school in Munich at one of Germany’s highest-ranked universities is currently running an elective course in homeopathy. For those who do not read German (the original announcement [apparently posted all over Munich university hospitals] is copied below), it teaches the use of homeopathy in/for:

  • INTERNAL MEDICINE
  • NEONATOLOGY
  • SINUSITIS
  • RECURRENT OTITIS MEDIA
  • INSOMNIA
  • PALLIATION OF RESPIRATORY PROBLEMS
  • PROSTATE CANCER
  • POST-TRAUMATIC SYNDROMES
  • BIPOLAR DISEASE
  • MULTIMORBID PATIENTS WITH UVEITIS
  • COUGH
  • DISEASES OF THE FEMALE BREAST
  • SUPPORTIVE CANCER CARE
  • PAEDIATRIC ASTHMA

The course is being organised by Dr. med. Sigrid Kruse, von Haunersches Kinderspital des Klinikums der Universität München in co-operation with the ‘Landesverband Bayern des Deutschen Zentralvereins homöopathischer Ärzte’. The lecturers of this course seem to be mostly homeopaths from practices in and around Munich.

This article provides further explanations:

The project „Homeopathy in pediatrics“ was established in the Dr. von Hauner’s Children’s Hospital University of Munich in 1995 to integrate homeopathy into a university hospital. Selected children (outpatients and in the wards) are treated conventionally and homeopathically. The Karl and Veronica Carstens-Foundation initially financed the project over six years. An association of parents, whose children were treated for cancer, funded the project for one year. Since 2002, for the first time in Germany, the National Health Insurance is providing the financial background for two consultants for Homeopathy at this University hospital.

Who are we?

Dr. Mira Dorcsi-Ulrich, who initiated the project and carries out the supervision. She is a pediatrician in her own practice with 23 years of experience.

Dr. Sigrid Kruse has managed to integrate homeopathy into the clinic, starting at first in 1995 as a resident for pediatrics. Now she fulfills the requests of doctors and parents in the wards demanding concomitant homeopathic treatment.

Dr. Christian Lucae mainly treats the outpatients while focussing on his research project with children showing attention-deficit-hyperactivity-syndrome (ADHS).

Concomitant homeopathic therapy was successful in the following cases: intracerebral bleeding 3rd degree in premature babies, drug withdrawal in neonates addicted mothers, epilepsy, handicapped children, ADHS, migraine, tic, recurrent infections, asthma and atopic eczema, complications in wound healing and other problems. Homeopathic treatment of children parallel to conventional methods is particularly well accepted in the treatment of cancer. The side effects of oncological treatment like vomiting and stomatitis can be relieved, aggressions and anxiety intercepted and life quality improved.

END OF QUOTE

Which journal with a modicum of self-respect or rigor allows a homeopath to publish anything like the last paragraph without providing a jot of evidence? The answer is the ‘ALLGEMEINE HOMOEOPATHISCHE ZEITUNG’ – no further explanation needed, I think.

Courses like the one above, run at university level, make me first a little speechless and then more than a little angry. Medical schools should have other roles than teaching impressionable students things that fly in the face of science and evidence. They should guide them to become responsible doctors not misguide them to turn into irresponsible quacks. The fact that this comes from the medical school where I,  many years ago, studied, graduated, worked and made both my MD and PhD theses renders the whole thing painfully sad for me personally.

But let’s not get depressed… ‘always look on the bright side of life’!!!

Luckily, there are glimpses of a bright side here. For instance, the fact that doctor Quak is one of the lecturers of this course (see below) is not without jollity, I must admit. Also amusing – at least to me – is be the vision of Dr. med. Mira Dorcsi-Ulrich (see below) standing in front of her students explaining the findings of one of the few RCT of individualised homeopathy for paediatric asthma. This study from my team found no evidence that “adjunctive homeopathic remedies, as prescribed by experienced homeopathic practitioners, are superior to placebo in improving the quality of life of children with mild to moderate asthma in addition to conventional treatment in primary care.”

——————————————————————————————————————————————

Here is the German original announcement of the course:

RINGVORLESUNG IM WINTERSEMESTER 2016/2017
HOMÖOPATHIE VON DER THEORIE ZUR PRAXIS MIT PRAXISBEISPIELEN UND PATIENTENVORSTELLUNGEN

1. 20.10.2016 … IN DER INNEREN MEDIZIN: MÖGLICHKEITEN UND GRENZEN Dr. med. Ulf Riker
2. 27.10.2016 … IN DER NEONATOLOGIE: IKTERUS, ASPHYXIE UND UNRUHE Dr. med. Monika Grasser
3. 03.11.2016 … BEI PATIENTEN MIT SINUSITIS Dr. med. Michael Schreiner
4. 10.11.2016 … BEI KINDERN MIT REZIDIVIERENDER OTITIS MEDIA Dr. med. Christian Lucae
5. 17.11.2016 … BEI SCHLAFSTÖRUNGEN Dr. med. Brigitte Seul
6. 24.11.2016 … BEI PALLIATIV-PATIENTEN MIT RESPIRATORISCHEN PROBLEMEN Herbert Michalczyk
7. 01.12.2016 … IN DER BEGLEITUNG VON PATIENTEN MIT EINEM PROSTATA-CARCINOM Uwe Kraemer-Hoenes
8. 08.12.2016 … BEI POSTTRAUMATISCHER BELASTUNGS-STÖRUNG Dr. med. Ingrid Pfanzelt
9. 15.12.2016 … BEI EINER PATIENTIN MIT BIPOLARER AFFEKTIVER STÖRUNG Dr. med. Stephan Gerke
10. 12.01.2017 … BEI EINEM MULTIMORBIDEN PATIENTEN MIT UVEITIS Dr. med. Thomas Quak
11. 19.01.2017 … BEI PATIENTEN MIT HUSTEN Dr. med. Renate Grötsch
12. 26.01.2017 … BEI ERKRANKUNGEN DER WEIBLICHEN BRUST Dr. med. Ute Bullemer
13. 02.02.2017 … IN DER BEGLEITUNG VON KREBSPATIENTEN MIT Q-POTENZEN Miclós Takács
15. 09.02.2017… BEI KINDERN MIT ASTHMA BRONCHIALE Dr. med. Mira Dorcsi-Ulrich
Organisation: Dr. med. Sigrid Kruse, Dr. von Haunersches Kinderspital des Klinikums der Universität München
E-Mail: sigrid.kruse@med.uni-muenchen.de in Zusammenarbeit mit dem Landesverband Bayern des Deutschen Zentralvereins homöopathischer Ärzte,

What? Holistic dentistry? Dentists drilling holes in our teeth?

No, it is something quite different; this article tries to explain it in some detail:

… holistic dentistry involves an awareness of dental care as it relates to the entire person, with the belief that patients should be provided with information to make choices to enhance their personal health and wellness…

Some of the philosophies include:

— Alternatives to amalgam/mercury fillings

— Knowing and following proper mercury removal

— Multi-disciplinary, or integrated, health care

— Nutritional and preventive therapies and temporomandibular joint disorder therapy.

Personally, I find this sounds a bit like a string of platitudes designed to lure in new customers and boost the dental business. An awareness that the mouth and its content is part of the whole body is not a philosophy; alternatives to amalgam have existed since decades and are used by ‘normal’ dentists, integrated health care is a con, nutrition is part of conventional healthcare and temporomandibular joint disorders are most certainly an issue for conventional dentistry. Perhaps another article might do a better job at explaining what ‘holistic dentistry’ is all about:

…Holistic dentistry is not considered a specialty of the dental profession, but a philosophy of practice. For those dentists who take the concept to its core, holistic dentistry includes an understanding of each patient’s total well-being, from their specific cosmetic, structural, functional, and health-related dental needs to the concerns of their total body and its wellness. Holistic dentists tend to attract very health-conscious individuals.

Some of the things holistic dentists are especially concerned about are the mercury found in traditional amalgam dental fillings, fluoride in drinking water, and the potential relationship of root canal therapy to disease in other parts of the body. Holistic dentists’ primary focus is on the underlying reasons why a person has dental concerns, and then help correct those issues by strategic changes in diet, hygiene and lifestyle habits.

Natural remedies to prevent and arrest decay and periodontal (gum) disease can also be utilized. Many holistic dentists are skilled in advanced levels of nutritional physiology and use natural means of healing patients, often avoiding the more standard use of systemic antibiotics, pain control management and surgical procedures.

This partly describes what good dentists have always done and partly it seems to be nonsense. For instance, natural remedies for tooth decay and gum disease? Really? Which remedies precisely? I know of no such treatments that are backed by sound evidence. Let me try a third quote; this one is directly from the horse’s mouth (pun intended), i. e. from a holistic dentist:

Holistic Dentistry, many times referred to today as “Biological” or “Biocompatible” Dentistry, is based on the concept that the mouth and oral structures are an integrated part of the body. It is a paradigm or a philosophy within dentistry and not a specialty.

Holistic dentistry supports your choice to live a healthier, more natural and less toxic life. We bridge the gap between conventional clinical dentistry and natural healing modalities. All holistic health care models share basic philosophical foundations. They all promote health and well being through healthful nourishment, elimination of toxins, and the promotion of physical, mental and energetic balance.

As holistic dentists we recognize that the mouth is connected to the body and that it cannot be viewed as an independent system. It is a reflection of the overall health of the body and much can be done to impact it both positively and negatively. Like many conventional dentists we first look to see if the foundation is solid. Are your gums bleeding and swollen? Is this a reflection of poor nutritional habits? Or are there signs of infection and disease? Are the teeth moving? Is there a stable bite? Can you chew comfortably on both sides of your mouth? Do you get frequent headaches? Are your teeth in harmony with your jaw joint? Are there signs of oral cancer?
The Basic Principles of Holistic Dentistry
Proper nutrition for the prevention and reversal of degenerative dental disease.
Avoidance and elimination of toxins from dental materials.
Prevention and treatment of dental malocclusion (bite problems = physical imbalance)
Prevention and treatment of gum disease at its biological basis
We check the condition of the teeth themselves. Is there more filling than tooth structure? Are the fillings made from the most non-toxic materials available? Are they supporting the bite correctly? Will they be there in five years? Is there decay? Does your diet support your oral health? Then together with our patients we formulate a plan to determine what we can do to help you achieve a stable and healthy mouth. This examination can be a first visit scenario in many dental offices.
Holistic dentists also make fillings, take x-rays and use anesthesia to numb your mouth. However we only use mercury-free white fillings. More importantly, we take extra precautions when removing your old silver fillings to minimize your exposure to mercury vapor. Why don’t we use Mercury? Mercury is one of the heavy metal toxins implicated in Alzheimer’s Disease and autism. However according to the American Dental Association, it is a safe filling material and, as recently as two years ago, the Florida board of dentistry attempted to pass legislation to prevent doctors from advertising as mercury-free dentists.

In holistic dentistry we minimize your exposure to toxic substances in every area of our work. Therefore we use a digital computer generated x-ray unit to take your x-rays which reduces your exposure to radiation by as much as 90%. We don’t advocate the indiscriminant use of fluoride in adults or children, for it is a known poison (check the label on your toothpaste tube) and a commonly used pesticide. We have installed distilled water sources in our office to minimize bacterial contamination. We research and attend courses to find the safest and most biocompatible materials available for dental work. Further, because we recognize that each individual has a different threshold of tolerance for dental materials, we sometimes suggest further testing to determine an individual’s ability to tolerate particular restorative material over long periods of time.

Ultimately you are responsible for your own health. You can choose your health care partners consciously. You can reunite with a part of your body that has been disenfranchised and polluted with toxins. You can reclaim your own unity and wholeness by taking the time to notice what goes into your mouth and how it comes out of it. Your mouth is a sacred portal through which breath, mantra and food travel in and out of your body.

See what I mean?

This is more of the same again. PHILOSOPHY? PARADIGM? REUNITE WITH DISENFRANCHISED PARTS OF THE BODY? The more I read about holistic dentistry, the more I suspect that it is the equivalent of integrative/integrated medicine: a smoke-screen for smuggling bogus treatments into conventional care, a bonanza of BS to attract gullible customers, a distraction for highjacking a few core principles from real medicine/dentistry without getting noticed, and a dubious con for maximizing income.

‘Holistic dentistry’ makes not much more sense than holistic banking, holistic hairdressing, holistic pedicure, holistic car-repair, etc., etc. Dentistry, medicine, hairdressing, etc. are either good, not so good, or bad. The term holistic as it is currently used in dentistry is just a gimmick, I am afraid.

If I am wrong, please tell me so, and explain what, in your view, ‘holistic dentistry’ means.

This is your occasion to meet some of the most influential and progressive people in health care today! An occasion too good to be missed! The future of medicine is integrated – we all know that, of course. Here you can learn some of the key messages and techniques from the horses’ mouths. Book now before the last places have gone; at £300, this is a bargain!!!

The COLLEGE OF MEDICINE announced the event with the following words:

This two-day course led by Professor David Peters and Dr Michael Dixon will provide an introduction to integrated health and care.  It is open to all clinicians but should be particularly helpful for GPs and nurses, who are interested in looking beyond the conventional biomedical box.  

The course will include sessions on lifestyle approaches, social prescribing, mind/body therapies and cover most mainstream complementary therapies.  

The aim of the course will be to demonstrate our healing potential beyond prescribing and referral, to provide information that will be useful in discussing non-conventional treatment options with patients and to teach some basic skills that can be used in clinical practice.  The latter will include breathing techniques, basic manipulation and acupuncture, mind/body therapies including self-hypnosis and a limited range of herbal remedies.  There will also be an opportunity to discuss how those attending might begin to integrate their everyday clinical practice.  

The course will qualify for Continuing Professional Development hours and can provide a first stage towards a Fellowship of the College.

Both Dixon and Peters have been featured on this blog before. I have also commented regularly on the wonders of integrated (or was it integrative?) medicine. And I have even blogged about the College of Medicine and what it stands for. So readers of this blog know about the players as well as the issues for this event. Now it surely must be time to learn more from those who are much better placed than I to teach about bogus claims, phoney theories and unethical practices.

What are you waiting for? Book now – they would love to have a few rationalists in the audience, I am sure.

Would you like to see a much broader range of approaches such as nutrition, mindfulness, complementary therapies and connecting people to green spaces become part of mainstream healthcare?

No?

Well, let me tell you about this exciting new venture anyway!

It is being promoted by Dr Dixon’s ‘College of Medicine’ and claims to be “the only accredited Integrative Medicine diploma currently available in the UK… [It] will provide you with an accredited qualification as an integrative medicine practitioner. The Diploma is certified by Crossfields Institute and supported by the College of Medicine and is the only one currently available in the UK. IM is a holistic, evidence-based approach which makes intelligent use of all available therapeutic choices to achieve optimal health and resilience for our patients. The model embraces conventional approaches as well as other modalities centred on lifestyle and mind-body techniques like mindfulness and nutrition.”

Dr Dixon? Yes, this Dr Michael Dixon.

College of Medicine? Yes, this College of Medicine.

Integrative medicine? Yes, this cunning plan to adopt quackery into real medicine which I have repeatedly written about, for instance here, here and here.

Crossfields Institute? Yes this Crossfields Institute which promotes the Steiner/’Waldorf quackery and has Simon Fielding as the chair of trustees.

Simon Fielding? Yes, the Simon Fielding who “devoted much of his professional life to securing the recognition of osteopathy as an independent primary contact healthcare profession and this culminated in the passing of the Osteopaths Act in 1993. He was appointed by ministers as the first chair of the General Osteopathic Council responsible for bringing the Osteopaths Act into force… He is currently vice-chair of the board of trustees of The College of Medicine… In addition Simon has… served as a long term trustee on the boards of The Prince of Wales’s Foundation for Integrated Health… and was the founder chair of the Council for Anthroposophical Health and Social Care.”

You must admit, this IS exciting!
Now you want to know what modules are within the Diploma? Here they are:

  • The Modern Context of IM: Philosophy, History and Changing Times in Medicine
  • IM Approaches and Management of Conditions (part 1)
  • Holistic Assessment: The Therapeutic Relationship, Motivational Interviewing & Clinical Decision Making in    Integrative Medicine
  • Critical Appraisal of Medicine and IM Research
  • Holistic assessment: Social prescribing, a Community Approach in Integrative Medicine
  • Managing a Dynamic IM Practice and Developing Leadership Skills
  • IM Approaches and Management of Conditions (part 2)
  • Independent Study on Innovation in Integrative Medicine

Sounds terrific, and it reminds me a lot of another course Michael Dixon tried to set up 13 years ago in Exeter. As it concerned me intimately, I wrote about this extraordinary experience in my memoir; here is a short excerpt:

…in July 2003… I saw an announcement published in the newsletter of the Prince of Wales’ Foundation for Integrated Health:

“The Peninsula Medical School aims to become the UK’s first medical school to include integrated medicine at postgraduate level. The school also plans to extend the current range and depth of programmes offered by including healthcare ethics and legislation. Professor John Tooke, dean of the Peninsula Medical School, said: ‘The inclusion of integrated medicine is a patient driven development. Increasingly the public is turning to the medical profession for information about complementary medicines. This programme will play an important role in developing critical understanding of a wide range of therapies’.”

When I stumbled on this announcement I was taken aback. Is Tooke envisaging a course for me to run? Has he forgotten to tell me about it? When I inquired, Tooke informed me that the medical school planned to offer a postgraduate “Pathway in Integrated Health” which had been initiated by Dr Michael Dixon, a general practitioner who had at that stage become one of the UK’s most outspoken proponents of spiritual healing and other dubious forms of alternative medicine, and for this reason was apparently very well regarded by Prince Charles.

A few days after I received this amazing news, Dr Dixon arrived at my office and explained with visible embarrassment that Prince Charles had expressed his desire to establish such a course in Exeter. His Royal Highness had already facilitated its funding which, in fact, came from Nelson’s, the manufacturer of homoeopathic remedies. The day-to-day running of the course was to be put into the hands of the ex-director of the Centre for Complementary Health Studies (CCHS), the very unit I had struggled – and even paid – to be separated from almost a decade ago because of its overtly anti-scientific agenda. The whole thing had been in the planning for several months. I was, it seemed, the last to know – but now that I had learnt about it, Dixon and Tooke urged me to contribute to this course by giving a few lectures.

I could no more comply with this request than fly. Apart from anything else, I was opposed in principle to the concept of “integration.” As I saw it, “integrating” quackery with genuine, science-based medicine was nothing less than a profound betrayal of the ethical basis of medical practice. By putting its imprimatur on this course, and by offering it under the auspices of a mainstream medical school, my institution would be encouraging the dangerous idea of equivalence – i.e., the notion that alternative and mainstream medicine were merely two parallel but equally valid and effective methods of treating illness.

To add insult to injury, the course was to be sponsored by a major manufacturer of homoeopathic remedies. In all conscience, this seemed to me to be the last straw. Study after study carried out by my unit had found homoeopathy to be not only conceptually absurd but also therapeutically worthless. If we did not take a stand on this issue, we might just as well all give up and go home…

END OF QUOTE FROM MY MEMOIR

Dixon’s Exeter course was not a brilliant success; I think it folded soon after it was started. Well, better luck up the road in Bristol, Michael – I am sure there must be a market for quackery somewhere!

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