MD, PhD, FMedSci, FSB, FRCP, FRCPEd

integrative medicine

Yes, I think he does deserve to join this fast-expanding club which, so far, consists of the following people:

Simon Mills

Gustav Dobos

Claudia Witt

George Lewith

John Licciardone

They have been admitted mostly because they have demonstrated that they exclusively or mostly publish positive results about alternative medicine. Therefore, their ‘TRUSTWORTHYNESS INDEX’ is remarkable.

With Peter Fisher, things are a little different, and in a way much more convincing. He also has a remarkable publication record, of course. As the Queen’s homeopath, he is a stark defender of homeopathy. He has just under 100 Medline-listed articles in this area, and, if I am not mistaken, only one of them cast any doubt on the effectiveness of homeopathy.

Peter is also the long-term editor of the journal HOMEOPATHY, and he used this position to fire me from its editorial board. Furthermore, he has been shown to have an unusual attitude towards telling the truth. But the decider for his admission to THE ALT MED HALL OF FAME was the following recent interview for NATURALLYSAVVY where he shows himself as a fierce defender of science, evidence-based medicine and critical thinking:

Andrea Donsky: I understand you arrived yesterday from England. I’m curious what you take for jetlag?

Peter Fisher: We have a traditional combination that we use for jetlag, which is arnica montana, and cocculus indicus. So arnica is something that is traditionally used for bruises, and cocculus is used for sleep problems. So arnica and cocculus combined, 6CH every hour or two, helps with jetlag.

Andrea Donsky: I read about the incredible work you do as an Integrative Medicine Doctor so I thought we would start today’s interview with having you explain what that means.

Peter Fisher: Simply put, it means the best of both worlds: the best of conventional, and the best of complementary medicine. There is also a much longer and more complicated definition, but essentially it’s integrating complementary medicine in care packages to avoid some of the worst excesses of conventional medicines, like over-drugging, and excess use of medication.

Andrea Donsky: I know you don’t see patients with the common cold or flu, but if you did, what would be your protocol?

Peter Fisher: I’ve done quite a lot of research on the flu. It’s quite clear that conventional treatments don’t work all that well, and may even prolong the flu. Most of the conventional treatments push the symptoms down [suppress them] and actually prolong the illness.

Andrea Donsky: So something like Oscillococcinum would be a perfect thing to recommend to people.

Peter Fisher: Yes, and other homeopathic combinations that can speed up the resolution, relieve the symptoms, and make the flu go away quicker.

Andrea Donsky: Tell me a little bit about the European way of practicing medicine. I remember hearing that in Europe doctors prescribe homeopathy alongside medication. Is this true?

Peter Fisher: It varies widely between countries. In France, Germany, and increasingly in Spain, it is the case, but not so much in the UK. A lot of doctors do incorporate it in their practice and they integrate homeopathy when it seems appropriate, but they also use antibiotics and other drugs when they feel it is appropriate.

Andrea Donsky: Do you often approach these skeptics and say: “Listen, you are wrong because there is research behind it!”

Peter Fisher: I will debate with anybody, anytime. The trouble is, skeptics don’t like that because they always lose. I’ve been involved in a series of debates with “so called” skeptics. But many well-known skeptics avoid me because they lose the debate. What they prefer to do is to blog, or tweet, so they can make nasty sneering public remarks and you can’t come back at them. If it’s a proper debate, I say my piece, you say your piece, there’s somebody there to make sure that it’s fair play, and that could be in a journal, it could be in a lower court, I don’t care. There was a big court case in the U.S. that was resolved in September where that happened. An allegation was made that false claims were being made for homeopathic medicines and they lost the case…homeopathy won!

Andrea Donsky: Tell us how you came to be a physician to Her Majesty the Queen.

Peter Fisher: There’s a long tradition of the Royal Family having a homeopathic physician. It actually goes back 150 years to Queen Victoria and her beloved Prince Albert. The founder of our hospital was Prince Albert’s father’s doctor. There has been an official homeopathic physician treating the Royal Family since the 1930s. It’s been me since 2001.

Andrea Donsky: It is nice to hear that the Royal Family is open to integrative medicine. Do you just treat the Queen, or the whole family? I read that Prince Charles eats organic and has an organic garden so I am assuming he is quite open to it as well.

Peter Fisher: I treat the entire family. I think Kate and Will are too young and healthy so they don’t need medicine. But the Prince of Wales, Prince Charles, is very friendly, and he is more than willing to stick his neck out to actually say things. He has spoken at the World Health Assembly, which is the AGN of the World Health Organization. So he’s really quite fond of integrative medicine.

Andrea Donsky: I think that’s incredible. As a conventionally trained physician, how did you become interested in homeopathy?

Peter Fisher: At the end of the Cultural Revolution I went to visit China. I was a medical student at the time, and I remember the moment when it became clear to me. I was in the operating room of a small Chinese provincial town and there was a woman lying on the operating table with her entire abdomen open, fully conscious talking to the anesthetist with three needles in her left ear.

Andrea Donsky: Acupuncture needles?

Peter Fisher: Yes.

Andrea Donsky: That’s amazing.

Peter Fisher: The needles were connected to a little electrical box. I thought, “That doesn’t happen. They didn’t tell us about this at Cambridge.” I went to the best medical school, Cambridge, a very elite medical school, and I just thought, “This can’t happen. This doesn’t happen.” That experience is what made me think that there was more to medicine than what we were taught in medical school. Then a few years later, I became ill myself. I was still a medical student so I went to see a very distinguished professor at my medical school who made a precise diagnosis and said, “Tough, nothing can be done.” So my friends suggested I try homeopathy, and I did, and it helped. So it snowballed from there.

Andrea Donsky: Oftentimes we need to see things for ourselves and/or experience it to believe it.

Peter Fisher: Yes. I got almost obsessed by it, you know. In many ways as a scientific thing it shouldn’t work. I mean I do understand to that extent where the skeptics are coming from. There does appear to be a good reason why it can’t possibly work, and yet it does.

Andrea Donsky: Can you define what homeopathy is and how it works?

Peter Fisher: Homeopathy is based on the idea of like curing like. So you give a very small dose of something that could cause a similar illness if given an enlarged dose. Some people say it’s like holding a mirror up to nature. You’re saying to the body, “OK, this is what your problem is, this is what the disease is.” The idea is that the body has very strong self-healing capabilities; it is strong, but sometimes it can be stupid like when it comes to autoimmune diseases. In that case it is actually the body’s defensive mechanism being misdirected.

Andrea Donsky: Can you explain the difference between a single remedy and a combination?

Peter Fisher: A single remedy is one remedy and a combination is multiple. Broadly speaking, there are two kinds of homeopathy. One is the so-called “keynote prescribing way,” where you prescribe for one or two keynote symptoms like a cold, sore throat, or runny nose.Then there is “constitutional medicine” where you are not so much treating the disease, but rather the person. So for example, if someone has insomnia, muscular aches and pains or even a cold and/or flu, they can take a combination of two, three, four, or even five different homeopathic medicines, which will likely cover the symptoms. This is more for self-treatment, rather than doctor prescribed.

Andrea Donsky: That makes sense. I like that there is a role in homeopathy for both self (like for the common cold) and expert prescribing.

Peter Fisher: Yes. It is one thing if someone has a short-term health issue, but it is another thing if they have a chronic complicated, multi-faceted issue. I mean one of the interesting things about homeopathy is the idea of treating the person, and not the disease

I AM CONFIDENT THAT THE MAJORITY OF MY READERS AGREE TO ADMIT DR FISHER TO THE ALT MED HALL OF FAME.

Recently, I came across the ‘Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer’ published by the ‘Society for Integrative Oncology (SIO) Guidelines Working Group’. The mission of the SIO is to “advance evidence-based, comprehensive, integrative healthcare to improve the lives of people affected by cancer. The SIO has consistently encouraged rigorous scientific evaluation of both pre-clinical and clinical science, while advocating for the transformation of oncology care to integrate evidence-based complementary approaches. The vision of SIO is to have research inform the true integration of complementary modalities into oncology care, so that evidence-based complementary care is accessible and part of standard cancer care for all patients across the cancer continuum. As an interdisciplinary and inter-professional society, SIO is uniquely poised to lead the “bench to bedside” efforts in integrative cancer care.”

The aim of the ‘Clinical Practice Guidelines’ was to “inform clinicians and patients about the evidence supporting or discouraging the use of specific complementary and integrative therapies for defined outcomes during and beyond breast cancer treatment, including symptom management.”

This sounds like a most laudable aim. Therefore I studied the document carefully and was surprised to read their conclusions: “Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment.”

How can this be? On this blog, we have repeatedly seen evidence to suggest that integrative medicine is little more than the admission of quackery into evidence-based healthcare. This got me wondering how their conclusion had been reached, and I checked the document even closer.

On the surface, it seemed well-made. A team of researchers first defined the treatments they wanted to look at, then they searched for RCTs, evaluated their quality, extracted their results, combined them into an overall verdict and wrote the whole thing up. In a word, they conducted what seems a proper systematic review.

Based on the findings of their review, they then issued recommendations which I thought were baffling in several respects. Let me just focus on three of the SIO’s recommendations dealing with acupuncture:

  1. “Acupuncture can be considered for treating anxiety concurrent with ongoing fatigue…” [only RCT (1) cited in support]
  2. “Acupuncture can be considered for improving depressive symptoms in women suffering from hot flashes…” [RCTs (1 and 2) cited in support] 
  3. “Acupuncture can be considered for treating anxiety concurrent with ongoing fatigue…” [only RCT (1) cited in support]
One or two studies as a basis for far-reaching guidelines? Yes, that would normally be a concern! But, at closer scrutiny, my worries about these recommendation turn out to be much more serious than this.

The actual RCT (1) cited in support of all three recommendations stated that the authors “randomly assigned 75 patients to usual care and 227 patients to acupuncture plus usual care…” As we have discussed often before on this blog and elsewhere, such a ‘A+B versus B study design’ will never generate a negative result, does not control for placebo-effects and is certainly not a valid test for the effectiveness of the treatment in question. Nevertheless, the authors of this study concluded that: “Acupuncture is an effective intervention for managing the symptom of cancer-related fatigue and improving patients’ quality of life.”

RCT (2) cited in support of recommendation number 2 seems to be a citation error; the study in question is not an acupuncture-trial and does not back the statement in question. I suspect they meant to cite their reference number 87 (instead of 88). This trial is an equivalence study where 50 patients were randomly assigned to receive 12 weeks of acupuncture (n = 25) or venlafaxine (n = 25) treatment for cancer-related hot flushes. Its results indicate that the two treatments generated the similar results. As the two therapies could also have been equally ineffective, it is impossible, in my view, to conclude that acupuncture is effective.

Finally, RCT (1) does in no way support recommendation number two. Yet RCT (1) and RCT (2) were both cited in support of this recommendation.

I have not systematically checked any other claims made in this document, but I get the impression that many other recommendations made here are based on similarly ‘liberal’ interpretations of the evidence. How can the ‘Society for Integrative Oncology’ use such dodgy pseudo-science for formulating potentially far-reaching guidelines?

I know none of the authors (Heather Greenlee, Lynda G. Balneaves, Linda E. Carlson, Misha Cohen, Gary Deng, Dawn Hershman, Matthew Mumber, Jane Perlmutter, Dugald Seely, Ananda Sen, Suzanna M. Zick, Debu Tripathy) of the document personally. They made the following collective statement about their conflicts of interest: “There are no financial conflicts of interest to disclose. We note that some authors have conducted/authored some of the studies included in the review.” I am a little puzzled to hear that they have no financial conflicts of interest (do not most of them earn their living by practising integrative medicine? Yes they do! The article informs us that: “A multidisciplinary panel of experts in oncology and integrative medicine was assembled to prepare these clinical practice guidelines. Panel members have expertise in medical oncology, radiation oncology, nursing, psychology, naturopathic medicine, traditional Chinese medicine, acupuncture, epidemiology, biostatistics, and patient advocacy.”). I also suspect they have other, potentially much stronger conflicts of interest. They belong to a group of people who seem to religiously believe in the largely nonsensical concept of integrative medicine. Integrating unproven treatments into healthcare must affect its quality in much the same way as the integration of cow pie into apple pie would affect the taste of the latter.

After considering all this carefully, I cannot help wondering whether these ‘Clinical Practice Guidelines’ by the ‘Society for Integrative Oncology’ are just full of honest errors or whether they amount to fraud and scientific misconduct.

WHATEVER THE ANSWER, THE GUIDELINES MUST BE RETRACTED, IF THIS SOCIETY WANTS TO AVOID LOSING ALL CREDIBILITY.

I just came across this announcement and thought I let the readers of this blog know about it:

Journal of Cancer Therapy Special Issue on Complementary and Alternative Therapies for Cancer

A complementary therapy is treatment that is used along with standard medical treatment.  An alternative therapy is generally used instead of conventional medical treatment. They both are non-traditional methods of diagnosing, preventing, or treating cancer or its symptoms, and usually have not gone through rigorous testing and are not supported by evidence. Some types of therapy may not be completely safe and may even cause harmful side effects.

In this special issue, we intend to invite front-line researchers and authors to submit original research and review articles on exploring Complementary and Alternative Therapies for Cancer. Potential topics include, but are not limited to:

  • Acupuncture
  • Amygdalin
  • Brachytherapy
  • Cyberknife
  • Essiac therapy
  • Herbal remedies
  • Hyperbaric oxygen therapy
  • Ketogenic diet
  • Massage therapy
  • Music therapy
  • Photodynamic therapy
  • Relaxation techniques

I know nothing about this journal; I cannot say that it looks overtly woolly – but the announcement seems a little odd. Some of the treatments listed, for instance, clearly do NOT fall under the umbrella of CAM. And, somehow, I get the feeling that they might be looking for contributions that are in favour of CAM for cancer or promote ‘integrative oncology’ – but I might be entirely wrong here.
Anyway, to make sure they get some critical submissions on the subject, I thought I let all of you know. Perhaps you feel like sending them an article pointing out that AN ALTERNATIVE CANCER CURE IS A CONTRADICTION IN TERMS.

Non-validated diagnostic methods, like those in abundant use in alternative medicine, run an unacceptably high risk of producing false positive or false negative diagnoses. The former would be a diagnosis that the patient is, in fact, not suffering from; this enables the charlatan to get rich on treating something that is not even there. The latter would be missing an illness that might even kill the patient. Thus both scenarios are unquestionably harmful.

It is now 21 years ago that I published a review of alternative diagnostic techniques entitled ‘WHICH CRAFT IS WITCHCRAFT?’. Here is the abstract:

The prevalence of complementary medicine in most industrialised countries is impressive and increasing. Discussions of the topic often focus on therapeutic approaches and neglect diagnostic methods specific for complementary medicine. The paper summarises the data available on such “alternative” diagnostics. Scientific evaluations of these are scant, and most techniques have never been properly validated. The ones that have can be demonstrated to be not reproducible, sensitive, or specific. The ones that have not should be regarded as such until shown otherwise by rigorous testing. Therefore it seems that “alternative” diagnostic methods may seriously threaten the safety and health of patients submitted to them. Orthodox doctors should be aware of the problem and inform their patients accordingly.

Exactly 15 years after the publication of this paper, PRINCE CHARLES published his book ‘HARMONY‘ where is covers amongst many other topic also the subject of alternative diagnostics. This is what he tells us about them:

I have also learn from leading experts how we can understand a great deal about the causes of ill health through more traditional methods of diagnosis – for example, through examination of the iris, ears, tongue, feet and pulse, very much the basis of the Indian Ayurvedic system. This is not to say that modern diagnostic techniques do not have a role, but let us not forget what we can gain by using the knowledge and wisdom accumulated over thousands of years by pioneers who did not have access to today’s technology. In fact, an over-reliance can often mean that the subtle signs of imbalance revealed by the examination of the eyes, pulse and tongue are totally missed. Including the fruits of such knowledge, gleaned over 8 000 years of studying the relationship of the human body to the rest of Nature and to the Universe, can but only provide an extra, valuable resource to doctors as they seek to make a full diagnosis. Why persist in denying the immense value of such accumulated wisdom when it can tell us so much about the whole person – mind, body and spirit? Employing the best of the ancient and modern in a truly integrated way is another example of harmony and balance at work.

Charles is talking here about iridology, amongst other methods. Iridologists try to diagnose disease or susceptibility to disease by analysing the colour pattern of a patient’s iris. It happens to be a technique that has repeatedly been put to the test. In 1999, I published a systematic review of the evidence and concluded that the validity of iridology as a diagnostic tool is not supported by scientific evaluations. Patients and therapists should be discouraged from using this method.

Given that the evidence for alternative diagnostic techniques is either negative or absent, why does the heir to the throne advocate using them? Does he not know that he has considerable influence and endangers the health of those who believe him? Why does he call this nonsense valuable? The answer probably is that he does not know better.

There is nothing wrong with Charles’ ignorance, of course. He is not a medic (if he were, his quackery might get him struck off the register!) and does not need to know such things! But, if he is ignorant about certain technicalities, should he write about them? At the very least, when giving such concrete medical advice about diagnostic methods, should he not recruit the expertise of people who do know about such matters?

In Charles’ defence, I should mention that apparently he did ask several physicians for help with his book. Two of those who he acknowledged in HARMONY have been mentioned on this blog before: Mosaraf Ali and Michael Dixon.

I MIGHT BE MISTAKEN, BUT IT SEEMS TO ME THAT CHARLES IS NOT JUST IGNORANT ABOUT MEDICINE BUT ALSO ABOUT THE ART OF CHOOSING EXPERTS.

Over the years, I had to get used to some abominably poor research in alternative medicine, particularly homeopathy. This new paper takes the biscuit, in my fairly well-informed opinion.

The article in question reports a survey investigating the management of paediatric tonsillopharyngitis, with a focus on natural remedies. For that purpose, 138 paediatricians, general practitioners and ear-nose-throat (ENT) specialists from 7 countries were sent a self-made, non-validated questionnaire.

The results indicate that a rapid strept test (RST) to diagnose acute tonsillopharyngitis was routinely used by 41% of the respondents. The use of RST allowed 200 diagnosis/year compared with 125 diagnosis/year for clinicians who did not use this tool. Homeopathic remedies were prescribed as a supportive therapy by 62% of participants. Among different homeopathic remedies, SilAtro-5-90 was the most frequently prescribed. In the chronic setting, homeopathy was suggested as a supportive therapy by 59% of all participants, phytotherapy by 28% and vitamins/nutritional supplementation by 37%.

The authors of this paper concluded from these results that the management of tonsillopharyngitis in paediatric patients still remains empiric. Natural remedies, and homeopathy in particular, are used in the management of URTIs. An integrative approach to these infections may help reduce excessive antibiotic prescription.

No wonder that homeopathy and research into it are the laughing stock of the scientific community!

A survey of this nature is already a fairly daft idea. What could it possibly show? That health care professionals who like homeopathy answer, while the vast majority don’t!

But the pinnacle of silliness must be the conclusions drawn from such ‘research’. Let’s take them step by step:

  1. the management of tonsillopharyngitis in paediatric patients still remains empiric – this is not true nor is it borne out by the data generated.
  2. Natural remedies, and homeopathy in particular, are used in the management of URTIs – this may be true, but it has been known before; we therefore do not need to waste time and effort to re-state it.
  3. An integrative approach to these infections may help reduce excessive antibiotic prescription – this is not supported by the data and it also seems nonsensical: if it truly successful in reducing antibiotic prescribing, it is arguably no longer integrative but alternative.

So?

Say no more!

Consensus recommendations to the ‘National Center for Complementary and Integrative Health from Research Faculty in a Transdisciplinary Academic Consortium for Complementary and Integrative Health and Medicine’ have just been published. It appeared in this most impartial of all CAM journals, the ‘Journal of Alternative and Complementary Mededicine’. Its authors are equally impartial: Menard MB 1, Weeks J 2, Anderson 3, Meeker 4, Calabrese C 5, O’Bryon D 6, Cramer GD 7

They come from these institutions:

  • 1 Crocker Institute , Kiawah Island, SC.
  • 2 Academic Consortium for Complementary and Alternative Health Care , Seattle, WA.
  • 3 Pacific College of Oriental Medicine , New York, NY.
  • 4 Palmer College of Chiropractic , San Jose, CA.
  • 5 Center for Natural Medicine , Portland, OR.
  • 6 Association of Chiropractic Colleges , Bethesda, MD.
  • 7 National University of Health Sciences , Lombard, IL

HERE IS THE ABSTRACT OF THE DOCUMENT IN ITS FULL AND UNABBREVIATED BEAUTY:

BACKGROUND:

This commentary presents the most impactful, shared priorities for research investment across the licensed complementary and integrative health (CIH) disciplines according to the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). These are (1) research on whole disciplines; (2) costs; and (3) building capacity within the disciplines’ universities, colleges, and programs. The issue of research capacity is emphasized.

DISCUSSION:

ACCAHC urges expansion of investment in the development of researchers who are graduates of CIH programs, particularly those with a continued association with accredited CIH schools. To increase capacity of CIH discipline researchers, we recommend National Center for Complementary and Integrative Health (NCCIH) to (1) continue and expand R25 grants for education in evidence-based healthcare and evidence-informed practice at CIH schools; (2) work to limit researcher attrition from CIH institutions by supporting career development grants for clinicians from licensed CIH fields who are affiliated with and dedicated to continuing to work in accredited CIH schools; (3) fund additional stand-alone grants to CIH institutions that already have a strong research foundation, and collaborate with appropriate National Institutes of Health (NIH) institutes and centers to create infrastructure in these institutions; (4) stimulate higher percentages of grants to conventional centers to require or strongly encourage partnership with CIH institutions or CIH researchers based at CIH institutions, or give priority to those that do; (5) fund research conferences, workshops, and symposia developed through accredited CIH schools, including those that explore best methods for studying the impact of whole disciplines; and (6) following the present NIH policy of giving priority to new researchers, we urge NCCIH to give a marginal benefit to grant applications from CIH clinician-researchers at CIH academic/research institutions, to acknowledge that CIH concepts require specialized expertise to translate to conventional perspectives.

SUMMARY:

We commend NCCIH for its previous efforts to support high-quality research in the CIH disciplines. As NCCIH develops its 2016-2020 strategic plan, these recommendations to prioritize research based on whole disciplines, encourage collection of outcome data related to costs, and further support capacity-building within CIH institutions remain relevant and are a strategic use of funds that can benefit the nation’s health.

AND WHY DID THIS SURPRISE ME?

Well, I would have expected that such an impartial, intelligent bunch of people who are doubtlessly capable of critical analysis would have come up with a totally different set of recommendations. For instance:

  1. Integrative health makes no sense.
  2. Integrative medicine is a disservice to patients.
  3. Integrative health is a paradise for charlatans.
  4. No more research is required in this area.
  5. Research already under way should be stopped.
  6. Money ear-marked for integrative health should be diverted to other investigators researching areas that show at least a glimpse of promise.

Alright, you are correct – my suggestions are neither realistic nor constructive. One cannot expect that they will turn down all these lovely research funds and give it to real scientists. One has to offer them something constructive to do with the money. How about projects addressing the following research questions?

  1. How many integrative health clinics offer evidence-based treatments?
  2. Is the promotion of bogus treatments in line with the demands of medical ethics?
  3. If we need to render health care more holistic, humane, patient-centred, why not reform conventional medicine?
  4. Is the creation of integrative medicine a divisive development for health care?
  5. Is humane, holistic, patient-centred care really an invention of integrative medicine, and what is its history?
  6. Which of the alternative treatments used in integrative medicine can be shown to do more good than harm?
  7. What are the commercial drivers behind the integrative health movement?
  8. Is there a role for critical thinking within integrative health?
  9. Is integrative health creating double standards within medicine?
  10. What is better for public health, empty promises about ‘the best of both worlds’ or sound evidence?

On the website of the Bristol University Hospital, it was just revealed that UK homeopathy seems to have suffered another blow:

“Homeopathic medicine has been available in Bristol since 1852, when Dr Black first started dispensing from premises in the Triangle. During the next 69 years the service developed and expanded culminating in the commissioning in 1921 of a new hospital in the grounds of Cotham House. The Bristol Homeopathic Hospital continued to provide a full range of services until 1986 when the in-patient facilities were transferred to the Bristol Eye Hospital, where they continue to be provided, and outpatient services were moved to the ground floor of the Cotham Hill site. In 1994, following the sale of the main building to the University by the Bristol and District Health Authority, a new purpose built Department was provided in the Annexe buildings of the main building, adjoining the original Cotham House. The NHS Homeopathic Service is now being delivered on behalf of University Hospital Bristol by the Portland Centre for Integrative Medicine (PCIM), a Community Interest Company.”

The Portland Centre for Integrative Medicine has joined Litfield House offering medical homeopathy with Dr Elizabeth Thompson. And this is how the new service is described [I have added references in the following unabridged quote in bold which refer to my comments below]:

Medical Homeopathy is a holistic [1] approach delivered by registered health care professionals that uses a low dose of an activated [2] natural [3] substance [4] to stimulate a self-healing response in the body [5]. At the first appointment the doctor will take time to understand problem symptoms that might be physical, emotional or psychological and then a treatment plan will be discussed between the patient and the doctor [6], with homeopathic medicines chosen for you or your child on an individual basis.
WHAT CONDITIONS ARE SUITABLE FOR MEDICAL HOMEOPATHY?

Homeopathy can be safely [7] used to improve symptoms and well-being across a wide range of long term conditions: from childhood eczema [8] and ADHD [9]; to adults with medically unexplained conditions [10]; inflammatory bowel disease [11], cancer [12] or chronic fatigue syndrome [13]; and other medical conditions, including obesity [14] and depression [15]. Some people use homeopathy to stay well [16] and others use it to help difficult symptoms and/ or the side effects of conventional treatments [17].

This looks like a fairly bland and innocent little advertisement at first glance. If we analyse it closer, however, we find plenty of misleading claims. Here are the ones that caught my eye:

  1. Homeopaths claim that their approach is holistic and thus aim at differentiating it from conventional health care. This is misleading because ALL good medicine is by definition holistic.
  2. Nothing is ‘activated’; homeopaths believe that succession releases the ‘vital force’ in a remedy – but this is little more than hocus-pocus from the dark ages of medicine.
  3. Nothing is natural about endlessly diluting and shaking a medicine, while pretending that this ritual renders it more active and effective. And nothing is natural about remedies such as ‘Berlin Wall’.
  4. It is misleading to speak about ‘substance’ in relation to homeopathic remedies, because they can be manufactured also from non-material stuff too; examples are remedies such as X-ray, sol [sun light] or lunar [moonlight].
  5. The claim that homeopathic remedies stimulate the self-healing properties of the body is pure phantasy.
  6. “The doctor will take time to understand problem symptoms that might be physical, emotional or psychological and then a treatment plan will be discussed between the patient and the doctor” – this also applies to any consultation with any health care practitioner.
  7. Homeopathy is not as safe as homeopaths try to make us believe; several posts on this blog have dealt with this issue.
  8. There is no good evidence to support this claim.
  9. There is no good evidence to support this claim.
  10. There is no good evidence to support this claim.
  11. There is no good evidence to support this claim.
  12. There is no good evidence to support this claim.
  13. There is no good evidence to support this claim.
  14. There is no good evidence to support this claim.
  15. There is no good evidence to support this claim.
  16. True, some people use anything for anything; but there is no sound evidence to show that homeopathy is an effective prophylactic intervention for any disease.
  17. Nor is there good evidence that it is effective to “help difficult symptoms and/ or the side effects of conventional treatments”.

So, what we have here is a short paragraph which, on closer inspection, turns out to be full of misleading statements, bogus claims and dangerous lies. Not a good start for a new episode in the life of the now dramatically down-sized homeopathic clinic in Bristol, I’d say. And neither is it a publication of which the Bristol University Hospital can be proud. I suggest they correct it as a matter of urgency; otherwise they risk a barrage of complaints to the appropriate regulators by people who treasure the truth a little more than they seem to do themselves.

We used to call it ‘alternative medicine’ (on this blog, I still do so, because I believe it is a term as good or bad as any other and it is the one that is easily recognised); later some opted for ‘complementary medicine’; since about 15 years a new term is en vogue: INTEGRATED MEDICINE (IM).

Supporters of IM are adamant that IM is not synonymous with the other terms. But how is IM actually defined?

One of IM’s most prominent defenders is, of course Prince Charles. In his 2006 address to the WHO, he explained: “We need to harness the best of modern science and technology, but not at the expense of losing the best of what complementary approaches have to offer. That is integrated health – it really is that simple.”

Perhaps a bit too simple?

There are several more academic definitions, and it seems that, over the years, IM-fans have been busy moving the goal post quite a bit. The original principle of ‘THE BEST OF BOTH WORLDS’ has been modified considerably.

  • IM is a “comprehensive, primary care system that emphasizes wellness and healing of the whole person…” [Arch Intern Med. 2002;162:133-140]
  • IM “views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment.” [BMJ. 2001; 322:119-120]

During my preparations for my lecture at the 16th European Sceptics Congress in London last week (which was on the subject of IM), I came across a brand-new (September 2015) definition. It can be found on the website of the COLLEGE OF MEDICINE  This Michael Dixon-led organisation can be seen as the successor of Charles’ ill-fated FOUNDATION FOR INTEGRATED HEALTH; it was originally to be called COLLEGE FOR INTEGRATED MEDICINE. We can therefore assume that they know best what IM truly is or aspires to be. The definition goes as follows:

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.

This may sound good to many who are not bothered or unable to think critically. It oozes political correctness and might therefore even impress some politicians. But, on closer scrutiny, it turns out to be little more than offensive nonsense. I feel compelled to publish a short analysis of it. I will do this by highlighting and criticising the important implications of this definition one by one.

1) IM is holistic

Holism has always been at the core of any type of good health care. To state that IM is holistic misleads people into believing that conventional medicine is not holistic. It also pretends that medicine might become more holistic through the addition of some alternative modalities. Yet I cannot imagine anything less holistic than diagnosing patients by merely looking at their iris (iridology) or assuming all disease stems from subluxations of the spine (chiropractic), for example. This argument is a straw-man, if there ever was one.

2) IM is evidence-based

This assumption is simply not true. If we look what is being used under the banner of IM, we find no end of treatments that are not supported by good evidence, as well as several for which the evidence is squarely negative.

3) IM is intelligent

If it were not such a serious matter, one could laugh out loud about this claim. Is the implication here that conventional medicine is not intelligent?

4) IM uses all available therapeutic choices

This is the crucial element of this definition which allows IM-proponents to employ anything they like. Do they seriously believe that patients should have ALL AVAILABLE treatments? I had thought that responsible health care is about applying the most effective therapies for the condition at hand.

5) IM aims at achieving optimal health

Another straw-man; it implies that conventional health care professionals do not want to restore their patients to optimal health.

In my lecture, which was not about this definition but about IM in general, I drew the following six conclusions:

  1. Proponents of IM mislead us with their very own, nonsensical terminology and definitions.
  2. They promote two main principles: use of quackery + holism.
  3. Holism is at the heart of all good medicine; IM is at best an unnecessary distraction.
  4. Using holism to promote quackery is dishonest and counter-productive.
  5. The integration of quackery will render healthcare not better but worse.
  6. IM flies in the face of common sense and medical ethics; it is a disservice to patients.

The Americans call it ‘INTEGRATIVE MEDICINE’; in the UK, we speak of ‘INTEGRATED MEDICINE’ – and we speak about it a lot: these terms are, since several years, the new buzz-words in the alternative medicine scene. They sound so convincing, authoritative and politically correct that I am not surprised their use spread like wild-fire.

But what is INTEGRATED MEDICINE?

Let’s find out.

If the BRITISH SOCIETY OF INTEGRATED MEDICINE (BSIM) cannot answer this question, who can? So let’s have a look and find out (all the passages in bold are direct quotes from the BSIM):

Integrated Medicine is an approach to health and healing that provides patients with individually tailored health and wellbeing programmes which are designed to address the barriers to healing and provide the patient with the knowledge, skills and support to take better care of their physical, emotional, psychological and spiritual health. Rather than limiting treatments to a specific specialty, integrated medicine uses the safest and most effective combination of approaches and treatments from the world of conventional and complementary/alternative medicine. These are selected according to, but not limited to, evidence-based practice, and the expertise, experience and insight of the individuals and team members caring for the patient.

That’s odd! If the selected treatments are not limited to evidence, expertise, experience or insight, what ARE they based on?

Fascinated I read on and discover that there are ‘beliefs’. To be precise, a total of 7 beliefs that healthcare 

  1. Is individualised to the person – in that it takes into account their needs, insights, beliefs, past experiences, preferences, and life circumstances
  2. Empowers the individual to take an active role in their own healing by providing them with the knowledge and skills to meet their physical and emotional needs and actively manage their own health.
  3. Attempts to identify and address the main barriers or blockages to a person experiencing their health and life goals. This includes physical, emotional, psychological, environmental, social and spiritual factors.
  4. Uses the safest, most effective and least invasive procedures wherever possible.
  5. Harnesses the power of compassion, respect and the therapeutic relationship
  6. Focuses predominantly on health promotion, disease prevention and patient empowerment
  7. Encourages healthcare practitioners to become the model of healthy living that they teach to others.

I cannot say that, after reading this, I am less confused. Here is why:

  1. All good medicine has always been ‘individualised to the person’, etc.
  2. Patient empowerment is a key to conventional medicine.
  3. Holism is at the heart of any good health care.
  4. I do not know a form of medicine that focusses on unsafe, ineffective, unnecessarily invasive procedures.
  5. Neither am I aware of one that deliberately neglects compassion or disrespects the therapeutic relationship.
  6. I was under the impression that disease prevention is a thing conventional medicine takes very seriously.
  7. Teaching by example is something that we all know is important (but some of us find it harder than others; see below).

Could it be that these ‘beliefs’ have been ‘borrowed’ from the mainstream? Surely not! That would mean that ‘integrated medicine’ is not only not very original but possibly even bogus. I need to find out more!

One of the first things I discover is that the ‘Founder President’ of the BSIM is doctor Julian Kenyon. Now, that name rings a bell – wasn’t he mentioned in a previous post not so long ago? Yes, he was!

Here is the post in question; Kenyon was said to have misdiagnosed/mistreated a patient, exposed on TV, and eventually he ended up in front of the General Medical Council’s conduct tribunal. The panel heard that, after a 20-minute consultation, which cost £300, Dr Kenyon told one terminally-ill cancer patient: “I am not claiming we can cure you, but there is a strong possibility that we would be able to increase your median survival time with the relatively low-risk approaches described here.” He also made bold statements about the treatment’s supposed benefits to an undercover reporter who posed as the husband of a woman with breast cancer. After considering the full details of the case, Ben Fitzgerald, for the General Medical Council, called for Dr Kenyon to be suspended, but the panel’s chairman argued that Dr Kenyon’s misconduct was not serious enough for this. The panel eventually imposed restrictions on Kenyon’s licence lasting for 12 months.

Teaching by example, hey???

This finally makes things a bit clearer for me. There is only one question left to my mind: DOES BSIM PERHAPS STAND FOR ‘BULL SHIT IN MEDICINE’?

Recently, I was sent an interesting press release; here it is in full:

A new study has shed light on how cancer patients’ attitudes and beliefs drive the use of complementary and alternative medicine. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings may help hospitals develop more effective and accessible integrative oncology services for patients.

Although many cancer patients use complementary and alternative medicine, what drives this usage is unclear. To investigate, a team led by Jun Mao, MD and Joshua Bauml, MD, of the Abramson Cancer Center at the University of Pennsylvania’s Perelman School of Medicine, conducted a survey-based study in their institution’s thoracic, breast, and gastrointestinal medical oncology clinics.

Among 969 participants surveyed between June 2010 and September 2011, patients who were younger, those who were female, and those who had a college education tended to expect greater benefits from complementary and alternative medicine. Nonwhite patients reported more perceived barriers to the use of complementary and alternative medicine compared with white patients, but their expectations concerning the medicine’s benefits were similar. Attitudes and beliefs about complementary and alternative medicine were much more likely to affect patients’ use than clinical and demographic characteristics.

“We found that specific attitudes and beliefs — such as expectation of therapeutic benefits, patient-perceived barriers regarding cost and access, and opinions of patients’ physician and family members — may predict patients’ use of complementary and alternative medicine following cancer diagnoses,” said Dr. Mao. “We also found that these beliefs and attitudes varied by key socio-demographic factors such as sex, race, and education, which highlights the need for a more individualized approach when clinically integrating complementary and alternative medicine into conventional cancer care.”

The researchers noted that as therapies such as acupuncture and yoga continue to demonstrate clinical benefits for reducing pain, fatigue, and psychological distress, the field of integrative oncology is emerging to bring complementary and alternative medicine together with conventional care to improve patient outcomes. “Our findings emphasize the importance of patients’ attitudes and beliefs about complementary and alternative medicine as we seek to develop integrative oncology programs in academic medical centers and community hospitals,” said Dr. Bauml. “By aligning with patients’ expectations, removing unnecessary structural barriers, and engaging patients’ social and support networks, we can develop patient-centered clinical programs that better serve diverse groups of cancer patients regardless of sex, race, and education levels.”

And here is the abstract of the actual article:

BACKGROUND:

Complementary and alternative medicine (CAM) incorporates treatments used by cancer survivors in an attempt to improve their quality of life. Although population studies have identified factors associated with its use, to the best of the authors knowledge, assessment of why patients use CAM or the barriers against its use have not been examined to date.

METHODS:

The authors conducted a cross-sectional survey study in the thoracic, breast, and gastrointestinal medical oncology clinics at an academic cancer center. Clinical and demographic variables were collected by self-report and chart abstraction. Attitudes and beliefs were measured using the validated Attitudes and Beliefs about CAM (ABCAM) instrument. This instrument divides attitudes and beliefs into 3 domains: expected benefits, perceived barriers, and subjective norms.

RESULTS:

Among 969 participants (response rate, 82.7%) surveyed between June 2010 and September 2011, patient age ≤65 years, female sex, and college education were associated with a significantly greater expected benefit from CAM (P<.0001 for all). Nonwhite patients reported more perceived barriers to CAM use compared with white patients (P<.0001), but had a similar degree of expected benefit (P = .76). In a multivariate logistic regression analysis, all domains of the ABCAM instrument were found to be significantly associated with CAM use (P<.01 for all) among patients with cancer. Attitudes and beliefs regarding CAM explained much more variance in CAM use than clinical and demographic variables alone.

CONCLUSIONS:

Attitudes and beliefs varied by key clinical and demographic characteristics, and predicted CAM use. By developing CAM programs based upon attitudes and beliefs, barriers among underserved patient populations may be removed and more patient centered care may be provided.

Why do I find this remarkable?

The article was published in the Journal CANCER, one of the very best publications in oncology. One would therefore expect that it contributes meaningfully to our knowledge. Remarkably, it doesn’t! Virtually every finding from this survey had been known or is so obvious that it does not require research, in my view. The article is an orgy of platitudes, and the press release is even worse.

But this is not what irritates me most with this paper. The aspect that I find seriously bad about it is its general attitude: it seems to accept that alternative therapies are a good thing for cancer patients which we should all welcome with open arms. The press release even states that, as therapies such as acupuncture and yoga continue to demonstrate clinical benefits for reducing pain, fatigue, and psychological distress, the field of integrative oncology is emerging to bring complementary and alternative medicine together with conventional care to improve patient outcomes.

I might be a bit old-fashioned, but I would have thought that, before we accept treatments into clinical routine, we ought to demonstrate that they generate more good than harm. Should we not actually show beyond reasonable doubt that patients’ outcomes are improved before we waffle about the notion? Is it not our ethical duty to analyse and think critically? If we fail to do that, we are, I think, nothing other than charlatans!

This article might be a mere triviality – if it were not symptomatic of what we are currently witnessing on a truly grand scale in this area. Integrative oncology seems fast to deteriorate into a paradise for pseudoscience and quacks.

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