MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

One of my last posts prompted a comment informing us that Dr Dixon has just put himself forward as a candidate for the presidency of ‘THE ROYAL COLLEGE OF GENERAL PRACTITIONERS’ (RCGP) of the UK. This must be big news in the small world of alternative medicine and deserves further discussion.

Dr Dixon works in Cullompton Devon, where, according to one website, he has introduced over 20 complementary therapists alongside the normal GP services that would be expected anywhere. Patients have to pay for therapies such as healing, massage, acupuncture, or herbal medicine but at a reduced fee. The practice has its own organic and herb gardens and is next to a Boots store that stocks many of the remedies.

The RCGP’s announcement describes him with the following words:

Dr Dixon is NHS Alliance chairman, and has been a GP since 1984 at the College Surgery in Cullompton, Devon. He is acting president of NHS Clinical Commissioners, set up to represent CCGs after their creation in 2012, and has held a number of NHS advisory posts.

THE TELEGRAPH once listed Dr Dixon amongst the top ‘health gurus’ of Britain and commented: A trustee of the Prince’s Foundation for Integrated Medicine, the soothingly avuncular Dixon is one of the most persuasive advocates of complementary medicine, as well as one of its most dynamic practitioners. His new venture is an integrated health centre in Cullompton, Devon (opening in January), where practitioners of massage, homeopathy, acupuncture and so on will have rooms alongside his conventional GP’s surgery. If he’s good enough for Prince Charles… 

Flattering as they may be for Dr Dixon, I don’t think that these descriptions do him justice. They fail to stress that he has, since over 20 years, been fighting tirelessly for integrating unproven alternative therapies into the NHS. He even presided over Prince Charles’ FOUNDATION FOR INTEGRATED MEDICINE when it had to be closed down amidst allegations of fraud and money laundering. He now heads the successor organisation, THE COLLEGE OF MEDICINE, and is involved in uncounted similar initiatives promoting outright quackery. Examples include:

Dixon is a medical advisor to ‘YES TO LIFE’, an organisation advocating unproven treatments for cancer.

Dixon is a practitioner of spiritual healing.

Dixon advocates Johrei healing despite the fact that he was involved in a study we did which failed to show that it is effective.

Dixon is an advocate of homeopathy.

Dixon created the Culm Valley Integrated Centre for Health which offers unproven treatments such as homeopathy, neurolinguistic programming, Bowen technique, aromatherapy and, of course, healing.

Dixon is a patron of ‘THE QUIET MIND CENTRE’ which offers unproven treatments such as healing, reflexology, kinesiology, shiatsu, Indian head massage, zero balancing, and craniosacral therapy.

Dixon encourages GPs to use alternative medicine.

Dixon advocates the statutory regulation of Chinese herbalists.

Dixon is a ‘key lecturer’ at the BRITISH COLLEGE OF INTEGRATIVE MEDICINE.

Further revealing comments on Dr Dixon can be found here and here and here.

Finally, I recently published a short excerpt from my recent book ‘A SCIENTIST IN WONDERLAND’ in which Dr Dixon played a prominent role. I am hopeful that many GPs will read it.

Bearing all this in mind, I hope that many GPs will vote wisely on 5 May and vote for anyone except Dr Dixon to become the new president of the RCGP.
The question who presides over the RCGP is by no means trivial. It might decide whether we will have more quackery in British medicine or less; it might even turn the RCGP into the RCQ: the Royal College of Quackery.

38 Responses to Will the UK ‘ROYAL COLLEGE OF GENERAL PRACTITIONERS’ soon become a ‘ROYAL COLLEGE OF QUACKERY’?

  • Is there a reader of this account who can promulgate it (and the related posting -‘Dr Dixon’s safe herbal remedy’) to GPs more widely?
    “The only thing necessary for the triumph of evil is for good men to do nothing.” (Edmund Burke).

  • Previous President of the RCGP Clare Gerada has defended using placebo without informed consent. I’d rather have a doctor who promoted transparent nonsense like homeopathy than one who encouraged the manipulative use of less obvious placebos with vague references to reassurance, care, and the psychosocial aspects of health.

    I’d like to get rid of all the quackery from British medicine, but I do worry that there is a one-sided aspect to some people’s outrage, with supporters of ‘alternative’ nonsense receiving far more criticism than supporters of interventions with no better evidence of efficacy, but are seen as ‘mainstream’ or ‘conventional’.

      • Just ‘placebo’ was the example I used above, which is still seen by some within mainstream medicine as something which can be used on patients without informed consent. Beyond that, but related, there seems to be a worrying disinterest in problems with bias in unblinded trials for a range of behavioral and psychosocial interventions. This is a particular problem for patients with poorly understood diagnoses like back pain, fibromyalgia, chronic fatigue syndrome, etc.

        The Lancet Psychiatry recently published a number of letters in response to a RCT for CFS raising concerns about the quality of evidence that the way results have been presented. One specifically detailed potential problems with bias in unblinded trials: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2815%2900089-9/fulltext Another with deviations from the trial’s protocol: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2815%2900110-8/fulltext Another with problems with the interventions underlying hypothesis: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2815%2900054-1/fulltext and so on.

        In response the authors felt able to dismiss these concerns out of hand: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2815%2900114-5/fulltext

        If homeopaths had tried to get away with presenting results in this way, or so casually dismissing concerns about their interpretations without supporting evidence or argument, I think that this would have drawn more criticism. Currently a lot of money is being spent on interventions like these, and a lot of patients are putting their time and effort into them on the basis of exaggerated claims about their efficacy.

        • ‘Chucky’ (who ever he/she is) raises interesting issues (anonymously), but they have nothing to do with this thread which is about Dr Dixon, his professionalism, and ambition to lead the GP profession.

          ‘Tu Quoque’ (‘you’re just as bad’) is a fallacy and unhelpful to the thrust of present discourse.

          Problems with conventional medicine will not be solved, and ongoing attempts to solve them are not helped by association or comparison with health systems inimicable to good science and founded as alternatives.
          Dragging concerns about conventional care into discussions is a ‘red herring fallacy’.

          • Pardon my taking things somewhat off-topic. My original comment was just a brief one, and partly prompted by the response to this post I had seen elsewhere rather than this post itself. I do not think my posts contain any sort of fallacy, and do think that important lessons can be learned from the problems around CAM, and that these can be usefully applied to conventional medicine. Perhaps this is not the time or place to discuss this, but then, it is a discussion that many seem to want to avoid.

          • Any other time, any other place.
            If only we knew who you are.

          • Actually the post is everything to do with Dr. Dixon, since your criticism of him is based solely on the fact that he is supporting CAM initiatives and not on his qualities and skills as a doctor. Your dislike of CAM seems overstressed given that orthodox studies get away with poor science but are not criticised in the same way. Hence your dislike of Dr. Dixon rests on a more tenuous base than you would like us to believe. I don’t know anything about Dr. Dixon but his attempts to run orthodox and unorthodox treatments side by side seem to be a good way of confirming or not confirming the benefits of CAM where it really matters.

          • please study the links I provided before you write such nonsense.

        • Indeed, I take your specific point here, x, but not what I think is your general one.

          Science doesn’t work because it assumes that people are good: it works because it assumes that they are full of cognitive biases. Scientific methods and protocols of science help address these biases, in the long run. In the short term, they can make it clear when good practice has not been followed, as, perhaps, in your example.

          But this is a different category from homoeopathy. Homoeopathy is impossible in a non-magical world: its major principles of Like Cures Like and Nothing is better than Something, are absurdities. None the less, I would be easy to convince. Back in the days before Health and Safety, we used to run a class practical for medical students showing the effect of aspirin on blood clotting. Give me a reliable class practical schedule showing homoeopathy working, and I’d be most impressed.

          Instead, though, homoeopaths take refuge in the last resort of scientific scoundrels: since scientific methods do not show any repeatable effect of homoeopathy, then scientific methods must be wrong. Those whom the evidence is against, are geneally opposed to the concept of evidence

          Not far from the time of homeopathy’s origins, chemists believed in phlogiston and physicists believed in the luminiferous ether. Neither do so any more. That some doctors still ‘believe’ in homoeopathy is a question for sociologists of medical culture, not scientists.

          • ‘x’ is chucky, BTWE – I was drafting off screen, and when I came on to check Chucky’s name, my draft posted incontinently.

          • I’m not sure what the general point that you’re challenging is Allo V Psycho. It may not be something I intended to put forth, but it can be difficult to be clear in a brief comment. I certainly recognise the value of science in helping patients to make more informed decisions about their healthcare (and may other things).

            My problems with quackery stems more from political and moral concerns than scientific ones. In the long-run, we’re all dead, but meanwhile patients are being misled and resources misdirected. While in other areas the self-correcting processes of science may be able to whirr away without causing too much harm, in medicine error, bias, hype and exaggeration can rapidly lead to the mistreatment of other human beings.

            And beyond medicine, we have seen how the biopsychosocial model of disability and the exaggerated claims made about the role of psychosocial factors in maintaining sickness and ill health have been used by the DWP and Lord Freud (the trial criticised in the letters I posted above is the only piece of medical research to have received funding from the DWP) to justify dramatic changes to the British welfare state which have left sick and disabled people much worse off. They also seem to play a role in senior politician’s misguided views about the extent to which people’s refusal to engage in effective treatment costs the state money, most recently illustrated by the Conservative parties manifesto including this: “People who might benefit from treatment should get the medical help they need so they can return to work. If they refuse a recommended treatment, we will review whether their benefits should be reduced.”

            Allowing people to claim expertise about how others should live their lives based upon poor quality or spun evidence is an abuse of power, and we should be pushing back against it regardless of whether it is justified through transparent absurdities, spiritualism, or tales better suited to a more secular and scientific age. Derren Brown’s earlier use of psychology to dress up his magic tricks was clever and amusing, but also reflects how people dismissive of ‘magic’ can be fooled by old tricks when more plausible sounding nonsense is used as a distraction.

            While none of this is to say that we should not be concerned by things like homeopathy, I think that more transparent absurdities now tend to be less able to harm others because they can be so readily challenged by those who are being mistreated. The lessons we have learned from picking apart misleading arguments and evidence used to support the promotion of CAM needs to be quickly applied to the evidence used to justify some conventional medical interventions and claims of expertise. I doubt that the most serious problems with quackery to be faced by the RCGP’s President in the next few years will be related to alternative medicine and worry that some of the responses I have seen to this post reflect more of a concern to maintain respect for GPs as a profession than a real commitment to ensuring that patients are treated fairly.

  • While immediately declaring that I am a Trustee of the College of Medicine (principally governance not policy) and agreeing with Richard that Chucky’s comments, while well thought through, are slightly left field, they are nevertheless relevant to the underlying questions raised about Michael Dixon’s well known interest and support for elements of complementary medicine.

    I am certainly no apologist for homeopathy and it is arguable that some complementary therapies (e.g. acupuncture and traditional Chinese medicine) can have positive therapeutic effects although we may not understand the science, but I do believe in the placebo effect. Voltaire said that medicine was ‘the art of entertaining the patient while nature cures the disease’ and he wasn’t far wrong in the 18th century – although the over prescription of antibiotics comes to mind as I write – but what many complementary medicine practitioners do bring to their patients is those old arts of medicine which have always ‘entertained’ the patient – time, touch and compassion – and which, I believe, may enhance the placebo effect.

    I have great respect for Professor Ernst and I used to take a very tough scientific evidence based line when I was representing a commissioner (health insurer) in the private sector but, having seen the great psychological or feel-good ‘benefit’ which many people seem to gain from some complementary therapies (and are prepared to pay for in their millions), particularly those with cancer and long term conditions, I do feel we in the medical profession need to be careful in making judgements about those therapies and the people who advocate their use as a part of an integrated approach to care, as long as proper medical diagnosis and informed consent for all treatment options comes first.

    Returning to Richard’s red herring, ‘primum nil nocere’ (first do no harm) is a key maxim for all health professionals but, sadly, sometimes our interventions (and occasionally over-intervention) do cause harm, whereas I believe this is rarely the case with most complementary therapies i.e. if in a glass house be careful about throwing stones!

    • Andrew,
      Conventional, Orthodox Medicine (COM) is not perfect, but it tries to be and uses the scientific method in persuit of perfection.
      CAM does not.
      CAM that has any effect on specific disease is…medicine.

      CAM ‘works’ to the extent it provides comfort and solace to some patients on account of placebo effects.
      The problem is few camists (practitioners of CAM and their apologists) tell their patients this.
      They claim they move ‘innate intellegence’, ‘vital forces’ and their remedies have effects though they contain no active principle. They have no controlled trials to speak of to support these contentions.

      It is irrelevant whether COM is perfect or not. That is a red herring and logical fallacy.
      The issue is – are camists honest with their patients or do they lack integrity?
      If so, should they lead the medical profession?
      Patients are being misled and cannot give informed consent.
      That is to be deprecated and so are practitioners who endorse this approach.

      Chucky (whoever you are). I do not dislike Dr Dixon. I have never met him.
      They way to find out if a treatment works is to find out by comparing it to placebo treatment in a controlled trial. Do you know any CAMs to have been trialled thus?

      • Richard, I have no more time for blatant quackery (i.e. people deliberately conning patients out of their money) than you or the other responders do. I accept that some CAMs may not have professional integrity but some do have that integrity.
        I have seen the application of time, touch and compassion and a bit of ‘therapy’ in properly organised clinics and centres run, for instance, by cancer charities and I have seen the benefit they bring. So, no, it’s not evidence in highly selective RCTs, but it’s observational and real world.
        At a time when many patients with long term conditions and end-stage cancer are as much concerned with quality of life as quantity of life, good CAMs attempt to treat the patient not the condition. These CAMs seek to be as professional as you and I and, at a time when technology increasingly drives healthcare and many doctors say they just don’t have the time for those old arts to which I referred, who are we to judge and try and take that undoubted benefit away from those patients?

        • I do not seek to deny patients access to camistry.
          I simply ask that camists practice with honesty and integrity and obtain patient’s fully informed consent with the understanding they are to receive TLC and the benefit of placebo effects.
          There are no chakras, innate intelligence, manually created healing energies, meridians, energy zones, auras.
          Any practitioner who tries to suggest otherwise is trying to mislead patients and may be committing fraud.
          As a member of The Magic Circle I do try to fool folks, but health care practitioners must practice with more probity and not patronise their patients.

      • You seem to have misunderstood something. I am not sure what.

    • @Andrew Vallance-Owen

      …having seen the great psychological or feel-good ‘benefit’ which many people seem to gain from some complementary therapies…

      If you read the comments in the many threads on this blog, as well as testimonies to the great psychological or feel-good effects of complementary witchcraft you will find a pretty considerable number of people who comment that they experienced no benefit and even definable harms from CAM. So how do you reconcile these positions? Good sense would suggest respectably designed scientific trials might reveal the quantitative risks and benefits rather than the hand-waving your post indulges.
       
      Sadly, from the many trials that have been done, there emerges no serious support for any of the many branches of educationally insulting superstitions that masquerade as a complement or alternative to medical science. You, yourself, simply cannot predict which patients will benefit from which form of what you reasonably call ‘entertainment’. So referring patients to quacks, regardless of informed consent, itself amounts to a form of over-treatment. And you are plain wrong about the lack of harm.
       
      Bottom line… your tu quoque reasoning shows beyond doubt that you most definitely have become an apologist for homeopathy — and the rest of the belief in fairies. You prefer to keep your patients happy and ignorant. This is the sort of patronizing attitude that needs to be stamped out of medical practice.

      • “Returning to Richard’s red herring, ‘primum nil nocere’ (first do no harm) is a key maxim for all health professionals but, sadly, sometimes our interventions (and occasionally over-intervention) do cause harm, whereas I believe this is rarely the case with most complementary therapies i.e. if in a glass house be careful about throwing stones!”

        We must take into account the fact that desperate patients can spend thousands of pounds on quackery. Harm is done – to their wallets, as they seek cure after cure after cure. Some sick people are no longer able to work, and this money comes from benefits or savings – money they can ill afford to fritter away on useless therapies. There’s no placebo effect once the patient realises that they have been conned!

        Complimentary therapies are occasionally free, but often quackery costs the patient dearly, in £. I am astonished and rather appalled by your attitude to be honest.

        • “often quackery costs the patient dearly, in £”

          Yes, and it is also important to be aware of costs to patients in terms of time, effort, social consequences, and so on. Quackery, placebo without informed consent and all inaccurate information can cause harm in a wide range of ways even when provided for free. Much placebo-based CAM will do less harm than other forms of inappropriate medical care, but they can still bring with them a wide ranges of costs. Downplaying these potential harms has been used to justify a careless and manipulative approach to informed consent.

          Andrew Vallance-Owen said “if in a glass house be careful about throwing stones!”

          There are problems in both CAM and conventional medicine with attitudes towards informed consent and a fair presentation of the available evidence, and I would like to encourage the stone-throwing. Hopefully the concern people feel at the obvious problems with complementary medicine can help lead to real improvements to some of the similar but less transparent problems in conventional medicine too.

          • You mention harm(s) arising from “other forms of inappropriate medical care”, and “the similar but less transparent problems in conventional medicine too” in relation to “attitudes towards informed consent and a fair presentation of the available evidence”.

            I think it would be helpful to have a fuller description of these issues, with examples of what the harms and similar but less apparent problems might consist of. I am neither agreeing nor disagreeing, but seeking clarification and expansion of your argument.

            I am reasonably familiar with the issues relating to the NICE recommended treatments for CFS/ME. And I understand the patient/voluntary sector concerns about those, and the controversial PACE trial.

            But moving outside that relatively narrow sphere (no disrespect to people with CFS/ME), I’d be interested to see your evidence for a more widespread problem within “mainstream” medicine, which you imply exists.

          • “moving outside that relatively narrow sphere”

            I’ve already been told off for going OT here!

            There are lots of things, many of which are widely discussed amongst researchers, but that patients are left largely oblivious to. I tried to give a rough outline of my concerns in my earlier response to Allo V Psycho. I don’t think I’m saying anything particularly novel, even if there is sometimes a willingness to hold conventional medicine to unfortunately low standards.

            A wide range of talking, behavioral, rehabilitative and occupational therapies have no better evidence for efficacy than improvements in self-report measures from unblinded trials. Yet patients are routinely informed that these interventions have been shown to improve symptoms, without clinicians explaining the potential problems with bias, the difficult of reliably measuring symptoms, or putting results in the context of the effects shown for interventions such as homeopathy. There is the now more widely recognised problems with results from some trials not being reported, or being spun by researchers in ways which which serves to exaggerate the value of their work. More broadly the systems of academia and research do more to encourage exaggerated claims than they do to encourage people to take the time to look carefully and critically at the evidence and call colleagues out on their hype and spin. (There’s been more discussion about the need for greater incentives for post-publication review recently, but nothing has really come of it). There are more particular things like, for example, problems related to assumptions of cognitive distortions in depression that endure and affect how patients are treated despite evidence that those with mild-moderate depression tend to have realistic beliefs and expectations. The view that patients should be manipulated into engaging in treatments is not just a creation of politicians, but something that is also seen within the mainstream medical profession. There are the political and social problems related to the promotion of the biopsychosocial model that I mentioned above and seem most targeted towards stigmatised health conditions. One can go on and on. If you are familiar with the problems surrounding the PACE trial, that seems to be relatively good example of many of these problems.

            You might be interested in articles like this: http://www.biomedcentral.com/2050-7283/1/2 ? Ioannidis’s ‘Why Most Published Research Findings Are False’ is now ten year’s old, but I’m not sure how much things have really moved on since then: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124 These focus more on research than the political and social side of things.

    • Andrew, I really enjoyed reading your thoughtful comment. Those old arts of medicine that you described — entertainment, time, touch, and compassion — I believe not just enhance the placebo effect, in many cases they are the placebo. I think these things are exactly what some/many patients want and need from a complementary therapist: such patients don’t actually want the therapy itself, they want just the time, touch, and compassion aspects of the complementary therapy. Entertainment, when used appropriately, can be wonderfully uplifting.

      Such patients tolerate receiving the actual ‘treatment’ aspect because it would be deeply humiliating to admit to an acupuncturist, for example, “I want only your time, touch, and compassion; I don’t actually want to be a pincushion during our sessions together.”

      What I’m suggesting is that the placebo *is* the time, touch, and compassion; whereas the treatment itself serves the very different, yet equally important, purpose of creating a binding contract between the patient and practitioner: the ‘treatment’ builds a two-way trust relationship between the them; it also creates a tangible transaction between them. E.g. if a homeopath admitted to their patients that the sugar pill remedies were just a placebo then it would not properly establish the trust relationship and tangible contract with their patients that is required to elicit the maximal placebo reaction.

      I’ll now explain the reasons for my strong objection to the use of complementary therapies (alt-med). Reflexology is a nice relaxing foot massage with a fancy name and it appears to meet my above suggestion regarding a maximally beneficial placebo. However, just because the evidence shows us that reflexology is only a foot massage does not lead to the conclusion that a foot massage is therefore equivalent to reflexology. A reflexologist mistakenly believes that they can diagnose and treat health problems. Any health ‘diagnosis’ by a reflexologist will very likely elicit in the patient a nocebo reaction rather than a placebo reaction: eliciting nocebo reactions is well known to be more powerful than eliciting placebo reactions — the mass media and advertising relies very heavily on this reaction asymmetry!

      What actually happens when patients of complementary therapist either get no better or get worse during the treatment? Do the therapist refund the treatment costs? No, of course therapists never admit that their treatment is quackery; the timeless art of vending snake oil. Astute therapists suggest that the patient might be suffering from candida, leaky gut, heavy metal toxicity, etc. and should book an appointment with another therapist — whom they just happen to know personally to be very good at treating this ‘illness’. It’s the game of “pass the parcel” with an interesting twist: the patient is the parcel and the winners are always the alt-med practitioners.

      I fully support the appropriate use of evidence-based placebos, so where might we find adequately qualified and audited providers who will be summarily dismissed for using scaremongering to line their pockets via nocebo reactions? It certainly isn’t within alt-med aka complementary medicine aka integrative medicine because none of these practices are mandated to have, as a bare minimum, a recognised qualification in basic counselling and listening skills, which includes the requirement to fully understand one’s therapeutic limitations and to properly identify the patients who must be referred and transferred to a suitably qualified medical health care professional (not transferred to another quack).

      Physical and psychological conditions are frequently, perhaps nearly always, compounding and confounding co-morbid conditions. No single practitioner, nor single branch of medicine, has nearly enough expertise and scope to treat these dual conditions in their patients. Alt-med is by far the worst choice for ‘integrative medicine’. In the UK we are very fortunate to already have teams of highly qualified and accountable people to address the psychological aspects of illness — these people rely heavily on evidenced-based health care rather than on alt-med quackery which profits by vending snake oil.

      • So can we perhaps link two different threads on Edzard’s blog? What we should be teaching medical students about alt med is a mix of evidence-based critique of the anti-scientific claims together with some training in being good nocebo/placebo “entertainers”. Very many practitioners, particularly in primary care where it’s most important, seem to lack even rudimentary abilities where empathy and compassion are concerned. The current pressures within the (UK) health services do little to help.

        • “Very many practitioners” – what is your evidence for this?

          I don’t know of any research into the prevalence of compassion/empathy in the NHS, in either primary or secondary care. Perhaps you do and can extract the data for our benefit!

          If this statement about “very many practitioners” is based on your personal experience or the anecdotal experience of others, of course that is fine, but I’d rather be clear about that.

          • @Cathy Stillman-Lowe
            Fair enough; point taken. The comment is based on my own personal experience (as a colleague and a patient) plus the endless succession of media stories from patient anecdotes that attest to their feeling of not being treated as people. Like you I’m unaware of dispassionate research into the levels of compassion shown by practitioners, but would be delighted to find there is something to address this widely publicized problem. CAM people often (impression, no data) claim that patients are driven into their hands by the lack of empathy from qualified medics.
            Edited to add: good grief — see comment below from Andrew Vallance-Owen that health professionals are just too busy to give patients the time they need! Is that too busy pushing paper or too busy because we have too low a ratio of doctors to patients in the UK? Evidence please, Dr Vallance-Owen. Either way, there’s your attestation from a man at the top!

      • Thanks for your response Pete, I agree with much of what you say.
        In my own piece I said that medical diagnosis must come first and I am equally concerned about CAMs who make their own diagnosis and do their best to keep people away from conventional medicine. As you say, ‘physical and psychological conditions are frequently, perhaps nearly always, compounding and confounding co-morbid conditions’ so, to me, where there is a role for CAMs, it comes after diagnosis and should be complementary to, not alternative to conventional medicine.
        I was involved in the work towards regulation of osteopathy and believe that has led to proper qualifications, higher standards and more consistent approaches to that therapy. So, in answer to your question: ‘where might we find adequately qualified and audited providers who will be summarily dismissed for using scaremongering to line their pockets via nocebo reactions?’, my answer is through professional regulation and clear standards of practice which require not an alternative approach but a complementary, post-medical diagnosis approach with the professional requirement to understand limitiations and, as you say, qualification in counselling and listening skills.
        As you have seen, I believe certain complementary therapies do have a place in the modern high pressure world where many health professionals are just too busy to give patients the time they need, but there are some quacks and charlatans out there who are able to practise and sell their snake oil with no constraint or regulation to constrain them. It is high time, in my view, that this unconstrained highly dubious and commercial practice, which may indeed potentially harm patients was tackled, leaving those CAMs who do actually do good work within a professional context to continue bringing benefit particularly to people in need for whom conventional medicine has run out of steam.

        • @Andrew Vallance-Owen
          I’m sure we all understand the sentiment you’re expressing. But who is to judge which CAMs actually do good (albeit sham, entertainment) work? The regulation that each witchcraft ‘profession’ seeks is the kind of self-governance we see for chiropractic. Homeopaths should regulate homeopaths, and so on. That’s simply absurd. Why can’t qualified doctors do a better job themselves on the entertainment/compassion side of the business? If you really think we need legions of regulated people spouting nonsense as a support for orthodox medicine you’re advocating something that makes the present situation even worse!

          • Famous French magician Jean-Robert Houdin (thence ‘Houdini’) said
            “A magician is an actor playing the part of a magician.”

            By the same token, for some of the time a doctor is indeed an actor playing the part of a doctor. Offering care, compassion, hope and love.
            TLC works.
            For much of the time, doctors and conventional healthcare practitioners are affecting disease as well.
            Camists do not reach that stage – but pretend and falsely claim they do.
            That is the difference, and the issue.

          • @Richard
            Hear, hear! I’m trying to picture the informed consent form for a patient referred to a CAM practitioner by a qualified physician…
             
            “I am referring you for extramural TLC from a person who practices complementary/alternative medicine. Please choose from the following list. Note that each of the therapies listed claims to be able to cure every type of disease, but well conducted clinical trials have shown no effects above placebo, and none is based on any form of rationale that is consistent with current scientific knowledge.”

          • I wholly agree that doctors could often do a better themselves in bringing time, touch and compassion to the consulting room. When I speak to young medics I promote this all the time, not only because of the benefit to patients but also because it helps to build trust, and trust enables a better and more open discussion with the patient which helps when it comes to diagnosis and deciding on appropriate treatment.

            Sadly, though, sometimes it is qualified doctors and healthcare professionals who are peddling highly doubtful treatments. I gather that on ‘Inside Harley Street’ tonight we will see a financial consultant forking out for an intravenous vitamin infusion (sometimes advertised to enhance the immune system). I have found no evidence of benefit from these infusions and there is always, of course, risk with injecting anything intravenously. Frankly, I would prefer that these qualified healthcare professionals ‘only’ stuck to time, touch and compassion!

          • Andrew Vallance-Owen said:

            Sadly, though, sometimes it is qualified doctors and healthcare professionals who are peddling highly doubtful treatments. I gather that on ‘Inside Harley Street’ tonight we will see a financial consultant forking out for an intravenous vitamin infusion (sometimes advertised to enhance the immune system). I have found no evidence of benefit from these infusions and there is always, of course, risk with injecting anything intravenously. Frankly, I would prefer that these qualified healthcare professionals ‘only’ stuck to time, touch and compassion!

            I’m not sure the people giving these treatments are ‘qualified healthcare professionals’! As I understand it, ‘Dr’ Zhai and ‘Dr’ Culp are not GMC-registered doctors.

          • Andrew, many thanks for your comments and especially for your endeavours in bringing about worthwhile changes (perhaps the most difficult task that anyone can undertake).

            Best wishes,
            Pete

  • If all that we were not enough, Michael Dixon seems to like the notorious private medical company, Capita, rather too much. Details at http://www.dcscience.net/2012/05/03/the-college-of-medicine-is-in-the-pocket-of-crapita-capita-is-graeme-catto-selling-out/

  • The election results have been published: RCGP announces Terry Kemple as new President

    Dixon came last:

    The role was contested by four College members and the results are as follows:
    1. Dr Terry Kemple
    2. Professor Mayur Lakhani
    3. Dr Colin Hunter
    4. Dr Michael Dixon

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