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

Prince Charles has published his views on integrated health several times before in medical journals. In 2001, authored an editorial in the BMJ promoting his ideas around integrative medicine. Its title: THE BEST OF BOTH WORLDS.[1] This was followed in 2012 by an article in the JRSM where he expressed his views even more clearly.[2] Here is an excerpt: 

… By integrated medicine, I mean the kind of care that integrates the best of new technology and current knowledge with ancient wisdom. More specifically, perhaps, it is an approach to care of the patient which includes mind, body and spirit and which maximizes the potential of conventional, lifestyle and complementary approaches in the process of healing. Integrated health, on the other hand, represents an approach to individual and population health which respects and includes all health-related areas, such as the physical and social environment, education, agriculture and architecture…

… I have been attempting to suggest that it might be beneficial to develop truly integrated systems of providing health and care. That is, not simply to treat the symptoms of disease, but actively to create health and to put the patient at the heart of this process by incorporating those core human elements of mind, body and spirit…

This whole area of work – what I can only describe as an ‘integrated approach’ in the UK, or ‘integrative’ in the USA – takes what we know about appropriate conventional, lifestyle and complementary approaches and applies them to patients. I cannot help feeling that we need to be prepared to offer the patient the ‘best of all worlds’ according to a patient’s wishes, beliefs and needs. This requires modern science to understand, value and use patient perspective and belief rather than seeking to exclude them – something which, in the view of many professionals in the field, occurs too often and too readily…

Now, surely, is the time for us all to concentrate some real effort in these areas. We will need to do so by deploying approaches which, at their heart, retain the crucial bedrock elements of traditional and modern civilized health care – of empathy, compassion and the enduring values of the caring professions.

Now Charles has used the current health crisis to do it again. His new article has just been published in the RCP’s ‘Future Healthcare Journal’ [3]. Allow me to show you a crucial section from it:

For a long time, I have been an advocate of what is now called social prescription and this may just be the key to integrating the biomedical, the psychosocial and the environmental, as well as the nature of the communities within which we live and which have such an enormous impact on our health and wellbeing. In particular, I believe that social prescription can bring together the aims of the health service, local authorities, and the voluntary and volunteer sector. Biomedicine has been spectacularly successful in treating and often curing disease that was previously incurable. Yet it cannot hold all the answers, as witnessed, for instance, by the increasing incidence of long-term disease, antibiotic resistance and opiate dependence. Social prescription enables medicine to go beyond pills and procedures and to recognise the enormous health impact of the lives we lead and the physical and social environment within which we live. This is precisely why I have spent so many years trying to demonstrate the vitally important psychosocial, environmental and financial added value of genuinely, sustainable urban planning, design and construction.

There is research from University College London, for instance, which shows that you are almost three times more likely to overcome depression if you have a hobby. Social prescription enables doctors to provide their patients with a bespoke prescription that might help them at a time of need (such as advice on housing and benefits) but which may also provide them with opportunities, hope and meaning by being able to engage in a range of physical, environmental and artistic activities, which resonate with where they are in their lives. Furthermore, social prescription has the potential not only to transform our understanding of what medicine is and does, but also to change the communities in which we all live. I understand, for instance, that alongside social-prescription link workers, there are now people responsible for redesigning and increasing the capacity of the local volunteer and voluntary sector, who can help to create a new social infrastructure and eventually, one might hope, communities that make us healthier rather than making us ill.

When we hear that a quarter of 14–16-year-old girls are self-harming and almost a third of our children are overweight or obese, it should make us realise that we will have to be a bit more radical in addressing these problems. And though social prescription cannot do everything, I believe that, used imaginatively, it can begin to tackle these deep-rooted issues. As medicine starts to grapple with these wider determinants of health, I also believe that medicine will need to combine bioscience with personal beliefs, hopes, aspirations and choices.

Many patients choose to see complementary practitioners for interventions such as manipulation, acupuncture and massage. Surely in an era of personalised medicine, we need to be open-minded about the choices that patients make and embrace them where they clearly improve their ability to care for themselves? Current NHS guidelines on pain that acknowledge the role of acupuncture and mindfulness may lead, I hope, to a more fruitful discussion on the role of complementary medicine in a modern health service. I have always advocated ‘the best of both worlds’, bringing evidence-informed conventional and complementary medicine together and avoiding that gulf between them, which leads, I understand, to a substantial proportion of patients feeling that they cannot discuss complementary medicine with their doctors.

I believe it is more important than ever that we should aim for this middle ground. Only then can we escape divisions and intolerance on both sides of the conventional/complementary equation where, on the one hand, the appropriate regulation of the proven therapies of acupuncture and medical herbalism is opposed while, on the other, we find people actually opposing life-saving vaccinations. Who would have thought, for instance, that in the 21st century that there would be a significant lobby opposing vaccination, given its track record in eradicating so many terrible diseases and its current potential to protect and liberate some of the most vulnerable in our society from coronavirus?

The new article has, I think, all the hallmarks of having been written by Dr Michael Dixon (who has featured many times on this blog). Like the previous papers under Charles’ name, it is a simple ‘BAIT AND SWITCH’ affaire (Bait and switch is a morally suspect sales tactic that lures customers in with specific claims about the quality or low prices on items that turn out to be unavailable in order to upsell them on a similar, pricier item. It is considered a form of retail sales fraud, though it takes place in other contexts).

The bait, in this case, is ‘social prescribing’ (the new hobby horse of Dixon) and the switch is the good old so-called alternative medicine (SCAM). I have discussed social prescribing before, looked at the evidence, and concluded as follows:

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.

So, was I right with my prediction that social prescribing will be used to smuggle bogus alternative therapies into the mainstream?

Sadly, the answer seems to be YES.

 

REFERENCES

[1] The best of both worlds | The BMJ

[2] Hrh. Integrated health and post modern medicine. J R Soc Med. 2012 Dec;105(12):496-8. doi: 10.1258/jrsm.2012.12k095. Epub 2012 Dec 21. PMID: 23263785; PMCID: PMC3536513.

[3] HRH The Prince of Whales: A message from HRH The Prince of Wales, honorary fellow of the Royal College of Physicians. Future Healthcare Journal 2021 Vol 8, No 1: 5–7

 

PS

Charles new article has a footnote: Address for correspondence: Clarence House, London SW1A 1BA, UK

If you feel strongly about his message, please do write to him and let us know what his response is.

10 Responses to Prince Charles did it again!

  • “ancient wisdom” = old wives’ tales i.e. unproven and unsubstantiated folk remedies that have not been scientifically tested. The vast majority turn out to be pure pseudoscience and therefore worthless.

    “integrated medicine” = the worst of both worlds i.e. mixing Evidence Based and Science Based Medicine with pseudoscientific claptrap and mumbo-jumbo that is cleverly couched in sciency sounding meaningless words such as “holistic” and “wellness” and referencing substances that have never even been demonstrated by any method to exist such as “chakras,” “qi,” “meridians,” “biofields,” and the like.

    It is especially unhelpful for “HRH the clueless” to refer to fields such as Acupuncture and Mindfulness as “proven” when this is far from the case.
    Acupuncture is nothing but a “theatrical placebo” and has never been demonstrated to be a practical treatment or cure for any condition beyond that of a placebo. It is far from a “proven” therapy.

    Mindfulness has been well overblown as a therapeutic modality. It is difficult even to reach a consensus on what is being referred to by different sources and what they mean by “mindfulness.” It has even been shown to worsen mental health states in many instances or cause some individuals to obsess about their state of mind.
    It has led to a glut of books, apps and individual “consultants” or “leaders” all with their own take on what is the best method.
    What is clear is that it is far from the panacea that it is made out to be and maybe HRH should “mind” his own business.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353526/

    https://www.theguardian.com/lifeandstyle/2019/jun/14/the-mindfulness-conspiracy-capitalist-spirituality

    https://www.learnreligions.com/the-mindfulness-controversy-449769

    https://neurosciencenews.com/mindfulness-problem-14196/

    As per usual HRH knows little or nothing whereof he speaks. He is dangerous not only because he lacks the self-awareness and the intelligence to realize that he s misinformed and is spouting nonsense with a big megaphone, but also because he lacks the ability to learn anything when he is informed of the truth.

    As Mark Crislip always says of Integrative Medicine – “mixing Cow Pie with Apple Pie doesn’t make the Cow Pie better – it makes the Apple Pie worse.”

    So my message disrespectfully to HRH would be to shut up and stick to talking to his potted plants where he can do less harm as he is totally clueless about anything else. The man is a complete idiot.
    SCAM should be consigned to the dustbin of history as good for nothing.
    The world would be better off sticking to those approaches to health which have a good scientific and evidence basis for actually being shown to work well.
    Listening to shamans and SCAMmers doesn’t turn out well and those who, like HRH, are gullible and easily easily misled by fairy tales and stories about the Emperor’s New Clothes and Tooth Fairy Science are not safe to be entrusted with the health of the nation.

    Unfortunately the Prince wouldn’t recognize Critical Thinking or a Logical Fallacy if he tripped over one on his estate.

  • Surely there is not a Doctor, Nurse, or other practitioner in Primary Healthcare, who is not well aware of the role of many integrated factors in healthcare and patient wellness. But you would need to quadruple the NHS budget, to make time and resources available to fully explore all these factors for each patient. Offering fake stuff instead, isn’t going to help (at least, not better than placebo).

    • @ David B

      absolutely!

      but that is part of the “Big Lie” of SCAM. they claim to have discovered this “holistic” nonsense. Conventional medicine has been using diet, exercise, sleep and all the other stuff that SCAM has misappropriated for itself for ages as well as the doctor/patient relationship as a healing tool (see Balint et al.)

      But one of the big differences is the amount of time that SCAMmers have to spend with their patients versus that allowed in the real world for conventional doctors and which patients appear to be prepared to pay for as long as it is SCAM.

      The other is that SCAMmers are allowed to lie through their teeth and promise all manner of utterly false outcomes from completely nonsensical therapies based on mere fantasy. Whereas conventional doctors are for the most part bound by a more stringent code of ethics and truth. It never sounds quite as miraculous when it is couched in realistic terms and patients are given true “informed consent.”

      And let’s face it there can be no side-effects from having “your chakras unblocked” can there? I mean performing a dyno-rod service on a non-existent entity can hardly do much harm so it’s really just fraudulent rather than physically damaging. It must be quite freeing to work in an environment where one can do no harm, merely invent fancy sounding procedures that sound mystical and expensive and wait for the dosh to roll in.

      Like PT Barnum once said – there’s one born every minute. (apparently he did not actually coin the phrase but who cares about accuracy any more?)

      This is not a level playing field.

  • So if one improves the social, economic, and physical environments, the overall level of health and well-being should improve? HRH may be on to something here.

    Those drains in London seem to have helped.

    • Joseph Bazalgette’s sewers have served London remarkably well for over 150 years, though unfortunately now they cover a population that is six times as large as they were originally rated for and they are starting to show their age. As a result Thames Water frequently has to discharge raw sewage into the River Thames when the storm drains can’t cope and the storm and sewage systems end up mixing. One consequence of this is a large number of wet wipes washing up on the banks of the river at Hammersmith and Chiswick (where I live when I’m not in Wiltshire). I don’t know why people think that it is OK to flush these down the loo.

  • I think people probably get confused between moist toilet tissues, which are flushable, and wet wipes for household cleaning, which are not. Maybe it’s a manifestation of simply not caring enough, as in fly tipping, where people dump an old sofa in the nearest bit of countryside, just to get it out of the house without paying.

  • Does anyone here believe that their mind has nothing to do with their health?

  • Maybe he is working on a plan to Escape from Eden

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