On this blog, I have repeatedly tried to explain why integrative (or integrated) medicine is such a deceptive nonsense; see for instance here, here and here. Today, I have reason to make another attempt: The International Congress on Integrative Medicine & Health.
In 2012, I published an analysis of the ‘3rd European Congress of Integrated Medicine’ which had taken place in December 2010 in Berlin (in Europe they call it ‘integrated’ and in the US ‘integrative’ medicine). For this purpose, I simply read all the 222 abstracts and labelled them according to their contents. The results showed that the vast majority were on unproven alternative therapies and none on conventional treatments.
The abstracts from the International Congress on Integrative Medicine & Health (ICIMH, Green Valley Ranch Resort, Las Vegas, Nevada, USA, May 17–20, 2016) which were just published provide me with the opportunity to check whether this situation has changed. There were around 400 abstracts, and I did essentially the same type of analysis (attributing one subject area to each abstract). And what a tedious task this was! I spotted just two articles of interest, and will report about them shortly.
This time I also assessed whether the conclusions of each paper were positive (expressing something favourable about the subject at hand), negative (expressing something negative about the subject at hand) or neither of the two (surveys, for instance, rarely show positive or negative results).
Here are the results: mind-body therapies were the top subject with 49 papers, followed by acupuncture (44), herbal medicine (37), integrative medicine (36), chiropractic and other manual therapies (26), TCM (19), methodological issues (16), animal and other pre-clinical investigations (15) and Tai Chi (5). The rest of the abstracts were on a diverse array of other subjects. There was not a single paper on a conventional therapy and only 4 focussed on risk assessments.
The 36 articles on integrative medicine deserve perhaps a special mention. The majority of these papers were about using alternative therapies as an add-on to conventional care. They focussed on the alternative therapies used and usually concluded that this ‘integration’ was followed by good results. None of these papers discussed integrative medicine and its assumptions critically, and none of these investigations cast any doubt about the assumption that integrative medicine is a positive thing.
I should also mention that my attributions of the subject areas were not always straight forward. I allowed myself only one subject per paper, but there were, of course, many that could be categorised in more than one subject area ( for instance, a paper on an herbal medicine might be in that category, or in TCM or in pre-clinical). So I tried to attribute the subject that seemed to dominate the abstract in question.
My analysis according to the direction of the conclusions was equally revealing: I categorised 260 papers as positive, 5 as negative and 116 as neither of the two. That means for every negative result there were 52 positive ones. I find this most remarkable.
Essentially, my two analyses of conference abstracts published 6 years apart show the same phenomenon: on the ‘scientific level’, integrative medicine is not about the ‘best of both worlds’ (i. e. the best alternative medicine has to offer integrated with the best conventional medicine offers) – the slogan by which advocates of integrative medicine usually try to ‘sell’ their dubious approach to us. It is almost exclusively about alternative therapies which advocates of integrative medicine aim to smuggle into mainstream healthcare. Critical analysis seems to be unwelcome in this area, and – perhaps worse of all – in the last 6 years, there does not seem to have been any improvement.
And that’s just on the ‘scientific level’, as I said. If you wonder what is happening on the ‘practical level’, you will find that, in the realm of integrative medicine, every quackery under the sun is being promoted at often exorbitant prices to the often gullible and always unsuspecting public. If you don’t believe me, search for ‘integrative medicine clinic’ on the Internet; I promise, you will be surprised!
Personally, I am sometimes amused by the sheer idiocy of all this, but more often I am enraged and ask myself:
- Why are we allowing quackery to make such a spectacular come-back?
- Why is hardly anyone voicing strong objections?
- Is it not our ethical duty to do something about it and try to prevent the worse?
One argument I hear over and over again; it could be called ‘the fallacy of the benign placebo’ and goes like this:
- Alright, I accept that the evidence for xy isn’t brilliant.
- I might even accept it is a pure placebo therapy.
- But that is not important.
- What counts is that it helps suffering patients.
- Who cares about the mechanism?
- As long as a therapy can be shown to be helpful, we should use it!
I am sure you agree, this fallacy is extremely common. What is more, it is damn difficult to argue against. Whatever I used to counter, people would look at me in disbelief thinking: those scientists really sit in their ivory towers and haven’t got a clue about the real issues.
In my frustration of not getting through to many people, I have now thought of THE TELLING TALE OF THE PLACEBO BANKER.
Allow me to explain:
Imagine you are in real difficulties. You lost your job, your wife is ill, your children need feeding, the bills are stacking up – in a word, you need a loan to survive the next few months until things are sorted out.
Luckily, you know a very nice chap who is in charge of your local bank and who has a reputation of trying his utmost to help clients in need. So, you make an appointment and see him. He listens attentively and shows compassion for your situation. He gives you all the time to explain things in full detail and then re-assures you that there is hope: he will help you! At the end of the consultation you leave his office feeling well and optimistic. You even have in your hands a tidy amount of money that will get you through this bad patch. All is fine…because you have seen a real banker who knows his job in such situations consists mainly of two things:
- be kind, listen with empathy and give assurance that makes customers feel good,
- give the necessary credit.
- show compassion and empathy,
- prescribe an effective treatment.
Now, imagine you are in dire straights again. This time you go to a different banker, someone who has the reputation to be even kinder and more ‘holistic’. The consultation proceeds much as the last one. The banker listens, offers help and shows compassion. If anything, this new chap is even better at this task. He is more understanding than the last one, he even explains why you got into difficulties, and he has a full hour just to talk with you. Consequently, you feel really good about the whole thing, and you are happy as he gives you an envelope full of money that will assist you solving your current problems. You go home and feel great…until, three days later, you need to pay your first bill, open the envelope and discover that it contains plenty of notes, but they are all Monopoly money. You discover that you have become the victim of THE PLACEBO BANKER.
The placebo banker is, of course, akin to the placebo therapist who can do little more than:
- show compassion and empathy,
- dish out placebos.
I know, the analogy is not perfect but is explains the fallacy a bit, I hope.
Good banking consists of courteous behaviour and adequate financial assistance.
Good medicine consists of compassion and effective treatments.
If one of the two essential elements is missing, neither the banking nor the medicine can be good or ethical.
You have to admit, quacks had a difficult time recently:
- homeopathy has been disclosed as humbug,
- chiropractic is not much better,
- ‘acupuncture awareness week’ left acupuncturists bruised…
Need I go on?
One has to pity these guys; their income is dwindling; they have no pensions, no unions to protect them etc., they know nothing other than quackery…what can they do? They are clearly fighting for survival.
I suggest we all focus, use our imagination and come up with come constructive ideas to help them.
Alright, I start: HOLISTIC DOPING
The fate of the poor (not in a monetary sense, of course) tennis star Sharapova gave me that brainwave.
Our elite athletes are in a pickle: they feel the need to enhance their performance but more and more ways of achieving this with cleverly administered drugs are becoming illegal. Their livelihood is at stake almost as much as that of our dear quacks.
What if the two groups jointed forces?
What if they decided to help solve each others’ problems?
This could be a classical win/win situation!
I am sure homeopaths, chiropractors, acupuncturists etc. could design holistic program for improving athletic performance. It would be highly individualised and embrace body, mind, spirit, sole and anything else they can think of. It could include the newest concepts in quantum healing, energy field, qi, vital force, etc. The advantages are obvious, I think:
- none of these interventions will ever be found on a list of forbidden drugs,
- the program will work perfectly well because it will generate large placebo responses,
- performance will therefore increase (as always in alternative medicine, anecdotal ‘evidence’ will suffice) ,
- and so will the quacks’ cash flow.
Is there a downside? Not really…oh, hold on…yes there is!
My idea is not that original; others have had it already. In fact, there are quite a few quacks offering alternatives to good old-fashioned doping.
THAT’S THE AWFUL THING ABOUT QUACKERY: ALL THE GOOD IDEAS TURN OUT TO BE ALREADY TAKEN!
MORE than £150,000 was spent by NHS Grampian on homeopathic treatments last year. Referrals to homeopathic practitioners cost £37,000 and referrals to the Glasgow Homoeopathic Hospital cost £7,315 in 2014-15. In view of the fact that highly diluted homeopathic remedies are pure placebos, any amount of tax payers’ money spent on homeopathy is hard to justify. Yet an NHS Grampian spokeswoman defended its use of by the health board with the following words:
“We have a responsibility to consider all treatments available to NHS patients to ensure they offer safe, effective and person-centred care. We also have a responsibility to use NHS resources carefully and balance our priorities across the population as well as individuals. We also recognise that patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited. Homeopathy can be considered in this arena and we remain connected with the wider debate on its role within the NHS while regularly reviewing our local support for such services within NHS Grampian.”
Mr Spence, a professional homeopath, was also invited to defend the expenditure on homeopathy: “When a friend started talking to me about homeopathy I thought he had lost his marbles. But it seemed homeopathy could fill a gap left by orthodox medicine. Homeopathy is about treating the whole person, not just the symptoms of disease, and it could save the NHS an absolute fortune. If someone is in a dangerous situation or they need surgery then they need to go to hospital. It’s often those with chronic, long-term problems where conventional treatment has not worked that can be helped by homeopathy.”
What do these arguments amount to, I ask myself.
The answer is NOTHING.
The key sentence in the spokeswomen’s comment is : “patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited.” This seems to admit that the evidence fails to support homeopathy. Therefore, so the argument, we have to abandon evidence and consider experience, opinion etc. This seemingly innocent little trick is nothing else than the introduction of double standards into health care decision making which could be used to justify the use of just about any bogus therapy in the NHS at the tax payers’ expense. It is obvious that such a move would be a decisive step in the wrong direction and to the detriment of progress in health care.
The comments by the homeopath are perhaps even more pitiful. They replace arguments with fallacies and evidence with speculation or falsehoods.
There is, of course, a bright side to this:
IF HOMEOPATHY IS DEFENDED IN SUCH A LAUGHABLE MANNER, ITS DAYS MUST BE COUNTED.
One of the most common claims of alternative practitioners is that they take a holistic approach to health care. And it is this claim which attracts many consumers. It also makes conventional medicine look bad, reductionist and inhuman, as it implies that mainstream medicine is non-holistic.
The claim can be easily disclosed to be a straw man, because all good medicine was, is and always will be holistic. Moreover, the claim amounts to a falsehood, because much of alternative medicine is everything but holistic. I will try to explain what I mean using the recent example of acupuncture for neck pain, but I could have used almost any other alternative treatment and any other human complaint/condition/disease:
- chiropractic for back pain;
- homeopathy for asthma;
- energy healing for depression;
- aromatherapy for jet lag;
- etc. etc.
The recent trial found that adding acupuncture to usual care yields a slightly better outcome than usual care alone. This is hardly a big deal; adding a good cup of tea and a compassionate chat to usual care might have done a similar thing. Acupuncturists, however, will say that their holistic approach is successful.
How holistic is acupuncture?
A ‘Western’ acupuncturist would normally ask what is wrong with the patient; in the case of neck pain, he would probably ask several further questions about the history of the condition, when the pain occurs, what aggravates it etc. Then he might conduct a physical examination of his patient. Eventually, he would get out his needles and start the treatment.
A ‘traditional’ acupuncturist would ask similar questions, feel the pulse, look at the tongue and make a diagnosis in terms of yin and yang imbalance. Eventually, he too would get out his needles and start the treatment.
Is that holistic?
Certainly not! If we look at alternative practitioners in general, we cannot fail to notice that they tend to be the very opposite of holistic. They usually attribute a patients illness to one single cause such as yin/yang imbalance (acupuncture), subluxation (chiropractic), impediment of the life force (homeopathy), etc.
Holistic means that the patient is understood as a whole person. Our neck pain patient might have physical problems such as muscular tension; the acupuncturists might well have realised this and placed their needles accordingly. But neck pain, like most other symptoms, can have many other dimensions:
- there could be stress;
- there could be an ergonomically disadvantageous work place;
- there could be a history of injury;
- there could be a malformation of the spine;
- there could be a tumour;
- there could be an inflammation;
- there could be many other specific diseases;
- there could be relationship problems, et. etc.
Of course, the acupuncturists will claim that, during an acupuncture session, they will pick up on all of these. However, in my experience, this is little more than wishful thinking. And even if they did pick up other dimensions of the patient’s complaint, what can they do about it? They can (and often do) give rather amateur advice. This may be meant most kindly but it is rarely optimal.
And what about conventional practitioners, aren’t they even worse?
True, there often is far too much room for improvement. But at least the concept of multifactorial conditions and treatments is deeply ingrained in everyone who has been to medical school. We learn that symptoms/complaints/conditions/diseases are almost invariably multifactorial; they have many causes and contributing factors which can interact in complex ways. Therefore, responsible physicians always consider to treat patients in multifactorial ways; in the case of our neck pain patient:
- the stress might need a relaxation programme,
- the work place might need the input of an occupational therapist;
- in case of an old injury, a physio might be needed;
- specific conditions might need to be seen by a range of medical specialists;
- muscular tension could be reduced by a massage therapist;
- relationship problems might require the help of a psychologist; etc. etc.
I am NOT saying that all of this is necessary in each and every case. But I am saying that, in conventional medicine, both the awareness and the possibility for a professional multidisciplinary approach is well established. You don’t believe me? Ask a physiotherapist or an occupational therapist who refers more patients to them, an acupuncturist or a GP!
Alternative practitioners claim to be holistic and some might even be aware of the complexity of their patients’ symptoms. But, at best, they have an amateur approach to this complexity by dabbling themselves in issuing more or less suited advice. They are not adequately trained to do this job, and they refer very rarely.
My conclusion: professional multidiscipinarity is an approach deeply engrained in conventional medicine (we don’t often call it holism, perhaps because many doctors associate this term with charlatans), and it beats the mostly amateurish pseudo-holism of alternative practitioners any time.
We could have expected it, couldn’t we? With so much homeopathy in the press lately, Dr Dixon (we have seen him on this blog before, for instance here, here and here) had to comment. His article in yesterday’s NURSING IN PRACTICE is far too perfect to abbreviate it; I just have to cite it in full (only the reference numbers are mine and refer to my comments below).
HERE WE GO
Should homeopathy be blacklisted in general practice?
I have not prescribed them myself but I know of many GPs and patients who find homeopathic preparations helpful, especially in clinical areas where there is no satisfactory conventional treatment . They are cheap and entirely safe , which cannot always be said of conventional treatment . Is the concern about cost? That is implausible as GP prescriptions cost a mere £100,000 per annum, approximately £10 per UK General Practice but effectively less as some patients will be paying for them and they may reduce other prescriptions or medical costs . Is it about evidence?  Possibly, and that is because the necessary pragmatic trials on comparative cost effectiveness have never been done . Homeopathy thus joins the frequently quoted 25% of general practice activity that has an insufficient evidence base… So, why not do the research rather than single out homeopathy for blacklisting ? Apparently, because it irritates a powerful fraternity of “scientists”  with a narrow biomedical perspective on health and healing, who feel the need to impose their atheism  on others. They seem opposed to “patient-centred medicine” which factors in the mindset, culture, history, wishes and hopes of each patient, and a wider concept of science that might take account of them . Led by the World Health Organization, many countries are examining the appropriate role of complementary and traditional medicine (CAM). Indian Prime Minister Modi has created the first minister for medicine in this area (called AYUSH with the “H” standing for homeopathy). Australia, whose government and medical deans (unlike the UK ) are not intimidated by this breed of scientific fundamentalism, has invested money in research, regulated its herbal  practitioners and created important trade links with China in this area . Meanwhile the UK invests 0% of its research budget on CAM and appears to have a closed mind . General practice is at its best a subtle and complex blend of science and art combined in a heady mixture, which recognises personal belief and perspective and respects differences . Blacklisting homeopathy would be the thin edge of the wedge. It would be a mean-minded act of outside interference by many who do not treat patients themselves, denying patient choice and signifying a new age of intolerance and interference . It is a threat to the autonomy of general practice that should concern every GP and patient whatever their views on homeopathy .
About the Author
Chairman of the NHS Alliance and a GP
Mike Dixon, chairman of the NHS Alliance and a GP at College Surgery in Cullompton, Devon and a Royal College of General Practitioners presidential candidate.
END OF QUOTE AND BEGINNING OF MY DELIBERATELY BRIEF COMMENTS
- Whenever this argument comes up, people fail to cite an example. Are they afraid that we would point out what can be done for such a patient other than prescribing placebos?
- Actually, they are extremely expensive considering that they are just lactose or water. And the claim that homeopathy is safe merely displays an embarrassing lack of knowledge; see the many posts on this blog that deal with this issue.
- Classical ‘tu quoque’ fallacy; display of the ignorance of the risk/benefit concept for judging the value of medical interventions.
- Display of ignorance regarding the actual evidence, see here, for instance.
- Yes, it’s the evidence but also it’s the biological implausibility and the fact that disregarding it undermines rationality in general.
- Pure ignorance again, see my point 4.
- Are ~ 300 clinical trials and about 100 systematic reviews not enough? How much more money needs to be wasted?
- It seems that Dixon has a problem with science and those who pursue it to improve future health care for the benefit of patients.
- Does Dixon admit that homeopathy is a religion?
- Patient-centred medicine which factors in the mindset, culture, history, wishes and hopes of each patient, and a wider concept of science that might take account of them – does Dixon not know that all good medicine fits this description, but homeopathy certainly does not?
- Every one with an IQ above 50 knows by now that herbal is not homeopathic; is Dixon the exception?
- What about the Australian report which concluded that “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.”
- This is simply not true, and Dixon should know it.
- No reason to include disproven nonsense like homeopathy.
- Intolerance is on Dixon’s side, I think. Improving health care by abandoning disproven therapies in favour of evidence-based treatments is no interference, it’s progress.
- This can only be true, if we misunderstand autonomy as arbitrariness without rules, checks, ethics and controls. Good general practice has, like all medicine, be in the best interest of patients. An obsolete, expensive, unsafe, ineffective and implausible treatment is clearly not.
I am probably more used to nonsensical statements by promoters of alternative medicine than the average person. But the ‘ALTERNATIVE MEDICINE ZONE’ just broke my BS-meter. Here are a few samples from their most remarkable website, all relating to homeopathy:
There has always been a debate whether allopathic treatment methods of the modern age are more beneficial or are the natural homeopathic treatment ways more reliable. The goal of healing the sick is the same in both these groups of treatment, but there is a strong contrast in the methods use, the ideology behind the treatment and the detailed theories. The following is a detailed comparison between homeopathy and Allopathy for those who wish to pick between the two:
Allopathic practitioners aim to target that part of the body that has been affected by a problem or disease and they do so by identifying the causing agent. On the other hand, in Homeopathy, doctors believe that emotional stress or psychological reasons make the body more susceptible to diseases and use more of a holistic approach of treatment.
Allopathic doctors make use of those medications which are produced by pharma companies or are man-made. On the other hand, Homeopathy uses natural supplements and cures such as herbs, dietary changes and other such ways to cure a disease. Allopathic doctors use an aggressive approach whereas homeopathic doctors consider one dose enough to treat a disease.
While on one hand, allopathic doctors consider surgeries to be very important for removal of tumors etc. or correcting problems inside the body, Homeopathic doctors almost never use surgery as a treatment method. Only when certain tissue in the body has become seriously damaged they practice this technique.
Allopathic surgeons heavily rely on surgical procedures in case of serious diseases which cannot be cured by medicines or any other approach. Homeopathic doctors try to treat each and every condition with a natural method or by recommending strong dietary changes.
Homeopathy is basically based on beliefs of German Physician Samuel Hahnemann whereas Allopathic system of treatment or cure of diseases is based on the principles of the ancient Greeks, for example Hippocrates. Allopathic is considered to be regular medicine in many countries such as US but Homeopathy is argued to be a natural and holistic way of cure.
Both these schools of medicine consider the other to be non-beneficial. Homeopathy thinks that allopathic medicines tend to make people even sicker in the long run whereas Allopathy doctors believe that Homeopathy only uses Placebo as its mechanism to cure people. Supporters of both schools are often seen defending their preferred method of treatment.
The ‘ALTERNATIVE MEDICINE ZONE’ also does not shy away from giving concrete medical advice on their website. Two examples will have to suffice:
HOMEOPATHY FOR SHINGLES
Compare to anti-viral medicines, homeopathy has proved more effective for shingles and chicken pox. It offers rapid and successful approach in treating this infection. People with weak immune system are more prone to get shingles. Homeopathy medicines influence the immune system efficiently from within and improve body’s healing capacity. The homeopathy medicines are also capable of defusing pain, discomfort in body due to shingle. It also refrain shingles from spreading.
HOMEOPATHY FOR PILES
The homeopathic treatment is considered much better than surgery because it corrects the problem from the root which is not the case in surgery. Homeopathy is considered very useful in the early cases of piles and can help in complete healing. However as the problem becomes complex, it can only help in the healing of the symptoms.
Both articles finish by giving a list of homeopathic remedies that are recommended for the two conditions.
So there we have it!
My BS-meter has just broken.
Who can I sue?
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:
- Proponents of IM mislead us with their very own, nonsensical terminology and definitions.
- They promote two main principles: use of quackery + holism.
- Holism is at the heart of all good medicine; IM is at best an unnecessary distraction.
- Using holism to promote quackery is dishonest and counter-productive.
- The integration of quackery will render healthcare not better but worse.
- 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
- Is individualised to the person – in that it takes into account their needs, insights, beliefs, past experiences, preferences, and life circumstances
- 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.
- 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.
- Uses the safest, most effective and least invasive procedures wherever possible.
- Harnesses the power of compassion, respect and the therapeutic relationship
- Focuses predominantly on health promotion, disease prevention and patient empowerment
- 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:
- All good medicine has always been ‘individualised to the person’, etc.
- Patient empowerment is a key to conventional medicine.
- Holism is at the heart of any good health care.
- I do not know a form of medicine that focusses on unsafe, ineffective, unnecessarily invasive procedures.
- Neither am I aware of one that deliberately neglects compassion or disrespects the therapeutic relationship.
- I was under the impression that disease prevention is a thing conventional medicine takes very seriously.
- 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’?
In a recent Editorial, I wrote: “Complementary and alternative medicine (CAM) is popular, and many nurses seem to be embracing it in the hope of helping their patients…But despite its popularity, CAM has remained a highly controversial area: the evidence-base is often unconvincing or non-existent. For most forms of CAM, we thus know too little to claim with confidence that they generate more good than harm. In the interest of our patients, it might, therefore, be wise to exercise caution and be aware of some of the fallacies which can easily mislead us.”
Yet, my calls for caution seem to fall on nurses’ deaf ears. This is at least what a new article on this subject implies.
This paper investigated how frequently nurses include CAM in their clinical practice. In so doing, its authors investigated nurses’ knowledge of and attitudes towards CAM as well as their ability to communicate the risks and benefits of these therapies with patients. For this purpose, a review was conducted in five stages: (1) identification of research question(s), (2) locate studies, (3) selection of studies, (4) charting of data, and (5) collating, summarising, and reporting of results.
Fifteen papers met the inclusion criteria for the review, among which 53·7% referenced how frequently nurses include CAM in their practice. The researchers found that 66·4% of nurses had positive attitudes towards CAM; however, 77·4% did not possess a comprehensive understanding of the associated risks and benefits. In addition, nearly half of the respondents (47·3-67·7%) reported feeling uncomfortable discussing CAM therapies with their patients.
The authors concluded that the lack of knowledge about complementary and alternative medicine among nurses is a cause for concern, particularly in light of its widespread application. Findings from this study suggest that health care professionals need to promote evidence informed decision-making in complementary and alternative medicine practice and be knowledgeable enough to discuss complementary and alternative medicine therapies. Without involvement of complementary and alternative medicine communication on the part of our profession, we may put our patients at risk of uninformed and without medical guidance.
I think I understand why many nurses feel attracted by CAM; if nothing else, it offers the opportunity to exercise compassion and empathy in patient care – and these are qualities that are often badly needed in routine practice. But it would be important (not just for nurses but for all health care professionals) to realise that compassion is best when it is paired with evidence-based care and effective treatments rather than with quackery and unproven therapies.