Charles III is about to pay his first visit to France, his second visit to any state. Earlier this year, he has already visited Germany. Originally, France had been first on his list but the event was cancelled in view of the violent protests that rocked the country at the time. Now he is definitely expected and the French are exited. I am currently in France and have been asked to give several interviews on the king’s love affair with so-called alternative medicine (SCAM).
The French have long been fascinated by our royal family which seems a bit odd considering what they did to their own. Now that Charles and Camilla are about to appear with an entourage of about 50 servants between them, the press is full with slightly bemused reports and comments:
Since childhood, Charles has been accustomed to a luxurious, gilded life, which is reproduced on every trip outside the royal palaces, to ensure maximum service, comfort and security… The new king always travels with his private secretary, Sir Clive Alderton, his press advisor, his steward, his doctor, his personal valets, his security guards, and his private chauffeur, Tim Williams… And, of course, his regular osteopath to relieve his lower back. Since he’s had a lot of falls playing polo, Charles regularly suffers from back pain…”.
Really, just an osteopath?
What about all the other SCAM-practitioners whose businesses Charles so regularly supported in the past:
- · Acupuncture
- · Aromatherapy
- · Ayurveda
- · Chiropractic
- · Detox
- · Gerson therapy
- · Herbal medicine
- · Homeopathy
- · Iridology
- · Marma massage
- · Massage therapy
- · Pulse diagnosis
- · Reflexology
- · Tongue diagnosis
- · Traditional Chinese Medicine
- · Yoga
Will they not be disappointed?
I do wonder who Charles’ osteopath and doctor are. Are they competent? I am sure they both must be well-informed and evidence-based experts. If that is the case, they will have, of course, told Charles that osteopathy is hardly an optimal solution for an injured back.
In any case, now I am concerned about the royal back and therefore urgently recommend that HIS MAJESTY reads some of my previous posts on the subject, e.g.:
- Manual therapy (mainly chiropractic and osteopathy) does not have clinically relevant effects on back pain compared with sham treatment
- Spinal manipulative therapy for older adults with chronic low back pain fails to generate convincing results
- NICE no longer recommends acupuncture, chiropractic or osteopathy for low back pain
- The Effects of Yoga, Naturopathy, and Conventional Medical Treatment in Managing Low Back Pain
- Chronic non-specific low back pain: comparing cognitive functional therapy and movement system impairment (MSI)-based treatment
- Cognitive functional therapy for chronic low back pain
- Meditation for Chronic Low Back Pain Management?
Let’s hope all goes well here in France, and please let’s not be so akward as to ask about the environmental aspects – we all know how worried Charles truly is about not just his health but also the health of the planet – of moving such an entourage for a two-day visit.
Charles flew in a private jet from London to Paris and took his Bentley with him.
Charles has a well-documented weakness for so-called alternative medicine (SCAM) – not just any SCAM but predominantly the type of SCAM that is both implausible and ineffective. Therefore, nobody can be all that surprised to read in THE TIMES that he has decided to use SCAM for helping women who have difficulties getting pregnant.
If one really wanted to employ SCAM for this aim one is spoilt for choice. In fact, there are only few SCAMs that don’t claim to be useful for this purpose.
A recent review, for instance, suggested that some supplements might be helpful. Other authors advocate SCAMs such as acupuncture, moxibustion, Chinese herbal medicine, psychological intervention, biosimilar electrical stimulation, homeopathy, or hyperbaric oxygen therapy.
Yes, I know! The evidence for these treatments is lousy, and I would never issue a recommendation based on such flimsy evidence.
Yet, the SCAM project at Dumfries House, the Scottish stately home Charles restored in 2007, offers acupuncture, reflexology, massage, yoga, and hypnotherapy for infertile women.
Reflexology, also called zone therapy, is a manual treatment where pressure is applied usually to the sole of the patient’s foot and sometimes also to other areas such as the hands or ears. According to its proponents, foot reflexology is more than a simple foot massage that makes no therapeutic claims beyond relaxation. It is based on the idea that the human body is divided into 10 zones each of which is represented on the sole of the foot. Reflexologists employ maps of the sole of the foot where the body’s organs are depicted. By massaging specific zones which are assumed to be connected to specific organs, reflexologists believe to positively influence the function of these organs. While reflexology is mostly used as a therapy, some therapists also claim they can diagnose health problems through feeling tender or gritty areas on the sole of the foot which, they claim, correspond to specific organs.
Reflexology is not merely implausible as a treatment for infertility, it also boasts of some fairly rigorous trial evidence. A clinical trial (perhaps even the most rigorous of all the trials of SCAM for female fertility problems) testing whether foot reflexology might have a positive effect on the induction of ovulation stated that “the results suggest that any effect on ovulation would not be clinically relevant”.
So, as so often before in the realm of SCAM, Charles has demonstrated that his lack of critical thinking leads him to the least promising options.
Well done, Your Majesty!
Last September, THE GUARDIAN published an article about the HEAD OF THE ROYAL MEDICAL HOUSEHOLD. I did not know much about this position, so I informed myself:
The royal household has its own team of medics, who are on call 24 hours a day. They are led by Prof Sir Huw Thomas (a consultant at King Edward VII’s hospital [the private hospital in Marylebone often used by members of the royal family, including the late Prince Philip] and St Mary’s hospital in Paddington, and professor of gastrointestinal genetics at Imperial College London), head of the medical household and physician to the Queen – a title dating back to 1557. Thomas has been part of the team of royal physicians for 16 years and became the Queen’s personal physician in 2014. The role is not full-time and does not have fixed hours or sessions but Thomas is available whenever he is needed. Thomas received a knighthood in the 2021 new year honours, and was made Knight Commander of the Royal Victorian Order (KCVO) – a personal gift of the monarch. At the time of the honour, in an interview with Imperial College London, he said it had been a “busy couple of years in this role,” adding that he felt “very grateful to have been recognised for my service to date”. Thomas added that being the Queen’s personal physician was a “great honour” and “a very enjoyable and rewarding role”. He said: “The nature of the work is interesting because you see how a whole different organisation, the royal household, operates. You very much become part of that organisation and become the personal doctor to the principal people in it, who are patients just like other patients.” …
In previous generations the royal doctor has caused controversy. When the Queen’s grandfather King George V was in his final hours, Lord Dawson, the royal doctor with personal responsibility for the 70-year-old monarch issued a bulletin, declaring: “The King’s life is moving peacefully towards its close.”
In 1986, four decades after Lord Dawson’s death, his diaries were made public – revealing that he had administered a lethal dose of morphine and cocaine to relieve the King’s pain, but also to ensure that the death could be announced in the morning edition of the Times, rather than “less appropriate evening journals”.
During the last few days, it was difficult to escape all the hoo-hah related to the coronation, and I wondered whether Charles has replaced Prof Thomas in his role as HEAD OF THE ROYAL MEDICAL HOUSEHOLD. It did not take long to find out. There even is a Wiki page on the subject! It provides a list of the recent heads:
List of Heads of the Medical Household
The Head of the Medical Household was first appointed in 1973.
- 1973–1981: Sir Richard Bayliss, KCVO MD FRCP MRCS
- 1981–1989: Sir John Batten, KCVO MD FRCP
- 1989–1993: Sir Anthony Dawson, KCVO MD FRCP
- 1993–2005: Sir Richard Thompson, KCVO DM PRCP
- 2005–2014: Professor Sir John Cunningham, KCVO BM BCh MA DM FRCP
- 2014–2022: Professor Sir Huw Thomas, KCVO MBBS MA PhD
- 2022 – to present: Dr Michael Dixon, LVO, OBE, MA, FRCGP, FRCP
Yes, Michael Dixon! I am sure this will be of interest. Michael Dixon used to be a friend and an occasional collaborator of mine. He has featured prominently in my memoir as well as in my biography of Charles. In addition, he has been the subject of numerous blog posts, e.g.:
- Today, integrative medicine is about to make history, says Dr. Michael Dixon
- My (most forgettable) paper with Dr Michael Dixon
- Boosting immunity against coronavirus? Dr Michael Dixon’s infinite wisdom on the pandemic
- Dr Michael Dixon seems to support homeopathy as a treatment for cancer
- Should homeopathy be blacklisted in general practice? Dr Michael Dixon’s profoundly misleading comments
- Johrei healing and the amazing Dr Dixon (presidential candidate for the RCGP)
- Dr Dixon’s safe herbal medicine
- Remember the ‘Foundation for Integrated Health’? Here is a good summary of its infamous history
- Prince Charles becomes patron of the ‘College of Medicine and Integrated Health’
- Uncharitable charities? The example of ‘YES TO LIFE’
- A treasure trove of fallacies, falsehoods and deceptions
I am sure that many of my readers would like to join me in wishing both Michael and Charles all the best in their new roles.
Social prescribing (SP) has been mentioned here several times before. It seems important to so-called alternative medicine (SCAM), as some enthusiasts – not least King Charles – are trying to use it as a means to smuggle nonsensical treatments into routine healthcare.
SP is supposed to enable healthcare professionals to link patients with non-medical interventions available in the community to address underlying socioeconomic and behavioural determinants. The question, of course, is whether it has any relevant benefits.
This systematic review included all randomised controlled trials of SP among community-dwelling adults recruited from primary care or community setting, investigating any chronic disease risk factors defined by the WHO (behavioural factors: smoking, physical inactivity, unhealthy diet and excessive alcohol consumption; metabolic factors: raised blood pressure, overweight/obesity, hyperlipidaemia and hyperglycaemia). Random effect meta-analyses were performed at two time points: completion of intervention and follow-up after trial.
The researchers identified 9 reports from 8 trials totalling 4621 participants. All studies evaluated SP exercise interventions which were highly heterogeneous regarding the content, duration, frequency and length of follow-up. The majority of studies had some concerns about the risk of bias. A meta-analysis revealed that SP likely increased physical activity (completion: mean difference (MD) 21 min/week, 95% CI 3 to 39, I2=0%; follow-up ≤12 months: MD 19 min/week, 95% CI 8 to 29, I2=0%). However, SP may not improve markers of adiposity, blood pressure, glucose and serum lipid. There were no eligible studies that primarily target unhealthy diet, smoking or excessive alcohol-drinking behaviours.
The authors concluded that SP exercise interventions probably increased physical activity slightly; however, no benefits were observed for metabolic factors. Determining whether SP is effective in modifying the determinants of chronic diseases and promotes sustainable healthy behaviours is limited by the current evidence of quantification and uncertainty, warranting further rigorous studies.
Great! Regular exercise improves physical fitness.
But do we need SP for this?
Don’t get me wrong, I have nothing against connecting patients with social networks to improve their health and quality of life. I do, however, object if SP is used to smuggle unproven or disproven SCAMs into EBM. In addition, I ask myself whether we really need the new profession of a ‘link worker’ to facilitate SP. I remember being taught that a good doctor should look after his/her patients holistically, and surely that includes mentioning and facilitating social networks for those who need them.
I, therefore, fear that SP is taking something valuable out of the hands of doctors. And the irony is that SP is favoured by those who are all too quick to turn around and say: LOOK AT HOW FRIGHTFULLY REDUCTIONIST AND HEARTLESS DOCTORS HAVE BECOME. WE NEED MORE HOLISM IN MEDICINE AND THAT CAN ONLY BE PROVIDED BY SCAM PRACTITIONERS!
I know, I have often posted nasty things about integrative medicine and those who promote it. Today, I want to make good for all my sins and look at the bright side.
Imagine you are a person convinced of the good that comes from so-called alternative medicine (SCAM). Imagine you believe it has stood the test of time, is natural, holistic, tackles the root problems of illness, etc., etc. Imagine you are such a person.
Your convictions made you support more research into SCAM because you feel that evidence is needed for it to be more generally accepted. So, you are keen to see more studies proving the efficacy of this or that SCAM in the management of this or that condition.
This, unfortunately, is where the problems start.
Not only is there not a lot of money and even fewer scientists to do this research, but the amount of studies that would need doing is monstrously big:
- There are hundreds of different types of SCAM.
- Each SCAM is advocated for hundreds of conditions.
Consequently, tens of thousands of studies are needed to only have one trial for each specific research question. This is tough for a SCAM enthusiast! It means he/she has to wait decades to see the light at the end of the tunnel.
But then it gets worse – much worse!
As the results of these studies come in, one after the other, you realize that most of them are not at all what you have been counting on. Many can be criticized for being of dismal quality and therefore inconclusive, and those that are rigorous tend to be negative.
Bloody hell! There you have been waiting patiently for decades and now you must realize that this wait did not take you anywhere near the goal that was so clear in your sight. Most reasonable people would give up at this stage; they would conclude that SCAM is a pipedream and direct their attention to something else. But not you! You are single-minded and convinced that SCAM is the future. Some people might even call you obsessed – obsessed and desperate.
It is out of this sense of desperation that the idea of integrative medicine was born. It is a brilliant coup that solves most of the insurmountable problems outlined above. All you need to do is to take the few positive findings that did emerge from the previous decades of research, find a political platform, and loudly proclaim:
SCAM does work.
Consumers like SCAM.
SCAM must be made available to all.
Consumers deserve the best of both worlds.
The future of healthcare evidently lies in integrated medicine.
Forgotten are all those irritating questions about the efficacy of this or that treatment. Now, it’s all about the big issue of wholesale integration of SCAM. Forgotten is the need for evidence – after all, we had decades of that! – now, the issue is no longer scientific, it is political.
And if anyone has the audacity to ask about evidence, he/she can be branded as a boring nit-picker. And if anyone doubts the value of integrated medicine, he/she will be identified as a politically incorrect dinosaur.
The ‘Münster Circle‘ is an informal association of multi-disciplinary experts who critically examine issues in and around so-called alternative medicine (SCAM). We exist since June 2016 and are the result of an initiative by Dr Bettina Schöne-Seifert, Professor and Chair of Professor and Chair of Medical Ethics at the University of Münster.
In the past, we have published several documents which have stimulated discussions on SCAM-related subjects. Yesterday, we have published our ‘MEMORANDUM INTEGRATIVE MEDICINE‘. It is a critical analysis of this subject and will hopefully make some waves in Germany and beyond.
Here is its English summary:
The merging of alternative medicine and conventional medicine has been increasingly referred to as Integrative (or Integrated) Medicine (IM) since the 1990s and has largely replaced other terms in this field. Today, IM is represented at all levels.
IM is often characterised with the thesis of the ‘best of both worlds’. However, there is no generally accepted definition of IM. Common descriptions of IM emphasise:
– the combination of conventional and complementary methods,
– the holistic understanding of medicine,
– the great importance of the doctor-patient relationship,
– the hope for optimal therapeutic success,
– the focus on the patient,
– the high value of experiential knowledge.
On closer inspection, the descriptions of IM show numerous inconsistencies. For example, medicine in the hands of doctors is stressed, but it is also emphasised that all relevant professions would be involved. Scientific evidence is emphasised, but at the same time, it is stressed that IM itself includes homeopathy as well as other unsubstantiated treatments and is only ‘guided’ by evidence, i.e. not really evidence-based. It is claimed that IM is to be understood as ‘complementary to science-based medicine’; however, this implies that IM itself is not science-based.
The ‘best of both worlds’ thesis impresses many. However, if one investigates what is meant by ‘best’, one finds that this term is not interpreted in nearly the same way as in conventional medicine. Many claims of IM are elementary components of all good medicine and thus cannot be counted among the characterising features of IM. Finally, it is hard to ignore the fact that the supporters of IM use it as a pretext to introduce unproven or disproven modalities into conventional medicine. Contrary to promises, IM has no discernible potential to improve medicine; rather, it creates confusion and entails considerable dangers. This cannot be in the interest of patients.
Against this background, it must be demanded that IM is critically scrutinised at all levels.
In a previous post, I reported about the ‘biggest ever’, ‘history-making’ conference on integrative medicine. It turns out that it was opened by none other than Prince Charles. Here is what the EXPRESS reported about his opening speech:
Opening the conference, Charles said:
“I know a few people have seen this integrated approach as being in some way opposed to modern medicine. It isn’t. But we need to combine this with a personal approach that also takes account of our beliefs, hopes, culture and history. It builds upon the abilities of our minds and bodies to heal, and to live healthy lives by improving diet and lifestyle.”
Dr. Michael Dixon, Chair of the College of Medicine, said:
“Medicine, as we know it, is no longer affordable or sustainable. Nor is it able to curb the increase in obesity, mental health problems and most long-term diseases. A new medical mindset is needed, which goes to the heart of true healthcare. The advantages and possibilities of social prescription are limitless. An adjustment to the system now will provide a long-term, sustainable solution for the NHS to meet the ever-increasing demand for funding and healthcare professionals.”
Charles very kindly acknowledges that not everyone is convinced about his concept of integrated/integrative medicine. Good point your royal highness! But I fear Charles did not quite understand our objections. In a nutshell: it is not possible to cure the many ills of conventional medicine by adding unproven and disproven therapies to it. In fact, it distracts from our duty to constantly improve conventional medicine. And pretending it is all about diet and lifestyle is simply not true (see below). Moreover, it is disingenuous to pretend that diet and lifestyle do not belong to conventional healthcare.
Dr. Dixon’s concern about the affordability of medicine is, of course, justified. But the notion that “the advantages and possibilities of social prescription are limitless” is a case of severe proctophasia, and so is Dixon’s platitude about ‘adjusting the system’. His promotion of treatments like Acupuncture, Alexander Technique, Aromatherapy, Herbal Medicine, Homeopathy, Hypnotherapy, Massage, Naturopathy, Reflexology, Reiki, Tai Chi, Yoga Therapy will not adjust anything, it will only make healthcare less efficient.
I do not doubt for a minute that doctors are prescribing too many drugs and that we could save huge amounts by reminding patients that they are responsible for their own health while teaching them how to improve it without pills. This is what we learn in medical school! All we need to do is remind everyone concerned. In fact, Charles and his advisor, Michael, could be most helpful in achieving this – but not by promoting a weird branch of healthcare (integrative/integrated medicine or whatever other names they choose to give it) that can only distract from the important task at hand.
Today, a 3-day conference is starting on ‘INTEGRATIVE MEDICINE’ (IM) in London. Dr. Michael Dixon, claims that it is going to be the biggest such conference ever and said that it ‘will make history’. Dixon is an advisor to Prince Charles, chair of the College of Medicine and Integrated Health (CoMIH, of which Charles is a patron), and joint-chair of the congress. The other co-chair is Elizabeth Thompson. Both have been the subject of several previous posts on this blog.
Dixon advertised the conference by commenting: “I am seeing amongst by younger colleagues, the newly trained GPs, that they have a new attitude towards healthcare. They are not interested in whether something is viewed as conventional, complementary, functional or lifestyle, they are just looking at what works for their patients. Through this conference, we aim to capture that sense of hope, open-mindedness, and patient-centred care”. I believe that this ‘history-making’ event is a good occasion to yet again review the concept of IM.
The term IM sounds appealing, yet it is also confusing and misleading. The confusion starts with the fact that our American friends call it integrative medicine, while we in the UK normally call it integrated medicine, and it ends with different people understanding different things by IM. In conventional healthcare, for instance, people use the term to mean the integration of social and medical care. In the bizarre world of alternative medicine, IM is currently used to signify the parallel use of alternative and conventional therapies on an equal footing.
Today, there are many different definitions of the latter version of IM. Prince Charles, one of the world’s most ardent supporter of IM, used to simply call it ‘the best of both worlds’. A recent, more detailed definition is a ‘healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies’. This seems to imply that conventional medicine is not healing-orientated, does not account for the whole person, excludes aspects of lifestyle, neglects the therapeutic relationship, is not informed by evidence, and does not employ all appropriate therapies. This, I would argue is a bonanza of strawman fallacies, i.e. the misrepresentation of an opponent’s qualities with a view of defeating him more easily and making one’s own position look superior. Perhaps this is unsurprising – after all, Dixon has been once named ‘a pyromaniac in a field of (integrative) strawmen’.
Perhaps definitions are too theoretical and it is more productive to look at what IM stands for in real life. If you surf the Internet, you can find thousands of clinics that carry the name IM. It will take you just minutes to discover that there is not a single alternative therapy, however ridiculous, that they don’t offer. What is more, there is evidence to show that doctors who are into IM are also often against public health measures such as vaccinations.
The UK ‘Integrated Medicine Alliance’, a grouping within the CoMIH, offers information sheets on all of the following treatments: Acupuncture, Alexander Technique, Aromatherapy, Herbal Medicine, Homeopathy, Hypnotherapy, Massage, ,Naturopathy, Reflexology, Reiki, Tai Chi, Yoga Therapy. The one on homeopathy, for example, tells us that “homeopathy … can be used for almost any condition either alone or in a complementary manner.” Compare this to what the NHS says about it: “homeopathic remedies perform no better than placebos (dummy treatments)”.
This evidently grates with the politically correct definition above: IM is not well-informed about the evidence, and it does use inappropriate treatments. In fact, it is little more than a clumsy attempt to smuggle unproven and disproven alternative therapies into the mainstream of healthcare. It does render medicine not better but will inevitably make it worse, and this is surely not in the best interest of vulnerable patients who, I would argue, have a right to be treated with the most effective therapies currently available.
The conference can perhaps be characterized best by having a look at its sponsors. ‘Gold sponsor’ is WELEDA, and amongst the many further funders of the meeting are several other manufacturers of mistletoe medications for cancer. I just hope that the speakers at this meeting – Dixon has managed to persuade several reputable UK contributors – do not feel too embarrassed when they pass their exhibitions.
Yesterday, my new book arrived on my doorstep.
Its full title is CHARLES, THE ALTERNATIVE PRINCE. AN UNAUTHORISED BIOGRAPHY. I guess that it also clarifies its contents. In case you want to know more, here is the full list of topics:
Foreword by Nick Ross v
1. Why this Book? 1
2. Why this Author? 5
3. Words and Meanings 10
4. How Did It All Start? 13
5. Laurens van der Post 17
6. The British Medical Association 25
7. Talking Health 31
8. Osteopathy 37
9. Chiropractic 43
10. The Foundation of Integrated Health 50
11. Open Letter to The Times 56
12. The Model Hospital 62
13. Integrated Medicine 66
14. The Gerson Therapy 73
15. Herbal Medicine 77
16. The Smallwood Report 82
17. World Health Organisation 90
18. Traditional Chinese Medicine 96
19. The ‘GetWellUK’ Study 100
20. Bravewell 106
21. Duchy Originals Detox Tincture 110
22. Charles’ Letters to Health Politicians 115
23. The College of Medicine and Integrated Health 120
24. The Enemy of Enlightenment 126
25. Harmony 132
26. Antibiotic Overuse 142
27. Ayurvedic Medicine 147
28. Social Prescribing 154
29. Homeopathy 160
30. Final Thoughts 169
End Notes 187
In case you want to know more, here is chapter 1 of my book:
Over the past two decades, I have supported efforts to focus healthcare on the particular needs of the individual patient, employing the best and most appropriate forms of treatment from both orthodox and complementary medicine in a more integrated way.
The Prince of Wales 1997
This is a charmingly British understatement, indeed! Charles has been the most persistent champion of alternative medicine in the UK and perhaps even in the world. Since the early 1980s, he has done everything in his power
- to boost the image of alternative medicine,
- to improve the status of alternative practitioners,
- to make alternative therapies more available to the general public,
- to lobby that it should be paid for by the National Health Service (NHS),
- to ensure the press reported favourably about the subject,
- to influence politicians to provide more support for alternative medicine.
He has fought for these aims on a personal, emotional, political, and societal level. He has used his time, his intuition, his influence, and occasionally his money to achieve his goals. In 2010, he even wrote a book, ‘Harmony’, in which he explains his ideas in some detail (discussed in chapter 25, arguably the central chapter of this biography). Charles has thus become the undisputed champion of the realm of alternative medicine. For that he is admired by alternative practitioners across the globe.
Yet, his relentless efforts are not appreciated by everyone (another British understatement!). There are those who view his interventions as counter-productive distractions from the important and never-ending task to improve modern healthcare. There are those who warn that integrating treatments of dubious validity into our medical routine will render healthcare less efficient. There are those who claim that the Prince’s preoccupation with matters that he is not qualified to fully comprehend is a disservice to public health. And there are those who insist that the role of the heir to the throne does not include interfering with health politics.
- So, are Charles’ ideas new and exciting?
- Or are they obsolete and irrational?
- Has Charles become the saviour of UK healthcare?
- Or has he hindered progress?
- Is he a role model for medical innovators?
- Or the laughing stock of the experts?
- Is he a successful reformer of healthcare?
- Or are his concepts doomed to failure?
Charles appears to evade critical questions of this nature. Relying on his intuition, he unwaveringly pursues and promotes his personal beliefs, regardless of the evidence (Box 1). He believes strongly in his mission and is, as most observers agree, full of good intentions. If he even notices any criticism, it is merely to reaffirm his resolve and redouble his efforts. He is reported to work tirelessly, and one could easily get the impression that he is obsessed with his idea of integrating alternative medicine into conventional healthcare.
I have observed Charles’ efforts around alternative medicine for the last 30 years. Occasionally, I was involved in some of them. For 19 years, I have headed the world’s most productive team of researchers in alternative medicine. This background puts me in a unique position to write this account of Charles’ ‘love affair’ with alternative medicine. It is not just a simple outline of Charles’ views and actions but also a critical analysis of the evidence that does or does not support them. In writing it, I pursue several aims:
- I want to summarise this part of medical history, as it amounts to an important contribution to the recent development of alternative medicine in the UK and beyond.
- I hope to explain how Charles and other enthusiasts of alternative medicine think, what motivates them and what logic they follow.
- I will contrast Charles’ beliefs with the published evidence as it pertains to each of the alternative modalities (treatments and diagnostic methods) he supports.
- I want to stimulate my readers’ ability to think critically about health in general and alternative medicine in particular.
My book will thus provide an opportunity to weigh the arguments for and against alternative medicine. In that way, it might even provide Charles with a substitute for a discussion about his thoughts on alternative medicine which, during almost half a century, he so studiously managed to avoid.
In pursuing these aims there are also issues that I hope to avoid. From the start, I should declare an interest. Charles and I once shared a similar enthusiasm for alternative medicine. But, as new evidence emerged, I changed my mind and he did not. This led to much-publicised tensions and conflicts. Yet it would be too easy to dismiss this book as an act of vengeance. It isn’t. I have tried hard to be objective and dispassionate, setting out Charles’ claims as fairly as I can and comparing them with the most reliable evidence. As much as possible:
- I do not want my personal discords with Charles to get in the way of objectivity.
- I do not want to be unfairly dismissive of Charles and his ambitions.
- I do not want to be disrespectful about anyone’s deeply felt convictions.
- I do not aim to weaken the standing of our royal family.
My book follows Charles’ activities in roughly chronological order. Each time we encounter a new type of alternative medicine, I will try to contrast Charles’ perceptions with the scientific evidence that was available at the time. Most chapters of this book are thus divided into four parts
- A short introduction
- Charles’ views
- An outline of the evidence
- A comment about the consequences
While writing this book, one question occurred to me regularly: Why has nobody so far written a detailed history of Charles’s passion for alternative medicine? Surely, the account of Charles ‘love affair’ with alternative medicine is fascinating, diverse, revealing, and important!
I hope you agree.
The nature of evidence in medicine and science
- Evidence is the body of facts, often created through experiments under controlled conditions, that lead to a given conclusion.
- Evidence must be neutral and give equal weight to data that fail to conform to our expectations.
- Evidence is normally used towards rejecting or supporting a hypothesis.
- In alternative medicine, the most relevant hypotheses often relate to the efficacy of a therapy.
- Such hypotheses are best tested with controlled clinical trials where a group of patients is divided into two subgroups and only one is given the therapy to be tested; subsequently the results of both groups are compared.
- Experience does not amount to evidence and is a poor indicator of efficacy; it can be influenced by several phenomena, e.g. placebo effects, natural history of the condition, regression towards the mean.
- If the results of clinical studies are contradictory, the best available evidence is usually a systematic review of the totality of rigorous trials.
- Systematic reviews are methods to minimise random and selection biases. The most reliable systematic reviews are, according to a broad consensus, those from the Cochrane Collaboration.
In case you want to know even more – and I hope you do – please get yourself a copy.
The 13th European Congress for Integrative Medicine is about to take place online between 4 and 7 November 2021. It will host 125+ speakers presenting from around the world. The programme will cover the following topics.
- Anthroposophic Medicine
- Arts in Healthcare
- Antimicrobial Resistance
- Covid Research
- Integrative Oncology
- Lifestyle Medicine
- Medical Education
- Mental Health & Stress Management
- Mind and Body Connection
- Mistletoe Therapy
- Nutrition, Gut Health & Microbiome
- Pain Management
- Patient Activation & Self-Management
- Planetary & Environmental Health
- Research and Evaluation
- Social Prescribing
- Traditional Health
Even looking at the more detailed list of lectures, I did not find a single contribution on conventional medicine (“Integrative medicine combines conventional medicine with…” [see below]) or a lecture that is remotely critical of integrative medicine. The definition of INTEGRATED MEDICINE (IM) adopted here seems similar to the US definition we recently discussed. Here is the European definition:
Integrative medicine combines conventional medicine with evidence-informed complementary medicine and therapies to achieve the optimum health and wellbeing of the patient. Focusing on a holistic, patient-centred approach to healthcare, it takes into consideration the patient’s physical and psychological wellbeing and treats the whole person rather than just the disease.
Allow me to do a quick analysis of this definition by looking at its key elements:
- Evidence-informed: While proper medicine is BASED on evidence, IM is merely INFORMED by it. The difference is fundamental. It allows IM clinicians to use any un- or disproven so-called alternative medicine (SCAM) they can think of or invent. The evidence for homeopathy fails to show that it is effective? Never mind, IM does not need to be evidence-based, it is evidence-informed. IM physicians know homeopathy is a placebo therapy (if not they would be ill-informed which would make them unethical), but they nevertheless use homeopathy (try to find an IM clinic that does not offer homeopathy!), because IM is not EBM. IM is evidence-informed!
- Therapies that achieve optimum health and wellbeing. This is odd because the website also states that “therapies can include anything from acupuncture, yoga, massage, aromatherapy, herbal medicine, nutrition, exercise along with many more approaches, tailored to the needs of the individual” indicating that virtually anything can be included. Anyway, “optimum health and wellbeing” seems a strange and unachievable criterion. In fact, it is nothing but a ‘bait and switch‘ salesmen’s trick.
- Holistic: This is a little trick that IM proponents love. With it, they imply that normal medicine is not holistic. However, this implication is demonstrably wrong. Any good medicine is holistic, and if a sector of healthcare fails to account for the whole person, we need to reform it. (Here are the conclusions of an editorial I published in 2007 entitled ‘Holistic heath care?‘: good health care is likely to be holistic but holistic health care, as it is marketed at present, is not necessarily good. The term ‘holistic’ may even be a ‘red herring’ which misleads patients. What matters most is whether or not any given approach optimally benefits the patient. This goal is best achieved with effective and safe interventions administered humanely — regardless of what label we put on them.) Creating a branch of medicine that, like IM, pretends to have a monopoly on holism is grossly misleading and can only hinder this process.
- Patient-centred: This is the same mean little trick in a different guise. They imply that conventional medicine is not patient-centred. Yet, all good medicine is, of course, patient-centred. To imply otherwise is just daft.
- Consideration of the patient’s physical and psychological wellbeing and treating the whole person rather than just the disease: Same trick yet again! The implication is that physical and psychological wellbeing and the whole person are not all that relevant in conventional medicine where only disease labels are being treated.
Altogether, this definition of IM is unworthy of anyone with the slightest ability to think critically. I find it much worse than the latest US definition (which already is fairly awful). In fact, it turns out to be a poorly disguised bonanza of strawman fallacies combined with ‘bait and switch’ deception.
How can this be?
How can a professional organisation engage in such mean trickery?
Perhaps a look at the list of speakers will go some way towards answering the question. Have a good look, you might recognize many individuals as members of our ALTERNATIVE MEDICINE HALL OF FAME.
Registration costs £ 249 (standard rate)
Perhaps I should also mention at least 4 of the many commercial sponsors of the conference: