The Other Medicine: Programme 6

FORD
A vociferous spokesman of those who believe that the move towards integration is ill-judged and too speedy is Professor Edzard Ernst of the Department of Complementary Studies at the Universities of Exeter and Plymouth.

ERNST
I’m all in favour of using complementary therapies which demonstrably do more good than harm. I wouldn’t call this integrated medicine, in fact I have my problems with that term. I would call this evidence-based medicine, simply because that’s what it is. If you find any therapeutic modality to do more good than harm then you would use it in routine, you don’t need a whole new philosophy to do that because the philosophy exists. What slightly disturbs me with some proponents of integrated medicine is that they seem to think integration now and research tomorrow. And I believe if you integrate treatments into routine care which are perhaps of debatable value or perhaps even worthless then this could mean a serious step backwards in medicine.

REILLY
If complementary medicine just becomes longer corridors of care there is a possibility of even greater fragmentation. There is a positive side to that that fall into one of the rooms of the complementary therapist and there is a possibility they’ll take a more holistic approach and a more mind, body approach and help you start to think in different ways but they might not, they might just try and balance your chakra or manipulate your back or prescribe you a herb. And no this will be the king’s new clothes because therapists like to treat people - how many times do you go to a complementary therapist and come out being told you don’t need anything at all? Right, it’s not happening.

FORD
The fundamental problem about bringing together or even attempting to integrate these two healthcare cultures is their very different ideologies - one celebrating the individual, the other providing a state-wide system of care. Paul Dieppe is Professor of Health Services Research at the University of Bristol.

DIEPPE
There is a constant major tension in all healthcare provision between the societal view that says that we should do the best thing for the greatest numbers and the individual primacy view that says this single individual I’m faced with now has a problem now is the most important thing and to heck with the whole societal view. That tension is intrinsic in the whole of healthcare delivery. Now when it comes to CAM it seems to me that the essence of most CAM is that it takes a much better stab at the individual approach to what’s right for that individual than most current orthodox medicine, which is based on what’s the average number we get if we do this to a group of people. And of course the fact is that nobody’s average. But neither side has really managed to deal with the tension between the two perspectives.
FORD
One place which has demonstrated that the tensions can be resolved and has been operating an integrated care system for 18 years is a doctor’s surgery in London - the Marylebone Health Centre.

ACTUALITY - MARYLEBONE HEALTH CENTRE
Hi Susie.

Hi.

Come in and have a seat.

FORD
Susie has been a patient at the centre almost since it opened..

ACTUALITY
… soaked and now the sun’s shining now everywhere.

Well you can take your coat off…

SUSIE
When you have a check up, I have a check up with my GP because of my diabetes, Sue Morrison, my GP, was well I think you need this and I’m going to suggest you have some massage because you’re under a lot of stress or you’ve got some aches here you know you could do with some acupuncture. Remember that complementary medicine was there before modern medicine, it was always there and now we can use it with modern medicine, it’s brilliant, they shouldn’t be in battle with each other, they should be working together.

FORD
In Marylebone ,GP Sue Morrison works closely alongside CAM practitioner Arnold Desser, an acupuncturist.


MORRISON
In this context for me it means about an ongoing dialogue really between practitioners coming from a more traditional background and those currently working in complementary and alternative medicine. And the integration is the bringing together of our thinking and learning and working.

DESSER
We all have a need to share our findings with people and you learn more about your own form of medicine, I think, by talking with people who don’t practise your form of medicine, in other words they can ask you questions - what do you mean, when you say this what do you mean by that? Well why did you prescribe that particular drug? I think it’s a learning experience here, you can’t just parachute in an acupuncturist or a homeopath into an NHS centre, it just doesn’t work that way. The advice would be don’t see it as an add on service, don’t see it as a pill and that’s often how it’s used.

MORRISON
When you talk about integrated medicine it sounds as if this is an understood thing, this is a body of knowledge or a skill or a total whole that we can move towards - tick these boxes to say these competencies have been achieved, then you’re an integrated practitioner, well I don’t think so because the whole point is about the process. So it’s about being able to think, doing the joined up thinking, it’s about keeping an open mind.

FORD
It sounds to me like an organic thing, which is reacting, constantly moving.

MORRISON
Yes. I can’t imagine working in another way, I don’t know how I would do it now.

FORD
So integration is not yet a clearly defined process which is an aggravation to its critics and a problem for its supporters. The many disparate examples of an integrated approach are just the seeds of a movement which seems to be gaining impetus.

There’s also evidence that politicians are beginning to view this patient-led process with interest. Peter Hain, Leader of the House and Secretary of State for Wales, was converted to the benefits of complementary medicine when his son suffering from eczema and asthma was greatly helped by homeopathy. I asked him how the government was going to respond to the growing popularity of CAM?

HAIN
We are already making a great deal of progress, I mean the Prime Minister, himself, is personally enthusiastic about complementary medicine if properly assessed and in perspective, as I am and I know that John Reid has encouraged that dimension as well. And I think that we now - we’re almost seeing a popular movement in that direction, which is kind of swelling up underneath government and underneath the conventional medical establishment and saying - whether it’s taking dietary supplements or vitamin or mineral supplements or various other herbal type of remedies, on the one hand just in a sense self-treatment from an appropriate source or whether it’s using an osteopath, using reflexologists, using nutritionists, chiropractors, homeopathy - very widespread and very effective - I think more and more people are saying that we shouldn’t be at war here between conventional and complementary medicine, we should be working together.

FORD
On the point of integration shouldn’t we do all the rigorous research on complementary medicine before it’s integrated into the health service?

HAIN
Well I’m in favour of rigorous research of course, I’m not in favour of just introducing it willy-nilly without proper regulation. But here are proven results over many decades and I think we would be failing in our responsibilities to just simply saying we want to keep on testing forever, when actually what I think behind that demand lies a certain scientific prejudice against complementary medicine from the traditionalists in the conventional medical camp. And I think they should be more open-minded as frankly more and more doctors and other medical practitioners and experts are and that is why they are prescribing more complementary medicines and good luck to them.

FORD
During the research for these programmes I met many people who said they were no longer interested in simply being treated for an illness. They were more concerned with staying healthy, looking after their immune system and searching for methods of treatment that looked at them as a whole. And many healthcare professionals would love to be able to work in that way.

But what sort of healthcare system could meet these needs whilst still providing effective and affordable care? Paul Dieppe expresses the view that in future we may have to abandon all the old divisions - of complementary, alternative or orthodox - and focus on providing a healthcare system that is simply interested in whether a medicine works or doesn’t, no matter what form it takes.

DIEPPE
We have a lot of different beliefs, be they religious beliefs or health beliefs, we have a lot of different practices and behaviours in a very pluralist society. We need a pluralist health system to accommodate those different views and approaches of different individuals in our society. I would hope that the future will bring an understanding that the pluralist society should accept and accommodate pluralist approaches to healthcare.

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