Page last updated at 06:00 GMT, Wednesday, 25 March 2009

'A shabby smokescreen for unproven treatments'

Edzard Ernst
VIEWPOINT
Professor Edzard Ernst
Chair of complementary medicine, University of Exeter

Hypnotherapy
Therapies such as hypnotherapy should only be used where there is evidence they work, says Ernst

Mixing conventional and complementary medicine is a fashionable concept, backed by the Prince of Wales.

But in this week's Scrubbing Up health column Professor Edzard Ernst, who analyses the effectiveness of complementary therapies, warns "integrated medicine" can be a "shabby smokescreen" for unproven treatments.


We used to call it "alternative medicine".

But the term is misleading; it implies that people employ homeopathic or herbal remedies, acupuncture, aromatherapy or chiropractic instead of conventional medicine.

Most of us, however, use these treatments as an adjunct to it. Thus the term "complementary medicine" seemed much better suited.

Just as we were about to get used to it, a new term popped up: "integrated medicine".

Not least thanks to the "The Prince's Foundation of Integrated Health", "integrated" is now becoming fashionable. But what does it mean?

Laudable?

Integrated medicine is, according to its proponents, based on two different concepts.

The first is that of "whole person care" or holism, as the experts would call it.

Implying that integrated healthcare practitioners have a monopoly on holism would be like suggesting that only bankers are rich or only the Germans watch football

Integrated healthcare practitioners, we are being told, treat not just the physical complaints of their patients but look after the whole individual: body, mind and soul.

On the surface, this seems extremely laudable. Yet a closer analysis reveals significant problems.

Implying that integrated healthcare practitioners have a monopoly on holism would be like suggesting that only bankers are rich or only the Germans watch football.

The simple and undeniable truth is that all good medicine is holistic. A GP, for instance, should care for the whole individual from the physical symptoms to mental problems, perhaps even social and spiritual issues.

I say "should" because it is true that nowadays many doctors seem to neglect this aspect of their work. By that definition, they are then not good doctors.

Therefore we might consider reforming conventional healthcare and remind ourselves how fundamentally important the concept of holism is.

But delegating holism to integrated healthcare practitioners would be a serious disservice to patients and a detriment to the healthcare of tomorrow.

Evidence based medicine

The second concept upon which "integrated medicine" rests has been described by Prince Charles and others as "the best of both worlds".

Proponents of "integrated medicine" claim to use the "best" of complementary medicine and combine it with the "best" of conventional healthcare. Again, this concept looks commendable on the surface but, if we dig a bit deeper, serious problems emerge.

What does "best" stand for in this context? Surely it cannot mean the most popular, fashionable or exotic?

Leeches
Leeches were once thought 'appropriate' for conventional care.

In healthcare, "the best" can only signify "the most effective".

If we understand "the best of both worlds" in this way, all is fine - except perhaps for one thing: the concept would then be synonymous with evidence-based medicine.

This describes the now accepted philosophy in medicine.

According to its principles, treatments must be tested scientifically and doctors should apply the best available evidence when treating their patients, in fact, they are obliged to do this according to their code of ethics.

If "the best of both worlds" is synonymous with evidence-based medicine, we clearly don't need it; it would only distract from the auspicious efforts of evidence-based medicine to improve healthcare.

'Devoid of meaning'

In actual fact, things are a bit more serious than that.

As soon as we look behind the smokescreen of fancy words and theoretical concepts, we see that in, "integrated medicine", "best" does not mean "effective" at all. It turns out to be almost devoid of meaning.

To better understand what I mean, we need to consider a real life example.

The website of "The Prince's Foundation of Integrated Health" leads us straight to what they believe is "a flagship service, a blueprint for future development".

Healthcare is in danger of disintegrating into utter nonsense

This practice incorporates a Boots store which sells Bach flower remedies, homeopathic medicines and Duchy's Originals Detox Tincture.

Two dozen complementary practitioners rent rooms offering treatments, including "healing" and "thought field therapy"

None of the therapies are supported by sound data for effectiveness.

'Seductively attractive'

In other words, "the best of both worlds", as practiced and promoted in real life, evidently means the integration of nonsensical and unproven treatments into conventional medicine.

The Foundation may well have realised that and cleverly use their own terminology: instead of speaking of "effective" treatments, they seem to prefer the term "appropriate".

"Appropriate" is an entirely inappropriate term for describing the value of medical interventions.

Who decides what therapy is "appropriate"? The doctor? The patient? The healer? And on what basis?

Medicine does not work like this; treatments cannot be based on opinions about appropriateness, they are based on evidence of effectiveness and safety.

Not so long ago, blood letting, purging, mercury and leeches, were all thought of as "appropriate".

Medicine only made real progress when we exchanged the notion of "appropriateness" for the current concept that demands scientific proof of effectiveness.

The long and short of it all this is simple. "Integrated medicine" is a term that, to many consumers, sounds seductively attractive; its two basic concepts seem meritorious.

In reality, it is a shabby smoke screen behind which unproven or disproven treatments are (re-)admitted into routine healthcare.

When this happens, patients are clearly not better but worse off, and healthcare is in danger of disintegrating into utter nonsense.




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