Page last updated at 06:52 GMT, Wednesday, 8 April 2009 07:52 UK

Patients 'are not lab rats'

Mike Dixon
VIEWPOINT
Dr Michael Dixon
GP

Ear with acupuncture needles
Acupuncture is one treatment which some NHS practices offer

Combining complementary and orthodox medicine into what is called integrated health is a controversial idea - criticised recently in the Scrubbing Up health column by Professor Edzard Ernst.

In this week's column, Dr Michael Dixon, medical director of the Prince's Foundation for Integrated Health, says patients should be able to choose what works for them.

Integrated health is not a new concept - the best doctors and their clinical colleagues have practised it for years.

It means treating patients as whole human beings - paying attention to body, mind and soul - instead of regarding them as nothing more than a set of symptoms to be got out the door as quickly as possible.

But according to a small number of vociferous opponents, it is a "smokescreen for unproven treatments".

The objection seems to be that many of us who practice integrated health include some complementary treatments in our repertoire.

They claim there is no evidence for them and that medicine must always be based on scientific evidence.

Of course we should always use the best evidence that is available, but the patient and his or her views are also an essential part of the equation.

I am a doctor - a GP - and, like many of my colleagues, I will recommend complementary treatments to suitable patients depending on that patient's clinical condition, on whether there is an effective conventional treatment available and - crucially - on the patient's own wishes.

'Wonderfully rosy view'

As medical director of the Prince's Foundation for Integrated Health, I encourage other doctors and health professionals to do the same.

Am I going against evidence-based medicine? Certainly not.

It is wrong to say there is no evidence for complementary therapies.

For instance, the British Medical Journal recently published a study demonstrating that the Alexander Technique was more effective in treating lower back pain than either pain relief drugs or physiotherapy.

The argument that science always knows best, that conventional treatments are always safe and complementary treatments unsafe, simply does not hold water
And the notion that all conventional medicine is based on scientific evidence is equally wrong.

That is a wonderfully rosy view of medical science, but utterly misleading.

Why? Quite simply because there is no evidence for many conventional treatments. One scientific review found that of 2,500 commonly used conventional treatments, effectiveness was "unknown" for 46%.

At the same time, all treatments, all medical interventions, carry some risk.

Take the commonly used anti-inflammatory drugs called NSAIDs for instance.

Mostly, they are beneficial. But there are 2,000 deaths and around 14,000 hospital admissions every year for gastro-intestinal bleeding resulting from this class of drug alone.

The argument that science always knows best, that conventional treatments are always safe and complementary treatments unsafe, simply does not hold water.

'Equal partners'

So where does the patient come in all this?

Those who campaign against integrated health seem not to understand that there are many conditions and many patients for whom no conventional treatment will offer a complete cure, ranging from back pain to terminal cancer.

For these patients, treatment is about relieving their symptoms, improving the quality of their lives, perhaps helping them adjust to the restrictions their illness imposes.

Integrated healthcare takes into account their personal circumstances, their beliefs, their lifestyles. And it treats them as equal partners in decisions about their treatment.

Evidence is there to serve the patient, not the other way round

For some patients - not all - complementary treatments can help.

And the test is not whether someone has carried out a scientific trial, but whether the patient's condition improves.

Research shows around half of patients using a complementary therapy do not tell their doctor.

Often that is because they feel the doctor will disapprove or even be angry.

Yet this can be dangerous because of the risk of adverse interactions between conventional and complementary treatments.

That alone is good reason for the integrated health approach, where patients are free to discuss all their options with their doctor.

'The patient's decision'

Those who aggressively oppose integrated health forget that it is the patient who should ultimately make the decision on their treatment, whether that is conventional or complementary or a combination of both.

Most patients want to make their decisions in partnership with a trusted medical adviser who understands them.

What they don't want is to be given orders, or to be sneered at because they want the choice of being able to test safe complementary treatments for themselves.

Patients are not lab rats on whom "science" can impose its will.

Evidence is there to serve the patient, not the other way round.

We are all patients at some time or other in our lives.

We all want to be treated with dignity and compassion - not as if we are mere mechanisms that can, or perhaps can't, be fixed by some intervention that takes no account of us as people, however "scientific" that might be.

And what do those who oppose integrated health want to happen to those patients for whom no conventional treatment is available, and those who are not able to tolerate the recommended orthodox treatment for their condition?

If these patients are currently being helped by a complementary therapy that these "scientists" disapprove of, do they want that treatment withdrawn?

I believe that would be cruel, inhumane and arrogant. It is an approach to medicine I want no part of.





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