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College? No, 'Quackery', Say CAM Critics

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CAM NEWS SPECIAL NEWS FEATURE College? No, ‘quackery’, say CAM critics A short report in the British Medical Journal on the fund-raising activities of the new College of Medicine, which aims to promote integrated health care in the NHS, has been followed by a storm of feedback in the BMJ. * This has included a comment from Dr Edzard Ernst headed “College of Quackery” and the statement “this is not ‘excellence’ but outright quackery which has the potential to kill patients”. Michael Ash, BSc, DO, ND, F DipION, responds to the commentary. lternative and integrative The pressure comes from self-styled rhetoric and scientific racialism. practitioners must feel at times skeptics and vocal opponents of CAM, as Integrative and alternative therapies as though their career choice well as a plethora of EU legislation. Finding (CAM) are most effective for patients who is suddenly less than ideal in a way forward can be daunting, and even have already developed chronic illness, or Athe face of relentless attempts to diminish significant organisations such as the who have risk profiles suggesting they will. their role in assisting and improving the recently formed College of Medicine are Despite efforts in the BMJ to health status of their clients and patients. seeing their mission mired in ego-driven inappropriately compare homeopathy with acute medicine interventions, emergency medicine is not the ground on which CAM’s allegedly unsubstantiated and evidence- deficient therapies predominately operate and deliver most benefit. Mainstream medicine development Mainstream medicine (dominated by drugs and surgery) has in the main continued to evolve by remaining heavily reliant on its early 20th century model and its success in attacking infectious diseases, rather than in the resolution and prevention of chronic, complex diseases. It has been remarkably successful and we have much to be thankful for, albeit that mainstream medicine’s “seek and destroy” mentality may be a significant contributor to the current evolutionary drift towards illnesses such as allergy, autoimmunity, diabetes and cardiovascular disease, which are now so common. (1) Helping people change is no mystery It is no mystery that what motivates patients to make the lifestyle changes that appear to be so crucial for managing and/or lowering the risk of serious chronic disease is having 6 cam AUGUST 2011 WWW.CAM-MAG.COM CAM NEWS attention lavished on them. That means to an “alternative” practitioner. Instead longer, more frequent visits; more focus of passively or actively supporting on what’s going on in their lives; more polarised positions, doctors and effort spent ameliorating anxieties, researchers might wish to keep their instilling healthy and positive attitudes, minds open and show tolerance or even getting patients to take responsibility praise for the alternative approach, for and engaging in their well-being; and these practitioners mostly fill the gaping concerted attempts to provide hope. (2) holes in modern medicine. Patients do Our current understanding of chronic not care about the mechanism; they want disease origins is that they emerge improved health. from a complex interaction between the The Holy Trinity of patient-centred genetic uniqueness of the individual outcomes – satisfaction, functionality and his/her lifestyle and environment. and cost – is well met by alternative/ (3) Modifying gene expression to integrated medicine practitioners. diminish risk, promoting and sustaining There is regular anti-CAM posturing positive lifestyle changes, requires an from a small group of well-recognised increasingly personalised approach and vocal skeptics. The main players to lifestyle and nutritional inputs that include Prof David Colquhoun, a is likely to exceed recommendations respected researcher but not a physician; delivered by public health care Prof Edzard Ernst, a recently retired providers. (4) professor of complementary medicine “????????????????????????????????????? ????????????????????????????????????? ????????????????????????????????????? ????????????????????????????????????? ????????????????????????????????????? ????????????????????????????????????? ????????????????????????????????????? A New England Journal of Medicine who is long since removed from daily paper by A.L.Barabasi suggests that the clinical practice; Dr Steven Novella, a future of medicine lies in the systems neurologist with disproportionate levels approach, which views disease as of blogging time; and Dr David Gorski, arising from complex alterations in our a surgical oncologist with a corybantic pliable physiological network, drawing (frenzied; agitated; unrestrained) writing connections from genetic inheritance, style. If, however, we were to seek expression, environment and social support from all the physicians and factors. (5) researcher-physicians who remain open- minded and actually employ or tolerate Skeptics – what do they add to “alternative medicine” because they see our future health needs? and experience patient benefits, this We are all aware of the almost rabid journal would need to double in size to attacks on alternative strategies and accommodate them all. practitioners (by self-appointed skeptic experts). We also know that patients are Proven benefits of integrative frequently challenged by their GPs or approaches consultants when the patients ascribe A popular target, Dr Dean Ornish, MD, marked improvement in their health has repeatedly demonstrated that WWW.CAM-MAG.COM cam AUGUST 2011 7 CAM NEWS SPECIAL NEWS FEATURE integrative medicine approaches may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, obesity, hypercholesterolemia, and other chronic conditions. (6) Many of these are recognised to be the leading cause of morbidity and mortality in the Western, and increasingly the Eastern, world and are essentially diet and lifestyle related illnesses. (7) But for skeptics, randomised, controlled clinical trials (RCTs) are the only approved method for demonstrating efficacy (often Fig 1: Summary of results assumed to be the same as real-world of analyses by Prof Edzard Ernst, based on his research effectiveness). It comes as a surprise group’s ‘The Evidence So to many, therefore, to learn that RCTs Far’ review document. published in the New England Journal of Medicine (8) and elsewhere have shown that angioplasties and stents – common surgical procedures used to treat heart disease – do not prolong life or even prevent heart attacks in stable patients (ie at least 95% of those who receive them). Coronary bypass surgery prolongs life in fewer than 2% of patients who receive it. Lifestyle changes have profound effects on people’s health, and yes, those of a skeptical persuasion will argue that all medical professionals advocate eating well, exercising regularly and reducing daily stresses. However, the reality is that they have little time or motivation to manage what are very difficult changes to sell to the patient, especially when both patient and clinician have bought into the over- simplistic “pill-for-every-ill” drug solution. Fig 2: Ongoing analysis of some 2500 “commonly used” conventional treatments as undertaken by BMJ Clinical Evidence (redrawn from data given Time is not a luxury, but essential at http://clinicalevidence.bmj.com/ceweb/about/ clinical care knowledge.jsp) Integrative practitioners commit to spending more time and more energy assisting individual in their choices so that decisions fast and often abrupt communications. patients to change, and benefits are seen are mutually agreed upon, can have Medicine is not simply the delivery of in transitions to positive, healthier lifestyles. profound effects on that person’s health technique; it also requires the art of support The conversion from self-destructive, status. and development through a cooperative industry-driven behaviours can be complex Unfortunately, RCTs continue to throw relationship between the participants. and riven with emotional, physical and up spectacular failures and few successes Employing different disciplines adds economic constraints that far exceed when applied to separated aspects of the substantive healing benefit to the recipient. the time and skills of many “mainstream” alternative armoury, rather than to the These benefits should be harnessed and medics. collective experience. But to deny patients employed as part of the therapeutic toolkit. Humans, being what they are, find their the entire option of alternative healthcare own solutions; some may find a GP or is to deny the powerful effects that this A future model of care private doctor with the time and motivation interaction and mutual care generates on Snyderman and Hood’s proposal is to counsel them accordingly, but most do mood and personal belief. These benefits that future medicine – they refer to it a not. Coming into contact with a caring are dismissed as placebo by the skeptics, prospective medicine – should become health care practitioner – an alternative, yet the same placebo-esque strategies are focussed on improving the functional health functional or integrative practitioner employed by their colleagues on a daily of the individual. To achieve this medicine – who spends time and engages with the basis, where time and intellect demand needs to be: 8 cam AUGUST 2011 WWW.CAM-MAG.COM CAM NEWS • Personalised, the evidence that satisfies the critics, • Predictive, and meanwhile employ the techniques • Preventive, and and treatments that satisfy them. (15) • Participatory. Even Edzard
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