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Thursday, April 9th, 2009 Integrated Health

An interesting article from Dr Michael Dixon (08 04 09) on the differing values surrounding integrated health.

Integrated health essentially is combining both complementary medicine and orthodox medicine - it is somewhat controversial and more recently it has been criticised by Professor Edzard Ernst, in the Scrubbing Up health column.

Notably in this week’s column, the medical director of the Prince’s Foundation, Dr Michael Dixon says simply that patients should know what works for them and with that in mind ought to be able to choose their preferred method of approach. He says, ‘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”.

There is a claim from the sceptics that there is no scientific evidence where complimentary medicine is concerned and that is the stumbling block. Dr Michael Dixon agrees that the best evidence should always be used; however he argues that the patient’s views are also essential in that part of the equation.

Clinical decisions are indeed based on the patients needs, Dixon states that ‘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.’

In addition he adds, ‘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.

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. He goes on to offer some factual information, ‘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.’ From that point of view, as patients there is a fundamental need to know where we stand in relation to our care.

Dixon argues that 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.’

Essentially, for some, not all alternative treatments can be deemed effective; however, 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.

Ultimately it is the patient that should make the agreement between their chosen health practitioner on how to proceed with their treatment. They do not need to be given orders or rebuffs in their choice making process.

As Dr Dixon states, ‘ 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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