“Can the NHS become a Natural Health Service?” was the question up for debate between the audience and a distinguished panel of scientists and practitioners at the inaugural Hygeia Symposium. A simple question, perhaps, but one that raises a whole host of highly complex and emotive issues.
Held at University College London (UCL) on 26 January 2011, the Hygeia Symposium was the first of an ongoing series of meetings designed to chart a course for the development of natural healthcare in the UK. The meeting is the brainchild of Dr Harald Gaier, a London-based naturopathic physician, and was organised in collaboration with ANH-Intl.
The chosen format was a series of short presentations by each speaker, followed by audience questions on the meeting topic. Broadcaster Chantal Cooke, co-founder of Passion for the Planet, chaired the meeting.
The first speaker, Roger Newman Turner, a practitioner of osteopathy, naturopathy and acupuncture, mulled over the question "Is evidence-based medicine in the best interests of our patients?" He pointed out that, if he hadn't used what proponents of evidence-based medicine (EBM), particularly the randomised, controlled trial (RCT), described as 'unproven' therapies in his practice, thousands of patients would have received no relief from various chronic conditions. Nevertheless, for many of its admirers, EBM is both a mantra – “The blessed RCT shall be the only valid proof for me” kind of thing – and a stick with which to beat non-orthodox medicine in cases where such treatments appear to fall short. But, asked Mr Newman Turner, does such a limited definition of 'proof' actually benefit patients? After all, if a patient derives relief from a treatment, who gains if that treatment is denied on the basis that 'scientific proof' does not exist?
Chris Burley, a practicing naturopath, pointed out in her presentation "The distinct uniqueness of naturopathic medicine" that patients are unique biochemically, medically, structurally and socially, and they must be treated as such. Unlike allopathy, with its focus on the disease process, naturopathy is not a “one size fits all” approach to medicine. Rather, naturopaths act as catalysts, working with their patients to make critical alterations in diet, lifestyle and attitudes both physical and mental. These changes, plus judicious application of natural therapies, free the healing power of nature to restore health and balance anomalies.
Next up, Stan Switala PhD, as might be expected from the title of his talk "Interconnectedness of everything in nature, in us and in medicine," took a ‘big picture’ approach. He pondered why science is so adamant about its certainties, given that certainties disappear when one looks at the quantum level. So-called ‘emergent properties’, which are complex systems that arise when multiple simple entities interact, are central to the difficulties faced by researchers into natural healthcare. Because natural medicine deals with emergent properties, said Dr Switala, RCTs are of little benefit, since emergent properties are not suitable for analysis in this manner.
Next, Dr Robert Verkerk, Executive & Scientific Director of ANH-Intl, spoke on the "Scientific and legal challenges to mainstream adoption of natural medicine." His talk emphasised the startling fact that the much-trumpeted evidence base of orthodox medicine is actually sorely lacking. According to the British Medical Journal (BMJ)’s Clinical Evidence initiative, 51% of around 2500 evaluated orthodox medical treatments are of “unknown effectiveness”. As a comparison, Edzard Ernst, Professor of Complementary Medicine at Exeter University, mentioned in an article in Pulse that his own, pooled research showed that non-orthodox treatments brought positive results in 53% of cases, compared with only 7% negative results! Not only that, but David Sackett, the originator of modern EBM, wrote an editorial for the BMJ in 1996, in which he declared that the EBM concept was being derailed. EBM was not meant to evaluate efficacy, said Sackett, and clinical experience is vital. Dr Verkerk called for new paradigms in the scientific evaluation of therapeutic effectiveness, which must take into account the full range of physiological, emotional and psychosocial effects that comprise the healing process. Furthermore, he said, “It is time to stop preaching to the converted, and to work to influence the wider medical profession and public”.
Dr Harald Gaier, convenor of the Hygeia Symposium and a practicing naturopath, compared rational, orthodox medicine with natural, empirical-based medicine in his presentation entitled "Historical schism in medical thought sketching from antiquity to the present." The rationalism of orthodox medicine, which relies on external theories for its development, is basically incompatible with the empirical thought of natural medicine, where experience is the only guide. Orthodox medical thought is constantly changing because of its very rationalism, said Dr Gaier, whereas empirical medicine has grown and built on itself. As such, natural medicine has a well-developed, organically grown evidence base.
The final speaker was Professor George Lewith, who considered "How natural medicine considers evidence and interprets research." His main point was that more research is needed into natural medicine: at present, complementary and alternative medicine (CAM) accounts for <0.01% of the UK’s national healthcare research budget! “If you pay peanuts, you get monkeys” was Prof Lewith’s opinion, especially given his contention that no research can be done for less than £500,000. An effective, and highly positive, trial of the Alexander technique for non-specific lower back pain, for example, cost £1.5 million. Prof Lewith went on to discuss the lack of evidence for much orthodox medicine, such as antibiotics for chest infections in influenza (“No evidence at all!” was his opinion) and antidepressants, which are inferior to placebo when all trials, including unpublished ones, are considered. He also drew attention to a paper by Gabbay and Le May that showed the small extent to which published research influences GPs’ prescribing decisions. On the other hand, we do not really know how much of CAM works; it may have a powerful, non-specific effect, but we need more research to clarify “What we do and how we do it and what it adds”. Prof Lewith is instrumental in the new College of Medicine, which rose from the ashes of the Foundation for Integrated Health and intends to carry out such research by bringing “Patients, doctors, nurses and other health professionals together, instead of separating them into tribes”.
Two over-riding messages emerged from the inaugural Hygeia Symposium. One: the evidence base of orthodox medicine is surprisingly poor, while, conversely, the evidence base of CAM is encouraging but in dire need of investment and expansion. Two: new research paradigms are needed that take into account different aspects of health, disease and healing and the relationship between patient and physician/healer. The RCT is fine as it goes, but as Dr Verkerk wrote in a paper published in the ACNEM Journal in 2009 , “The originators of the concept intended that EBM represent an analytical approach to medicine by which the results of clinical and basic research, clinical experience, observation and empathy with the patient are combined to provide the most appropriate treatment and care by the medical clinician. A mere four years after the publication of the concept, Sackett and colleagues complained that the EBM concept was being widely misinterpreted through its almost exclusive reliance on evidence from randomised clinical trials for the determination of treatment and care regimens.”
Certain institutions are leading the way in this regard, including the College of Medicine and the Institute for Functional Medicine in the US. Both these and the ANH’s forthcoming Scientific and Medical Collaboration (ANHSMC) recognise that the way forward for medicine must lie in a synthesis of different schools of thought, bringing together practitioners, patients, physicians, researchers, nurses and other health professionals to further open-minded, objective research.
A vital aspect of this debate, not really touched upon during the Hygeia Symposium, is the issue of disease prevention, or more specifically, proactive measures taken by individuals in order to prevent their bodies manifesting dis-ease. Although lip service is currently paid to such preventive measures, little is done on a society-wide basis to encourage such measures: the existing healthcare system may more accurately be described as a sick-care system, preferring to patch up the problems caused by inappropriate lifestyles after the damage is done. Looking at society as a whole, users of natural healthcare are disproportionately more likely to adopt active lifestyle measures to maintain health, whether via herbs, diet, supplements, exercise, homeopathy or a combination of these and other modalities.
In the end, then, research into all aspects of CAM is sorely needed, along with a ‘gathering of the tribes’ from different disciplines to erode the barriers between those disciplines. In an ideal world, the government would make funds available for this research, bearing in mind the potential to reduce NHS costs and improve the health of society, especially through preventive approaches. Of course, prevention is a cornerstone of sustainable healthcare, along with other measures, such as a whole-body heath paradigm, quality of life evaluation and environmental considerations. The College of Medicine and ANHSMC are hopeful and long-overdue pointers that attitudes may be beginning to change. Today’s world of austerity measures and the ‘new NHS’, where commissioning GPs will look increasingly to CAM to save money, is a great opportunity to plant a foot firmly on the road toward a truly sustainable system of healthcare.
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