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Time to reclaim ‘holistic’ care

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Prince Charles’ recent editorial in the Journal of the Royal Society of Medicine1 is worth reading – because it explains how a little knowledge paired with unwavering beliefs can result in vastly mistaken conclusions.

Allow me to summarise: integrated health ‘maximises the potential of conventional, lifestyle and complementary approaches in the process of healing’. HRH acknowledges he has been criticised for his belief that integrated healthcare is not just about ‘repair of the (human) machine’, but care of the ‘mind, body and spirit’. To achieve this aim, he argues medicine should become ‘less literal in its interpretation of patient needs and more inclusive in terms of what treatment may be required’. Symptoms may therefore be ‘a metaphor for underlying disease and unhappiness’.

The upshot, he says, is that ‘treatment may often be effective because of its symbolic meaning to the patient through effects that are now increasingly understood by the science of psychoneuroimmunology’. Big words!

The editorial then cites Marmot on stress and Blackburn on telomeres, expands on the need to have the ‘human touch’ and to hear the ‘narrative’ of the patient, and describes how his charities, working in Burnley, are making a difference because ‘we know that alienated and uncaring communities adversely affect the health and wellbeing of those living in them’.

Let us examine the subliminal references to complementary therapies and the way in which pick-and-mix evidence selection can undermine what we know about health. HRH is right when he says that we should do more to ‘enhance the length of contact and continuity’ between doctors and patients – but if that time is spent doling out alternative medicine, we may as well not bother.

Where Prince Charles has it wrong, in my view, is in assuming that complementary therapies have a role in modern medicine. Relying on things we know don’t work means we don’t pay attention to what does work.

Sticking to alternative medicine because it is sometimes good at delivering placebo effects creates massive problems, not least in effectively misleading patients. Spending time with patients to talk, to understand, and to plan has positive effects, as too does continuity of care. My book, The Patient Paradox2, gathers evidence on how to generate caring effects without the use of alternative medicines or unethical placebos.

It we really want to look at the social determinants of health, we could start by believing the copious amount of work that tells us how bad inequalities are for health.

It’s time for hard-nosed, evidence-based medicine to take back the word ‘holistic’. For too long, the advocates of alternatives have allowed themselves to think that it is only them who really ‘care’.

In fact, it is impossible to truly care for patients whom we think so little of that we give them placebos. This kind of thinking is endarkening. Our NHS deserves better.

References

1 HRH the Prince of Wales. ‘Integrated health and post modern medicine’. JR Soc Med 2012, online 21 December. tinyurl.com/JRSM-HRH

2 McCartney M, The Patient Paradox. Pinter and Martin, 2012. thepatientparadox.com/references

Readers' comments (13)

  • Margaret, your articles are always a great tonic, even after a hard day on holiday.

    HRH's views are dangerous not just because of his little knowledge paired with unwavering beliefs.

    Here's my theory: humankind's need for what Robin Dunbar calls "social grooming" makes vulnerable people and greedy alternative medicine entrepreneurs particularly susceptible to HRH's eminence + seemingly good intentions + empathy (at a distance) + beliefs in magic and witchcraft (limited knowledge disguised by sciencey terms such as psychoneuroimmunology).

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  • Acupuncture was considered an alternative modality. If everything about complimentary medicine is full of nonsense, why is advocated by NICE for knee, back pains and headaches? Current medicine is very narrow minded and can't see beyond is myopic vision...

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  • Mark Struthers

    HRH just wants a bit of compassion, caring and kindness introduced into health services. What's wrong with that?

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  • Mark Struthers

    A book I'd recommend "to generate caring effects" ... without bashing the alternatives or the Prince of Wales is,

    'Intelligent Kindness: Reforming the Culture of Healthcare' by John Ballatt and Penelope Campling.

    http://amzn.to/GVKN71

    Kate Pickett, Professor of Epidemiology, University of York wrote in review,

    "To be kind is to be in harmony with human need, requiring empathy and a sense of equality. Kindness, camaraderie and mutuality are essential for our physical and emotional well-being, and never more so than when we are ill, or when we are caring for those who are ill. Ballatt and Campling show how kindness can work to heal individuals, organizations and society".

    PS. Kate Pickett, along with Richard Wilkinson, wrote 'The Spirit Level: why equality is better for everyone', another book I'd strongly recommend.

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  • Laudable Margaret, but you are a voice crying in the wilderness. Except In criticising HRH you are treating the symptom and not the cause - ask how many of your colleagues have heard of Balint. You might have to open your own medical,school if you really want to improve much of what passes as compassionate clinical practice for the better.

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  • Mark Struthers

    Dr McCartney wrote,

    "Relying on things we know don’t work means we don’t pay attention to what does work. Where Prince Charles has it wrong, in my view, is in assuming that complementary therapies have a role in modern medicine."

    I don't want to appear unkind, even subliminally, but is it possible that Dr McCartney is wrong ... even just a little bit?

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  • Mark Struthers

    "So Charles was right - you should talk to plants, scientists discover"

    http://www.dailymail.co.uk/news/article-478558/So-Charles-right--talk-plants-scientists-discover.html

    "Asked about his habits in the garden, Prince Charles replied: "I just come and talk to the plants, really - very important to talk to them, they respond.""

    I think Dr McCartney is wrong. The scientific evidence suggests that the Prince will make the desert bloom with his kind and caring attitude towards plants and other animals.

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  • Mark Struthers

    Dr McCartney said,

    "HRH is right when he says that we should do more to ‘enhance the length of contact and continuity’ between doctors and patients" ...

    And the Prince is right about tomatoes too. Science has spoken: a very long empathetic consultation with a tomato plant will produce bigger, brighter, happier tomatoes, and more of them. Sadly, there are doctors who doggedly refuse to engage with the evidence.

    http://www.bmj.com/rapid-response/2011/11/03/retalking-animals-trick-or-talking-treatment

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  • Mark Struthers

    It's hypocrisy! The fluffiness of the evidence base that orthodox medicine sits on doesn't seem to stop the anti-CAM PR fluffers from fluffing along hypocritically.

    http://www.bmj.com/rapid-response/2011/10/30/respect-professor-baum-youve-got-it-wrong

    With respect, Dr McCartney, you too have got it wrong.

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  • Alas your understanding of the concept of holism in medicine is primitive and you give your bias away by using pejorative phrases such as 'sometimes good at delivering a placebo'. Your understanding of the concept of 'evidence' also leaves a great deal to be desired. Have you read the BMAs Clinical Evidence Handbook and see what the evidence is for commonly used ORTHODOX treaments is like? Probably not. Do you think SSRIs are useful in mild and moderate depression, the sort that GPs treat? Have you read Kirsch et al on SSRIs and antidepressants?
    Prince Charles understands the concept of the philosophical approach of holism in medicine which of course INCLUDES effective conventional methods. It is YOU who might benefit on some alternative type reading. In the meantime I'll pass on your book

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