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At the heart of general practice since 1960

Patients have a right to choose complementary medicine

It was good to see Professor Edzard Ernst acknowledge in his blog that medicine is about alleviating suffering ('The reddest herring in town').

But he complains that those of us who support integrated care are never specific about conditions for which we have no effective conventional treatment.

It isn't quite that simple, although every GP could provide a list of examples from his or her own practice. Here are just a few.

The conventional first-line treatment for irritable bowel syndrome is pharmacotherapy with antispasmodic medication. Yet peppermint oil is effective for more patients with fewer adverse effects. That was confirmed by a systematic review published in the BMJ last year. Several of my patients are currently controlling their symptoms successfully using peppermint oil.

The only treatment we have for chronic tiredness is to prescribe antidepressant medication. Yet at least a third of these patients do not have depression. Should we prescribe antidepressants anyway, or look to complementary therapies that might help?

Then there are patients for whom the preferred conventional treatment is contraindicated. No doctor would prescribe anti-inflammatories to a patient with a stomach ulcer. Or elderly patients may be too frail to undergo surgery. In these cases, does Professor Ernst believe we should send our patients away - telling them they have to go on suffering? That is unacceptable to patients, as well as cruel and inhumane.

Complementary medicine is almost always used alongside orthodox treatment. Patients do not usually abandon conventional care or use complementary approaches as ill-considered and ineffective replacements for traditional medicine, as Professor Ernst seems to assume.

At the other end of the scale from irritable bowel syndrome, look at the treatment of cancer. There is considerable morbidity associated with chemotherapy and radiotherapy, and these patients often feel distressed and anxious. An increasing number find complementary therapies can reduce the adverse effects of treatment and help them cope with stress. Therapies ranging from visualisation and relaxation techniques to acupuncture and homeopathy are recommended in many NHS cancer centres.

Professor Ernst forgets patients make their own decisions about treatment. The days when doctor was God and patients did as they were told are long gone. And a good thing too.

Many patients expect to integrate complementary therapies with conventional medicine.

As doctors, we should help our patients have a clear understanding of their medical condition and the options available. And respect the decisions they make.

From Dr Michael Dixon, GP, Cullompton, Devon, and medical director, The Prince's Foundation for Integrated Health

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