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Gold, incentives and meh

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)

  • Mark Struthers

    "With respect, your highness, you've got it wrong". This was the title of breast surgeon, Professor Michael Baum's open letter to the Prince of Wales, published in the BMJ in 2004. Dr Steve Hickey was one of the many commentators to BMJ rapid responses.

    http://www.bmj.com/rapid-response/2011/10/30/bully%E2%80%99s-cloak-bigotry

    Baum "argues that the Prince is embracing unproven therapies. This is true, as the scientific method does not prove things. There are no proven results in science as all facts are to a greater or lesser degree provisional. The term "scientific proof" is used as shorthand for people who claim scientific support but do not understand the scientific process. This term can indeed be used as a “cloak for bigotry” to support unscientific arguments by less-able members of the medical profession."

    Steve Hickey went on to say,

    "Baum’s attack on the Prince has the quality of a playground bully."

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  • Mark Struthers

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