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A faulty production line

Are you a NICE doctor, or a fan of the alternative?

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Recently I had a minor tiff with my fiancée, who is not a medic, about reflexology. My opinion of the "therapy" is that it was total bunkum, as there is no proven evidence base for it. Of course, as expected, this statement did not help matters.

The reason this topic arose in the first place was because my tutorial class were all doing presentations on different types of alternative therapies. Our source material was a book called Trick or Treatment, by Simon Singh and Pulse blogger, Edzard Ernst. My topics were ear candling and massage therapy.

Before I read the relevant chapters, I decided to read the homeopathy chapter which I found fascinating. I thought the introduction was interesting too as it described the old days of heroic medicine, which involved using venesection (a.k.a. bloodletting) to treat all manner of conditions.

As a modern NHS doctor where NICE guidelines advise management options for a variety of conditions and diseases, the thought of using a treatment which does not have proven evidence base would seem odd - nay, dangerous.

But until the mid-nineteenth century, there was no such thing as evidence-based medicine and the use of hazardous and unproven treatments was commonplace by the medical profession. As well as bloodletting, there was intestinal purging, induced vomiting, profuse sweating and blistering of the body, which were all thought to help make people better.

So, compared to heroic medicine, modern medicine is obviously far better and humane. But modern medicine is still not perfect. Medications often have horrible side effects and often don’t work in the way people expect. GPs are constrained by time and budgets and cannot always give patients the time they want or the medications they want, so some people look elsewhere.

That is where alternative therapies come into play. Some are just frankly rubbish, such as ear candling, or cupping, with no logical therapeutic use. But others, such as massage therapy, are based on sound anatomy that may help some muscular problems, as well as improving ones wellbeing.

So despite my apparent cynicism, I am conscious that I must be open to and aware of some of these alternative therapies. At the same time, thought I should also be able to give sound (modern) medical advice where appropriate, especially if potentially lifesaving treatment is being avoided in order to use untested and expensive therapies.

At the end of the day, if a person has capacity, then they have the autonomy to pick therapies they feel will help them, even though we as doctors know they are pure quackery.

And just to keep you updated on my 5:2 diet, after four weeks I have lost 2.3kg, and my BMI is 30.5 (which puts me in the 'obese' category, class 1). Read more about how I started this diet here.

Dr Avradeep Chakrabarti is a GPST3 from Swindon


Singh, S & Ernst, E. (2008). Trick or Treatment? Alternative Medicine on Trial.




Readers' comments (8)

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  • You are welcome to come and sit in with me at our training practice and witness the safe use of homeopathy and acupuncture alongside normal medicine in a standard GP surgery.
    How is your scientific and clinical curiosity aroused when patients do not respond to scientifically evidenced treatments?

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  • Why do you say massage therapy 'may' help some muscular problems. It does. It's just more expensive than a painkiller, which just suppresses symptoms. I had extensive muscular problems from sitting on my backside all day using a computer and making repetitive movements. The younger doctor in the practice didn't examine me and referred me to a rheumatologist and had me x-rayed. In the meantime, I went to the older doctor, who had returned from holiday. He asked me what I did, came round the side of his desk and felt my shoulders, said they were like a board and to go get a massage. I did and that helped get the problem under control and enabled me to continue working. Of course, this is just anecdotal, not 'evidence based'.

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  • you can find more of my posts here

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  • There may be no scientific research done into these alernative therapies because there is no big pharmaceutical interest in them - hence no money to fund such research.

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  • Congratulations to 'GP to be' for his inclination to remain open minded. Not an easy task when the pressures to conform to the 'norm' are so intense. And well funded.
    He mentions his 'apparent cynicism '. Those of us with decades in primary care may either be semi comatose / burnt out, or, if we are lucky we may be unapologetic cynics and sceptics, who have have recognised the amazing results one can achieve with complementary therapies ( particularly homeopathy ). As well as having many more grateful and satisfied patients, one also has huge satisfaction and enjoyment from using such approaches.
    When did you last see a complaint/warning about medical homeopathy in the Defence journals ?
    Remain open minded, seek out what works, and beware the expert critics who know as much about the practices they deride as we do about the taste of moon dust.
    Enjoy your career.

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  • Penelope- I've just turned 36- so am I still classed as young.

    I regularly suggest massage therapy to patients with back pain, as it worked for me. Of course I mention they will have to pay for it, but Edvard Ernst and Simon Singh's book suggests that not all massage therapies are good for MSK issues- the more Eastern sounding the therapy, the less likely it will clinically work, although it will likely improve ones well being and thus may be acting as a placebo?

    My fiancee is a layman and swears by some of these alternative therapies. If I want to stay in her good books, I need to be more open minded, especially as some of the best cures and medications only have anecdotal evidence at best.


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  • You have to read Ernst and Singh's book to realise how biased it is. It misleads in that it gives the impression that conventional 'modern' medicine is all evidence based. It most certainly is not. According to the BMJ's handbook on Clinical Evidence (which I have with me at all times) only 11-13% of commonly used conventional medications have the highest level of evidence to back them. The major 'bunkum' and quackery in medicine is withing the sphere of the orthodox I am afraid.

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