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



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

References

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