02 July 2012

What proper doctors have to learn from alternative medicine

Seek the inner centre of the soul within the harmony etc...
 Now settle down before you have a WTFeurysm – I have not gone all soft and altie. It’s still the same old Dr Shaney McKee, hard-nosed rationalist and scoffer-at-quacks, here. I’m not about to tell you that homeopathy or cranial osteopathy are anything other than mumbo-jumbo gobshitery. No. However, I think there are certain features of the “alternative medicine” interaction that real doctors need to have a long hard look at, and then look again at their own practice of medicine, and indeed the whole business of medicine altogether.

And by “business”, I am not talking about the generation of lucre. I’m not talking about soft-soaping gullible punters with sibilant whisperings that they want to hear. I’m not talking about lying to patients. Let’s cut to the quick. Not everything the alties say is complete cobblers. Much is, but some of it’s not. In our rush to apply intervention-looking things to every aspect of our patients’ lives, we’ve come perilously close to pushing the impression that people are only alive because we’re keeping them that way. Doctors hold the keys to life and death, and if we lose them down the back of the sofa, everyone is doomed.

The reality is different. If we lost many modern medicines, but kept things like good nutrition, clean water, sanitation, air quality etc, then probably most people would reach a reasonably ripe and happy old age. Heaven help me from the ministrations of too many doctors. Of course, many of these “non-medical” things owe their value-recognition to medics and their research, so I’m perhaps being a bit cavalier. Nevertheless, here is the deal: the human race survived and flourished for many millennia without modern medicine. The only “medicine” that was available was the purely empiric type; very few people were on regular prescribed treatments (and those that were generally died from them). There are a great many important exceptions to this, and I don’t want to get bogged down in the detail, but bear with me. To get to this stage, a hell of a lot of people had to die – it’s a process called natural selection – but the result is that the human body has evolved to be a reasonably resilient vehicle, even given a rather wide variety of environments.

Which brings me to the point where I think we could learn from the alties. In alternative medicine there is a great emphasis on allowing the body to “heal itself”. This is not surprising, given that most alternative medicines don’t contain anything that is actually likely to combat whatever disease process it’s being prescribed for. However, let’s be realistic. The human organism has many mechanisms that act together to maintain a certain equilibrium, and in most people, given reasonable supportive care, and barring nasty accidents, infections, cancers etc., this equilibrium will be sustained over a considerable period of time, say 70 years (the threescore years and ten of biblical allusion). For wetware, that’s really not bad at all. Many patients go to see an alternative medicine practitioner who tells them nice things they want to hear, does precisely nothing for them, then they feel a bit better, and hey presto, equilibrium restores itself (as evolution has effectively programmed it to do), and the patient thinks it was the alternative medicine that did the trick.

Of course there is something hugely unethical about this, as well as the huge fees some alternative practitioners charge, as well as their frequent discouragement of patients to attend real doctors when they have a real problem. But there is something in the interaction that proper doctors need to be aware of. I’m not saying that it is not the exact same interaction that many people would love to have with their doctors, and doctors would love to have with their patients, but the National Health Service is configured to make that seem the exception rather than the rule. Those exceptions are often extremely therapeutic, but it seems that they are insufficiently valued.

As doctors, we very frequently diagnose “disorders” that require “treatments” to put the body back on track, and then maintenance treatments to keep it on that track (the track generally being within a range of parameters that we’ve decided are normal for a 25 year-old male). And as our patients get older, their disorders of different systems require treatments that work via different mechanisms on various parts of our physiology, and it becomes less and less clear exactly what point in physiological Hilbert space the patients should (and even “should” is a loaded term) occupy. Take the octogenarians being admitted to British hospitals, and have a look at the multiplicity of medications we have them on – surely not all of these are contributing to their longevity or bon santé?

Perhaps – and I offer this somewhat tentatively – we need to take a step back. Instead of treating every damn thing, and putting people on maintenance medication to keep them “healthy” (as if the only thing standing between them and the grave is our drug cabinet), should we not adopt a general philosophy of supporting the body as it restores its own equilibrium? It sounds almost vomit-inducingly New-Age; I can hear the tinkle of crystals and wind-chimes already. And of course I am being spectacularly over-simplistic. I’m also attacking a gross straw man – most doctors are perfectly aware of this, and we do try to de-medicalise our patients where possible. Furthermore, for my rhetorical point, I am glossing over the very many harms alternative medicine can do. I am very much aware of this.

But in the face of endless marketing pressure from Big Pharma and haranguing from patients and pressure from government seeking adherence to proxy indicators of health, should we not be open with the public and with each other? We are searching for that Island of Calm where the patient is at ease within their own body, and where we rely a little bit more on the Harmony of Nature to do work its healing magic. After all, it has spent the last 4 billion years ruthlessly pruning failure out of the genepool in myriad rather messy ways, so we the survivors must have something going for us.

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