Richard G. Petty, MD

Herbal Remedies

Edzard Ernst’s group at Peninsula Medical School, Universities of Exeter in England has published another study that is critical of one aspect of complementary medicine.

They set out to summarize and evaluate the evidence from randomized clinical trials for the effectiveness of individualized herbal medicine.

They conducted a search of electronic databases and also contacted experts in the field to identify randomized controlled clinical trials of individualized herbal medicine. They then conducted an independent data extraction and assessed the quality of the studies.

They found three randomized clinical trials of individualized herbal medicine. They concluded that statistically non-significant trends favoring herbal remedies over placebo treatment in osteoarthritis of the knee probably resulted from large baseline differences and “regression to the mean.”

They also concluded that individualized treatment was superior to placebo in four of five outcome measures in the treatment of irritable bowel syndrome, but was inferior to standardized herbal treatment in all outcomes.

Finally individualized herbal treatment was no better than placebo in the prevention of chemotherapy-induced toxicity.

The final conclusion was that there is very little evidence regarding the effectiveness of individualized herbal medicine.

Though this result is rather gloomy, it is important not to throw out the baby with the bathwater.

The researchers did the right thing: they asked the experts and examined the published data. Yet every practitioner has seen herbal remedies that seem to help certain specific conditions. So my take on this study is not to abandon herbalism, but to realize that there is a great deal more research to be done.

New Treatment Options: Knowing What to Use

One of the main reasons that I created this blog is that I want to empower you: I want to give to give you the information that you need to care for yourself and the people around you.

One of the problems with many new treatments is that they promise the earth, sometimes drag people away from things that may help them and then fail to deliver.

This is something that I struggled with in the field of holistic medicine for thirty years. I constantly hear and see fantastic claims that cannot be right and are often based on a complete misunderstanding of how the body functions. On the other hand there are some highly unorthodox methods and techniques that can be amazingly helpful. My job has been to find out which is which!

But it is not only in the field of unorthodox medicine. I have recently heard about something very questionable in the field of psychotherapy. Somebody has invented a new form of therapy that cuts across and ignores decades of research. He is now offering certifications in his method. So long as you have a very basic healthcare qualification, you pay him a few hundred dollars, do an online training and then you can set up shop as a therapist. Many members of the public do not know how little regulation there is for some of these therapies.

Here are some guidelines for checking out a new therapy or remedy:

1. Efficacy
Be suspicious of any treatment or therapist if they:

• Claim that a treatment works for everyone: I have yet to find ANY treatment that works for everyone
• Only use case histories or testimonials as proof. The plural of anecdote id not evidence. If we see or hear about something that looks promising, it is essential to confirm the reports with systematic, independent controlled research. Be aware that if that has not been done, the person selling you the treatment or the therapist claiming to help is essentially experimenting on you. And if they want to experiment they need your consent and the approval of an Institutional Review Board. And don’t buy into the “my work is so brilliant and cutting edge that nobody will publish it in a journal.” It is hard to publish really new work, but we cannot believe what people are saying until it has been subjected to peer review: other experts go through the work with a fine toothcomb to see if it is right.
• Cite only one study as proof. Hundreds of promising studies have turned out to be dead ends when someone else tried to repeat it. You can be a lot more confident if several studies have shown the same thing.
• Cites a study that did not have a control (comparison) group. That is always a first step in evaluating a new treatment.
• Cite a study that you cannot see yourself. We spend a lot of time checking some of the claims made on infomercials and websites. They often talk about some obscure study in a hard-to-find journal written in a foreign language. We go and find the papers and if necessary translate them. We constantly find that the studies quoted contain results that are 180 degrees away from what they claim.
• Only reference themselves. This recently came to light with a form of therapy that comes with a short book. There was not one scientific citation, but loads of self-references, so it looked as if there was something credible behind it.
• Testing a treatment without a control group is a necessary first step in investigating a new treatment, but subsequent studies with appropriate control groups are needed to clearly establish the effectiveness of the intervention.

2.  Safety?
Be wary if:

• A therapist or someone promoting a remedy cannot tell you the exact consequences of not following up with some other treatment. Safety is not only about the safety of a product or a therapy: it is also about the risks of declining a proven treatment
• A therapist tells you stop any other treatment that you are on without discussing the risks of stopping it, and without discussing the situation with any previous therapist. It does not matter whether you were on a medication or having acupuncture. Different treatments interact, and stopping and starting can be risky. If a therapist who does not prescribe medications tells you stop them, be very, very careful. There are precise ways to discontinue most treatments
• A remedy comes without precise directions about how to use it
• Something does not list its contents or ingredients
• A product has no information or warnings about side effects
• If a product or therapeutic approach is described as natural, with the implication that natural means safe. Hurricanes, arsenic and deadly nightshade are all natural!

3.  Promotion
Be very cautious if a therapy or treatment:

• Claims to be based on a secret formula or a secret that has been deliberately hidden from you
• Claims that the particular treatment or therapy is being suppressed or unfairly attacked by the medical or therapeutic communities
• Claims to work immediately and permanently for everyone
• Is described as an “Amazing breakthrough” or a “Miracle.”
• Claims to be a cure for something that other experts believe is incurable. They could be right, but then we have to go back to the first point about efficacy
• Is only promoted through infomercials, self-promoting books, online or by mail order

4. Evaluating Media Reports

• When evaluating reports of health care options, consider the following questions:
• What is the source of the information? Good sources of information include medical schools, government agencies (such as the National Institutes of Health and the National Institute of Mental Health), professional medical associations, and national disorder/disease-specific organizations. Information from studies in reputable, peer-reviewed medical journals is more credible than popular media reports.
• Who is the authority? The affiliations and relevant credentials of "experts" should be provided, though initials behind a name do not always mean that the person is an authority. Reputable medical journals now require researchers to reveal possible conflicts of interest, such as when a researcher conducting a study also owns a company marketing the treatment being studied or has any other potential conflict of interest.
• Who funded the research? It may be important to also know who funded a particular research project.
• Is the finding preliminary or confirmed? Unfortunately, a preliminary finding is often reported in the media as a "breakthrough" result. An "interesting preliminary finding" is a more realistic appraisal of what often appears in headlines as an "exciting new breakthrough." You should track results over time and seek out the original source, such as a professional scientific publication, to get a fuller understanding of the research findings

5. What Are the Financial Implications of This New Therapy or Remedy?

• Is the treatment covered by health insurance?
• What out-of-pocket financial obligation will you or your family have?
• How long will this out-of-pocket financial obligation be?
• Is there any kind of guarantee?
  

Tips for Finding Reliable Information Online
The good news is that the Internet is becoming an excellent source of medical information. The bad news is that with its low cost and global entry, the Web is also home to a great deal of unreliable health information.
In addition to the tips cited earlier, Web surfing really needs some special considerations:
Know the source. The domain name tells you the source of information on the Web site, and the last part of the domain name tells you about the source. For example:
.edu = university/educational
.biz/.com = company/commercial
.org = non-profit organization
.gov = government agency

The same rules do not always apply if you are looking at websites in other countries.
Obtain a "second opinion" regarding information on the Web. Pick a key phrase or name and run it through a search engine to find other discussions of the topic or talk to your health care professional.

Experts who spend time and trouble evaluating reports and then publish their findings online will often answer questions. RichardGPettyMD.blogs.com is one that does, and there are many others.

More on Rescue Remedy

My piece about Rescue Remedy has brought in a lot of questions about where to obtain it.

In the United States, Australia and most of Europe consumers can buy it over the counter without a prescription. Most health food stores in the United States have it, and you can order it on line. A bottle is usually in the US$6-10 range, and even in my world, where there is a constant stream of hurt animals, children and adults, the bottle lasts a long time.

I also mentioned Nelsons, who I have relied upon for three decades or more. Nelsons USA is based in Wilmington, Massachusetts is part of the Nelsons group that is still located in London. It was founded in 1860, and Nelsons remains a family-owned business with a longstanding commitment to supplying high quality natural medicines. I have seen their products on sale in at least a dozen countries.

Apart from Rescue™ Remedy, they also manufacture Bach™ Original Flower Remedies, Nelsons Arnicare™,  Nelsons Teetha™, and Nelsons™ Homeopathy.

There is a good website: that has more information. It also has a nice online tool for helping you decide on which other Bach Essence may be right for you.

Non-pharmacological and Lifestyle Approaches to Attention-Deficit/Hyperactivity Disorder: 9. Flower Essences

The original flower essences were created by a Welsh physician named Edward Bach. He passed away in 1936 at the age of forty-nine and in many ways he was well ahead of his time. He was a firm believer not only in psychosomatic medicine, but also in the impact of the soul on the body.

He used a combination of scientific knowledge, intuition and clinical practice to find and refine the use of the flower essences. He walked all over Great Britain to find the correct remedies, and prepared them by taking flowers at the peak of their blossoming, and placing them in a bowl of pure water in sunlight. The water then became the raw material from which the remedies were created. Each is bottled, and a small amount of brandy added to “preserve” the remedy, which is then administered, usually diluted in water or fruit juice.

Originally there were 38 “Bach Flower Essences” together with a 39th called Rescue Remedy, which is a combination of five of them.

As time has gone by, new remedies have been created in Europe, the Continental United States, Alaska and Australia. The appearance of these “new” remedies has caused a great deal of controversy amongst traditionalists who believe that there can only be the 38 remedies discovered by Dr. Bach.

Yet people change as they move to new regions of the earth, and it is to be expected that new remedies will be waiting for them wherever they go.

Before I came to the United States I was a dyed-in-the-wool Bach Remedies person. Although I had been using them for two decades, I soon realized that people in North America often needed a different approach, and within months of my arrival I started to try the remedies created in North America with great success. (Over on the left hand side of this blog you will find some suppliers of the remedies).

So what is the evidence that flower essences are of any value in treating ADHD? There is the evidence of case reports, but precious little in the way of controlled studies. A study from Israel failed to show any benefit in 44 children with ADHD treated with Bach Flower Essences.

However, there are experts throughout the world who continue to use them for ADHD and who claim good rates of success. They aim to treat not only the attentional symptom, but also the whole person. So in deciding on a remedy they look at all the associated symptoms. I give some examples of what they look for below.

These are the main English and American remedies that have been found in practice to help some people with ADHD. Some practitioners use them in place of medications, but it is difficult to be comfortable to do that, given the problems that can occur when young people or adults have ADHD and are left untreated.


Agrimony: The child who might be helped by this remedy looks cheerful and easy going but is often filled with inner torment. The child may have great difficulty in reading if he is in a group

Aspen: These people are anxious, apprehensive and tremulous. Their fears and anxieties have no readily apparent cause. They tend to be overly receptive to the emotions of other people. They can become very worried about the unknown, fearing that there are some dark forces that will engulf them. These people often engage in magical thinking, and the fear make them feel “paranoid.”

California Wild Rose: Children who might benefit from this tend to have low vitality, poor appetite and a lack of interest in food

Calendula: People who might benefit are typically argumentative poor listeners who have communication problems in relationships. They tend to have a lot of difficulty in receiving and acting on what others are saying

Chamomile: These children tend to be contrary, fussy and agitated. They often suffer from tension in the stomach area with related digestive disturbances. They usually have continuous emotional tension that interferes with learning and concentration

Chestnut Bud: These children often lag behind others, have difficulty with learning, repeat mistakes and have difficulty focusing on and retaining what they study

Chicory: These children demand a lot of attention because of their negative behavior. They may have temper tantrums, be overly fussy and easily get irritated if they do not get the attention that thy want. Then they tend to cling or feel sorry for themselves

Clematis: These children are daydreamers who escapes from the present by fantasizing about the future

Cosmos: These children and some adults have overly active minds that are flooded by too many ideas at once. They get so overwhelmed that they are unable to focus. This becomes very obvious when they try to think and talk at the same time. They feel overwhelmed by the overwhelming amount of information and find it hard to be articulate

Dill: These children are easily overwhelmed by new projects or when life moves too fast for them. They can feel also be overwhelmed by change

Elm: This is another remedy for people who easily feel overwhelmed. Not only do they have the feelings of being overwhelmed, they also feel over-extended and isolated

Filaree: These children get lost in details and worries. The find it very difficult to see a lose broad perspective, so they over-focus on details and can when they are be overcome by anxieties about them

Gentian: These children are not good at persevering with a project and easily get discourage. If they encounter some setback or difficulty, they find it difficult to bounce back. Gentian helps overcome discouragement after rejection or failure and makes it easier for them to get on with life without ruminating over the problem

Golden Yarrow: People who may benefit from this typically have performance anxiety. The essence may instill confidence and enable them to perform at their best

Goldenrod: These children are unsure of their own values and beliefs, so that group and family ties may easily influence them. They may become overly reliant on social approval and vulnerable to peer pressure and social expectations. Some create barriers between themselves and others by anti-social or obnoxious behavior

Holly: The child who might benefit from Holly tends to be jealous, envious and to have sibling rivalry. They tend to see any change or disruption as a threat. They are very sensitive to minor occurrences that most other people would not even notice. They may be angry, agitated, aggressive and intolerant. They are often quick to perceive others as threatening and are easily influenced

Impatiens: This can often be very helpful for children who are restless and impulsive and who eat too quickly. They often become easily frustrated and can be impatient, angry and intolerant with fiery temperaments. Some children – and adults – who might benefit form Impatiens may even become abusive or violent

Indian Pink: This is especially valuable for children with have attentional problems and are living in disorganized homes. The disorganization in their environments may make them nervous and they may have particular difficulties in staying calm and focused in the midst of emotionally intense and turbulent times. The remedy can help them focus and feel more grounded, calm and self-disciplined

Iris: People with ADHD who feel frustrated that they cannot express their creativity. Instead of being creative they feel weighed down by ordinariness of the world, which seems dull, colorless and uninteresting. They are usually hyperactive, and may easily become hypoglycemic and to crave candy and other sweets

Larch: For people who may benefit form this remedy, their symptoms stem from crushing doubt about themselves and their abilities. This lack of self-confidence comes out in many ways. They fear being ridiculed by other people, they are anxious and have a fear of failure. The lack of confidence may make them bad procrastinators and give them an “inferiority complex.” If this is the right remedy, it can help instill confidence in self-expression or performing in public

Lavender: People who might benefit form Lavender are typically nervous and high strung. They are very sensitive to sensation, not only from the five senses but also form spiritual influences. They tend to be light sleepers with very active minds and a strong attraction to spiritual practices. The tension in them often comes out in the neck and shoulders, as well as headaches and visual problems

Madia: These people are easily distracted, unable to focus, have scattered thinking and an inability to manage details. They are often dull and listless and can easily become “spacey.” They often have a great fear of public speaking. For the right person Madia enhances the ability to focus and concentrate and to be precise in his or her thinking

Mallow: These people not only have problems with attention, they also find it difficult to make and maintain social contacts and friendships. Their social insecurity and fear of reaching out to others means that they often suffer from feelings of isolation and abandonment. The remedy may help them become more accepting and to develop self-esteem, warmth and trust

Mariposa Lily: These children often feel alienated from their mother. In adults with attentional problems this remedy may be helpful in the healing of childhood traumas, including abandonment and abuse

Mimulus: These children are shy and have a lot of fears and phobias about concrete fearful events, objects, or people. They may have a fear of heights, flying, illness, dentists or almost anything else. This constant dread, worry and fear makes it hard for them to face the challenges of daily life. These children are often physically sensitive, shy and introverted, though they may talk a lot or puff themselves up to hide their fear

Morning Glory: These people tend to be dull and constantly toxic, especially in the mornings. Some engage in addictive behavior, have irregular habits and an erratic lifestyle typify. These are the children who crave junk food and stimulants, engage in late-night bingeing and suffer from nervous problems. Many of them have attachment problems during development and they often grind their teeth at night

Peppermint: These children can be dull and sluggish as a result of metabolic imbalances that leave them feeling sleepy they have eaten. They have difficulty maintaining mental attention and difficulty using and focusing their mental abilities. For the right child, the remedy can make them mindful and it promotes mental clarity and alertness

Pine: These children tend to be introverted, conscientious, self-critical, filled with guilt and always hard on themselves. They set unrealistically high standards for themselves and may become perfectionist or even obsessive about doing things correctly. They take on responsibility for the mistakes of others

Pink Monkeyflower: These are usually highly sensitive people who have groundless feelings of guilt, shame or unworthiness. These feelings together with a sense of vulnerability, makes them afraid of being hurt and they create barriers between themselves and the world outside. They want to hide and avoid attention. They have difficulty expressing their true feelings, which they hold deep inside

Poison Oak: These children are hypersensitive and fearful. The often come across as irritable, impatient and hostile, but it is a defense against their inner vulnerability. They are often afraid of contact with others and protective of their personal boundaries. They tend to be distant and to have difficulty in forming relationships

Quaking Grass:  These children tend to have a lot of trouble in social settings. They find it difficult to listen and communicate, mainly because they find it difficult to filter out sensory impressions and find it difficult t strike a balance between their own sense of Self and the demands of a group

Rabbitbrush: These people are easily confused and overwhelmed by too many details or too much going on at once. They have trouble multitasking and need to be more alert, mentally adaptable and able to synthesize and incorporate their experiences

Rescue Remedy (Five-Flower Remedy): This combination remedy may help with acute anxiety, crisis, panic or trauma, when both the child and the situation seem totally out of control. So it is often useful during extreme stress. (Regular readers will recall the recent study about the use of Rescue remedy in acute anxiety)

Rosemary: These people tend to be forgetful and lack physical and emotional warmth. They are often prone to hypoglycemia. It often helps give them more vitality, particularly in children who are sleepy or forgetful during the day. It is a classic remedy for poor memory, and it may help people with a sluggish digestion

Shasta Daisy: This remedy promotes awareness, concentration and insight. It often helps people who over-intellectualize but have scattered thoughts. It may enhance mental clarity, especially for people who are unable to put the pieces together into a cohesive whole

Shooting Star: These people have a profound feeling of alienation, especially not feeling at home on Earth. As children they often talk about space and other planets. They may be ambivalent and apathetic

Snapdragon: Children who might benefit from Snapdragon tend to get irritated, hostile and aggressive if they feel challenged or attacked. They are angry and argumentative when communicating with others. These children may even be verbally abuse and make derogatory comments. Some may even bite!

Vine: These people are often bullies who always have to be in control of the situation and will put their own wishes before those of others

Yarrow: These people are extremely vulnerable to other people and to the environment. They are easily depleted and are overly absorbent of negative influences. They can get real “people poisoning” or psychic toxicity if they are around a lot of people.

Flower Essence Society Pink Yarrow: This one can often be helpful for people who have a tendency to absorb the emotions of others


Deciding on the correct essence to use is a matter of clinical experience and taking a very careful history that looks at the physical, psychological, social, subtle and spiritual dimensions of the individual.

The essences are not known to have any side effects, and they may help in selected individuals despite the lack of any objective data to support their use.

"The earth laughs in flower."
--William Blake (English Poet, Painter and Mystic, 1757-1827)

“Flowers are words which even a baby can understand.”
--Arthur C. Coxe (American Bishop, Poet and Writer, 1818-1896)

“Flowers are the sweetest things God ever made and forgot to put a soul into.”
--Henry Ward Beecher (American Congregational Minister and Writer, 1813-1887)

Non-pharmacological and Lifestyle Approaches to Attention-Deficit/Hyperactivity Disorder: 8. Massage and Manipulation

There is a small but persuasive literature on the value of massage and manipulation in people with attention-deficit hyperactivity disorder (ADHD).

Massage
The first study involved 28 adolescents with ADHD who were given either massage therapy or relaxation therapy for 10 consecutive school days. The massage therapy group, but not the relaxation therapy group, rated themselves as happier and observers rated them as fidgeting less following the sessions. After the 2-week period, their teachers reported more time on task and assigned them lower hyperactivity scores based on classroom behavior.

The second study was a randomized controlled trial involving 30 students aged 7-18 years. The results indicated that therapeutic massage given for 20 minutes twice a week produced significant improvements in both classroom behavior and mood.

There are a large number of studies that have shown that massage therapy can be helpful in managing anxiety in many different situations (1. 2.)

And it may also have some beneficial effects on the immune system.

Manipulation
There has been a great deal of interest in the notion that chiropractic manipulation may have an impact on the symptoms of ADHD.

A small study of seven children diagnosed with ADHD showed some improvements in ratings of hyperactivity.

There are some interesting case reports:
In the first a young girl who had been diagnosed with ADHD whose symptoms had failed to respond to an astonishing array of medications, but who improved once a cervical kyphosis was treated.

The second concerned a nine-year-old with Tourette’s and ADHD who showed a remarkable improvement after a course of chiropractic treatment.

The third concerned an 8-year-old with multiple learning and behavioral disorders associated with ADHD that improved after a course of chiropractic treatment. This case was rather different form the others in that the symptoms began after a fall, and it seems likely that the problems were at least in part due to pain and discomfort, and the child’s improvement may have been related to an improvement in both. The case highlights the importance of remembering that problems with mood, sleep and attention may be secondary to other medical or psychological maladies.

A recent review article on chiropractic care in people with learning disabilities and dyslexia does touch on ADHD and rightly concludes that the evidence so far is interesting but far from conclusive.

There is clearly a great deal of scope for further research into massage and manipulative therapies and ADHD.

I shall keep you posted if any more studies come out.



I am indebted to Dennis da Ponte from Life University  in Atlanta for helping track down some of the papers that I referred to in this article.

Meditation for the Failing Heart

There is a remarkable study in the current issue of the journal Ethnicity and Disease that seems to show that Transcendental Meditation significantly decreases the severity of congestive heart failure.
   
Researchers from the University of Pennsylvania evaluated 23 African American men and women with an average age of 64 years, who had recently been hospitalized with New York Heart Association Functional Class II or III congestive heart failure. Participants were randomized to either the Transcendental Meditation (TM) technique or health education, in addition to usual medical care.

The investigators used a standard battery of tests to measure changes in heart function with a six-minute walk test, and scales to evaluate quality of life, depression, and re-hospitalizations. They analyzed changes in outcomes from baseline to three and six months after treatment.

The TM group improved significantly on the six-minute walk test after both three and six months of TM practice compared with the control group. The TM group also showed improvements in quality of life measurements, depression, and they had fewer re-hospitalizations.

Congestive heart failure is a serious illness carrying a very significant morbidity and mortality. According to the American Heart Association, congestive heart failure accounts for more than 2.5 million hospital admissions per year in the U.S. Each year, nearly 500,000 new patients are diagnosed with congestive heart failure - and 300,000 patients die annually from this disease. Despite advances in treatment, the number of deaths from congestive heart failure increased steadily over the past decade.

African Americans have twice the mortality rates from congestive heart failure as white Americans.

It is most likely that TM improves the functioning of the heart by reducing the stress associated activation of the sympathetic nervous system that is known to contribute to the failing heart.

The study was sponsored by the National Institutes of Health - National Center for Complementary and Alternative Medicine (NIH-NCCAM) in a collaboration between the University of Pennsylvania with the Institute for Natural Medicine and Prevention at Maharishi University of Management.


“Meditation is the tongue of the soul and the language of our spirit.”
--Jeremy Taylor (English Anglican Clergyman, Writer and Bishop, 1613-1667)

"The purpose of meditation is not enlightenment, it is to pay attention even at extraordinary times, to be of the present, nothing-but-in-the-present, to bear this mindfulness of now into each event of ordinary life.”
--Peter Matthiessen (American Naturalist and Writer, 1927-)

Chiropractic Treatment and Diabetes?

There is an interesting, thought still preliminary, article in the Journal of Vertebral Subluxation Research about the possibility that chiropractic manipulation may be able to make a valuable contribution to an overall program of wellness to help people with diabetes.

There is a case report of an insulin-requiring person with type 2 diabetes, whose diabetes stabilized as he had a short course of chiropractic manipulation. I've seen many such cases with acupuncture and homeopathy as well as osteopathic and chiropractic manipulation. But it has always been very difficult to tell if there was a causal relationship.  Diabetes is such a variable group of illnesses that something as simple as stress reduction or a person sleeping better can both help normalize glucose levels, as least for a while.

What I really liked about the article was the measured tone: the editor makes it clear that it's an interesting observation but that it's still early days. Nothing so irritates people in conventional medicine than wild grandiose claims that some treatment or other can cure everything.

The editor also calls for more research, and I totally agree. I've spent the last 25 years trying to get research moving in the fields of complementary, alternative and Integrated Medicine, and we have already had a decent level of success in getting many projects funded and completed.


“The simple exercise of stretching helps to counter the congestions, compressions, and adhesions which obstruct the flow of the vital force through the spinal column with its sixty-two branching nerves and thus to regain energy. This truth of the need of spine-loosening movement is instinctively known by every dog and cat, every lion and tiger, for they apply it immediately after awakening from sleep. The back, the legs, and even paws are bent and stretched and even rolled by them in this natural exercise.”
--Paul Brunton (English Spiritual Teacher and Author, 1898-1981)

Communicating About Complementary and Alternative Medicine

Two of the key points about Integrated Medicine are transparency and integration of different approaches.

It is true to say that all healing is ultimately self-healing, but at the heart of healing lies relationship: how we communicate with every part of ourselves, with other people and with our health care providers. At the most mundane level, there is published data that if a health care provider has a good relationship with the person coming to them for help, the chance that the person will follow through on a treatment plan is four times higher than if they meet a health care provider who just grunts at them.

There is also a magic that can happen in strong, dynamic relationships based on partnership rather than dominance: one of the themes of Healing, Meaning and Purpose.

It worried, but did not surprise me to see a study released today.

Most Americans age 50 and older use complementary and alternative medicine (CAM), such as supplements, herbal products or acupuncture. The trouble is that - according to a survey conducted by AARP and the National Center for Complementary and Alternative Medicine - they often do not tell their doctors or nurses.

It is very much in person's best interests to tell their doctor about the CAMs that they are taking because some unorthodox medicines may interfere with over-the-counter medications, prescription drugs, or other conventional medical approaches. See here for an example of some herbal remedies and supplements that may interact with psychotropic medicines.

As the report says, "Communication between patients and physicians about CAM and conventional therapies is vital to ensuring safe, integrated use of all health care approaches."

It goes on to say something that we have been preaching for years: an open dialog "allows patients and physicians the opportunity to identify CAM practices that might be beneficial and also minimizes risks to a patient from potential therapy interactions."

Among a total of 1,559 individuals age 50 and older surveyed in the spring of 2006, 63 percent reported having used one or more CAM therapies.

According to the survey - which can be found here - people between the ages of 50 and 59 are the most likely to report CAM use.

Forty-five percent of CAM enthusiasts used massage therapy, chiropractic manipulation or other bodywork; 42 percent used herbal or dietary supplements; 15 percent used mind/body practices, including hypnosis and meditation; 14 percent used naturopathy, acupuncture, or homeopathy; and 10 percent had tried energy therapies.

Sixty-six percent of CAM users said they did so to treat a specific health problem; 65 percent for overall wellness; 45 percent to supplement conventional medicine; and 42 percent to prevent illness.

Sixty-nine percent of those who reported using CAM had not discussed it with a doctor.

The intersting qustion is, "Why?"

Forty-two percent said because their doctor never asked; 30 percent said they did not know they should; 19 percent felt there was not enough time during the office visit; 17 percent didn't think the doctor would know about the topic; and 12 percent thought the doctor would be dismissive or tell them not to use CAM.

Women were more likely than men to have discussed CAM use with their doctor (26 percent vs 16 percent) and those younger than age 65 were more likely to discuss CAM use than were older individuals.

The report concludes that "patients need to mention CAM use to their physicians and physicians need to ask about it."

Spicy Foods as Cancer Killers

Several news services have picked up a very important piece of research in the February 16th issue of the journal Biochemical and Biophysical Research Communications.

In a nutshell, they have shown that capsaicin, an ingredient of jalapeno peppers, triggers cancer cell death by attacking mitochondria, the energy producing organelles in the cell. Some of the reports were a little confused and confusing and also missed out some critical pieces.

So first, a bit of revision, this is a graphical representation of what a mitochondrion looks like:

The mitochondrion is the primary producer of energy in the cell, converting molecules derived from food or stores into adenosine triphosphate (ATP) and several other less important molecules. ATP is the energy "currency" throughout the body. In recent years we have discovered that there are a number of diseases that are a result of faulty mitochondrial metabolism.

One of the biggest problems about most forms of chemotherapy for cancer is that the treatments often damage normal cells as well as the malignant ones. Therefore a great deal of research has aimed at identifying differences between normal and malignant cells.

Over the last ten years, increasing evidence has shown that mitochondrial dysfunction is a key feature of many types of cancer as well as part of normal aging. This has lead to the idea that we might have a new therapeutic target if cancer cell mitochondria are different from those in normal cells.

This new study showed that the family of molecules to which capsaicin belongs, the vanilloids, bind to proteins in the cancer cell mitochondria to trigger apoptosis - programmed cell death - without harming surrounding healthy cells. Capsaicin was tested on cultures of human lung and pancreatic cancer cells.

As the lead researcher Timothy Bates has said, "We believe that we have in effect discovered a fundamental 'Achilles heel' for all cancers."

This is extraordinarily interesting, not least because capsaicin is already in use for the topical treatment of peripheral neuropathy and some inflammatory conditions of the skin including psoriasis. The amount of capsaicin used in the experiments was similar to amounts that could probably be ingested safely. So now the next step if to see whether these observations can be translated into a viable treatment option for cancer, and if so, which types.

What the research does not say is that eating a lot of spicy food will help prevent or treat cancer.

The reports that I have seen have failed to mention that one of the reasons for doing this research was that  some spices have been used in traditional Chinese and Indian medicine for many centuries for the treatment of several conditions, and some of the investigators are engaged in the Nottingham UK–China Collaboration on Complementary and Alternative Medicine.

How many more treasures are waiting for us in the archives of traditional medicine?

And how many have already been lost as plant and animal species become extinct?

Eye Color

“The eye is the jewel of the body.”
--Henry David Thoreau (American Essayist and Philosopher, 1817-1862)

In November we had a look at new data suggesting that eye color may have developed as a kind of “instant paternity test.”

Now scientists in Brisbane, Australia are reporting that they have uncovered the genetics of eye color, and that they are surprisingly simple. Which is just what we would expect if something were biologically important.

The research is published in the current issue of the American Journal of Human Genetics.

After studying 3,839 individuals, it turns out that of the six billion or so “letters” that make up the human genetic code, a handful of "single nucleotide polymorphisms" (SNPs - pronounced "snips") are largely responsible for the color of your eyes. These SNPs consist of a change in just one “letter” in the genetic sequence. All the SNPs are located near a gene called OCA2. This gene produces a protein that helps give hair, skin and eyes their color. And mutations in OCA2 cause the most common type of albinism. So these gene mutations modify the amount of pigment in the iris: people with brown eyes have more pigment than people with blue. The odd one out is people with green eyes. In them the changes in the genes seems to have produced a functional change in the pigmentation protein itself.

This is interesting for another reason. There are a small number of medicines and clinical conditions that are associated with changes in the color of the iris. But I have also seen some people whose eye color has changed very rapidly in response to changes in mood, attention or concentration. I have also sometimes seen it happen when people have achieved some altered state of consciousness through prayer or meditation. Yet there is hardly any scientific research into this odd but uncommon phenomenon.

I did find two studies from Korea that attempted to associate a gene for angiotensin converting enzyme and the apolipoprotein e gene with iris type. The trouble with these studies was that they were very small and started with the assumption that iridology could be used to diagnose a physical problem, even though the research (1. 2. 3. 4.) has shown that it cannot.

I had assumed that these rapid changes in eye color had something to do with changes in blood flow in the eye, and that does remain the most likely explanation. But the question now is whether the SNPs associated with eye color are themselves modulated by mood, cognition or spiritual insight.

If you have ever observed changes in iris color in yourself or other people, I would be very interested to hear from you.

“All our souls are written in our eyes.”
--Edmund Rostand (French Poet, 1868-1918)

Integrated Medicine and Cancer

There's a very interesting and important piece of research from the School of Social Work at the University of South Florida in Tampa.

The title of the paper is “Patient-physician communication regarding use of complementary therapies during cancer treatment,” and it discusses something with which I’ve been very involved for many years.

The paper uses the terms “complementary and alternative medicine,” though the same principles apply to the far more sophisticated and comprehensive approaches of Integrated Medicine.

Studies from the United Kingdom, Germany, Holland, France and the United States have estimated that as many as 80% of adult cancer patients use at least one form of Complementary and Alternative Medicine (CAM) during or after conventional treatment. I’ve discussed before the pitfalls of trying to use unorthodox medicine in place of conventional medicine. In Europe some of the practices of Integrated Medicine, particularly acupuncture, homeopathy and massage, are used to help people cope with the rigors of chemotherapy and radiation therapy, rather than to treat the tumors themselves. Many people claim that they can use homeopathy or some herbal remedies as the sole treatment for different types of cancer. But I won’t endorse them unless they can show me some data.

We already know that patients frequently do not tell their oncologists about their use of unorthodox medicines and physicians consistently underestimate the numbers of their patients using them. The purpose of this study was to assess newly diagnosed cancer patients' and oncologists' communications with regard to unorthodox medicines. They looked at people with two types of cancer: 106 had breast cancer and 82 had prostate cancer. All the patients in the study were receiving regular conventional medical treatment.

In line with previous research, 84% reported that they were using at least one unorthodox therapy. The most popular were exercise, vitamins, prayer, and nutritional supplements.

But here was the surprise for the investigators: The oncologists surveyed were generally enthusiastic and supportive of patients' use of these therapies. In addition to those therapies popular with patients, at least half the physicians supported massage, journal writing, support groups, acupuncture, biofeedback, and art therapy.

This was no surprise to me at all. I spent most of my clinical career in tertiary referral centers, and I’ve worked with the best of the best. The vast majority was extremely supportive of anything that would help. Every one of them was a skeptic who would say, “show me.” But once they had been shown, they would be very helpful. After all, who doesn’t want to help people get better?

It has always been so noticeable that the biggest critics, not skeptics, but critics, have been people who were less secure. Often not the “Best of the best,” they would carp and complain that “we don’t do things that way,” and “I don’t see how it could work, so I’m sure that it doesn’t.”

What this new piece of research showed was that discussions the use of unorthodox medicine were relatively rare and were most likely to be initiated by the patients. When the topic was discussed, both patients and doctors said that it usually enhanced their relationship.

What do I take away from this study?

If you, a friend or loved one has cancer, or any other type of illness for that matter, consider using something else in addition to your regular medical care. Not as a replacement, but in addition. The regular treatment will be helping the physical side of the illness, but you also need help with the psychological, social, subtle and spiritual aspects of what is going on in your life.

And guess what? Chances are that if you have a good oncologist, or any other type of conventional clinician working with you, he or she will probably be very supportive of anything that you do.

I once said at a very large meeting that if I needed to put a bone through my nose and do a dance to get someone better, I’d do it.

And I’m not the only one.

What Integrated Medicine does is to put all the cards on the table from the very beginning. We tell people that we are going to be helping guide them toward physical, psychological, social, subtle and spiritual health. They need to be able to derive meaning and purpose from what’s happened to them, rather than just cussing at their misfortune.

And then using the experience to grow as individuals and to help others.

The Integrated Practitioner will also be working with the way in which this person’s challenge is changing them. If a practitioner is not changed by the person in front of him or her, they are working only as a technician and not as a healer.

There’s nothing wrong with that, but everyone needs to be clear about what the practitioner is bringing to the table, and what their expectation is for the person who has come to see them with a problem.

For now, if you are not working with an Integrated Practitioner, do tell your health care provider if your are doing something else to help yourself.

Chances are that he or she will be very supportive.

The Ethics of Complementary, Alternative and Integrated Medicine

In my recent item about ethics I mentioned that Paul Root Wolpe from the University of Pennsylvania is interested in the ethics of Complementary and Alternative Medicine (CAM), and, by extension, its offspring, Integrated Medicine. This caused some raised eyebrows, but it shouldn’t.

Using unorthodox therapies carries a number of ethical and moral responsibilities.

When I was still on faculty at the University of Pennsylvania, on one occasion I caused outrage amongst many friends using natural medicine, when I pointed out on a TV show that just because something’s natural doesn’t mean it’s safe. Think arsenic, deadly nightshade and hurricanes! But there is more to the ethics of CAM than just the safety of the treatments involved.

Just a few months ago I was asked to look at a study by someone claiming to debunk one of the tapping therapies. Neither the investigator nor the practitioners and patients inveigled into the “research,” understood the principles of informed consent. This is important: one of the many consequences of the Holocaust was a re-consideration of what to do with medical “data” collected by Nazi doctors in the most unprincipled ways imaginable. Should the data be kept, so that people would not have died in vain? Or should it be destroyed, because information from unethical experiments was tainted. After a great deal of heart searching, it was decided that any information obtained under those circumstances was likely to be junk. This is one of the reasons for the absolute insistence on informed consent. I shall say something else about consent in just a moment. Let’s have a look at the ethical issues involved in CAM, because much of the criticism of the emerging models of healthcare has come from people genuinely concerned about patient welfare.

1. If we do anything with or for an individual, there has to be informed consent. Informed consent includes full disclosure not just of the chances of efficacy, but also of the possible toxicity of a treatment and an agreement of what we hope to achieve. A therapist may want to balance your Qi and stop you getting sick in the future. You may just want to be rid of your headaches. When we ask about the chances of efficacy, we all run into the problem of positive bias. I was once planning some research with a very well known practitioner in the UK, who told me that he cured every single person he saw, whether they had cancer, schizophrenia, heart disease or anything else. I was astonished, and asked him for something to backup what he said. He flew into a rage! “How dare I question him?” he said.It soon turned out that although he probably was a genuine healer who got a lot of people better, he had no evidence at all. It was like a study in the medical arena in which the investigators decided that anyone who did not come back for treatment was cured! Not a common reaction if someone fails to turn up for an appointment!
2. People often say to me that there can be no harm in giving someone a homeopathic remedy. And of course, from a purely physical and psychological perspective, that’s probably true. Though I once participated in an experiment in which I took the homeopathic remedy Pulsatilla, that is prepared from the Passion Flower. I had what is known as an exacerbation, and was unable to function for several hours. But we also need to think about some of the other things that can follow from using treatments that work at the level of the subtle systems. One of our biggest objections to people who believe that they can do acupuncture after a weekend course, is that acupuncture, homeopathy and the rest are powerful medicines. Putting a needle into the wrong part of a person’s anatomy may not just cause physical harm, but can do extraordinary things to a person’s subtle systems. A fact that is exploited in some martial arts. In the Jet Li movie Kiss of the Dragon, Jet uses acupuncture needles to do some extraordinary things. The filmmakers used little artistic license: with one exception I have personally seen all of the things demonstrated in the movie.
3. I mentioned that informed consent includes full disclosure about the chances of efficacy and toxicity of a treatment and agreement on therapeutic goals. We can find ourselves in a real ethical dilemma when patients have unrealistic expectations for an untested remedy. Sometimes people don’t inform their patients realistically, and they rationalize it as either choosing not to remove hope or as providing support. But we have to be sure that we are not supporting potentially dangerous or harmful decisions. The problem is not necessarily the treatment itself. Using an untested treatment in place of something that we know can be effective can also lead us into difficult ethical waters. Regular readers will remember a sad case that I highlighted a few months ago.

I’m all for holistic therapy: the less invasive the better. I've spent the last 35 years helping develop new and better ways of integrating treatments.

But it’s really important to be realistic, to use what we know works and if we don’t know if a thing works, then to be totally honest with the individual, and keep meticulous records of why we want to use an untested remedy in combination with the conventional.

In the 1980s, the Research Council for Complementary Medicine began to train complementary practitioners in the basics of research, so that they could be better at obtaining informed consent and monitoring the effectiveness of treatments that they were using. We had some success, and it is high time that we helped practitioners in other parts of the world do the same thing.

Using Yoga: Some Measurable Effects in People with Alcohol Dependence

I was very interested to see a quite well designed pilot study which seems to show some clear antidepressant and hormonal effects (reduction in cortisol and increase in prolactin levels) in alcohol dependent individuals who could be persuaded to practice something called Sudarshana Kriya Yoga (SKY). This technique involves rhythmic hyperventilation at different rates.

Studies like this are difficult to perform, and this one was not perfect. It only involved males, and the study will inevitably be skewed by the kinds of people participating. The study involved quite a bit of time, and so the subjects had to be motivated. Some people still dropped out of the study, and their data should have been included in the analysis. They also had more than just the breathing exercises: they got a whole treatment package. It will be interesting to see how long the effects last. We're always interested to see how many people remain abstinent at one year.

One of the odd things was that the investigators measured the hormone prolactin. It is so named because its primary role is to promote lactation. It has at least 300 hundred other functions in the human body, and has at least ten major control systems. It is a little surprising that it should rise, since it normally goes up when people are stressed. However, I might have an explanation. As far as I can see, the techniques used in the study are pretty straightforward yogic pranayama. Hyperventilation slightly alkalinizes the blood. That would change the rate of firing in the reticular activating system of the brain stem, and could of itself be responsible for the elevated prolactin levels. Had I been designing the study, I would have measured arterial pH: it would have helped answer several questions.

Though not perfect, this study is a good piece of pilot data, and should stimulate further research into the use of these techniques for helping a very difficult problem.

I was interested to find out more about the technique. SKY was devised by a spiritual guru - Sri Sri Ravi Shankar - of the Art of Living Foundation in Bangalore, India. He has established a Foundation that seems to be engaged in a number of charitable activities. I have known a great many spiritual teachers; each has been criticized and controversial, and Shankar is no exception. I’m not in a position to judge whether or not it is justified.

All that I can say for now is that he has devised a technique rooted in the Indian classics, that seems to help some selected patients with an otherwise tough problem. And that is a good start.

Convergence

One of the many things differentiating complementary and alternative medicine from the more conventional type, is that complementary practitioners are not much interested in a pathological diagnosis, and instead focus far more on the whole person. There are more than 500 types of complementary and alternative medicine, and virtually all work on the principle that they want to stimulate the body to heal itself.

It is not so well-known that in recent years some of the most cutting edge academic research in medicine has been breaking down artificial organs-based barriers, and focusing instead on the whole person, and look at research in a more holistic way. So a cardiologist and liver expert may be working together on the same problem.

Someone was asking me why this blog has so many categories? The reasons is that artificial barriers between illnesses, health, wellness, consciousness and spirituality are breaking down, and this blog reflects that. I was asked, “So are you interested in self-help or health and wellness?” the answer to that one is “Yes.” All of these are inextricably linked.

A second conceptual change, that is not much known outside of research centers, is that much of the current thrust in pharmacology is based on modulating the body’s responses, rather than simply blocking diseases processes.

Despite this apparent convergence, there are still some enormous differences in approach:
1.    The medical research enterprise remains profoundly reductionist, and so it tends to ignore some key aspects of what it is to be human: we are a great deal more than sets of biochemical reactions.
2.    Dismissing the social and psychological aspects of health and illness remains an Achilles’ heel of most academic research. When I was working in academia, a distinguished colleague came over form the England to give a lecture. An expert in brain imaging, he spoke a lot about consciousness and free will. As one of my American friends said afterward: he sound just like you in our research meetings!
3.    Complementary, alterative and now integrated medicine remains firmly focused on relationships as a key to healing. Not just the relationship of a client and their family, but the relationship between client and therapist. And there is a third arm to this. When, in the mind-1980s, we first started putting together the principles of this new Information Medicine known as Integrated Medicine in the United Kingdom or Integrative or Integral Medicine in the United States, a key component of it was the insistence that the therapeutic encounter would require the therapist to do more than just show up and do something technical. But that the therapist would also be aware of the impact of the encounter on them, and the importance for the therapist to be involved in growth work themselves. There was a time when psychotherapists would remain in therapy throughout their careers. That may not now be feasible. But it is entirely feasible for a therapist to take a bit of time each day to calm themselves; to reflect on what is going on inside them and in the subtle currents of the interactions between them, the person who has come to them for help and guidance, and all the other people involved in the situation. This is the way in which medicine is going to develop in the future.

The extraordinary advances of biomedical research can be an incredible boon to humanity, but they need to be leavened by an understanding of the context within which they are developing.

“A physicist who rejects the testimony of saints and mystics is no better than a tone-deaf man deriding the power of music.”
--Sir Sarvepalli Radhakrishnan (Indian Philosopher and, from 1962-67 President of India, 1888-1975)

Technorati tags: Alternative medicine Complementary medicine Integrated medicine

Fibromyalgia

Fibromyalgia can be one of the most difficult of clinical problems. Sadly this illness or group of illnesses is often dismissed as no more than a series of symptoms caused by depression, and people then do not get the treatment that they need. Fortunately we are now seeing the emergence of consensus guidelines on how to diagnose the problem.

Fibromyalgia is a common syndrome of chronic pain and fatigue, but it is a great deal more than just pain. It may affect many systems of the body, and depression and cognitive symptoms are common.

One of the key difficulties in people with fibromyalgia is a disturbance in pain thresholds. There has also been a lot of interest in the idea that people with fibromyalgia are “hypervigilant,” as a result of disturbance in the serotonin pathways in the brain. Something similar happens in many people with other types of chronic pain, particularly low back pain. The problem with all of this research has always been the chicken and egg problem: how many of these abnormalities are due to having chronic pain, and how many might be the cause of the problem?

As an example, I was treating someone with fibromyalgia, and as part of the package of treatments, she was to have acupuncture. If practiced by a professional, acupuncture is usually painless. I had not seen anyone experience pain from the treatment in many years; however, this person was so sensitive that even gentle tapping was excruciatingly painful for her. I have colleagues who take this to be evidence that the whole thing is psychological. But I am sure that they are not correct. To a neurologist this is wrong on three counts:
1.    There is a lot of data indicating metabolic disturbances in people with fibromyalgia that is quite different from anything seen in anxiety or depression. These include reductions in the activity of the cellular powerhouses - the mitochondria - as well as subtle effects in blood flow.

2.    A number of other illnesses, like migraine, are associated with changes in pain threshold, indicating a disturbance in the mechanisms that control pain sensation, either in the brain stem on the thalamus.

3.    This notion that “it’s psychological rather than physical,” harks back to the kind of dualism that is not very helpful.

Recent research  indicates that although fibromyalgia is a little more common in women, the old view that it is predominantly a female illness is not correct. There are also some strong associations with other illnesses, including depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, and rheumatoid arthritis.

In the days that I treated a great many individuals myself, I always found that fibromyalgia and chronic fatigue syndrome were amongst the most difficult.

I’ve long been interested in the links between sleep disturbances and fibromyalgia as well as the modest improvement in people with a meditation program.  There is also another factor that is often not much talked about: people with chronic pain, from whatever cause can develop pain cycles: pain begins in some part of the body, but is then maintained by neurological circuits in the spinal cord and brain. Interfering with these pain cycles for even a day or two can sometimes be very helpful.

Fibromyalgia is one of the groups of conditions in which combinations are key. Trying just to use a medicine or just a diet is rarely likely to be crowned with success. The most helpful strategies that we have found have been combinations of:

1. Physical care:
   
   1. Appropriate medications to help with pain transmission and symptoms of depression
   2. Sleep hygiene, and some of the other approaches that I’ve suggested for dealing with disrupted sleep.
   3. Low intensity exercise
   4. Nutrition: this one of the clinical conditions that first persuaded  me that there are some people who have genuine food and environmental sensitivities, and, in some rare cases Candida overgrowth. There are quite a number of foods that may be very helpful, depending upon the individual’s likes and dislikes.   
   5. I’ve had colleagues who’ve had some great results with herbal remedies and supplements, but there is little published  evidence that these work.      
   6. Some people seem to have biochemical disturbances that can be  helped with some of the Schussler tissue salts.
2. Psychological support: there is some good evidence that some personality types and temperaments may be at increase risk of developing fibromyalgia, so any thing that helps build resilience and cope with negative cognitions can be very helpful. Some of the  tapping therapies can be very helpful adjunctive treatments, as can music therapy.
3. People with fibromyalgia are often very sensitive to the people around them, and their nearest and dearest often need help in understanding how best to support the person with the illness.
4. The subtle systems of the body are invariably compromised in people with fibromyalgia, and acupuncture – if people can tolerate it – as well as homeopathy can be very helpful. We have often used both together, though this is anathema to many classical homeopaths or acupuncturists. Perhaps they could not have been used in combination 50 years ago, but people have changed physically, psychologically, socially and energetically, and the rules have changed.
5. As with most people struggling with chronic illness, many people with fibromyalgia lose contact with their Source. And this is why - in my books and recordings – I spend so much time helping people  re-establish meaning and purpose in their lives, and help them use the illness not simply  as a barrier to be overcome, but as a stimulus for internal growth. I have also seen a number of indivudals in whom fibromyalgia was symptommatic of a spiritual awakening.       

One of my biggest worries with fibromyalgia, as with so many chronic illnesses, is that many desperate sufferers and their families can become victims of the unscrupulous. I have seen countless people selling advice and treatments that have no basis in fact.

Not everything that I have discussed here is evidence based: there is so little research on things like acupuncture and homeopathy. But those are treatments to be used in combination with more conventional approaches. Using all together is usually the best way forward. And everything that I’ve discussed here has been used in working with hundreds of people around the world.

Technorati tags: Fibromyalgia Chronic pain Integrated medicine Irritable bowel syndrome Sleep disturbance Candida

The Prince of Wales and Integrated Medicine

It is not widely known in the United States that His Royal Highness Prince Charles, the Prince of Wales, has been instrumental in the development and adoption of integrated medicine in the United Kingdom and in some parts of Europe and the Middle East. I had the privilege of working extremely closely with his Foundation for many years, and have acknowledged his personal influence in my most recent book, Healing Meaning and Purpose.

The British media is today reporting that his position on trying to integrated the best of conventional medicine with the best of traditional approaches if once again under attack, from a well-known group of critics. This time they are saying that the adoption of inadequately tested therapies is a needless drain on resources, and that regardless of what patients want, the money should be spent on treatments that are “evidence based.” This has become the new clarion cry of medicine: that everything that we do should have a defined research base. A terrific idea in theory, but sometimes disastrous in practice. As an example, there is not much in the way of an evidence base for appendectomy.

This morning, one day after the critics published their letter in the Times of London, the Prince of Wales spoke about his position and his work at a meeting of the World Health Assembly in Geneva and he had this to say:

"I believe that the proper mix of proven complementary, traditional and modern remedies, which emphasize the active participation of the patient, can help to create a powerful healing force for our world. This is where orthodox practice can learn from complementary medicine, the West can learn from the East and new from old traditions."

It will not surprise you to hear that I strongly agree with the Prince’s views. If you glance through a few of my blog entries, you will see that I am a huge advocate of good research: I analyze dozens of studies every week and present you with the best. I have also had to spend a great deal of time making decisions based upon cost. But it would be a big mistake for us to declare that any therapy that does not have a biological basis, or conform to the medical model should be excluded from health care. After all, patients also have a say, and they are clearly deriving benefit from complementary medical therapies. And as I have reported before, we are slowly collecting more and more data indicating that at least some of the 500 different schools of complementary and alternative medicine do have research to support their use.

“In scientific work, those who refuse to go beyond fact rarely get as far as fact.”
--Thomas Henry Huxley (English Biologist and Educator, 1825-1895)

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How Not to Use Complementary Medicine

There is a report in the British Medical Journal that the Amsterdam Medical Disciplinary Tribunal has struck one doctor from the medical register and suspended two others for their exclusive use of unorthodox approaches in the treatment of a famous Dutch actor and comedian named Sylvia Millecam, who sadly died of breast cancer in 2001 at the age of 45.

After being diagnosed, the patient was recommended to have surgery and chemotherapy, but instead sought unorthodox treatment. Although the patient wanted this type of treatment, the legal case was that the doctors failed to give a reasonable assessment of the chance that their treatments would help, or made it clear that the only treatment that had been proven to help the course of the illness is the conventional route. One of the doctors was also judged to have caused her unnecessary suffering by withholding conventional palliative care as she deteriorated.

Not surprisingly, this case has attracted a lot of interest in Europe, where alternative, complementary and integrated approaches to health care are far more commonly used than in the United States. Many alternative practitioners feel that conventional medicine simply “suppresses” the underlying cause of the illness, and that there is no need to use orthodox and unorthodox together.

The approach that I have been advocating for many years is that if the individual warrants it, to use conventional and unconventional approaches together. But to see them as working on different dimensions of the person: what I call integrated medicine, though the term “integrative” is more popular in the United States. There is nothing very integrated about using St. John’s Wort instead of Prozac. That is just an alternative, which may be appropriate for certain individuals. And everything gets tailored to the individual: a man came to see more for acupuncture, but left with a prescription for a medicine. Once the medicine had done its part, some acupuncture was a very helpful adjunct. And there have been many folk where we have worked the other way round: acupuncture or homeopathy, and sometimes also a medicine. Whatever it takes to help people get to where they need to be.

In an ideal world, Ms. Millecam would probably have had surgery, but also psychological and energetic work, and perhaps some other remedies and spiritual counseling to support her through the process. Would it have enabled her to live longer? Perhaps, but the point is that the integrated approach would have aimed to help her quality of life and to help her to find the meaning and purpose of what she was going through.

She may have declined all this, but the problem was that enthusiastic doctors were using their approaches in place of regular evidence based medicine, without making it clear to Ms. Millecam what she was letting herself in for. Yes, a mentally competent individual has the right to decide whether or not to have a course of treatment, but he or she must be given all the options, so that he or she can make an informed decision. It was all rather sad and probably avoidable.

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Adjunctive Homeopathy in an Intensive Care Unit

Although we normally try to get articles quickly, we are sometimes thwarted and they can be delayed in arriving. I have only just got my hands on a study abstract that was published by a research team from Graz in Austria last October. The investigators from the Ludwig Boltzmann Institute for Homeopathy examined the use of homeopathy in a group of severely ill people in an Intensive Care Unit.

This was a double-blind, placebo-controlled trial to see whether homeopathy would be able to influence the outcome of critically ill people with severe sepsis. Seventy people entered the study, and 35 received homeopathic treatment and 35 received placebo, in addition to their regular treatment. The main outcome measure was survival. At day 30 there was no difference between the survival rates of the people receiving homeopathy and placebo. But at day 180, the survival rate in the homeopathy group was 75.8% compared to 50% in the placebo group.

One study does not make a revolution, and it is still early days for this kind of experimental work. Yet two things stand out from this small investigation:

1. The homeopathy was being used as an adjunct to conventional medical care. I sometimes get worried when practitioners of unorthodox medicine say that they would ONLY use herbs or homeopathy. The best approach has to be to combine conventional treatments with those unorthodox ones that can be shown to be helpful.

2. Trained homeopathic physicians did the prescribing. This is important: some studies have foundered because the studies tried to test just one remedy. Yet homeopaths individualize each treatment. So two people may have the same infection, but because they have different personalities and constitutional make-ups, they will receive different treatments.

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Technorati Tags: homeopathy, complementary medicine, integrated medicine