GPs and CAMapathy
The scientific community has been vocal about the issues around CAM. What exactly is the medical establishment doing about CAM and what are GPs in particular doing about CAM?
The Royal College of General Practitioners
I can find a single page and it looks woefully out of date.
This is what they say:
Complementary and Alternative Medicine Action Group
The Action Group is a loose association of bodies representing major complementary and alternative therapies and is chaired by Dr Graham Archard, Clinical Network Chair. The group arose out of an initial meeting in May 2005, which had been requested by Council and focussed on perceived difficulties experienced by GPs in dealing with requests for referrals to complementary therapies and in providing advice on these to patients seeking their views.The Group has now identified criteria for membership and key areas of interest and is developing an action plan for work in these:
- Membership should include only bodies which had responsibility for registering practitioners
- The core objective, from the College’s perspective, was to look at the evidence for the effectiveness of therapies and to make this available to GPs
- Support to initiatives such as NelCAM, which supported the development of a robust evidence base
- Joint development of events and educational materials for GPs
There seems to be nothing else emanating from Princes Gate. I am all in favour of scrutinising the effectiveness of remedies but I am unclear how there is a requirement for a ”joint development of events and educational materials”. Presumably this could only be with alternative medicine providers and to do so before there is some convincing evidence for effectiveness would be putting the cart before the horse.
The Society for Academic Primary Care (SAPC)
The SAPC has a stated aim:
The aim of the Society is to promote excellence in research, education and policy development in general practice and primary health care.
Inevitably, they also have a CAM group. Or at least, some members are trying hard to get one off the ground. Here is some info from the Special Interests groups page on the SAPC website.
Message from CAM facilitators:
SAPC Complementary and Integrated Medicine Special Interest Group Online Survey
Complementary and Integrated Medicine is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine and may include examples such as reflexology, acupuncture, aromatherapy, homeopathy and hypnosis to name but a few. The recently re-formed Complementary and Integrated Medicine Special Interest Group (CIM-SIG) are developing a website to assist clinicians and researchers. To help us identify potential interest, we would like all SAPC members to complete our brief online survey. It’s only 1 page long and takes 5 minutes to complete.For more information about this special interest group or any questions about the survey please contact: Dr. Dawn-Marie Walker, University of Nottingham, Tel: 0115 82 30511; Email: dawn-marie.walker@nottingham.ac.uk or Dr. Sarah Brien, Dr. Felicity Bishop or Caroline Eyles at the Complementary and Integrated Research Unit www.cam-research-group.co.uk.
I should highlight that none of these good lady doctors are fake. They are bona-fide PhDs but none of them are the registered-with-the-GMC-type of doctors. There are some potted histories of Drs Walker, Brien and Bishop available on the SAPC page here.
Coincidentally I received the SAPC newsletter yesterday and the CAM group stated that they had held a meeting at the recent Annual Scientific Meeting in Galway which included some CAM-sceptic types. They obviously didn’t shout loud enough. I shall complete my questionnaire but I suspect it may take longer than 5 minutes.
I am struck by the irony that on one hand the scientific rigour of CAM is being held to account by a determined and passionate group of non-doctor scientists whilst on the other hand the CAM agenda is here being pushed forward by another determined and passionate group of non-doctor psychologist/behaviourist types. What happened to medical doctors?
I’ve blogged before about some GP attitudes to evidence based medicine. Medicine is not a profession that particularly needs (or encourages) abstract concepts on a daily basis. Perhaps the way we have taught medicine in the past has not helped this. The scientific method is not necessarily at the forefront of one’s mind when treating a patient but it is the foundation of evidence-based medicine. The introduction of critical thinking into medical school curricula is tempered by CAM/CIM modules. Dr Sarah Brien states:
I am involved in the education of CIM within the School of Medicine, at the University of Southampton; I am course leader for familiarization of CIM module for third year medical students and am involved in supervising fourth year medical student research projects in CIM.
How profoundly demoralising.
A final word from Prof David Colquhoun and one that makes me blush with embarrassment for the medical profession. This is one of his comments at the bottom of his post – University of Salford abandons “complementary” medicine.
In stark contrast to the scientific organisations, they have been disgracefully reluctant to take any firm stand. I hope their members will keep up the pressure.
Shame on us.
Sad, isn’t it? The BMA and RCP are as bad.
I wrote to the RCGP about their advocacy of Neurolinguistic Programming, and this is what I got in reply.
“Dear Professor Colquhoun
Thank you for your email to the College.
I am well aware of Neurolinguistic programming and its use in education and training. I am also aware that there are many GPs who have found Neurolinguistic knowledge and skills helpful in their Practices.
Best wishes
Steve”
Professor Steve Field FRCGP
Chairman of Council
Interesting, though not surprising, to see that several of the named social scientists work in the Complementary medicine research unit in Southampton. This unit is headed by Prof George Lewith (who of course is medically qualified, and a GP, and practices as a private CAM doctor). See David Colquhoun’s website here and here for more on Prof George., who must be one of the more influential pro-CAM voices in the UK primary healthcare arena.
Is part of the problem that there are a number of GPs who practice complementary medicine? — the first time I hurt my back badly I went to a GP (in those days, one could simply walk in, in the hope of seeing a doctor). I thought I had a kidney problem. Anyway. He diagnosed a disk problem and manipulated my back. Great. (I.e., the pain began to ebb.)
Again, in those days, and for some years afterwards, most doctors ‘prescribed’ rest for back pain. I’d say he saved me a lot of misery by using osteopathic/chiropractic techniques.
Yes I know that’s an anecdote. It’s a datum…
(I say ‘problem’ because clearly if a number of GPs practice CAM then there’s a political problem about opposing it.)
Yes I think there are two problems. The first is that there are a lot of GPs that endorse or practice alternative medicine – acupuncture being the obvious example. Moreover, the rest are totally apathetic shruggies. It is the ‘whatever-gets-you-through-the-day-is-ok-with-me’ approach to patient care.
The second is that GPs (and doctors generally) are absolutely cack at self-regulation. I won’t begin to discuss the number of reasons for this but I am fairly sure that if a GP is practising or endorsing alternative medicine (even if it is getting beyond the pseudo-mainstream of acupuncture and into more wacky woo variants) there is next to zero chance of that being criticised by colleagues.
Dr Aust – Yes, I have noticed the name creeping up and there looks to be a link through the SAPC. Thanks for the links.
The second is that GPs (and doctors generally) are absolutely cack at self-regulation.
I’m not surprised to hear that.
I’d say acupuncture is pseudo-mainstream now, yes, and osteopathy (i.e. manual therapy akin to physiotherapy) is too. And, I’d say, for good reason. (I forgot this when I posted before) in my thirties a GP told me, without examining me, that my intense shoulder pain was caused by arthritis and ‘we all have to put up with this kind of thing as we get older’. Two miserable years later, I happened to see a physician who was also an osteopath, who snorted with derision, told me I had a pinched nerve, and manipulated my neck; problem solved.
Obviously both that and the back manipulation can be explained away as interventions that had a placebo effect. I am not entirely convinced. But anyway, surely it’s better that CAM be regulated (albeit that does confer on it a greater legitimacy) and that some orthodox doctors take an interest in it, than not?
(I add that neither the ‘osteopath GP’ nor the physician practiced CAM privately, nor did either recommend it.)
I think it will be interesting to see if there is any reverse in the prevalence of acupuncture in GP surgeries as better quality evidence is suggesting absence of effect. Frankly I doubt it because neither GPs nor those patients that like it are inclined toward change. Collusion, I think we call it.
The problem with osteopathy is that it encompasses a much wider ranging philosophy of pseudo-science around the manipulations. Reviewing the evidence around manipulation (including the stuff physios do) is on my list of things to do.
I think I would be pretty wary about giving someone in their 30s a ‘you’ve got arthritis and there is nothing we can do chat’ for shoulder pain. In fact, I try to avoid the ‘nothing we can do’ line at any point, for any condition. There is usually always something – even if it is the metaphorical tea and sympathy.
I agree about the wider philosophy of osteopathy (and chiropractic). It’s never come into my dealings with osteopaths etc. (I’ve seen a number of non-medical osteopaths and one chiropractor, simply because I couldn’t get NHS physio; more recently I did manage to get it and it — basically exercises, but ones I couldn’t have ‘prescribed’ myself — has helped a lot.)
Reviewing the evidence around manipulation (including the stuff physios do) is on my list of things to do.
Good. Of course as, often, bad backs simply get better, it will be difficult to do (I’d say).
a ‘you’ve got arthritis and there is nothing we can do chat’
the man was in many ways a good doctor, but brusque. But I was in intense pain and he could have looked into giving me more help. And there are things that can be done for arthritis (which I definitely didn’t have anyway, I’d say; I’m sure the physician was right).
I forgot to say that I’ve been helped by acupuncture (!) and also that it doesn’t always help me. I do have my views about why that is, but I’ll leave that aside and say, the studies (‘fake’ v. ‘real non-traditional’ acupuncture) don’t actually make a compelling case for dropping it totally. (Of course it wouldn’t be ethical for doctors to give the fake kind instead.)
(metaphorical tea and sympathy, well, that wasn’t that particular GP’s thing! — yes it would have helped.)
I also forgot to say I’m glad you added physio as of course physio is usually OK with people who think osteopathy and chiropractic can’t possibly do any good.