Comments on: GPs and CAMapathy

By: jayann

jayann — Mon, 09 Feb 2009 17:14:23 +0000

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.

By: jayann

jayann — Sun, 08 Feb 2009 16:49:16 +0000

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.)

By: jayann

jayann — Sat, 07 Feb 2009 21:06:42 +0000

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).

By: northerndoctor

northerndoctor — Sat, 07 Feb 2009 20:39:22 +0000

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.

By: jayann

jayann — Sat, 07 Feb 2009 17:04:04 +0000

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.)

By: northerndoctor

northerndoctor — Sat, 07 Feb 2009 11:48:52 +0000

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.

By: jayann

jayann — Fri, 06 Feb 2009 22:10:17 +0000

(I say ‘problem’ because clearly if a number of GPs practice CAM then there’s a political problem about opposing it.)

By: jayann

jayann — Fri, 06 Feb 2009 22:09:08 +0000

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…

By: draust

draust — Fri, 06 Feb 2009 15:10:13 +0000

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.

By: David Colquhoun

David Colquhoun — Thu, 05 Feb 2009 15:16:24 +0000

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