A royal fisking – Prince Charles on integrated health

Well, the Princes’ Foundation for Integrated Health first Annual Conference kicked off today. That bastion of the nation’s health, er, Roger Daltrey, hasn’t been slow to offer his support for HRH and the author of Private Eye’s Medicine Balls, Dr Phil Hammond is chairing the shindig. Very satirical.

The Prince opened up proceedings and I felt his speech needs, frankly, a right royal fisking. However, given that time is precious and I am not sure I have the necessary moral fibre to wade through every point this is more like a mini-fisk. Fisk-lite. You can read the whole speech here.

The Prince initially offered his thanks and heaped much praise on Dr Michael Dixon, the Medical Director of the PFIH. I won’t dwell on Dr Dixon’s arguments in favour of integrative medicine and the interested reader can visit a comprehensive demolition of his fragile arguments at Science- Based Medicine. The Prince continued:

When my Foundation was created some fifteen years ago, a number of doctors and journalists thought that we had taken leave of our senses. (Apparently, I took leave of my senses long before that! However, I rather hope I didn’t lose my common sense – although as you cannot obtain a degree in common sense, but just about in everything else, no-one seems to value it!) Anyway, “How on earth can you mix the complementary and the conventional – witchcraft with proper evidence-based medicine?” they asked.

Good question. HRH then points out that many patients are already integrating it for themselves. Yes, indeed, but many of my patients play golf, eat pies and watch Big Brother. They manage to successfully ‘integrate’ all of those activities into their daily life without the aid of the Foundation. However, just because people are integrating them it does not necessarily follow that there is medical benefit in those activities and the NHS should be supporting them.

But are those who have criticized integration, speaking for patients or for somebody else? Perhaps they are speaking for themselves? For example, if an integrated approach is so dangerous, why is it that I have never heard of any patient groups campaigning against integration? Why have we not heard more opposition from doctors, nurses and other clinicians at the frontline, who deal with the daily suffering of those same patients?

Well, natch, I can only speak for myself but what possible ulterior motive could I have for criticising integration? It is a ludicrous argument to suggest that without a patient group campaigning against integration that this somehow infers safety. I qualify as a doctor at the frontline and I want to be absolutely clear that I oppose the integrated approach when it’s used to promote ineffective alternative therapies.

I am assured by those who are expert, those who are highly qualified and, most importantly, who do know what is going on in G.P. surgeries up and down the country that a mainstream research and evidence-based integrated approach to alleviating unnecessary suffering – quite apart from reducing the demand on consultancy time and the N.H.S.’s bill for drugs – is rapidly becoming more accepted because it is both safe and effective.

Where is the evidence that this integrated approach reduces demands on consultancy time and the drug budget? Please, please don’t tell me you are regarding the Northern Ireland ‘pilot’ as evidence. This statement is pure wishful thinking.

HRH then launches into some of the real canards of quackery. The rebuttal to the question of the safety of complementary medicine is met with the ‘how safe is conventional medicine’ diversion.

And what of the deaths which occur as a result of conventional approaches to treatment, otherwise known as iatrogenic? It is perhaps instructive to study the statistics

I agree it is instructive. Funny how HRH is happy to study the statistics when it relates to the safety of conventional medicine. The statistics also suggest that many complementary medicines are ineffective.

Does the accusation of “quackery” really amount to anything very significant when an increasing number of complementary therapies are coming under statutory and voluntary regulation?

The toothless nature of the Complementary and Natural Healthcare Council has been documented at The Quackometer. There is a feeble uptake amongst therapists and Ofquack is a long way from being an effective regulator of the estimated 150,000 practitioners in the UK.

I was fascinated to read the Independent Evaluation Report of the recent “Northern Ireland Integrated Medicine Pilot Project”, which suggested that integrated care not only helped the presenting problems, but also improved general health and might be cost-effective in the long run.

I wasn’t so much fascinated as embarrassed. Is this the best evidence that HRH can mention in his speech? It has no scientific credibility but again shows how defenders of quackery are happy to quote evidence when it points the right way.

HRH suggests that:

Human relationships, the human effect, personal care and continuity are, I believe, a crucial part of integrated care. The compassion that goes with them is an expression of values and humanity, and also the very act of healing itself.

This is a perfectly sound description of how many doctors practise medicine. I refuse to stand by and let this concept of treating patients as humans be misappropriated by HRH and his cronies. Dr Michael Dixon, a GP, has punted this argument in the past and it is utterly spurious. The implication is that doctors currently do not take these factors into consideration. They are a crucial part of any medical consultation and suggesting otherwise is simply wrong.

An integrated approach represents an advance from “doctor knows best” to empowering the patient by informing, motivating and enabling. It is about establishing a meaning and purpose for patients inside the therapeutic context and also in the world outside. In this way, I believe, we can reduce the burden of long term disease and enable those who have such disease to live longer, happier and more fulfilling lives. This is largely because integration hands more control back to them.

This is as insulting as it is misguided. Perhaps HRH would like to take a tour of the general practices of the UK? Does he think that we do anything other than practice patient-centred care? Medical schools (via the GMC) have recognised for years the importance of training students in patient-centred models of care and we try to give them the communications skills to deliver this aim. Every GP knows their community and integrates the cultural beliefs of their patient and tailors the care they give. Yes, there is room for improvement, and the system often makes it tough. I should think there are few GPs out there who see less than 30-40 patients a day. That doesn’t help when it comes to ‘informing, motivating and enabling’ and there are days when we all fall short.

The disappointing thing with the PFIH is that it is such an opportunity missed. There is nothing wrong with supporting social projects that could impact on health (as they do) but they could be campaigning for more physiotherapists or decent mental health services where there is a snowball’s chance in hell of getting CBT.

Instead, we are being treated to the usual canards that conventional medicine is dangerous with an emphasis on the natural and holistic qualities of complementary medicine. Worse still, they are distorting the true patient-centred focus of normal medical practice. The PFIH could be advocating longer consultation times for GPs or opposing polyclinics to help foster good continuity of care. It is a shocking perversion of the real issues driven by one man; unelected, unqualified and utterly misguided. The vision of integrated care from the Prince’s Foundation is a Trojan horse to ram complementary medicines deep into the heart of the NHS.