A few weeks ago I complained about the depiction of tonsillitis as a life-threatening illness
for children in BBC's daytime medical drama, Doctors
. I thought that I'd shrugged off how annoying medical dramas can be when I learned that this same drama is about to feature a GP Homeopath.
I was profoundly irritated at first and then wondered if I were jumping the gun. After all, I don't know how they will handle the storyline and homeopathy is
available on the NHS in the UK. Back in January, an interesting paper in the British Journal of Clinical Pharmacology
revealed that 60% of the 323 of the surveyed doctors' surgeries in Scotland prescribe homeopathic or herbal remedies
(there was also an intriguing analysis of the demographics of the people who obtained these prescriptions and the conditions for which they were prescribed: mostly the very young or female adults; mostly 'lifecyle' conditions). Whatever I think of homeopathy, perhaps it is not entirely unreasonable that a medical drama should cover homeopathy as part of the NHS (for the first time in the UK, as far as I know-please tell me if I'm wrong).
Coincidentally, the widely-esteemed Prof. Michael Baum has just published an anti-homeopathy piece in a newspaper that is notorious for its support of CAM and extravagant reporting of medical issues:Homeopathy is worse than witchcraft - and the NHS must stop paying for it
. In true Baum brimstone style, we learn:
Homeopathic companies are making a fortune marketing placebos. Yet, despite this, last September, the Medicines and Healthcare Products Regulatory Authority approved the marketing of homeopathic remedies for 'self-limiting conditions' (these are conditions which should improve by themselves) - even if there is no evidence of their efficacy.
This scares me. Homeopathy is to medicine what astrology is to astronomy: it's witchcraft - totally barmy, totally refuted, and yet it's available on the NHS. For while homeopathic medicine is not toxic, its use as an alternative to conventional medicine can, in fact, cause serious harm...
The majority of homeopathic physicians are nice, kind people and they're not stupid.
They will claim homeopathy is a complementary therapy, not an alternative to medicine. But how does homeopathy complement other medicine? Bogus potions aren't complementary, they are a deception and provide false hope.
Just to provide some further context as to what is happening about NHS provision of homeopathy in the UK, Prof. David Colquhoun of UCL's Dept. of Pharmacology, is calling for public support for the closure of Tunbridge Wells Homeopathic Hospital
Back to the medical drama, as far as I can tell, the background to the storyline is that the female GP has always been interested in 'alternative' things. Some time ago, she had a brief research fellowship (or similar) in Australia to allow her to study traditional medicine (not otherwise specified). For various reasons, she has decided that she wants to practise as a GP Homeopath. It is not clear whether she has decided that she is experienced enough to declare herself competent to be a homeopath or if she has actually qualified in the subject (I'm overlooking the issue of the content of homeopathy degree courses
because it is possible for GPs to take a one year course through continuing education credits to qualify as a homeopath). She has written articles about undisclosed subjects related to complementary medicine for un-named publications: some of these seem to have been in local newspapers, other newspaper articles seem to be about the fact that she was published elsewhere.
After declaring her intention, the partners in the practice asked her to make a presentation to make her case. At this point I was interested. I wondered if they were going to ask her about the evidence base for homeopathy or its remedies. I wondered if they were going to ask her if she is going to prescribe homeopathy or isopathy (a distinction I only learned about during an odd evidence session to a House of Lords enquiry but apparently it is isopathy rather than homeopathy that has failed in clinical trials that were supposedly about homeopathy
). I wondered if they were going to ask about the distribution of the workload and how she was going to fit a full homeopathic profile history taking etc. into the standard 7 minutes appointment. What would be the implications for the other partners? Is there a compounding homeopathic pharmacist in the local area (possibly harking back to my homeopathy v. isopathy enquiry). So, I decided not to pre-judge the way in which the storyline was handled but to tape the day of the presentation and see what happened.
Dramatic personae for the presentation (descriptions, as supplied by my neighbour)
Dr. Joe - practice partner. For the purposes of this vignette, a crusty, sneering rationalist who disdains 'new age' stuff.
Julia - practice manager and partner. Has made many questionable judgment calls in the past but for purposes of this is supposed to represent sound business sense and open mind.
Dr. Nick - newly made-up to partner. Previously reprimanded by GMC for something or other involving inappropriate care for asthma patient leading to death. Possibly here because he has previously been in conflict with Joe and may be more likely to vote with anyone who irritates him.
Dr. George - salaried doctor in the practice. Has always been pro the 'alternative'. Has declared herself as ready to be a GP Homeopath.
Broadcast Tuesday April 30, 2007. Any transcription errors and emphases are mine. I have put in readings and actions where they seemed necessary. I have offset some comments in the dialogue.Dr. George
: How do we treat someone with sciatica? We send them away with painkillers. They present with an upset stomach. It's the same thing, "There's the prescription. Take it to your local pharmacy".Dr. Joe
: What's wrong with that?Dr. George
: Well...the problem with modern medicine is that we're treating the symptoms and not the whole patient.Dr. Joe
: But if we're taking away the pain...Dr. George
: That's fine in the short term, Joe. But sometimes the pain comes back and sometimes it presents itself in an entirely different way. We haven't solved the underlying cause of the real problem.Dr. Nick
: So you want to take a more holistic approach.Dr. George
: Well, I think we need to because I think we're failing our patients.Dr. Joe
: But I don't hear many complaints. [Disingenuous, somewhat exasperated.]Dr. George
: [Very exasperated.] Don't take my word for it, Joe. Just look at the hundreds of thousands of people every year who are so
disenchanted by the NHS they seek the services of a complementary therapist. One of the increasing number of complementary therapists. The key word here is
complementary. What I'm proposing is that we offer the very best of modern medicine alongside traditional remedies, some of which have been successfully used for thousands of years. That way we are serving our patients better because we are offering them choice and well and truly bringing The Mill
[the name of the medical centre] into the 21st century.
I was badly confused at this point as I'd thought that she was only introducing homeopathy. However, here it seems that she may be referring to acupuncture and aboriginal remedies. I have no idea who is to provide the acupuncture or where she will obtain the ingredients for aboriginal remedies and who is to compound them. Nonetheless, I do regard it as classic that these ancient and traditional remedies will bring The Mill and, by extension, the NHS, into the 21st century.Julia
: That's very impressive. Well done, George.Dr. Joe
: Yes. The presentation was top-notch. However, I do have a few questions...
[Cuts to some unrelated scenes. Presumably, during this time most of the questions in which I would have been interested were asked because they certainly are not fully addressed in what follows.]Dr. George
: I'm suggesting that we start by offering acupuncture and homeopathy.Dr. Joe
: What do you mean, start? Do you mean that this is going to be some sort of creeping process? That eventually the asthma clinics and ante-natal classes are going to have to make way for some sort of aboriginal folk remedy? [Sneering 'woo'-ish tone to last 3 words with accompanying Twilight Zone
finger gestures.]Dr. George
: [Peeved and irritated.] I'm suggesting that we react to what our patients want. If there is a demand for alternative remedies then why aren't we offering them.
Julia: Well, there does seem to be a demand. I mean I'm still getting phone calls from people wanting to join our list and it's all down to George's articles.Dr. Joe
: But these therapies that you're talking about. How many of them have undergone any kind of rigorous scientific testing?Dr. George
: What-and that's the only way to prove a treatment works?Dr. Joe
: In my book - yes.Dr. George
: [Still seated, hand on hip.] Joe, this isn't some kooky scheme that I thought up on the way into work. I've put a lot of effort into this. And I won't have it dismissed by some close-minded cynic.
Because we didn't see the presentation perhaps I shouldn't judge, but "What - what can you possibly have thought up to get round the problems of those meta-analyses that show that homeopathy doesn't work, unless this character is also resorting to the "It was isopathy that was trialled" defence".
[Gets up from seat, on high horse, gives dismissive hand wave.] Do you know-Actually, do you know what? If you're not interested then maybe I'll take my services elsewhere-to a practice that has a little bit more imagination.
[Storms out of room and slams door.]Dr. Nick
: Do you think she was serious?
Sadly, here he is referring to her threat, rather than her lack of an adequate response to Dr. Joe's question about the scientific testing.Julia
: Well, I know George can be a little emotional at times, but, yeah, I think she was serious.Dr. Joe
: Then maybe we should call her bluff. Threatening to resign if you don't get your own way I think is tantamount to blackmail.Julia
: OK. Let's compromise. Why don't we give George's idea a trial run and see if any of the patients are interested?
I'm not clear here whether she thinks that clinical evidence and efficacy are irrelevant when compared to a business idea that will attract patients. However, if The Mill's lists are already full and (previous plot according to my helpful neighbour) they've recently lost another GP, how are they going to take on more patients?Dr. Joe
: Why waste time and money setting up something that patently is not going to work?Dr. Nick
: It's not what her research has suggested.
Again, this seems to be about the business angle, whereas the Joe character is trying to discuss the clinical efficacy.Julia
: Look, I know there's a certain amount of risk involved but if we didn't take risks sometimes, The Mill
would never have been created in the first place.Dr. Joe
: And I would not have contemplated joining you if I had known that after one year the whole practice was considering such a radical change.Julia
: OK. There's only one way to decide this. Let's take a vote.
[Unrelated scenes. Dr. George is summoned back to the room.]Julia
: As we couldn't agree, we thought that it only fair to put your proposal to the vote. And I'm happy to say that we've decided to implement your plans. On a trial basis. And we'll have an assessment after six months. See where we go from there.Dr. George
: I don't believe it.Dr. Nick
: It was a very persuasive presentation.Dr. George
: I know, but still...Thank you. Thanks Julia.Julia
: It'll mean a lot of extra work for you.Dr. George
: Well that's alright. It'll be worth it. Cheers, Nick.Dr. Nick
: It's only what you deserve.Dr. Joe
: [Somewhat sourly but playing the game.] Well done. [Leaves room.]Dr. George
: You won't regret it.
[Unrelated scenes. Cut to Dr. Joe's room. Dr. George knocks on door.]
: I'm presuming that the vote wasn't unanimous.Dr. Joe
: I made my position quite clear. Unfortunately, the others disagreed.Dr. George
: I just want the opportunity to prove that I'm right.Dr. Joe
: I'm entitled to my opinion. Look, I've worked hard to establish a good reputation and I don't want to see that ruined by being associated with a practice that is turning into, I don't know, a kind of Midlands version of Glastonbury [Woodstock with mud, wholefoods, CAM and various 'alternative lifestyle' trappings].Dr. George
: This isn't going to be some kind of hippy-dippy set-up. It'll be extremely professional.Dr. Joe
: So you say. I can not support something which encourages patients to turn their backs on scientifically-proven treatment.
Interestingly, both Prof. Baum (as above) and Orac (and again for Orac) relate instances where they say a patient with breast cancer has rejected advice in favour of other therapies.
[Dr. George turns away in disgust.]
Well, let's face it. You and I are never going to see eye to eye.Dr. George
: So, what? You're gonna try and ruin this for me?Dr. Joe
: I won't need to. There are so many things that can go wrong with your scheme all I have to do is sit back and wait for everything to implode and just hope it doesn't bring down The Mill
It is very difficult to sympathise with the rationalist voice in this set-up when he is being played as unbearably patronising and self-satisfied. This may be a neat way of shorthanding the CAM v. NHS medicine debate but it is horribly simple and doesn't address the evidence issue.
[Dr. George has been shaking her head in disbelief.]
[Unrelated scenes. Dr. George is having celebratory drink in bar with her husband.]Dr. George
: I did my presentation today and if I do say so myself, I was brilliant. I was business-like, professional, answered all the questions and guess what...
What, when did the business-like professional bit happen? Also, why did I see the slamming-out-of-office bit rather than answering of the questions?
They've given me the go-ahead. Complementary therapies will finally come to The Mill
. I think I've made an bit of an enemy of Joe but I'm sure I'll get round him once he sees the therapies working.
Well, I suppose that it depends on your baseline for your selected conditions. Will the 'therapies' work if they cost less than the present NHS offerings or if patients like them more? When did this character do this huge amount of work into putting together this baseline? How will the practice review progress in 6 months if there is no baseline?
So there you have it. The one attempt to ask about the evidence led to the remarkable anti-science riposte and a fauxrious storming off. Offhand, I can't decide whether that exchange or the claim about the remedies that have been successfully used for "thousands of years" bringing The Mill
/the NHS into the 21st century is the most outlandish.
I have no idea when acupuncture was added into the mix. I have no idea whether the homeopathy will be restricted to self-limiting conditions or if all conditions will be fair game. It may be interesting or infuriating to see how this develops. Will there be a pro-homeopathy, pro-science stance or an attempt at neutrality that attempts to present them as equivalent? Sadly, given the credulous nature of much mainstream media, I am not optimistic. My pessimism on this matter is summed up by the comments on Prof. Baum's article which can be captured in one sentence from one poster, "Though my comment will only be recorded as anecdotal, it is a fact!."Flickr artist Tom Morris offers a skit of Prince Charles talking about complementary and alternative medicine.
Labels: Baum, colquhoun, homeopathy, isopathy, NHS, television