Dr Michael Dixon, The College of Medicine’s Chair, has addressed the Integrative Health Convention, telling delegates that GPs are constrained by a prescription pad, offering treatments that too often don’t work and can have side effects.
Speaking at the online conference, which took place on February 11th, he said general practitioners are often reluctant to explore other options that would help people with chronic problems such as fatigue, frequent infections, irritable bowel, headaches, back pain, depression or stress.
address at the Integrative Health Convention 2022, saying healthcare needs to ‘urgently move to an integrated model’
The College Chair, who is an NHS GP in Devon, told those present that the answer to future healthcare problems lies in a move towards an integrated model, combining the best of conventional and complementary.
It sets the scene for the launch of the College’s Beyond Pills campaign later this year which focuses on campaigning to reduce unnecessary drug prescribing and to expand social prescribing.
In the impassioned address, Dr Dixon discussed his own burn-out after 10 years as a GP, when he realised that ‘blunt instruments’ from his conventional medical training were not enough.
He said: ‘Today my own prescription pad includes a mix of acupressure and massage, breathing techniques, self-hypnosis, mind/body therapies, a range of herbs and healthy eating.’
An integrated approach, he said, has turned his professional life from grey to colour, using these techniques and learning from qualified therapists.
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He says: ‘Medicine and science are moving away from the blunt use of population-based evidence to become more individual and personal, and the integrated approach is able to provide this personalised medicine, giving people real choice.
‘Integrated medicine is so much about what people can do for themselves and each other, and their communities both in healing and in enabling people and communities to be more resilient. It allows GPs to apply art and science, to use the power of compassionate relationships and the influence of mind and body in healing.’
Dr Dixon used his speech at the convention to launch the Integrated Medicine Alliance, bringing together
leaders from the main complementary therapies with the aim of better explaining the benefits of complementary approaches to patients and clinicians.
‘CONVENTIONAL MEDICAL TRAINING OFFERS ONLY BLUNT INSTRUMENTS’ DR MICHEAL DIXON’S INTEGRATIVE HEALTH CONVENTION 2022 SPEECH IN FULL
First of all, I want to thank you for inviting me here today and particular thanks to the brains behind today’s conference – Dr Toh Wong and Dr Naveed Akhtar. They represent medicine of the future – compassionate but also bold and open minded.
In the next quarter of an hour, I want to discuss why medicine needs to move from a conventional to an integrated model, why that integrated model is so urgently required today and to make an announcement that many of us have been waiting to hear for 40 years.
Let’s start with conventional medicine. I wouldn’t be alive without it and I suspect many of you at this conference would say the same. Many of my patients, who previously died in their late 60’s or early 70’s are now living until their mid-80’s or longer. But there is a problem. It has become too pervasive, too exclusive and is now unsustainable. I will explain why.
Today, we expect a pill for every ill. This has led to too many pills – not my words but those of the Chief Pharmaceutical Officer for England, in a report published at the end of last year. 10-15% of our patients at any one time are taking sleeping tablets, tranquilisers antidepressants or pain killers. Opiate overdoses are now the most common cause of death in American young men and the UK is now seeing the same percentage increases as the USA. Overuse of antibiotics is leading to antibiotic resistance and now deaths. It is because of this overuse of pills that the College of Medicine is launching, with senior politicians of all parties, an initiative “Beyond Pills” in social prescribing week during the first week of March.
There is another problem. That is – as every GP knows – our pills don’t work very well for a whole range of patients that we commonly see such as people with chronic tiredness, frequent infections, irritable bowel, headaches, back pain, depression or stress. Then there are also the side effects of the medication, two thousand people dying previously in the UK with stomach perforation from anti-inflammatory treatment. Surely we should give out pills only when they are absolutely necessary and effective?
These issues are compounded because modern medicine has also become too exclusive with its population-based evidence demanding double blind placebo trials for everything – appropriate when it comes to heart attacks and cancer but less so for many of the things that we see in daily general practice. Yet woe betide the GP that crosses the tramlines of NICE Guidelines or care pathways with “no win/no fee” lawyers poised to pounce at every opportunity – intuition and experience count for nothing.
Then finally, modern medicine faces an issue of sustainability. There will never be enough doctors and nurses and as the population ages and the rate of long-term disease increases the workload of clinicians each day becomes increasingly impossible. Resources that should be available to help the GP are simply not there – almost three quarters of GP referrals to child and adolescent mental health services are refused, waits for children with autistic disorder are commonly well over a year and what can our modern medicines do anyway for the 25% of girls between 14 and 16, who are self-harming?
Consequently, the modern GP has become like one of Pavlov’s unhappy dogs. Constrained only to give a few treatments that too often don’t work – often with side effects – and unable to explore wider options for fear of litigation, while being increasingly abandoned by services that should be supporting them and their patients. That is why we must now urgently move to an integrated model.
Integrated medicine is the coming together of the conventional and the complementary wherever this is safe, appropriate and has an evidence base that is relevant to the seriousness of the condition. It is what His Royal Highness The Prince of Wales calls “The best of both worlds”. It is not a return to some nostalgic past though it does value ancient wisdom and experience. It is the next stage of medicine – post modern medicine. Let me explain why.
Medicine and science are moving away from the rather blunt use of population-based evidence to become much more individual and more personal. NHS England has a whole department of personalised care. An increasing knowledge of the genome and of the biome are leading to much more bespoke and personalised medicine. It involves a new science called “systems medicine”, which is an application of systems biology to develop personalised healthcare. Last month, there was a striking example of this in the proceedings of no less than the National Academy of Sciences of USA. The paper concludes “These results make meditation an effective behavioural intervention for treating various conditions associated with a weakened immune system”. Integrated medicine is on the march with new molecular explanations.
Integrated medicine is able to provide this personalised medicine because it gives the patient a choice of whichever approach he or she feels to be appropriate. A priori that approach is likely to be more successful because the patient has chosen it aided and abetted by his or her beliefs and those of the clinician.
This personal effect is amplified by the extraordinary self-healing powers of each of us – those natural killer cells that are emotionally related, the hormones, the natural opioids within our body – all of which make us self-organising beings capable most of the time of healing ourselves and where mind/body individual processes are a major part of healing in every instance and, indeed, a major factor in whatever treatment we might provide – conventional or complementary. Remember also that a sick person is not a normal person plus that sickness – we are changed in mind and body by illness and our new science will need to factor this in as well.
Integrated medicine works with the forces of nature and the healing processes of the individual patient. Quite different from the more aggressive processes required to confound the workings of our body in conventional medicine if we have cancer, a heart attack or a bleeding limb. That is why we need both.
Healing may often involve reversing one process of the body, while reinforcing those processes that normally help us to heal. The latter is often a slower gentler process of healing so more sustainable in the long run.
That sustainability is partly because integrated medicine is so much about what people can do for themselves and each other and their communities both in healing and also in enabling individuals and communities to be more resilient. If we fail to make individuals and communities more resistant to disease in this way, our health services will become unaffordable.
That brings me back to those clinicians feeling like Pavlov’s dogs. Integrated medicine allows them to apply art and science, to use the power of compassionate relationships and the influence of mind and body in healing. It is liberating because it allows them again to think for themselves, to choose with their patients options that they mutually think best rather than following “one size fits all” guidelines. It allows us to be the doctors and nurses and therapists that we always set out to be and to stop banging our heads within a purely conventional model of medicine where too often I see deep misery and discontent.
Today, is the time to right a deep wrong of the past 30 or 40 years that has seen a dogmatic and bullying intolerance to therapists and those in conventional medicine, who have looked intelligently outside the box of the medicine that they were taught to practice. Today, those battle lines are over. The intolerant old guard has begun to look arrogant and insensitive to the needs of both patients and clinicians. We now have a new wave of young clinicians and therapists, who are working together – as you are at this Health Convention today – and leading the way towards a much better medical world for our patients and those that look after them.
That brings me to the announcement. For too many years, the complementary community has been too divided and behaved like tribes, which are all too common place in orthodox medicine and so many other walks of life. Today is the official birth of the Integrated Medicine Alliance. This is a coming together of inspiring leaders covering all the main complementary modalities. These are brave men and women, who have decided that the whole is more important than its parts and who have worked together over the last year or two to create a unity that can better explain the benefits of all complementary approaches to both patients and clinicians.
The aim of the Alliance is to inform, to educate and to enable access to qualified complementary clinicians and you can see a wealth of information on the College of Medicine website – different modalities, when they might be useful and what qualifications you should look for as well as plenty of videos with patients and therapists.
For me, this is something deeply personal. After working ten years into general practice, I was burnt out in the 1990’s – fed up with trying to sort such complex problems with the blunt instruments from my conventional medical training and desperate to look for alternatives that might help the daily suffering of my patients. Today my own armamentarium includes a mix of acupressure and massage, breathing techniques, self-hypnosis, mind/body therapies, a range of herbs, diets and an increasing interest in healthy eating. This has turned my professional life from grey into colour and learning these techniques and frequently referring to far more qualified therapists, I have witnessed the beneficial effects in so many patients. That has been proof enough for them and for me.
That brings me back to this wonderful Convention. Covid has shifted those tectonic plates. Our conventional medicine has proved itself to be so powerful with vaccines and new treatments but also so vulnerable because it is so impersonal and has failed to explain why one person falls iller than another, what we can do in terms of lifestyle and diet to help and how individuals and communities will in future withstand and prevent similar pandemics. Integrated medicine is the answer. It is time for it to move from side stage to centre stage. This conference represents the vanguard of change and a dawn of hope. A new medicine is coming. All of you here today carry a huge responsibility. Because you are it.
