Dr Michael Dixon, the College of Medicine’s Chair, addressed the European Congress for Integrative Medicine (ECIM) on November 4th 2021, telling those attending that the conference marked ‘a new dawn for integrative medicine and the beginning of a new age of hope.’
At the 13th conference, held online, Dr Dixon offered five reasons why healthcare is currently poised for a major change in thinking, with an approach that looks more to the mental, emotional, social and environmental factors that affect our health.
He said: ‘I do believe that we are now, at last, on the verge of breaking that glass ceiling of conventional medical thinking.’
Below, read an edited version of his speech:
THE COVID EFFECT
“The first reason is because we are witnessing some long awaiting humility in conventional medical thinking, which has come partly as a result of Covid 19. Yes of course vaccines have changed the game but the virus has hit some more than others – particularly the overweight and those with poor lifestyles and whom medicine has failed to protect. Furthermore, we have seen a singular lack of any simple advice on what people can do for themselves apart from wearing face masks and isolating and cleaning their hands.
Yet we know – even from research published last week – that a diet plentiful in fruit and vegetables provides protection and it seems that a diet rich in polyphenols should be helpful but there is no public advice or research on these things. Meanwhile, the public and even our politicians are voting with their feet.
So, while our National Institute for Clinical Excellence stated that there was insufficient proof for Vitamin D supplementation in improving resilience, our Secretary of State was, probably quite rightly, advocating it especially for the elderly.
We must also remember that the state of modern medicine was not so good before Covid. Over use of antibiotics was causing antibiotic resistance with over prescription of drugs generally being a major problem according to a very recent report by England’s Chief Pharmacist. This report, I have to say, has been met with stunning silence and inaction from the medical establishment.
So, I see a new humility giving way to open-mindedness about alternatives and open-mindedness is exactly what integrative medicine is all about. Of course, we need to proceed on the basis of evidence but getting that evidence in the UK is difficult when 0% of our national research funds are used to research complementary medicine in spite of a scoping report by Professor Debbie Sharp, commissioned by our Department of Health, which showed the need to
fund such research.
So in the UK we stand on the horns of a dilemma where the health service demands evidence but is not prepared to pay for it. At this time of instability, I believe it is time for the integrative movement to kick open the doors and demand a fair and level playing field – that is whether it is the funding of research or a sense of proportion, when it comes to comparing and offering conventional and integrative approaches. That is again why this conference is so important because we can come together as a European community and pool our knowledge, research and resources.”
ECONOMIC NEED FOR A DIFFERENT APPROACH
The second reason why things are changing is about sheer economic necessity. In England, we are today losing three GPs a day and there is a shortage of health staff generally. In some parts of the system, a shortage of physiotherapists is leading to the employment within the NHS of osteopaths.
But this economic necessity goes far beyond simply a labour shortage. We need to encourage better self-care avoiding professional NHS intervention and, of course, integrative medicine has a good reputation in this respect. In my own GP practice, we decided a few years ago to offer patients the choice of herbal preparations that they could buy for themselves or for us to prescribe conventional remedies such as antibiotics, sleeping tablets and arthritic tablets.
What surprised us when we did this was that 70% of the time people would choose the complementary remedy even if they had to pay for it and the prime statistic was at the end of our study, 40% of patients who had used a herbal
remedy said they would buy it themselves over the counter next time if they had the same problem. An integrative approach saves money for the health service at witnessed a study a few years ago showing that GPs (family doctors) who had an interest in complementary medicine prescribed 25% less than more conventional doctors.
This leads to the issue of choice. Why shouldn’t our patients be able to make their own choices as a fundamental right and especially where this saves health service money when that choice is offered in the context of integrative medicine? Furthermore, it is time to see our patients not as passive object of our medicines but as self-organising beings, whose choices are themselves more likely to lead to therapeutic success.
PUTTING THE PATIENT AT THE HEART OF THEIR CARE
In England we have a new movement called “Personalised Care”. Furthermore, it is a movement that is now rooted inside the medical establishment with its own department within NHS England. It recognises the importance of each individual and their choices, their beliefs, their culture and their history. Its clarion call is that we should ask patients not “What’s the matter with you?” but “What matters to you?” This represents a major change in direction for our health service.
Up until now, we have used population-based medicine and then forced our individual patients down care pathways that fit its narrow restrictions. In future, to use the rhetoric, we will organise care around the patient rather than vice a versa as it has been in the past. This movement is being reinforced by advances in our understanding of the genome and the biome and the promise that, in future, we can tailor our medicine to that of each individual rather than applying the blunt instrument of population-based medicine to individuals while well knowing that only a percentage will benefit.
In England this movement has been extended within the health service to giving patients their own budgets for healthcare and them often choosing complementary options. The extraordinary result of this is that not only do they do better but they are more likely to underspend their budget than would otherwise have been required to provide their care under the old health service regime.
Personalised care is, of course, integrative medicine. That is care integrated around the patient rather than the patient having to integrate different medical approaches whether it be complementary or conventional as in the past.
PRESCRIBING FOR COMMUNITY
A fourth element of this new dawn is a recognition that medicine, especially following Covid 19, must now be relevant not only to the individual but also to the community in which that individual lives. Social prescribing, which will be one theme of this conference, addresses individual inequalities for those, who are lonely, isolated, have chronic disease, mental problems or the 20% of patients that consult people like myself as a family doctor with primarily social
problems.
Social prescribing ends up with increasing the offer by the local volunteer and voluntary community sector and this opens Pandora’s box for complementary medicine. It is about medicine taking to the streets.
About medicine in primary care being relevant to the community and about complementary medicine becoming a relevant part of that community – for instance, the hypnotherapist in my own surgery would provide Monday sessions on breathing techniques and self-hypnosis for anyone in the community alongside his subsidised private practice. This involves a major change in thinking in both conventional and complementary medicine but I would contend that it is integrated medicine in its best form – integrating different medical approaches and therapies and integrating the individual with the community.
THE NEXT GENERATION OF DOCTORS
There’s a new generation of young doctors and others working in the health service with a new mindset. The UK College of Medicine, which I Chair, has a Student Council with several students in every medical school, who are impatient with the limited perspective of the old order.
They simply don’t understand why war lines have been drawn up in so many of our countries between conventional and complementary medicine. All that they are interested in is what works best for their patients. They are going to need support from all of you in the integrative community to support them and to show them how they might articulate this new concept of health and care in their future and daily professional lives.
Given that this new dawn is approaching, what finally should we be doing to accelerate the process? First of all, we must continue to spread the message. We must produce the thinking, the research and the stories. We must create
strength in numbers as we will at this conference over the next three days.
Then, we must campaign for parity and research funding between the complementary and the conventional. Thirdly, when we have produced the evidence, we must collectively demand that our health services have listened to it and are not paralysed by the usual historical and vested interests, which I am sure we have all experienced from time to time.
In the UK at least, it is time for our regulatory systems to acknowledge disciplines such as acupuncture and herbal medicine – if only to ensure the safety of those hundreds and thousands of patients that use them. Again,
conventional self-interest should no longer be allowed to lock them out.
