I am delighted that so many of you are here to celebrate the inaugural event of my Foundation's G.P. Associates. So many, in fact, that I can see I shall now get the blame for taking you away from your patients and subjecting you to my sinister powers of indoctrination! But more of that later... I am told that there are, in fact, approximately one hundred and twenty General Practitioners here from across Britain… all of whom, I rather suspect (unless they're here out of curiosity to see whether I speak to G.P.s differently from plants!), share an interest in integrated medicine, and an enthusiasm for promoting its principles. Indeed, many of you have already established integrated services in your surgeries: from homeopathy in Dorset to acupuncture in Malvern, and spiritual healing in Inverness.
I very much hope therefore that today represents a milestone in the development of integrated healthcare in the U.K. and its relationship with General Practice.
On an historical note you may be interested, by the way, to learn of the medical history of St. James's Palace. It was built on the original site of a medieval hospital for women suffering from leprosy, and dedicated to St. James the Less, Bishop of Jerusalem and patron saint of lepers. And during the reigns of the Tudor and Stuart sovereigns the practice of touching for the disease “King's Evil” – now more commonly known as a form of TB – used to take place here and it was believed, and you know this just as well as I do I expect, that the touch of the King of England could cure it! And I suspect this early evidence of the “placebo effect” probably did work from time to time!
As I'm sure many of you are aware, for well over twenty years I have shared a passionate belief in integrated medicine with those who wanted to listen – as well as with those who didn't, which tended to be an awful lot of people! – and, fortunately, with medical experts who welcomed my views. In doing so, I seem to have attracted a remarkable degree of controversy for something as apparently harmless as advocating a whole-person, holistic approach to healthcare. Today these sentiments sound relatively tame, but over twenty years ago they were thought by some (although certainly not intended by me) to be an “attack on modern medicine” – and, by implication I was therefore “anti-science”. But it was worth persevering: because I have always believed that an integrated approach to healthcare will lead to the betterment of the patient's welfare and the relief of unnecessary suffering – not because of some self-indulgent “pet project,” or because of some half-baked obsession with unsubstantiated quackery.
In 1997 my Foundation for Integrated Health was established, and I believe that it has been instrumental in developing the concept of integrated healthcare. It speaks with an independent voice, free from political, professional and other vested interests. I am extremely proud of its successes, not least as, to my astonishment, it recently secured funding of £900,000 from the Department of Health to continue its work in supporting the regulation of complementary therapies. And I am enormously grateful to the Department for their help.
Times and attitudes change, thankfully, and today integrated health is moving steadily towards the centre stage. Indeed, I have just come from reopening the Royal London Homeopathic Hospital in Bloomsbury which has gone through a £20 million refurbishment and has now become one of the first Foundation Trusts. Interestingly, the support they have had from the public has been overwhelmingly more than there has been for any other foundation trust and it really indicates the degree of public interest out there and the degree to which the public actually want this kind of choice.
As I said when rather bravely addressing the B.M.A.'s one hundred and fiftieth Anniversary Dinner in 1982 – “today's unorthodoxy has an uncomfortable habit of becoming tomorrow's orthodoxy.” According to research, a phenomenal sixteen million people in the UK now use complementary treatments and over 50 per cent of G.P.s are making complementary healthcare available to patients in some form or other. Earlier this year, the Royal Society of Medicine held a conference to celebrate its bi-centenary, entitled “Integrated Health: Coming of Age”. And, of course, rarely a day passes without a report in the media about complementary healthcare and its pros and cons. Usually, it would seem, I am portrayed as one of the “cons” – and if certain organs of journalistic rectitude are to believed, you are all the subject of a highly sophisticated brainwashing operation!
So it seemed to me, therefore, that it might be useful to commission a report looking at the main available evidence in order to encourage a better informed debate about the effectiveness of different therapies and treatments. Last week's report compiled by the economist, Christopher Smallwood, which I think you have all heard about already, who addressed the conference earlier, was the result. The report found that there was good evidence to show that complementary treatments could help to fill "effectiveness gaps" in some of the orthodox treatments offered by the NHS - particularly in relation to many chronic conditions such as lower back pain, osteo-arthritis of the knee, stress, anxiety and depression, and post-operative nausea and pain. The report also suggested that many of these conditions are more prevalent in deprived areas. I was talking to patients earlier this afternoon at the homeopathic hospital, and one lady said homeopathy had totally transformed her irritable bowel syndrome in a matter of 12 hours.
This evidence, which is so important in building confidence amongst patients and professionals, I think takes an important step towards developing a more effective degree of integration – that is, combining the best of complementary and conventional approaches to healthcare in the UK.
Obviously, the powers of orthodox medicine cannot be underestimated. In the eighteenth century, Samuel Johnson was incredibly prescient when he called it “the greatest benefit to mankind”. That we have made extraordinary advances in medicine, science and technology is without doubt. That conventional medicine has saved the lives of countless thousands of people is also beyond question. In the case of many diseases, major accidents or serious infections, conventional medicine is essential; and we are fortunate in our day and age to have the prospect of successfully treating conditions previously considered incurable, such as meningitis or pneumonia or many cancers, such as Hodgkin's lymphoma.
But we are living in a highly technological, unprecedently scientific age: an age in which the agents of industrial efficiency, profit and speed can also be viewed as potential threats to our lives – from agriculture to architecture, and of course, our health. Too often, we have reduced the human body to its individual parts and treated it without reference to the whole person, with his or her unique qualities. Doctor George Engel, who recognized the singular importance of human relationships to the work of the physician, said, “By concentrating on smaller and smaller fragments of the body, modern medicine perhaps loses sight of the patient as a whole human being, and by reducing health to mechanical functioning it is no longer able to deal with the phenomenon of healing”.
We might easily say the same about the way we have been treating our entire world – and now we are being made forcibly aware of the incredibly dangerous side-effects from such treatment.
We are infinitely complex beings – mind, body and spirit – that cannot just be reduced to mechanical functioning, and healthcare should, and must attend appropriately to all three aspects. As Plato said, “The cure of the part should not be attempted without treatment of the whole”.
What, then, is a whole-person approach to healthcare? I believe it is a medical approach that makes both orthodox and complementary treatments available to the patient, not as competing or separate approaches, but in unison. It addresses not only the specific illness or ailment, but always considers it in the wider context of the patient's circumstances. And, crucially, integrated health stresses the importance of encouraging patients to help heal themselves, and to take individual responsibility for their health.
Taking account of the whole person necessitates a more personal, individual approach to healthcare consultations, and emphasizes the more traditional and humane aspects of healing, such as listening, intuition and empathy. I think there is a worry that, all too often, patients feel rushed and confused by short – (I understand often under 10 minutes), - consultations, in which their role is too passive. Mind you, how you, as G.P.s, fit everything into a ten-minute consultation I really don't know! And I can well imagine the pressures created by both patient and Doctor needing more time.
Nevertheless, integrated healthcare would seem to be a “best of both worlds” approach, in which the patient is given a choice. The patient can decide (with the G.P. obviously) which treatment – orthodox, complementary or a combination of the two – is the most appropriate. It is not, as some of the more outrageous media reports would have it, about quackery and witchery, hocus-pocus and snake oil. It is about giving patients accurate information, and then – and this cannot be stressed enough, as well you know! - allowing them to make informed choices.
To my mind, the group of people best placed to give patients accurate information, and to encourage them to take responsibility for their healthcare, is yourselves, the G.P.s. General Practice has been the cornerstone of the N.H.S. since its inception in 1948, (just think, I am as old as the NHS and look what's happened to me!) with General Practitioners known as its “Gatekeepers”. In 1952, the Steering Committee of the newly formed Royal College of General Practitioners wrote, “General Practitioners are essential to the heart and soul of medicine”. Much more recently, a B.M.A. report in June of this year stated, “General practice is the part of the N.H.S. that patients know best and appreciate most. It is crucial in providing patients with a continuity of high quality, personalized healthcare, and in enabling appropriate patient access to wider N.H.S. care”.
As General Practitioners Ladies and Gentlemen, you are therefore on the very frontline of healthcare, and without you the quality of many lives would be greatly reduced and believe you me I know that.
Unfortunately, as you know so much better than I do, our collective health is, in some areas, being reduced by the insidious effects of today's lifestyles. Children are suffering from obesity and so-called attention deficit disorders, with expert opinion rooting these things in exposure to pollution and the years of polluting, processing and over-refining of our food. Many adults are still suffering from cardiovascular disease, adult on-set diabetes and various forms of cancer, some of which, we are told, can be rooted in controllable factors .
Crucially therefore, the connections have to be made; the links understood between lifestyle choices and health consequences. As such, I believe that you, as G.P.s, are in an unrivalled position to explain these fundamental connections to patients; to demonstrate to us that the state of our health is so often determined by our ways of life, our diet, our human relationships, and the way in which we form our built surroundings or treat the natural environment. The pervasive effects of uglification are all around us. And yet beauty can have a truly positive effect on our health. That's why, I established my Foundation for the Built Environment over fifteen years ago – but that's another story you'll be glad to hear! The next installment of this exciting series . .
General practitioners can therefore play an integral role, not just in tackling illness, but also in preventing it, and can contribute to improving patients' lifestyles by the promotion of healthy living.
There are already many shining examples of integrated services in General Practice, but if I may, I'd just like to allude to the findings of one. The Glastonbury Healthcare Centre, of which I understand Roy Welford has already spoken, discovered in a recent survey that eighty five per cent of patients who were referred to its complementary therapists reported some, or much, improvement in their health. Its patients also appeared to reduce their usage of orthodox health services: such as G.P. time, prescriptions, X-Rays and other tests.
So one crucial reason for the inclusion of integrated healthcare into General Practice is to tackle the rise in long-term and chronic conditions. I have been told that far greater demands are now being placed on G.P.s as a result of more patients presenting with chronic and multiple health problems. In fact, a staggering eighty per cent of all G.P. consultations are being taken up with complex long-term conditions. Many of these - such as ME or Fibromyalgia - have no known treatments. Complementary medicine, therefore, offers a possible answer where otherwise there is little hope.
Managing a condition is thus increasingly becoming the challenge instead of curing it. Long-term conditions can bring acute frustration for the patient, and the resulting negative emotions can have a serious effect on the body's intrinsic healing ability. But this is exactly where complementary treatments can help enormously: giving patients treatment choice (that word seems to crop up fairly frequently!) helps to foster a renewed sense of control - and we know that if the patients make the choice, they are more likely to take the medicine and thus accelerate the healing process. According to a Doctor/Patient Partnership survey a few years ago, seventy one per cent of patients said they would like to be able to receive more information about complementary medicine from their G.P.s. If eighty per cent of patients want to make their treatment choices with their G.P., then I would have thought the G.P. would be the best person to help them choose, and also provide evidence on safety and effectiveness. Furthermore, offering choice is bound to be safer for patients – only fifty per cent of patients currently tell their Doctor they are taking a complementary medicine or seeing a complementary practitioner.
(Mental Health problems are perhaps a good example of chronic condition. As you know better than I, one in four people has a mental health problem, and the total annual cost of mental health problems in England has been estimated at £32 billion. The prescribing rate for anti-depressants continues to rocket. While they are clearly life-savers for some, they are not without their risks. The BMJ recently reported that the herb, St. John's Wort, has now been shown to be at least as successful in treating moderate depression as anti-depressants).
Now, ladies and gentlemen, I think we ought to turn to the reason for today's gathering … my Foundation's G.P. Associates. The aim of the G.P. Associates is, above all, to support and help those G.P.s in Britain who want to provide integrated medicine and, in turn, the patients who want to access it. I hope that through examples of best practice, networking and bringing together cumulative research, evidence, anecdotes and best practice, it will widen your knowledge and, in time, the choice you can offer your patients.
I would also very much like to see opportunities for educational and research visits abroad, to learn about different medical traditions in their cultural and geographical contexts. In February this year, a group of five British G.P.s visited Northern India to study Ayurvedic and local medicine in the foothills of the Himalayas. By the end of the week, patients from local villages were being diagnosed and treated using a combination of both Eastern and Western medicine. It was testament to the fact that no one medical tradition should have the monopoly.
Every new movement needs courageous pioneers: every pioneer needs the spirit of profound belief to motivate them (and to soften the blows of the inevitable critics!). George Bernard Shaw wrote, “Some men see things the way they are and ask “Why?” I dream things that never were, and ask “Why not?”. Ladies and Gentlemen, I have been dreaming and asking “why not?” for a long-time (usually to a chorus of concentrated abuse!) Today, then, I couldn't be more thrilled that the Foundation has gathered together experts who can continue to pose such questions with one united medical voice.
As I said earlier, there is nobody to my mind in a better position than yourselves to express to patients that healthcare is a matter of understanding the extent to which all aspects of life - and our place within it - are interconnected. Just as we need to see that if we pollute and degrade our natural environment and its limited resources we will create irreparable damage to our planet; so we need to see that if we abuse our bodies, we may suffer the consequences. After all our bodies return to earth…
Today marks the launch of a network of like-minded and forward-thinking Doctors with an enthusiasm for integrating the traditional and well-tried medicines of all disciplines for the good of their patients. I can't tell you how pleased and proud I am that so many eminent and sensible quacks are joining with my Foundation and it is my fervent hope that as more and more G.P.s spread the word of integrated healthcare across the country, so an increasing number of people will understand and adopt its preventative and holistic principles. You will be very much the standard-bearers for integrated medicine within General Practice, and I hope that with the seeds we're sowing today we may, in time, witness the development of a more balanced and harmonious approach to healthcare.