Mr President, Ladies and Gentlemen. I was just thinking that maybe after you've heard what I've got to say this evening you may want to change your mind about giving me an Honorary Fellowship… I'm enormously grateful to you for such a touching suggestion and, if I may say so, it is extremely good of you to invite me to join you here today.
And, if I may say so, I am also absolutely delighted to be contributing to this timely and important conference. I should also like to congratulate the Royal Society of Medicine on the anniversary of its bicentenary which is a magnificent achievement. And as many of you may know, the progenitor of the Royal Society of Medicine was the Medical and Chirurgical Society, founded for “the purpose of conversation on professional subjects”. Given the health challenges we face in the 21st Century, there can surely be no subject more fitting for professional conversation than integrated healthcare.
Now, integrated healthcare is a subject that has been close to my heart for many years as some of you may have discovered. Although I remember when going to open Dr David Riley's Homeopathic Hospital in Glasgow some years ago and I met all the students, who were about 20 or 21 or something, who'd been studying this subject. I remember them saying, “Are you interested in homeopathy?”. I remember thinking it just shows how far back I go! They had no idea that I had tried to take some interest in these matters and been soundly ridiculed for it. But in December of 1982, I spoke at the British Medical Association's 150th anniversary dinner and, in particular, advocated a whole-person, holistic approach. At the same time I gently encouraged the BMA to reintroduce elements of traditional therapies into modern medicine. Unfortunately it was suggested that I was “attacking modern medicine”, and so my speech was dismissed in the BMJ as a “flight from science”. I think you may have a copy with your conference papers so you can refresh your memories as to how far I'd departed into the realms of lunacy… In fact, I thought I was only pleading for a spot of balance at the end of the day. In the same year I found myself addressing the Royal Institute of British Architects for their 150th Anniversary and I've never forgotten it because all the Doctors came up to me and said it's right what you said about the architects but I don't agree with anything you said about the Doctors. And the architects said the same thing about the Doctors! So all I was pleading for there was a little bit of integrated architecture.
Despite this, and as a direct consequence of my speech, colloquia were in fact established under the aegis of the RSM which attempted to dispel suspicion about complementary therapies and encourage collaboration between orthodox and complementary practitioners. The colloquia also acted as a catalyst for the establishment of the Centre for Complementary Health Studies at Exeter University.
In the twenty-three years since then, I have continued to work at ways of establishing an integrated approach to healthcare, whereby the best of both worlds – orthodox and complementary – can be used in tandem. I have also learned that more and more people – in fact one in five of us – are now using complementary therapies; and a staggering seventy five per cent of people in the UK would like to see complementary medicine available on the NHS. What has also changed is the number of General Practitioners that are now making complementary medicine available to their patients – something like over fifty per cent.
Over the past two decades it really has been interesting to observe the growing criticism of the fact that the human body has too often been mechanistically reduced to individual parts and treated with limited reference to the whole person. I believe that the time is now right for a fundamental reappraisal of the way in which we view healthcare: quite simply, it is surely time to adopt a far more holistic approach to health. Humans are not just parts of a machine to be fixed when broken it seems to me. We are infinitely more complex beings - mind, body and spirit - and healthcare should attend appropriately to all three aspects, and keep these elements in balance. It was John Ruskin I think who said “in all perfectly beautiful objects there is found the opposition of one part to another and a reciprocal balance”. I'm one of those people who believes that when we tip the scales too far, we pay rather heavily… in the currency of both human and environmental health.
So Ladies and Gentlemen, I would suggest that in today's world there is an increasingly urgent need to find an alternative to the clumsy agents of whole-sale industrial homogenization that pervades, often detrimentally, many aspects of our lives, including agriculture, architecture and, of course, health. This means a move away from the often passive nature of the standard therapeutic relationship and towards one that is more human and more personalized. It seems to me there needs to be a more equal and adult partnership; one that allows patients to make their own decisions and which encourages individuals to take more responsibility for their own health.
Increasingly, this is what people with long-term conditions are doing. Several million people in the UK have a long-term condition, and I recently learned that eighty per cent of GP consultations are taken up with these consultations. So managing a chronic condition seems to be increasingly the challenge, something quite different from curing an acute one. Long-term conditions can bring frustration, and negative emotions can have a detrimental physical impact. This can, in part, be mediated by giving patients treatment choice, which helps to foster a renewed sense of control, through integrated approaches to health. It comes as no surprise to me that modern research into mind/body effects has shown there is a constant interplay between mental and physical states of wellbeing. For example, breast cancer patients have shown that a positive attitude can not only raise the quality of life, but in some cases can even prolong it.
Poor mental health is a prime example of a long-term condition. Two hundred years ago, when the RSM was established, people had very little understanding of its causes. In terms of acceptance and stigma we have progressed, though perhaps not as far as we could – mental illnesses are still social stigmas as well as being common problems. One in four people has a mental health problem, as you know better than I, and as many as one in 38 has clinical depression. The total annual cost of mental health problems in England has been estimated at £32 billion, with more than a third of this cost attributed to lost employment.
And yet there is still a tendency to perpetuate an over-reliance on drugs, without looking perhaps at the actual causes of mental health problems. The prescribing rate for anti-depressants continues to rocket and while they are clearly life-savers for severe depression, they are not without their risks. And obviously complementary approaches will not be suitable in every case, although the herb, St. John's Wort, has been shown by the BMJ to be more successful in treating moderate depression than anti-depressants. My Foundation for Integrated Health has recently received some funding from the Department of Health to help develop national guidelines for the use of complementary healthcare in mental health services, in collaboration with Mind, the Mental Health Foundation and the Royal College of Psychiatrists. The guidelines will address issues such as how to help people suffering from conditions including stress, anxiety and depression. Ultimately, I hope that they will help to improve access and availability of complementary healthcare for users of mental health services in the NHS.
One way, however, in which the individual can take an active role in the management of their mental healthcare, as well as in other aspects of their health, is by choosing nutritious, organic and locally-grown food. I was very interested to learn that the Royal Society of Medicine held a conference in March this year called “Will food take over from medicine?”, at which international experts met to debate whether we are now moving to a “pharmaco-nutritional model”. And in that sense Hippocrates would certainly have been absolutely delighted….!
After years of polluting, processing and over-refining our food, we are suffering from adverse health problems and, worse still, we are inflicting them on our children. We are all well-versed in the roll-call of conditions: childhood obesity and so-called attention deficit disorders, cardiovascular disease, adult on-set diabetes, various forms of cancer … I am only naming but a few examples of our food-related epidemics of chronic disease.
The results of animal-injected growth hormones and biological and chemical contaminants have been widely documented. Residues from pesticides used in conventional farming are stored in fatty tissues and may remain in the body for years, possibly contributing to neurobehavioural and neurotoxic effects, allergies and other immuno-regulatory disorders. Scientists from Glasgow University have found a link between the levels of nitrates in vegetables and gullet cancer, believing that an increase in the use of nitrate fertilizers since World War Two may be one of the main reasons for this particular rise in cancer.
The loss of local food and over-reliance on packaged, processed food is not just damaging our own health. We are also damaging our bio-diversity, our soil through agro-chemicals, our water-table through pesticides and, crucially, our climate through carbon emissions used in transporting food long-distances. And it seems to me we have lost touch with the source of our food and our rural communities have suffered socially from the loss of local distinctiveness, traditions and culture. It goes without saying, of course, that many farmers have also paid a heavy price at the hands of mass producers. And when you think about it could there be anything more ridiculous than green beans flown in from Kenya! The contents of the average food trolley in a UK supermarket has travelled over 3,000 kilometres, and for every 1,000 fruit products bought in the UK, only six will be grown here.
I could go on and on and on but I won't bore you… I'd rather continue by advocating the many health benefits of eating healthy and local, organic food. You can say I would say that anyway of course. Nitrate levels are on average fifteen per cent lower in organic foods. Although I dare say people will argue about it. Organic milk has on average fifty per cent higher levels of Vitamin E, antioxidants and omega 3 essential fatty acids than non-organic milk.
I was struck by recent trials, including one conducted by Durham County Council, which demonstrated that the concentration and behaviour of children under-performing in class were improved by taking a cocktail of fish oils and Omega 3 fatty acids. And in fact, talking to head teachers in schools that have adopted a different approach to school meals – getting in a different quality of food and organic food - they have found exactly the same thing. The attention of children is infinitely improved, as is behaviour. Surely if something so simple can make such an impact we should perhaps take more seriously the impact of a poor diet on our children. The chef, Jamie Oliver, has, as I'm sure you've heard, made this point very clearly recently on television. And, in Italy, home of the Slow Food Movement which advocates the more traditional, timeless methods of food production (the antithesis to Fast Food), there are now over 100,000 children eating organic food at school every day. Last year I went to Turin to the conference of the Slow Food Movement and found myself talking to 5,000 small farmers in this enormous hall. Nearly all of them were in their national, traditional costume. They had the most wonderful collection of people and I enjoyed it enormously.
The radical shift in thinking which I am hoping for should also recognize that optimum health is achieved by maintaining the balance and harmony between humans and the natural environment that sustains us. Sir Tom Blundell, the Chairman of the Royal Commission on Environmental Pollution, said two years ago at the launch of a major report on “Chemicals in Products” that, “Given our understanding of the way chemicals interact with the environment, you could say that we are running a gigantic experiment with humans and all other living things as the subject”.
This experiment I think is bearing the most unfortunate fruit. There has been, for instance, a three-fold rise in allergic diseases over the past 30 years, including asthma, rhinitis, food allergy, anaphylaxis, eczema and drug allergies. The 12 million people in the UK seeking treatment for allergies is costing the NHS £900 million a year, and the UK ranks highest in the world for asthma. But allergies are also increasing in developing countries, with experts suspecting that there is a strong association between the current high levels and the adoption of Western lifestyles. Our increasingly urban and somewhat sanitized society seems to be having a weakening effect on our immune systems. It has been shown that children who live with farm livestock are much less likely to develop allergies than their urban counterparts, and it is possible that exposure to higher levels of bacteria, viruses and fungi stimulates the immune response away from allergy.
In fact I remember talking to Professor Stephen Holgate, who chaired the Royal College of Physician's report on allergies, who said one of the best ways to overcome it would be for everybody to have a pet pig because the pig has the most beneficial micro-organisms. Anyway, he said “the answer to prevention of allergy lies in changing our lifestyle. Allergy should now be regarded as a public health issue that requires public health intervention if we are not to incubate a major health burden in the years to come”.
So it sees to me, greater access to integrated healthcare would help to tackle this rise in allergies, not because complementary medicine can miraculously cure allergies, but because complementary practitioners emphasize preventative care and encourage individuals to adopt different lifestyles and undertake a greater degree of self-management.
Well you know better than I Ladies and Gentlemen, we have undoubtedly made extraordinary advances in medicine, science and technology, and it goes without saying that conventional medicine has saved the lives of countless thousands of people.
However, just as we need well-designed buildings that relate to locality and landscape; and food that is traceable and locally distinctive, so we need to work with patients to create a health system now and for future generations that places greater emphasis on the unique qualities of every person, and on the prevention of illness and disease, as well as on its cure.
So to put it another way, we need to harness the best of modern science, the best, but not at the expense of losing the best of what complementary approaches have to offer. That is integrated health – it really is that simple.