As we roll into summer (hopefully a rock n’ roll summer according to Rog) a few developments in the strange world of “integrated medicine” caught my eye. Firstly, I am not really sure what “integrated medicine” is, as none of its proponents seem to be able to come up with a good definition, other than being a “holistic approach.” Frankly, it seems to be a conflation of medicine and stuff that isn’t evidence based and probably doesn’t work but has a strong following of folks who believe in it.
Naming and dividing up pseudoscientific or quasi-scientific practices as a form of medicine is rather an old trick of alternative practitioners. The classic examples being “Western medicine,” “Eastern medicine” or “alternative medicine” to emphasize different philosophical world views behind medical treatments and therapies. In reality, this is of course nonsense, and modern medicine is an evidence based endeavour, and there is simply “medicine” (i.e things that are based on scientific evidence and well-tested theories and actually do work; some better than others granted), and non-medicine (which generally doesn’t work, at least no better than placebo, but sounds hip and cool). Science-based healthcare doesn’t care if therapeutic interventions come from Brighton, Washington, Bejing or Bankok; as long as they work. Integrated medicine does look like the latest in this long line of different terms used to try and make pseudo-scientific practices sound credible.
There is big money behind these endeavours too (and I suspect big profits). A mail-out landed in my mailbox the other day for the Natural Standard website, which looks very well organized and professional when you visit. It looks like a site dedicated to providing sound and good scientific evidence on complementary as well as established medications.
However, upon closer inspection it seems to present far less than rigerous scientific standards are applied in their recommendations. For example one cited paper suggests that the extract of pulsatilla (a purple flower beloved by homeopaths) may be able to reverse cognitive impairment and be beneficial in the treatment of Alzheimer’s disease. This astounding statement is based on reported research from no-less an authority than the Life Science R&D Center of SK Chemicals in Korea, from it’s laboratory studies. Needless to say lab studies are at the bottom of the evidence pyramid for Evidence Based Practice, and the suggestion at this stage that this may help reverse Alzheimer’s is completely bonkers. Maybe after a wide range of succesful clinical trials you could start to make such a claim, but try getting that one published in the BMJ on the basis of lab studies.
In a similar vein, it looks like things are hotting up for homeopaths in the UK. A consolidation of existing regulations by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK will come into force on 1st July 2012 despite a campaign by supporters of homeopathy to try and prevent it.The problem for homeopaths is that under the new regulations there are only 5 appropriately qualified pharmacies which can now dispense the four dozen or so formally registered potions that can be legally sold in the UK. All other homeopathic prescribing and supply not involving a face-to-face consultation with a registered homeopath will be unlawful after July 1 2012. Thousands of unregistered homeopathic remedies that are not included in the regulations will no longer be legal for sale. Even for the handful of legal preparations, supply without a face-to-face consultation will cease and all online or telephone sales will be illegal. I am not sure what Prince Charles thinks of this, but looks like the stage is set for a rapid change in the black drugs market. One can imagine shady looking characters approaching you in the pub and saying “Psst, want to score some good argentum nictrium in a 5C dilution, I have a good deal going…”
This may pose a problem for the The Royal London Hospital for Integrated Medicine which is advertising for a pharmacist who specializes in (yes you guessed it) “integrated medicine.” The job requires a trained pharmacist with a minimum of 10 years of experience able to deliver clinical pharmacy services, and requires some sort of integrated medicine training (sadly it seems that the NHS is now getting into IM too) but it doesn’t say what that experience should be (maybe trifling with voodoo as a teenager would qualify)? The position would involve dispensing both regular medical medications and ones that probably don’t work too. Your tax dollars (sorry pounds) hard at work. Well at least Obama’s health reform’s went through this side of the Atlantic, so there is cause to celebrate here. Thanks to Andy Lewis of the Le Canard Noir who flagged this story, and also Scott Gavura’s excellent Science Based Pharmacy site.
Anyhow, as Roger noted the summer is upon us and I am off to Vancouver Island (Sooke) on my holidays for a while. Roger will be away for a bit too, so things may be a little quiet over the summer, but we will try and post when we can. We will of course, be back in full swing in the fall with more scientific quandaries for you (and us) to puzzle over.
Onwards and upwards scientists! Have great summer,