Saturday 20 July 2013

Medicine: Yesterday, today and tomorrow.

As medicine has developed side by side with the evolution of man, it has become progressively more scientific. With science comes fact. Without fact comes doubt. Rightly or wrongly, the doctor of today is brought up with an absolute trust in evidence based medicine. They don't always get it right. The most notable recent example was the decision of the Lancet to publish the article citing a link between the MMR vaccination and autism. The article and its author where subsequently discredited but not before Health Boards such as that in Swansea had to spend huge to sums of money to deal with the inevitable measles outbreak. The latter resulted from the scaremongering of the original Lancet article.

Put simply, if it hasn't got an evidence base, the medical profession doesn't want to know. I don't say here if this is right or wrong but would seek to draw your attention to a drug which you will all have taken. Paracetamol is one of the most frequently used drugs either over the counter or prescribed. See if you can find out how it works. My point is that nobody really knows. But it works. It will bring down a temperature and it will provide pain relief. We just don't know how.

Why then is paracetamol so willingly accepted when homeopathy is treated with such derision? Homeopathy comes under the heading of "Alternative Medicine". To the medical profession, it is thus little short of witchcraft and mumbo jumbo. For many proponents of homeopathy (including our heir apparent), they couldn't be without it and experience a benefit. My medical school afforded an entire morning to Alternative Medicine. They are therefore affording it a shop window for the medical students to look at - albeit very briefly. I much prefer honesty so I am glad that they give it the time they think it is due.

When I go to France, they have entire aisles in their supermarkets devoted to what we would call Alternative Medicine. Perhaps the French are just unaware of the lack of an evidence base. Alternatively, they might actually be deriving some form of benefit from buying and using it. It is not often in my experience that people repeatedly purchase anything from which they derive no comfort or benefit.

In the 1980s, the new breed of comedians pointed with mirth at the emerging "Alternative Music" which had started to grow in prominence. As I recall it, Alternative Music simply referred to music being made by bands who enjoyed making their music and for whom commercial success was secondary if not tertiary. A lot of it was quite good too not that you'd hear much of it on the commercially minded radio stations. The parallels with Medicine and Alternative Medicine are difficult to ignore.

Before the advent of antibiotics, chemotherapy and the rest, Alternative Medicine was the treatment of choice. In fact, the foxglove which currently adorns our hedgerows was identified by our forebears as being useful for the treatment of dropsy. We don't call it dropsy any more. We now call it heart failure. Digoxin is derived from the foxglove (digitalis) and still used today for aspects of heart disease. One of the new breed of drugs being used for chemotherapy is derived from the Yew Tree so synonymous with our churchyards.

The truth is that Medicine doesn't have all the answers and neither does Alternative Medicine. If either if them did, people would be living much longer in much better health. It seems intuitive therefore to use the word Complimentary Medicine since this better describes the role of non-evidence based treatments within the context of mainstream Medicine. Prince Charles has been a staunch advocate of homeopathy for a long time now and I don't doubt that he will continue to do so - even when he is King Charles III. I'd love to be a fly on the wall when he consults his Royal Physician because that would surely stretch diplomacy to levels which would test even the most capable politician.

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