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A view from a GP

Updated Monday, 17th March 2008

While watching Alternative Therapies, Tom Heller considers what science can learn from Kathy Sykes' journey.

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It is too easy for proponents of 'scientific' or evidence based medicine (EBM), to claim that any therapy which can be shown to 'work' - according to rather rigid criteria that have been designed to judge modern medical interventions - thereby disbars itself from being complementary or alternative. Instead, once its efficacy has been proven, it gets accepted under the umbrella of 'proper' medicine.

Of course, it's important to find out whether a particular therapy works, if only to avoid raising false hopes of a cure or investing time and effort backing implausible, wacky, or potentially even dangerous approaches.

For Alternative Therapies Kathy Sykes explores three different systems; hypnotherapy, reflexology and meditation. These three approaches definitely seem to 'work' - for some people under certain circumstances. This throws down a clear challenge for advocates of these therapies to provide robust evidence of their effectiveness: even evidence that would satisfy disciplinarians of the scientific school of medicine.

However the task of providing 'proof' can be enormously difficult because - unlike with regular medication - these therapies are not uniformly applied to each person in a standardised way. The essence of most complementary or alternative treatment is that it is tailored to each individual, thereby making orthodox clinical trials virtually impossible.

But if so many people have apparently been helped by CAM interventions there is also a challenge for orthodox science; how can these apparently effective treatments be explained in orthodox scientific terms? What is going on in the brain of people who are meditating or under a hypnotic trance? Is it really all smoke, mirrors and theatre?

The three programmes in this series have focused on these fascinating debates, bringing some very important issues to a wider audience. For myself, as a practising doctor, it has made me think about the nature of healing and our scattergun attempts at helping people to get better. I have been forced to the conclusion that the body has enormous restorative powers and a very wide spectrum of interventions seem to be able to trigger measurable physiological changes. These changes may have potentially positive, healing effects.

It could be that the key intervention is the medication that I've prescribed. Equally though, the trigger could be all the 'theatre' that surrounds coming to the doctor: from the waiting (a reminder that doctors try to portray themselves as important, busy people); the setting of the surgery and finally the laying on of hands and soothing words. Could it be that meditation, reflexology and hypnotherapy are just three other ways that the body can be encouraged to repair, restore and recover itself? And could this trio be less risky than many other chemically-induced therapies aimed at similar restoration?

Orthodox health care workers share more than we care to confess with the hypnotherapist or other CAM practitioners, perhaps. And if it is the surrounding phenomena and symbolic acts - the 'theatre' of CAM - that stimulates recovery in human beings and their tissues, then shouldn't this be the subject of proper scientific exploration? Whatever tradition we belong to, how can we harness these healing triggers and maximise the positive outcomes for our patients?

Perhaps we should learn from our CAM cousins about the importance of taking our time, setting up positive expectations, treating people in an individualised way and doing whatever is necessary to stimulate the body's own potential for healing. We don't need to attack or disparage CAM practitioners. In fact, perhaps we should try emulating them more?

The strength of the series lies in the interweaving of both scientific and human exploration. Kathy brings to a general audience some of the developing strands of orthodox enquiries into the fascinating science behind these therapies. Some of these lines of scientific investigation seem to open the possibility of increased understanding of the mechanisms through which CAM therapy might work.

However, looking for scientific explanations for some of these phenomena also demonstrates how crude and underdeveloped the science itself is. Many of the imaging devices and biological assays struggle when asked, for example, to provide evidence of what is going on in the brains of people who have meditated. Showing that certain areas of the brain become thicker after meditation seems to ask more questions than it answers; is this a good thing or a bad thing? Wouldn't we expect certain parts of the brain to change if they are exercised, but what does it really mean? Science seems to have a long way to go before it can answer many of the challenges that CAM has thrown down for it to study.

Kathy was also on a journey to find out for herself - at a personal level - about some of these therapies. Perhaps this will be seen as an abandonment of objectivity, but for me the human parts of the enquiry are equally engaging and challenging. By throwing herself into being hypnotised, or meditating, or receiving reflexology, Kathy connects directly with those watching who might be tempted to try out these experiences for themselves. Therapists - whether alternative or not - don't treat a dispassionate set of organs. All treatment is a human interaction; in Kathy's case, for the viewers' benefit, in front of camera. Being touched is (usually) nice, being hypnotised doesn't suit everybody and calming down your thoughts and bodily functions by the use of meditation probably does help you through the day. By sharing these universal intimacies Kathy again challenges scientific orthodoxy. Come on you scientists, show us why all these things are common experiences, yet orthodox science hasn't developed to a stage where it can meaningfully explain or prove the connection with health and healing responses.

More intimately still, Kathy tries to make sense of these therapies in the context of her own life. She's a busy, professional person under the familiar stresses of a complex life. Of the three areas she explores, meditation appears to be one that offers her some practical method of keeping control of her life. But when talking about touch some of her defences are breached; for example, holding hands with her dying father has been a pivotal moment in her life.

If meditation can help, and touch has an effect, does it matter what the science behind the results are? These potentially life-changing experiences, such as experienced by Kathy and so many others, can't, after all, be dissected, bottled or sold. Perhaps the greatest challenge CAM presents to science is to accept that there are some things which cannot be easily explained and that the ‘evidence’ required by some scientists to prove efficacy remains crude and unlikely to reveal all the answers to complex human interactions.


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