Come Back Science, ALL is ForgivenComment on this article?
Why I became involved with CAMI first became involved with CAM, and specifically with homeopathy, in 1974, when I began working and studying at RLHH. At the time I had just completed a period of intensive study to obtain membership of the Royal College of Physicians and was looking about for a new direction professionally. I knew nothing about homeopathy and would not have thought of taking it up, were it not for a friend whose opinion I respected and who told me she had found it to be impressively effective.
Homeopathy was certainly a big culture shock for me, coming as I did from a background in conventional medicine, but I was prepared for this up to a point. Conventional medicine in the early 1970s seemed not to be going forward very fast. Little new was happening and medical advances, such as they were, consisted mainly in ringing the changes on the existing antibiotics and antidepressants, so I was looking for something new. I suppose, also, that homeopathy appealed to a certain rebelliousness in me.
The RLHH at that time was a small general NHS hospital, with a very busy outpatients service and well over a hundred inpatients, though more of these were surgical than medical. There were several surgeons working at the hospital and they were in no sense homeopathic, although surgical patients sometimes asked for a consultation with one of the homeopathic physicians.
On the medical side the hospital had a slightly old-fashioned air, which was accentuated by the fact that two of the physicians were close to retirement. However, there were also some younger staff members and all of them gave the impression of being good doctors as well as good homeopaths. In fact, they were doctors first and homeopaths second, which is not to say that homeopathy was unimportant to them. And it seemed clear to me that, as they claimed, practising homeopathy entailed listening to patients in a way that the patients themselves appreciated and that had to some extent died out in mainstream medicine.
I continued working at the hospital and, when the two older physicians retired and a third resigned to work abroad, a colleague and I succeeded them.
However, my experience of homeopathy was not as fulfilling as I had initially hoped it would be. There were one or two early successes but these were not repeated and I increasingly began to suspect that the responses I did occasionally see were due to the placebo effect or other things rather than to the medicines. I attended talks or read articles in which people described their successes with various homeopathic remedies but they never seemed to work for me. At this time, also, I began to read some of the writing of the nineteenth-century homeopaths such as Richard Hughes and Robert Dudgeon, which helped me to see homeopathy in a different light.
This led me eventually to write a book on the history of homeopathy (The Two Faces of Homeopathy), which was published in 1984. My Homeopathy in Perspective, is a very considerably expanded and updated version of the earlier book.
Beginning acupunctureSome time before writing The Two Faces I had thought of learning acupuncture, largely because at the time I was interested in Eastern ideas. In 1977 I heard that a Dr Felix Mann was teaching the subject to doctors and I registered for his course.
The course lasted five days. There were fourteen of us. Before starting we were supposed to read Felix's books, which at that time were all based on the traditional system. They were pretty hard going and none of us, I think, made much headway with them. However, this didn't matter because the first thing Felix said to us when we arrived was: "I don't believe any of this stuff any more."
We naturally asked him why, in that case, he had asked us to read it. He replied that it was necessary to get an idea of the traditional system before moving on from it. And he went on to explain why he no longer believed in it.
He said he had originally learned the traditional system and practised it with success, but then he tried doing acupuncture in the "wrong" way, at incorrect sites, and found that it worked just as well. He therefore concluded that the traditional ideas were unnecessary. I was impressed by his intellectual honesty but I had to admit to a certain feeling of disappointment. I think now that I was lucky to have first encountered acupuncture through Felix; it would have taken me some time to work out for myself that the traditional approach was unncessary.
I continued to practise acupuncture in the way Felix had taught me and it gave remarkably good results. Gradually I used it more and more, in preference to homeopathy, which didn't seem to be working for me. And, as time went by, it became apparent that there were plausible neurophysiological explanations for acupuncture, or at least for the modern non-traditional version of it, and I felt that this was important. Later I developed my own ideas about what was happening during the treatment.
Encouraged by success I established an acupuncture service at the hospital, and later, in 1981, I began to teach acupuncture myself. Most of the staff used to attend my courses so eventually a large amount of acupuncture came to be done; we estimated in 1996 that we were doing about 500 treatments a week, for a wide range of disorders.
By this time surgery had ceased to be practised at RLHH and the hospital was entirely medical. The other consultants had developed their own special interests and so we decided to make it into a centre for the study and practice of a number of kinds of CAM, not just homeopathy. This is still the case today.
What about mainstream medicine?Mainstream medicine had not been standing still during the time I had been at RLHH. It took longer than one might have hoped, but discoveries in basic science about the structure of cells and the mechanisms of heredity were beginning to have practical relevance to clinical practice. That trend has continued and fundamentally new treatments are appearing today. Mainstream medicine is no longer in the doldrums, as I felt it was in the early 1970s; it is advancing fast and unpredictably.
At a more abstract level, there is another development in mainstream medicine that I find if anything even more exciting: I mean Darwinian medicine. Actually, this is an unfamiliar idea to most doctors. If you mention it to them the chances are that they will look at you in a puzzled way and ask what you mean. They are of course familiar in general terms with evolution, but they have not usually made much connection in their minds between those ideas and medicine. I see now that all of microbiology, much of pathology, and of course all of genetics, are manifestations of evolution through and through. Health and disease make no sense except in an evolutionary context. But if orthodox medicine has been slow to recognize the importance of evolution, CAM has not even begun to think about it.
Come back science, all is forgivenAfter more than thirty years' experience of CAM my thinking has come round full circle. I find science, and scientific medicine, to be profoundly exciting intellectually. I cannot say the same about CAM.
First, much of it is really an elaborate placebo. We are often told that placebos can be very effective, and this is true, but the fact remains that if you think that a treatment depends on the placebo effect for its efficacy it become difficult to practise it with any degree of conviction, quite apart from any ethical qualms you may feel.
Second, practically all forms of CAM are static, fixed, unchanging; indeed, this is often touted as a merit. Homeopathy, for example, has changed relatively little since it was founded by Samuel Hahnemann in the first half of the nineteenth century, and traditional acupuncture makes much of its roots in ancient Chinese philosophy. Even the newly invented CAM treatments often claim to be rediscovering ancient knowledge. But this means that they are essentially belief systems, not science.
Third, many of the underlying ideas in CAM are incompatible with modern knowledge. For example, there is no valid description of how homeopathic medicines might work. Traditional acupuncture is based on pre-scientific theories of yin and yang, chi, and so forth that belong to a bygone era. Osteopathy and chiropractic were originally founded, in the nineteenth century, on theories that make little sense today and which seem to have been at least partly abandoned or reintepreted by most modern practitioners.
It would be too sweeping a generalisation to say that no kinds of CAM treatments have any value. Modern medical acupuncture and other kinds of physical treatment are effective in certain situations and some herbal medicines have been shown to have better than placebo effects. But I think that we need to ditch the theoretical baggage that has accompanied such treatments in the past. Thus, for acupuncture, we don't need to bother about the traditional theory at all, and even much of the practice can be simplified a lot, with fewer needles and brief insertion. In some cases it may make little difference exactly where the needles are inserted (provided it is safe, of course!).
I expect that in the future those treatments that work will become increasingly incorporated into mainstream medicine and will lose their association with CAM. Traditional acupuncture, for example, will come to be thought of as having merely historical interest; it will be no more relevant to modern acupuncture than is alchemy to chemistry or astrology to astronomy.
At a personal level I find this way of thinking more congenial than how I thought previously. In the 1970s I was looking for a different approach to medicine, but most of what I thought I was finding turned out to be fairy gold. It is a great relief to let it fade away.
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