New from Dr. Kaplan

Homeopathy, Clinical Outcome and People

In a recent interview, I drew attention to aspects in the ongoing debate about homeopathy, that I feel have been somewhat under-discussed.

The first is that our critics never seem to mention the patient and empathic way homeopaths listen to the story of their patients’  illnesses in the context of their whole lives, before even thinking of which ‘controversial’ white pill to prescribe. Critics and sceptics may believe that homeopathic benefits (‘if any’) derive solely from this. If this is what they believe, they should say so openly. If they are genuinely interested in patients’ well being, the next logical step would be a major medical investigation into trying to understand why patients who are listened to in homeopathic, way start dramatically improving!

The second aspect I believe does not get enough attention is Outcome and Patient Satisfaction. An outcome study is a study in which patients are simply questioned comprehensively on the outcome of any medical intervention. In this regard, homeopathy has scored very highly as in the Spence  Outcome Study in Bristol. That study was attacked by critics – mainly due to their distaste for outcome studies in general.

But why? For patients outcome is everything. Patients care about getting better; how they got better is of secondary importance. What critics of homeopathy have done is to some extent deride the obvious beneficiaries of homeopathic treatment.

Just as homeopaths listen to suffering patients carefully and empathically, so critics of homeopathy should listen to what satisfied homeopathic patients have to say about their experiences. Outcome studies are no more than a collation of the voices of patients – the very people whose welfare this debate has  apparently been all about.

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Homeopathy, Clinical Outcome and People

Outcome studies are no more than a collation of the voices of patients – the very people whose welfare this debate has apparently been all about. Patients care about getting better; how they got better is of secondary importance.

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Homeopathy has to be Experienced to be Believed

Over the past few years homeopathy, has been the victim of many uncouth attacks in the media. The populist ‘wisdom’ of our time and place bleats that it’s ‘witchcraft’, lacks evidence for its efficacy and is a waste of  NHS money. In fact it is no more controversial today than it was when invited to be part of the National Health Service at its inauguration in 1948. Appalled by the double standards being used by homeopathy’s critics and assisted by the Pie Man, I have called for a level playing field for all interventions on the NHS  – ie one standard of evidence for all prospective treatments.That this has been scoffed at doesn’t surprise me. The makers of cough mixtures and a lot of other unevidenced, useless (and even potentially dangerous) medications sold over the counter in pharmacies and supermarkets would have a lot to lose if there was one standard for all. Eschewing a level playing field, opponents of homeopathy have ensured that the debate has focused on the ‘implausibility’ of homeopathic dilutions being able to have any clinical effect. I find it interesting that nothing has been written about the structured process of classical homeopathy starting with a comprehensive case taking and culminating in a homeopathic prescription that suits not only the condition but also the whole human being – physically and psychologically. Many homeopaths spend anything between 1 – 3 hours carefully listening to every detail of their patient’s symptoms and subjective physical and psychological experience of what is happening to them in any illness. It is a profound and empathic process culminating in a choice of medicine that suits the totality of a human being’s experience of being ill. While never a substitute for conventional medicine (which undoubtedly saves lives and does good) when responsibly practised (if possible with medical supervision) homeopathy has a huge role to play in people’s wellbeing all over the planet.

Homeopathy is not about small white pills or placebo. It is a profound process where you will feel fully received and listened to before you are prescribed anything. It is my belief most people going through this unique form of anamnesis would want to try the medicine prescribed thereafter – especially as everyone agrees it can certainly do no harm – and many millions of people are convinced that it has worked for them.

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Homeopathy has to be Experienced to be Believed

Homeopathy is no more controversial today than it was in 1948 when it was invited to be part of the NHS at its inauguration.

Homeopathy is a structured process involving a very detailed consultation at the end of which a medicine is prescribed which suits the patient and his or her illness in totality.

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ON HAVING A ‘BAD BACK’


Ever heard someone saying they have a ‘bad back’? That’s a rhetorical question because ‘bad backs’ are responsible not only for enormous suffering but also have a huge impact on the economy.

In 1950 backache accounted for 1.5 million days of work last but by 1995 this had risen to 115 million (sic) days lost. What on earth are we doing differently? Sitting too long? Working harder? More stressed? Less robust? Less willing to work while in pain?

The very fact that there is such a condition as a ‘bad back’ tells us that we know very little about backs and back pain. Ever heard of a ‘bad heart’, ‘bad brain’ or ‘bad eye’?

Tests can sometimes help by showing a severely prolapsed disc or other very obvious damage but people with back pain can have abnormal MRI results and people in debilitating pain can have normal X-ray and MRI results.

Without accurate diagnoses, medical treatment tends to be speculative. Surgery, micro-surgery, steroid injections, manipulation, pain killers, alternatives such as acupuncture and osteopathy – all claim results but no one form of treatment can claim uniformly good results for back pain.

The problem may be that helping back pain may be something that often requires great commitment by the patient. Our bodies are supported not only by our backs but also by a host of abdominal muscles including the very important oblique muscles of the abdomen. Strengthening these muscles by a carefully structure exercise programme can be spectacularly successful and yet I see so many patients who have not been taught and encouraged how to do this.

Is  this  because programmes to strengthen the abdominal muscles and produce core stability are ‘boring’ and are not easily packaged or sold in bottles.

A pity – because they really work.

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ON HAVING A ‘BAD BACK’

Back pain is a huge problem for people and the Economy. Diagnosis is difficult.
Strengthening the muscles of the back can have great results but involves a lot of work.

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Back pain: Jabs, Steroids and ‘Cures’

Back pain is a huge cause of suffering to humanity and often a very difficult problem to treat – or even properly diagnose – unless one can consider ‘a bad back’ a diagnosis. So it came as a bit of a surprise to see the front page of the Daily Express today which has the huge headline:

SIMPLE JAB TO CURE BACK PAIN

Now for me ‘cure’ is a very big word indeed so I  eagerly bought the Daily Express – but my search for a ‘cure’ to the debilitating problem that apparently costs us £12 billion a year in sick leave was to end in disappointment.

The article refers to the work of Steven Cohen, an anaesthetist at Johns Hopkins Medical School (a fine institution) in which he shows that back pain relieved by epidural steroid injections (and that is by no means all back pain) the relief may be due to the injection and not the steroid. This is because injections of salt water appear to do just as well as steroid injections – not that steroid injections (or salt water ones) can ever be claimed as a ‘cure’ for back pain.  Amazingly this is being presented as a medical breakthrough all over the net but at least one major TV news company led with a  rather different headline on the same story.

Spinal Injections may not aid lower back pain

Notice the word ‘not’. That seems to be a more honest and intelligent appraisal of Prof. Cohen’s work than what appears in most of the media. But even this is misleading as the injections (with or without steroid) do seem to have some effect.

What Cohen might have shown is that the steroid in the epidural injections may have nothing to do any possible good effects of these injections because the placebo treatment (saline) has just as good effect.

However I can hear anybody trained in musculoskeletal triggerpoint acupuncture (as I am) screaming at their newspapers and computers: ‘It’s the acupuncture effect! Dammit!’ For 5000 years acupuncturists have known that the thin, safe and cheap needling that occurs in acupuncture can relieve many sorts of musculoskeletal pain. Indeed many books have been written on the subject.

This may not be the news that the makers of steroid injections were waiting to hear but it is certainly no miracle ‘simple jab’ breakthrough in back pain either.  In my next post we will look at  significant challenge to the medical profession posed by back pain and explore what  can be done to help.

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Back pain: Jabs, Steroids and ‘Cures’

The media misrepresents findings of USA anaesthetist on back pain and injections

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Marching to 100 with Homeopathy!

Last week I was delighted to attend a very special birthday party. Jane Gilchrist, a lifelong homeopathy supporter and active member of the Friends of the Royal London Hospital for Integrated Medicine, was celebrating her 100th birthday.

After Her Majesty Queen Elizabeth II and her family, Jane is probably Britain’s most famous user of homeopathic medicine and what an advertisement for homeopathy she is! Watch a few minutes of her birthday speech and you will quickly see that this is a very special 100 year old lady. I was particularly pleased to learn from her that Charles Dickens and William Makepeace Thackeray were patients of the founder of the hospital, Dr Quin in the 19th century. Oh to have those two literary geniuses write a bit of copy for us now!

Jane volunteered to work at the tearoom of the hospital for decades and is still available there for chats about homeopathy. She claims that her life achievement was to start the Bromley Homeopathic Clinic (NHS) which was immensely popular, lasted for 14 years but was unfortunately lost when the homeopathic hospital at Tunbridge Wells to which it was affiliated, was forced to close in 2009.

The party was well attended and Jane was her usual effervescent self, looking anything but her 100 years.  As far as homeopathy is concerned, this is indeed anecdotal evidence – but then some!


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Marching to 100 with Homeopathy!

Jane Gilchrist, one of homeopathy’s greatest advocates celebrates her 100th birthday party at The Royal London Hospital for Integrated Medicine.

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Homeopathy and the Ex-Chief Scientific Advisor

Sir John Beddington, ex-Chief Scientific Advisor to the Government has appeared on these pages  before:

2009: He is attacked for defending (sic) the Government’s support of NHS homeopathy.

2010: He changes his tune (The Chief Scientific Advisor is apparently for turning) and attacks NHS homeopathy, claiming it could mislead patients.

2012: In a slightly less than scientific use of the language, he describes NHS homeopathy as ‘crazy’.

2013: Now as the ex-Chief Scientific Advisor, he has again referred to NHS homeopathy as ‘madness’.

Now Beddington is not a medical doctor so we should not hold these rather puerile ‘diagnoses’ of homeopathy against the man. He is a specialist in the economics and biology of sustainable management of renewable resources and has previously advised UK ministers on scientific and environmental issues.  He should therefore know that homeopathy is very, environmentally friendly and cost-effective. He should also know that two successive Governments have heard  much more sophisticated criticism of homeopathy than his crude insults and come out totally in favour of NHS homeopathy. They have done this because they still cling to a vestige of democracy and choose to protect the substantial minority of people who want homeopathy and CAM on the NHS. Finally he should understand that his statements are a gross insult to NHS GPs  who choose to send their patients to other medical doctors who include homeopathy in their medicinal arsenals. To think that he (a non-doctor) knows better than a patient’s GP (a qualified MD) what is clinically optimal for any of the GP’s patients, strikes me as a trifle arrogant.

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Homeopathy and the Ex-Chief Scientific Advisor

Once again, Sir John Beddington insults GPs who choose to send their patients for homeopathy on the NHS.

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On Art Therapy

This month an exhibition called Art + Healing will open at University College Hospital, London (19 April – 5 June). It will show the works of organisations and individuals who value art therapy: Combat Stress, Medical Foundation for Victims of Torture, London Art Therapy Centre, as well as the work of artists,  art therapists and their clients.

As a young doctor exploring whole person medicine, I’d heard of Art Therapy but carelessly put it in the same rubric as basket weaving and other ‘occupational activities’ to help psychologically disturbed people. Being married to an art psychotherapist has shown me how naïve and utterly incorrect that presumption was. I was surprised to hear that art therapists comprise – after doctors – the most qualified group of clinicians in the NHS. Art Therapy is a post-graduate training and art therapists have undergone formal education in both art and psychotherapy.

In the ‘talking therapies’ (ie most forms of psychotherapy) words are the main medium by which a client expresses feelings. In Art Therapy, a therapeutic conversation also takes place, but crucially the client is invited to use art materials to create images. What is expressed in this process of image making often transcends words. Using language in daily life can make us over-familiar with the medium of words allowing us to be unhelpfully guarded in expressing feelings. The less familiar media of paper, paint, crayons, sand and sculpture tends to lead to moving expressions and authentic insights that can surprise both art therapist and client.

An effective art therapist needs to be a good talking therapist of course, but the use of image making adds tremendous dynamism to both the therapeutic process and the relationship between therapist and client.

Art Therapy can be experienced one-to-one or in groups and you get to take your paintings home with you. No artistic talent is required and the whole therapeutic process is creative, energising and fun.

The forthcoming exhibition at University College Hospital and London Art Therapy Centre will introduce you to artworks which resulted in profound benefits for their creators, leaving no doubt as to the efficacy of Art Therapy.

Art therapy is a regulated profession and more information can be found here:

Art + Healing exhibition

London Art Therapy Centre

British Association of Art Therapists

 

 


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On Art Therapy

Major exhibition on Art and Healing opens in April at University College Hospital, London on Thursday 18th April

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Health, Medicine & Money

The brutality of the business of medicine has just been ruthlessly exposed in the cover article of the current edition of the popular magazine, Time. In an article entitled Bitter Pill: Why Medical Bills are Killing Us, a mirror is held up to what can befall you if you become sick in the land of the free. Life, liberty and pursuit of happiness (engraved in the Bill of Rights) pretty obviously does not include universal health care.

This has culminated in what has been described in the article as ‘the ultimate seller’s market’ where the hapless buyers (also known as desperate patients) can go into life-long debt just because they have a strong desire to stay alive. These poor sick people (about 16% of the USA population which means about 50 million people) are those who don’t own that ‘get out of death free’ card, Americans call ‘Health Insurance’. If you don’t have Health Insurance in the home of the brave, you had better be very brave indeed.

So what has this got to do with us on the other side of the Atlantic? Well, news like this should make us all be enormously grateful for our universal health care in the form of the NHS. The case studies in the Time article simply could not and would not have happened here. Private medicine in the UK has certainly become more expensive and ‘business-like’ with patients often being asked for credit card details before seeing a doctor. However, this is merely uncouth because the alternative is the NHS – not unnecessary suffering or death.

Last year I produced an animated little cartoon on the worrying state of medicine in the USA. In the light of the life-destroying cost of medicine making the cover of Time, I think it timely to revisit it.

(Disclaimer: For entertainment purposes only)

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Health, Medicine & Money

Time Magazine has on the cover of it’s current edition, an article highly critical of the money-led business of medicine in America. We in the UK should be hugely relieved we have universal health care.

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Health and Happy Relationships

Happy New Year!

As a doctor I am here to cure wherever possible but also to do my best to alleviate pain and suffering of any kind. Over the years I have seen many people in physical pain and a combination of holistic and conventional medicine has proved useful in reducing many different types of pain.

Practising whole person medicine requires you to consider all aspects of a patient’s life and 30 years of having these sorts of conversations with my patients has taught me that a huge area of pain and suffering in people’s lives occur in the arena of human relationships. It will come as no surprise that unsatisfactory and unsatisfying relationships between men and women; men and men; and women and women are often the cause of a lot of pain and suffering.

So is this any business of a doctor? Well I think it is – especially when I am keen on alleviating emotional suffering which impacts on general health and well-being. Seeing a person bloom as a result of developing a healthy or healthier relationship, is one of the most rewarding things I ever experience in medical practice. It is such a boon to health that it simply cannot be ignored medically.

So many people become disappointed and perhaps give up on relationships. I believe with a bit of psychological work, one can very often find or develop a fulfilling relationship.

There seem to be two main scenarios regarding unhappiness in relationships:

A) Specific problems or disappointments in your current relationship.

B) The problem of being single – yet yearning to be in a happy relationship.

The approach I use is based on Provocative Therapy which is a fast-track approach to identify how you may be sabotaging an existing relationship (or why you don’t have a partner) and to find better relationship strategies. I have found that just four sessions of Provocative Relationship Coaching can very often provoke you to change your behaviour so that you become much more likely either to improve an existing relationship or actually find a partner with which to have a loving relationship.

The Method of Provocative Coaching:

It’s quite straightforward.

If you are in a relationship that is unfulfilling or are single and yearn to be in a fulfilling relationship, it is often the case that your behavioural patterns are not serving you well and need to be changed.

External helpful advice can be useful but the real catalyst for behavioural change needs to be prescribed from within. Nobody can really tell you what you need to do and people often do not appreciate advice which can come across as patronizing and condescending.

Provocative Coaching provokes you to ‘get your Inner Joke’ the funny side about how you are hanging on to behavioural patterns that just are not working for you. When you see your own behaviour patterns as mirrored to you via the process, and see them packaged as absurd obstacles to getting what you want, you may well laugh. This laughter, or getting your inner joke is usually the catalyst for behavioural change. When you see, through the absurd filters, that your behaviour is the biggest obstacle to you being in a happy relationship, it becomes very difficult to continue with that behaviour!

At that point you tend to prescribe new behavioural patterns for yourself. As these come from within, they are owned by you and therefore much more likely to be carried out in real life.


A) Provocative Coaching for Couples:

Consisting of three one hour sessions close together (ideally a week apart) and then a follow up session 3 weeks later.

After receiving permission to say absurd provocative things (in the style of Provocative Therapy) to either of you, I sit between the two of you and we have a curious and amusing conversation. The aim is to identify the sabotaging behaviours which may be lampooned, but not mocked, and to engage in some reality-testing.. You may find yourself laughing at many of your problems as a couple. This doesn’t mean that every couple will be provoked to ‘live happily ever after’ but in my experience many, many couples find themselves rapidly provoked to do the right thing for them. In my experience, issues regarding money, sex, the children and the in-laws are particularly rewarding to treat with this sort of approach.


Audio or video recording is not essential but is often very useful as you can take the conversation home to provoke you (positively!) even more.

B) Provocative Coaching for People seeking a Partner:

Single people often don’t get much attention from the medical profession and yet many singles would prefer to be partnered. There may be many big and small reasons why you have not found your mate and this fast-track personal development process can kick-start a whole new adventure.

In my experience many singles can be provoked with humour and reverse psychology into changing their behaviour so that their chances of finding a mate are vastly improved. In many cases three one hour sessions of Provocative Coaching and one follow up session can often do the job.

Of course I cannot promise anything but the results I have seen since I started working with singles have been very encouraging. I have found this particular work to be the most rewarding in my job as a doctor.



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Health and Happy Relationships

A few sessions of Provocative Therapy can often provoke people to change their behaviour so that they end up in the sort of relationships they really want and deserve.

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Xmas, Royalty, CAM and Kindness

On Tuesday, many millions of us will watch the Queen’s personal Christmas day televised message to the Commonwealth. It is likely to be an uncontroversial and encouraging message carefully read from an autocue. For six decades, our monarch has avoided giving offence to almost anyone by simply adopting those very British qualities of reserve, manners, careful choice of words and partiality to talking about the weather to avoid any form of confrontation. Even illegal intruders on to her private property report being treated with courtesy. Thus, while it is common knowledge that the Queen is certainly partial to Complementary Medicine and has personally used homeopathy all her life, it is no surprise that she has not entered the fray of the present debate between the scientismic and authoritarian detractors of CAM and NHS homeopathy and the holistic and more liberal defenders of public choice in these matters.

Prince Charles, our monarch in waiting, could not be more different in this regard. He is open and vocal about his support for CAM, NHS homeopathy and a more compassionate and whole person orientated medicine in his country. Some may not be happy about a member of the Royal Family writing an article for a medical journal, but why should he not write for the journal of the ROYAL Society of Medicine? And why shouldn’t he be roundly applauded for saying that ‘much more can be done to foster and enhance those age-old qualities of human kindness and compassion ? After all, the Secretary of State for Health himself, Jeremy Hunt, (a supporter of NHS homeopathy) has gone as far as saying that there is a ‘kind of normalisation’ of cruelty in some of our hospitals.

There are those who say that the reason that CAM and homeopathic doctors get results is ONLY because of the time they spend listening and talking compassionately with patients. If the detractors of NHS homeopathy and CAM had a vestige of compassion for patients who claim to have been helped by CAM, they would focus their energy on trying to understand why and how these patients get better – which of course is always the bottom line in medicine. Even for those handcuffed by  scientism who abhor CAM, integrity demands that far from calling for an end to CAM on the NHS, one should campaign to keep NHS CAM clinics open . Results are all that matter, whether they are being achieved by the tools of CAM or in the words of our future monarch, ‘those age-old qualities of human kindness and compassion’.  Those who unlike me, think it’s exclusively the latter should at least emulate Prince Charles and call for more compassionate conventional medicine instead of irrationally attacking CAM practitioners who in their eyes are apparently ‘illegitimately’ getting results by being humane, kind and compassionate.

Happy Xmas to One and all: Royals, Patricians, Plebians, doctors and even practitioners of CAM!

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Xmas, Royalty, CAM and Kindness

The Queen’s Xmas Day message is likely to be uncontroversial. However Prince Charles, the monarch in waiting is courageously outspoken, uses CAM and homeopathy and has called for more care and compassion in medicine.

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