The opposite of “integrate” is “disintegrate”. We have seen far too much of this disintegration in our physical and mental health, in the health of society around us and in our ability to provide care for many of those who are chronically unwell – let alone in our climate and ecosystem services. So, isn’t it time to ask for something better?
Ladies and Gentlemen, I can really only begin to thank Michael Dixon who, if you don’t mind my saying so, I happen to think is something of a phenomenon who manages to straddle the conventional, complementary and integrated fields in a truly remarkable way. How he manages to juggle it all I will never know, but his remarks do prompt me to reflect on the great strides that my Foundation for Integrated Health has made in the last six months. So much of that is due to David Brownlow, as the relatively new Chairman, together with Michael Dixon as Medical Director, the two of them have been able to make a huge impact in a short time and through the initiatives which Michael has just mentioned I really do feel that we are in danger of making a substantial impact in the vital area of integrated health 25 years later…!
I did just want to say right at the start how enormously heartening it is to hear about all the award-winning projects this year and to understand how their integrated approach is making such an enormous difference to peoples’ lives. I would like to offer my warmest congratulations to all the Foundation’s Award-winners and runners-up and to wish you every possible success as you continue to develop your marvellous efforts.
When my Foundation was created some fifteen years ago, a number of doctors and journalists thought that we had taken leave of our senses. (Apparently, I took leave of my senses long before that! However, I rather hope I didn’t lose my common sense – although as you cannot obtain a degree in common sense, but just about in everything else, no-one seems to value it!) Anyway, “How on earth can you mix the complementary and the conventional – witchcraft with proper evidence-based medicine?” they asked. At the time, I and others tried to point out that many patients were already seeing both complementary and conventional practitioners and integrating care for themselves, but this fell on those who had taken leave of their hearing!
It seemed to me to make common sense that their attempts at integration should be supported, particularly so when scientific studies indicate that half of patients seeing complementary practitioners fail to tell their conventional doctors or nurses….something which qualified medical people point out is, frankly, dangerous. Many doctors and nurses, at that time, also told me that there were a large number of patients, symptoms and diseases which they could not adequately treat using conventional medicine alone. They were finding that an integrated approach was more effective because it offered what I have often called “The best of both worlds”.
Now Ladies and Gentlemen, as everybody in this room is aware, this philosophical and practical approach has, over the years, attracted attention from many quarters and, dare I suggest, has not, to put it mildly, always been wholeheartedly embraced.
But are those who have criticized integration, speaking for patients or for somebody else? Perhaps they are speaking for themselves? For example, if an integrated approach is so dangerous, why is it that I have never heard of any patient groups campaigning against integration? Why have we not heard more opposition from doctors, nurses and other clinicians at the frontline, who deal with the daily suffering of those same patients?
But you don’t have to take my word for all this. I am assured by those who are expert, those who are highly qualified and, most importantly, who do know what is going on in G.P. surgeries up and down the country that a mainstream research and evidence-based integrated approach to alleviating unnecessary suffering – quite apart from reducing the demand on consultancy time and the N.H.S.’s bill for drugs – is rapidly becoming more accepted because it is both safe and effective. Therefore, when some question the safety of complementary medicine, there are others who ask; “How safe is conventional medicine?” Does the accusation of “quackery” really amount to anything very significant when an increasing number of complementary therapies are coming under statutory and voluntary regulation? And what of the deaths which occur as a result of conventional approaches to treatment, otherwise known as iatrogenic? It is perhaps instructive to study the statistics…
When it comes to evidence, I am told that guidelines for consultation from the National Institute of Clinical Excellence include manipulation and acupuncture. In the past year or so, the British Medical Journal has featured (on its front cover) treatments as diverse as St John’s Wort, the Alexander Technique and peppermint.
Of course, this dichotomy between the conventional and the complementary, and those questions relating to which is safest and best completely disappear within an integrated approach that respects the best of both. Therefore, I do believe most strongly – and, indeed, have been saying so for some considerable time – that what we now desperately need are some practical, long-term studies on the outcomes and cost-effectiveness of integrated care, which will show us where our health service money can best be spent. I was fascinated to read the Independent Evaluation Report of the recent “Northern Ireland Integrated Medicine Pilot Project”, which suggested that integrated care not only helped the presenting problems, but also improved general health and might be cost-effective in the long run. Surely we now need further research to see if these conclusions are confirmed?
So I believe, ladies and gentlemen, that an integrated approach is becoming, and will increasingly become, mainstream. We are rapidly moving forward from the question, “Should patients be able to receive a choice of conventional or complementary medicine, where safe and appropriate and using best evidence?” to the next question:- “What does good integration look like and how and where should it be applied?”
This coming together of the conventional and the complementary represents just one of my Foundation’s three missions. The second emphasizes the importance of the patient as a whole rather than simply as a collection of symptoms, diseases and body parts in need of running repairs. That is not to criticize the reductionist scientific method – manifestly, it has achieved spectacular results and has completely revolutionized the care of patients with problems such as heart disease or cancer and, of course, we hope, our ability to withstand serious outbreaks of ‘flu …..
But it is equally important, especially in tackling the silent epidemic of long term disease, that we see patients as people in every sense of the word – in other words, mind, body and soul – not as mechanistic “entities”, which always behave in rational and statistically predictable ways. An integrated approach takes account of every patient’s hopes, beliefs, culture and history.
Because, in the end, we are not machines, but what scientists call “self-organizing beings”. Belief and intuition colour everything that we do. They have profound and proven biomedical effects, yet we so often ignore and debase them in our daily lives and only refer to them in the context of spiritual worship. Human relationships, the human effect, personal care and continuity are, I believe, a crucial part of integrated care. The compassion that goes with them is an expression of values and humanity, and also the very act of healing itself.
My Foundation’s third mission is more about health than healing. I often hear that the health service should cease to be what some describe as a “sickness service”, but I hear less often about exactly how that can be achieved! I just happen to believe that an integrated approach represents a workable solution to this conundrum..
A few years ago we renamed my Foundation for Integrated Medicine, The Foundation for Integrated Health. That is because we should not regard health in isolation…it is about the food we eat, the exercise we take and the lifestyle we choose – it is also dependent on our external environment, as I was trying to point out to the architects yesterday evening, and on our mindsets and motivation.
I have heard it reported, and I find it horrifying, for instance, to think that the next generation of children will die earlier simply because of childhood obesity. Tuberculosis, the Victorian scourge we all thought we had left behind, is back and, as always in the past, is linked with issues of poverty, homelessness, nutrition and lifestyle. It is equally worrying to learn that one in five under 16-year-olds have a mental disorder and World Health Organisation projections indicate that by 2030 depression will have become the second most prevalent cause of ill-health worldwide. These extraordinary indications surely require urgent and determined action?
But why this state of affairs when we have made such positive interventions and impacts in different areas of health? The answers may very well lie in the fact that over thousands of years Nature has integrated us with our environment to create a natural order that allows us to live in harmony with it. We interfere with this natural state of affairs at our peril. Yet it has been interrupted by all sorts of influences and attitudes that have now led to so many of the health problems that surround us; problems that are partly a result of our own lifestyles and partly a consequence of the dehumanizing environments in which so many have to live and work. But I said a lot about that yesterday!
These three missions of my Foundation have a common thread. It is about how we help and enable individuals and communities to become more effective in withstanding disease and improving health. Indeed, it is only by improving the will and the ability of each of us to help ourselves and improve our health that we can ensure that the health service remains sustainable and we can then continue to afford expensive technology and clinical expertize, when they are required. An integrated approach represents an advance from “doctor knows best” to empowering the patient by informing, motivating and enabling. It is about establishing a meaning and purpose for patients inside the therapeutic context and also in the world outside. In this way, I believe, we can reduce the burden of long term disease and enable those who have such disease to live longer, happier and more fulfilling lives. This is largely because integration hands more control back to them.
I know that many of you here are converts to this integrated approach. Some of you, I suspect, may simply be interested and some may feel thoroughly unconvinced. Whatever your views, I can only ask that you listen and keep your minds open. You have seen these examples today of innovation, determination and open-mindedness, which are also based upon the best health service traditions of unconditional altruism. They give me so much hope that this country and its health system will enable us to create integrated and sustainable solutions to problems that have eluded so many others.
The opposite of “integrate” is “disintegrate”. We have seen far too much of this disintegration in our physical and mental health, in the health of society around us and in our ability to provide care for many of those who are chronically unwell – let alone in our climate and ecosystem services. So, isn’t it time to ask for something better?
I can only offer you today, Ladies and Gentlemen, all the words of encouragement that I can. If we are to make a difference, then words must be translated into action and that will depend upon many of you here. We have seen some wonderful examples of action today, but those of you who know me will appreciate how impatient I am for success in these most vital of areas. So I look forward to seeing more and more, and yet more! Thank you Ladies and Gentlemen.
