Conference Report
by Dr David L. J. Freed, MB, MD, MIBiol
Shortly after taking office, our beloved President Dr Downing wrote an editorial in this Newsletter arguing that we should no longer stand aloof from Complementary and Alternative Medicine (CAM). Since everybody, doctors and patients alike, thinks we are CAM anyway and since there are early signs that CAM is beginning to wield some official influence in this country, we would do well be be part of that groundswell. Having myself strenuously argued for a quarter-century that Ecomed is in truth the most scientific of medical disciplines, only to be resolutely ignored by everyone except you, I found Damien’s argument persuasive and our Society has indeed moved to occupy a position within the emerging bureaucratic structures of CAM (largely due to his good offices) where our expertise is being sought. So when this conference was brought to my attention I decided to go along, listen to our CAM colleagues, and try to introduce them in turn to Ecological Medicine.
Originally Sarah Myhill and Shideh Pouria were also hoping to come along (one from each of the three main monotheisms, very appropriate) but for various reasons they were prevented. Having myself the added attraction of a daughter and a burgeoning tribe of grandchildren already living in Jerusalem, I went along.
Integrative Medicine (IM) is the name given to an harmonious blending of CAM with conventional medicine and I was pleasantly surprised to learn from one of the welcoming speakers that most big Israeli hospitals already possess a department of CAM or IM – a big advance over this country! I was not surprised to learn however that in many cases the cooperation between CAM and conventional practitioners is not always as harmonious as hoped! Nevertheless, in spite of the traditional Jewish view of “the doctor” as an authoratitive father-figure who must be obeyed, it seems that the big health purchasers in Israel, both government and insurance campanies - and even the Israel Medical Association - are acknowledging market demand. Similar developments were reported from Brazil, Argentina, Canada and Switzerland. Over 50% of Israeli cancer patients demand – and receive – some form of CAM in hospital in addition to their conventional therapy, and Professor Zajicek reports from one of the Jerusalem university hospitals that the combination of diet and nutrition with meditation, Chinese martial arts and herbal teas is more effective in breast cancer than chemotherapy.
To my disappointment the programme was so overloaded that the organisers were forced to lay on parallel sessions in different lecture-halls, precluding any hope of hearing everything. I chose the most interesting-sounding titles but it was still necessary to lecture-hop quite a lot. Simultaneous translation was available via headsets but to my relief most speakers chose to use English (with the exception of a Dr Abed Mohammed, a paediatrician specialising in obesity, who insisted on speaking in Hebrew – and a lot better than my Hebrew too).
Not surprisingly, acupuncture and homoeopathy were much in evidence wherever one went but so was spirituality in various guises, including a heavy dose of kabala (though how authentic that was I wonder – I’m not convinced that the stunning American female rabbi gesturing meaningfully to her pelvis while lecturing on sexual energy was entirely conveying the mainstream rabbinic tradition). As many of you know, I am the last person to belittle the importance of spiritual factors in health, but I find it hard to believe that we can capture them, bottle them, and serve them up to patients like any other medicine. To borrow yet again Douglas Adams’s glorious phrase, it’s like trying to eff the ineffable! I rose at question time to put this concern to one of the speakers but he looked a bit miffed and told me tartly that it took many years of training and a lot of intuition. Perhaps he was annoyed by my pidgin Hebrew.
But there was much good sense and much to learn, and I was glad I had gone. The Okinawa Centenarian Study has generated dietary recommendations for healthy ageing and I started to feel a bit more on solid ground. A good “healthy” intake of iron, I learnt without much surprise, encourages inflammation (certainly true of rheumatoid disease, as even rheumatologists know) and is not necessarily a good thing. I was also much taken with “health coaching”, which we all try to do with patients when drastic dietary or lifestyle changes are needed and the patient objects. I confess I don’t have much patience with patients when they’re obstinate, but maybe I should have – or else enlist the help of a health coach who can break down the process into manageable bites. There was a lot of emphasis on skeletal balance, barefoot running and so forth and I felt the need for a trustworthy osteopath to interpret for me. The mind-body relationship was alluded to by many but although psychology is a recognised branch of science, what I heard here didn’t strike me as very scientific.
So what do you expect from CAM – science? Well yes, at least in parts. Now I for one am a scientist both by temperament and by training, and my presentation on allergy was well received probably for that very reason. Nevertheless I recognise that science and double-blind trials have limitations, and predictably that lesson was repeated by many speakers. We can also recognise “truth” by beauty, emotion and experience, we were told, and although one relates to that belief instinctively I can’t help wondering how strong the evidence is.
But there was also a lot of strong and recognisable science, which cheered me up. A whole session was devoted to herbal research which now has an impressive record of positive clinical trials. A Russian group reported that children with ADHD invariably have stable disturbances of 3D depth perception, which can sometimes be corrected with subsequent clinical improvement. The effects of electromagnetic radiation, both negative and positive, were reported by many speakers. EM radiation is eminently measurable and amenable to study (and certainly a part of ecomed) and it is a mystery to me why research on its effects on human health are impeded by so much denial.
The most heart-warming talk for me was from an Israeli centre that specialises in the holistic management of Down’s syndrome. These children can often not only work productively, in jobs suited to their IQ’s, but some of them also grow up and get married – sometimes to each other – and produce healthy normal babies! Well well, I never knew that.
So as I expected, CAM is a very broad church, spanning the whole spectrum from the strongly scientific (the pole that Ecomed occupies) across to the frankly mystical, and we make somewhat uneasy bedfellows. Both approaches have their plusses and minuses and each has difficulty in swallowing the validity of the other. CAM is really defined by what it is not – it’s not conventional Western medicine, however scientific it may be. Whether CAM can ever have a coherent voice on anything – other than the desire to be taken seriously - is doubtful. But at least we can listen to each other politely, as this conference showed.
I’ll close by passing on some medical aphorisms from Dr Ruth Cohn Bolletino, which will resonate with many of us:
When a patient opens up to you, you are on holy ground – tread carefully.
If you see a patient who completely matches a diagnosis, you don’t know the patient.
If you treat three identical cases the same way, you’re treating them for your problems.
and most important of all,
The more perfectly you think, the less you know.
Happy CAMming!
