Why I became involved with CAM

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 new book, Homeopathy in Perspective, is a very considerably expanded and updated version of the earlier book.

Beginning acupuncture

The course lasted five days. There were fourteen of us. Before starting we were supposed to read his 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 of 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?

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 Darwinism, but they have not usually made much connection in their minds between those ideas and medicine.

Darwinian ideas have been around for over 100 years so it is rather odd to say that they are new. However, their relevance to medicine has been curiously understated until very recently. The extraordinary fact is that although Darwin published The Origin of Species over a hundred years ago, and in so doing precipitated what many people think is the greatest intellectual revolution of all time, the application of these ideas to medicine in any systematic way began a mere couple of decades ago at most.

In fact, I didn't realize their importance myself until comparatively recently. I read Richard Dawkins's The Selfish Gene when it first came out but I was resistant to its central idea, perhaps because I disliked its so-called reductionism. But when I went back to it later, and to Dawkins's more detailed examination of the same ideas in The Extended Phenotype, it was as much of a revelation as I am ever likely to experience.

I see now that all of microbiology, much of pathology, and of course all of genetics, are manifestations of Darwinian evolution through and through. Health and disease make no sense except in a Darwinian context. But if orthodox medicine has been slow to recognize the importance of Darwinism, CAM has not even begun to think about it.

But it should. CAM makes much of the body's alleged inherent tendency to harmony and balance; I used to expatiate on these myself. To think in this way is comforting and reassuring and valid up to a point, but it can also become sentimental and based on wishful thinking.

Darwinism tells us that, despite appearances to the contrary, the body is not perfect but has been "cobbled together" during the course of evolution and works "well enough" but no more. There is no guarantee that it will always tend towards health; on the contrary, it almost inevitably contains the seeds of its own destruction and is bound to break down sooner or later.

And there are external threats to its stability as well; we are constantly at war, engaged in an arms race between our defence mechanisms and the parasites (viruses, bacteria, protozoa) that want to invade us. Some have even proposed that cancer could be thought of as a kind of internally generated parasite.

The new science of Darwinian medicine is concerned with questions such as these, and the answers it gives are not always reassuring. It seems likely that, in the light of them, many of the assumptions on which at least the more radical forms of CAM are based will prove to be mistaken.

Come back science, all is forgiven

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 eseentially 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.

There are some exceptions to these rather sweeping generalizations. One concerns herbal medicine. Until about a hundred years ago practically all medicines were herbal and even today some important drugs, such as penicillin and digoxin, are derived directly or indirectly from natural sources. And some herbal medicines do work, although there is still a need for research to tell us for which ones this true and how safe they really are.

Another exception concerns physical treatments within CAM such as osteopathy and chiropractic. There is some, albeit limited, research evidence that these treatments can work and my own experience confirms this. (With all physical treatments the main research problem is to devise control procedures that will be plausibly similar to the "real" treatment but without genuine effect.)

Both osteopathy and chiropractic are of course physical hands-on therapies. Acupuncture can also be considered in the same light. In addition to the needles, it often involves physical examination of the patient for tender areas and so forth. There are reasons for believing that this literally hands-on procedure can have therapeutic effects in itself. My own belief is that all these therapies have a lot in common and probably act by similar mechanisms: that is, by influencing the nervous system.

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!).

There has been quite a bit of practical research and theorizing about modern acupuncture; enough, at any rate, to offer a reasonable explanation of how it might work. No doubt these ideas will need to be altered or even radically revised in the future but at least enough is known to make the treatment sound plausible, which is why a lot of doctors and other health professionals are taking it up. Much the same will be found to be true, I think, for other forms of physical treatment.

In very brief terms, it seems that acupuncture and probably other kinds of physical treatment act on the spinal cord and also on central parts of the brain that constitute the so-called limbic system. This system, I have suggested, could be thought of as a "final common path" by which all such treatments exert their effects. Even placebos may act on this path; recognizing this would do away with largely futile arguments about whether these treatments are "merely placebo".

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.

Notes and references

1. I have a number of articles on various features of CAM; please see Alternative/Complementary Medicine (CAM).

2. This discussion is mainly about CAM in general, not homeopathy in particular. Homeopathy is a complicated subject; for a fuller account of my views of it, please see Homeopathy in Perspective.

3. There are fuller discussions of modern acupuncture elsewhere on my website; please see my Articles about acupuncture.

4. I have written a full-length book about Darwinian medicine in relation to CAM: Alternative Medicine: A Darwinian Perspective. It is available at Online Originals.

5. Physiotherapy is part of mainstream medicine; osteopathy and chiropractic are not. However, all these treatments, especially physiotherapy and osteopathy, overlap to some extent in their approaches, and all three still require a lot of research to validate the methods they use. This is just one example of blurring of the boundary between CAM and orthodox medicine. The use of hypnosis as a medical treatment is another.