I had just completed a mornings’ teaching, and I felt it was going well. The subject we had been discussing had been arthropathies, and in particular psoriatic arthritis, rheumatoid arthritis and Reiter’s. I like to share an anonymised patient’s case history and treatment plan to help the students understand how to approach building prescriptions, and learn how to link them to dietary and lifestyle advice. On this occasion I had used a patient as an example of someone who had used the phrase ‘I am a new man because of herbal medicine’ in response to his treatment [the one I mentioned at the end of my last post].
When we broke for lunch I checked my emails. There was a message from new patient that I had seen only twice. It said this;
‘I am not continuing with herbal medicine as I feel it is haphazard and I do not have confidence in it.’
Let’s just say that burst my complacent bubble of the morning session.
As I reflected on his comment I had to decide if it was herbal medicine that had not gained his confidence, or was it specifically how I had delivered his care. So I had to examine my approach to his consultation and treatment. I always email my patients a management plan after I have seen them which includes;
· a summary of what we have discussed that day
· a brief resume of how we intend to progress
· their prescription and dosage instructions
· dietary advice
· lifestyle advice
· my contact details
Surely this couldn’t be what he was referring to as ‘haphazard’?
As I went over our conversations from his two visits, something became more clear. I had explained that the beauty of herbal medicine was that I could not only make an individual prescription suited to his specific needs and presentation, but that I could also tweak it as symptoms came and went. I extolled the flexibility of the herbal prescription explaining that I had hundreds of herbs to choose from. I pointed out that I had choice, a lot of choice…
When I considered what I understood about the orthodox model, I realised that he was comparing my way of working to how his GP might approach an appointment. From my experience of NICE [the National Institute of Health and Care Excellence] guidelines, doctors have been given a specific list of drugs they should prescribe in certain circumstance. If these don’t work, they then progress to the next list. And then the next list. And so on. It seems that they don’t have much autonomy to prescribe medicines that are not on that list for that condition, and indeed it could be very unwise for them to do so. Orthodox drugs are very powerful, they have side effects – some of which can be dangerous, or worse than the condition they are treating. And there is another thing. As one consultant neurologist explained to me, ‘if I sanction you giving herbs to this person under my care I am putting my head on the block’. He did anyway, bless him, but I understood that the risk he was taking meant he would be in deep trouble if something had gone wrong.
My patient’s GP would know exactly what to prescribe for reflux, hypertension, eczema or rheumatoid arthritis etc. from his list of NICE approved drugs for that condition. These would have been approved because they had been judged safe and effective through the ‘evidence-based’ criteria of double-blind controlled trials and research. In contrast, I seemed to be plucking different plants out of the air according to whim. That is not what happens, obviously, but seen from my patient’s point of view…
I wondered if this patient had since read a study from the British Pharmacological Society and the Royal College of Physicians which revealed that most prescription medications surprisingly only work on 30 to 50 per cent of people. Maths isn’t my strongest point but even I can work out what that means.
It means that 50-70% of patients are taking drugs that don’t work.
This not only is a colossal waste of money within the NHS, but think of the poor patients who keep going back for more.
I have a lot of respect for modern medicine, I wouldn’t be alive today without it. If I was in a serious car crash I would want an ambulance and a hospital and an emergency care team, not herbs. The herbal tonic could come later to speed my recovery.
But what are we doing as a society with all these drugs that don’t work but keep being prescribed? Several famous people have been said to have coined this phrase:
The definition of insanity is doing the same thing over and over again and expecting a different outcome…
From my perspective prescribing herbs isn’t haphazard, it is flexible. I have been trained to understand herbal actions, and which plants have those actions, and what conditions those actions benefit. But the choice of which plant with those actions I list for a prescription is up to me.
NHS drug prescribing may not be ‘haphazard’, but if it just doesn’t work for 50-70% of patients, I would say it isn’t ‘effective’ either.
