CONTINUING THE PHILOSOPHY OF REGINALD O. KAPP

9.1 RE-EDUCATING DOCTORS ABOUT COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)

by     JOHN G. KAPP

for the Journal of Holistic Healthcare
15th June 2004


Abstract
The government rightly wants a patient-centred health service, and patients want CAM. Doctors and nurses are an overloaded national resource, and CAM is an under-utilised national resource. Integration is therefore the natural solution to the crisis in the NHS, and there is a welcome growing political will for it. This article looks at how the iron curtain of incompatible paradigms between the two can be demolished, by the re-education and healing of doctors, which is both as possible, and as difficult, as the reunification of Germany was in 1990. It advocates training courses, and outlines what should be taught.



Health warning Doctors reading this may feel uncomfortable symptoms coming on, such as anxiety, fear, anger, frustration, rejection. If so, they should immediately refer themselves to their nearest CAM therapy centre for cathartic methods of meditation, visualisation, relaxation or counselling. Alternatively, they can project their feelings on to the author, who will be pleased to receive them.



Government guidelines (1) are rightly urging doctors to give patients ‘high quality information’ about CAM. Does this imply that the government at last recognises that CAM is a valid system of healthcare which should be integrated into the NHS? Or just that patients are asking about CAM? The latter would only.be lip service.

I do not know, as the guidelines do not specify what the ‘good information’ is. There certainly seems to be increasing political will for the integration of conventional medicine and CAM, (2) so I will optimistically assume that. ‘good information’ means ‘the truth’, and explore the uncomfortable implications of this assumption for government and doctors.

What doctors and the media believe about CAM
Doctors have been taught from medical school, that CAM is quackery, and its practitioners are charlatans. They are not so rude as to put it so bluntly, so tell their patients that there is no evidence for efficacy in CAM, so they can go to a CAM therapist if they like, but they will be wasting their money. This answer effectively rubbishes CAM.

They feel on strong ground in this belief because the very names ‘complementary’ and ‘alternative’ are divisive, making a distinction with ‘conventional’ medicine, and excluding them by definition from being conventional. If CAM was of any value it would not be called ‘CAM’, but would have been integrated (as chiropractic, osteopathy, homeopathy and accupuncture are currently being).

This is clearly the message that the government wants doctors to promulgate, as it trips off every health practitioner’s tongue like a religious mantra. They tell patients that, but is it the truth, and are they being believed? The media is constantly putting out the contrary message that CAM is wonderful. Does rubbishing CAM merely further tarnish conventional medicine’s credibility?. Government propaganda about capitalism was not believed in former communist countries.

The truth is that CAM is an alternative health service. It is a genuine health service, unlike the NHS, which should be renamed to reflect what it is, and always has been - a National Sickness Service. Economically, CAM has been playing uphill against the NHS, because CAM patients (called clients) have to pay, whereas NHS patients don’t. However, in the media, the NHS is playing uphill against CAM, as it is losing the battle of ideas. CAM gets a good press, and the NHS a bad press.

CAM is said to be the fastest growing industry in the western world, as public dissatisfaction with conventional medicine grows. Iatrogenic disease (doctor induced by mistake) is now said to be the third largest killer (after heart disease and cancer) killing 40,000pa in UK and 120,000pa in America.(3)

Can doctors give ‘good information’ about CAM?
Clinical governance requires that doctors be qualified through training before giving any advice to. patients. The public still tend to trust doctors, although that trust is being increasingly shaken. However, until they are re-educated, doctors are not the right people from whom to seek the truth about CAM. Indeed, they are the last people from whom patients should expect the truth, for doctors don’t know that they don’t know.

Like the fool who should be shunned, on CAM they have the absolute confidence of complete ignorance. They think that they knew everything worth knowing about CAM (ie that it is rubbish) whereas not only do they know nothing, but they are coming from a completely different place. Asking a doctor about CAM is like asking a blind man what an elephant looks like. If you do, you will just be confused. Clinical governance should therefore insist that doctors answer ‘I don’t know’ until they have been qualified to give an valid opinion, by attending a course that tells the truth about CAM.

Conventional and CAM practitioners cannot communicate, except as a dialogue of the deaf. They are separated by an iron curtain of different paradigms (unconscious unspoken belief systems, like religious or political beliefs). There can be no integration of CAM with conventional medicine until government and doctors undergo a paradigm shift in their belief system. The process, although possible, will be as difficult as the reunification of Germany in the 1990s, which required the reconciliation of totally different systems.

Like capitalism and communism, conventional and CAM are poles apart, polar opposites, dialectically different.. Their paradigms are not just different, they are antagonistic. Their systems are set up in diametrically opposite ways. The NHS is a monolith with one million employees, whereas CAM is totally fragmented. Most practitioners are self-employed, working from home. Many are doing it because they have suffered a breakdown in their own health, discovered their own salvation and seek to share it with others..

Training courses on CAM for doctors, disentangling the differences, need to be set up and promulgated in every town. The following sets out an outline of what needs to be taught in such courses, under various headings.

Conflicting definitions.
The old definitions, which doctors were originally taught, and many still believe are Conventional medicine is interventions which are evidence based, and CAM is those which are not (ie quackery, and its practitioners are charlatans. This may have been true prior to nationalisation of health in 1948, but today it is not true.

The following definitions are nearer the truth: Conventional medicine is those interventions that the government has decided to fund through taxation, and. CAM is the remainder, namely what patients have to fund themselves. As the government department that makes the decision (the Medicines Control Agency) is influenced by the drug companies, it is not surprising that the NHS has a drug based culture, and that the drug budget is out of control.

Different paradigms
Doctors have a reductionist, mechanistic paradigm, which means that their belief is reduced to the ‘scientific’ belief in materialism.(matter is the only reality). This results in treatment of the body only, with a disease-centred view. CAM practitioners have a holistic paradigm, based on belief in spirit, mind and body, resulting in treatment of the whole person, and a spirit- or soul-centred view.

Why practitioners can’t talk to each other is because people never preface their remarks with ‘according to my mechanistic belief system, it follows that…………’ Paradigms are often unconscious, the person being unaware that they hold that belief, because it is deep in their unconscious mind..

This unawareness is betrayed by the uneasy tone of voice that doctors use about CAM.. They are not just embarassed to be asked. With a few exceptions, they are simply not open to any discussion about it. If pressed, they react as if you are shaking their foundations.. They feel as I do when a Jehova’s witness appears at my door. This refusal to discuss the issues creates the above mentioned iron curtain, and the dialogue of the deaf between them. Why this intense emotion?

The addition of belief in spirit in CAM is not just a minor add on, but is revolutionary. It is the fundamental difference in belief between science and religion, Belief in spirit implies belief in spirituality, divinity, and turns an atheist into a theist. It also turns every attitude of conventional medicine upside down, as described below.

This conflict of paradigms is thousands of years old, and divided the ancient Greeks. The issue was ‘settled’ in Europe when the early scientists dissected cadavers, looking for the soul, and finding none, declared it non-existent. However, Eastern systems of medicine (Ayurveda, Yoga, Shamanic, Chinese) have always been holistic, believing that people have a spirit or soul which is guiding them...

What is the effect of the mechanistic paradigm?
Under the mechanistic paradigm, patients are seen like machines to be fixed by some external mechanic, like the modern doctor. This has been a popular belief system with patients, who then do not have to take any responsibility for themselves. They can eat junk food, and lead an indulgent, addictive lifestyle When they become ill, the NHS will fix them for free. If and when they are not cured, they have someone to blame, can play the victim and attract pity from others.

This attitude is not sustainably satisfying, so they become disillusioned and resentful, particularly if their quality of life has been wrecked by the side effects of their medication. When they come to the end of the conventional treatment road, and are labelled ‘terminal’, they feel dumped, like cars being sent to the scrap heap, with nothing on offer but palliative care (pain killers).

The mechanistic paradigm is also popular with doctors and politicians. The belief that they can take responsibility for others and cure them puts them on a pedestal, and inflates their self-esteem and ego. It makes them feel important and superior to their patients and electorate.

However, the party line forces health practitioners to be atheists at work, even if they are theists at heart, adding to their stress. As with patients, disillusionment and frustration is likely to set in when their patients don’t get better, are not grateful, and resent being nannied. If practitioners go on trying for too long, the attempt is likely to cause them to burn out and become ill. This explains why many are sick and tired of their job, long for early retirement, and have above average addiction and suicide rates.

The mechanistic paradigm explains conventional medicine’s attitude to death as a failure. Again, the unspoken belief that doctors can defeat death (playing God) inflates their ego. They seem desperate to persuade their patients to accept more and more interventions (like chemotherapy which shrinks tumours at the cost of quality of life) Patients like the attention of the doctor’s God-like endeavours, making them feel important, and needed, perhaps as a substitute for love, so go along with awful side effects inflicted on them, perhaps seeing it as God’s punishment..

Everybody knows that a permanent cure can only be effected by the eradication of the cause of the disease. However, causes are seldom seriously sought, because if they were, the disease might be found to be self-inflicted. This goes against political correctness with the axiom that the patient must never be blamed for their condition. This attitude reinforces the ‘helpless victim’ image, which the NHS projects, disempowering them from taking responsibility for themselves.

The paradigm limits conventional medicine to a small range of mechanistic interventions, namely surgery, drugs and radiation (cutting, poisoning or burning the body) When they do not work, the tendency is to look in a tunnelled vision way for ever increasingly invasive ways. The higher they fly, the harder they fall. Tiny mistakes can then be fatal, which accounts for the increase in iatrogenic disease.

The problems of the NHS stem from its absurd paradigm, the religion of conventional medicine. People are clearly more than mere machines, and it blinds doctors from seeing how people really work. The denial of soul conflicts with most patients’ and practitioners’ belief about themselves, and they all resent being treated in a soul-destroying way. A patient-centred health service is simply incompatable with a mechanistic paradigm.

Clinging to an unbelieved paradigm always results in an increasing mis-allocation of national resources and taxpayers’ money.(eg communism) The NHS budget is doubling from £50-100bn pa, yet the nations health is getting worse, not better, while the million NHS workers are being hammered into the ground. Even scientists, led by quantum physicists, are now abandoning materialism, and coming round to accepting the reality of ‘another’ world beyond the visible space/time dimensions, known as the zero point field. (4)

What is the holistic paradigm?
CAM is based on the holistic belief that every living creature (plant, animal, human) has three parts to it, namely a body, a mind and a spirit. The body is composed of matter as particles, atoms and molecules, made up in a cellular structure. The mind is an aura of wave energy, which can be detected by Kirlian photography, or in the case of fireflies and glow-worms seen, as their aura happens to be in the human visible light range. The spirit is a non-material influence, invisible, undetectable and without location in this world of space and time dimensions.

The origin of the holistic paradigm is religious, and all the world’s religions share the belief in the existence of the human spirit or soul. According to the Vedas (Hindu scriptures), on which Ayurvedic medicine is based, the soul is the ‘driver of the chariot’ at the top of the hierarchy. In computer terms, the body is the hardware, the mind is the software, and the spirit is the operator.

The evidence for the reality of a non-material spirit comes, not from itself objectively, but from its subjective effect on the bodies and minds of living creatures. An analogy is the wind, which is also invisible, but you can tell its presence by the way it blows things around.

The effect that spirit has on matter is to give it life, without which, it would die. This life force has been given many names, such as soul, spirit, being, consciousness, noumen (5), diathete (6), It has the capacity to create the waves of the mind, and create order in the atoms of the body, so that its resulting creature conforms to its specification, This is how a seed becomes a plant, an acorn becomes an oak tree, a puppy becomes a dog, a baby becomes a person.

According to eastern systems of medicine (Ayurveda, Yoga, Shamanic Chinese) on which holism is based, if the spirit is healthy, the mind and body will also be healthy. The cause of all disease originates in the soul. As this is in ‘another world’, it is inaccessible objectively. The key to change is subective, lying only in the soul of the person themself.

This means that you cannot be your ‘brothers keeper’, and no-one else can take responsibility for your health. You are therefore left with self-responsibility. Life is what you make it, and your attitude to everything is what you choose it to be. You can choose to be a victim, or a beneficiary of existence. Your cup can be half empty or half full. CAM practitioners accept you the way you are, without judgement, or blame.

The purpose of symptoms is to wake you up to change whatever in your lifestyle is the cause. If you get a pain, you should question what it is you need to change, and do so. Taking a pain killer is counter productive, like cutting the wires to the alarm on the dashboard to say that your car’s oil pressure is low. The light will go off, but a few miles on your engine may seize up, and you may be stranded.

Death is not a failure, but is a natural inevitability of the normal recycling of every living thing. The soul of the plant, animal or human knows when its time to die has come, lets go and accepts death and reincarnation without regret. The body is simply the soul’s dwelling place for the time being. When the soul leaves, the body dies and the atoms of which it was composed become dust again. In the computer analogy, if the operator leaves, the hardware and software becomes useless (dead), until another operator arrives to bring it back to life.

The holistic paradigm, of self-responsibity empowers everybody, patient and doctor, because we are all human, and will all become ill and die sometime. . The ancient dictum ‘physician heal thyself’ illustrates the spiritual truth that we cannot give to others what we do not ourselves possess. Every CAM therapist ‘walks that talk’, having come into CAM through their own sickness, as mentioned above.

What is common to every CAM therapy session?
There are hundreds of different types of CAM, and they can involve various types of intervention, eg movement (yoga, tai chi, pilates, Alexander technique,) touching (massage, aromatherapy, reflexology, shiatsu, cranio-sacral osteopathy) healing (reiki, laying on of hands, spiritual healing,) meditation (visualisation, relaxation,) counselling (nutritional, hypnotherapy, life coaching, tarot, astrology, rune reading, colour therapy, bach flower, journey work, sound healing) or combinations of them.

All CAM therapy sessions have to be patient centred, because the client is paying, and the therapist depends on them and others coming back. The therapist and client are equal, being fellow travellers on the journey of life. The interventions are comparatively gentle and non-invasive, virtually without contra-indications or side effects. The client is always conscious, and in control.

With the touching therapies, the masseuse always requests feedback on the pressure. With the movement ones, the client does it to himself, under the instruction of the therapist. A typical CAM session is an hour long, eight times as long as the average GP consultation of 7 minutes. It is held in an alternative therapy centre, or the practitioner’s or client’s home. This is a less stressful and more healing atmosphere than a hospital or doctors surgery. The client has an hour just for them, to relax, think what is troubling them, and explore what could be causing the problem.

Whether or not there is talking, the client is given a safe space to let go and get into a soul-centred, meditative state. This reconnects their mind to their soul, so that they can listen to the wisdom of the ‘still small voice’ of their consciousness The common benefit of all CAM is thus induced meditation. This is the root of CAM’s efficacy, as meditation is the most powerful ‘medicine’ that there is.

The root of the word ‘meditation’ is the same as ‘medicine’ (latin ‘medici’, to heal) In holism, you are ill when you have ‘fallen apart’ ie body, mind and soul are divided. You are healed when you have ‘pulled yourself together’, so that you become whole. The word ‘holistic’ was a recent combination of ‘healed’ and ‘whole’.

Meditation is a system of healing which has an evidence base in Eastern religions going back for thousands of years. Meditation does not have to be performed in any set way, though if you use a scientific method it will be far more effective in healing you. Many people meditate unknowingly when relaxing without pressure, letting their mind go silent (eg fishing, sitting outside, doing repetitive tasks) Today’s sick society is largely due to people filling their lives with noise, andnever giving themselves enough, (or any) meditative space to heal.

However, meditation is not day dreaming, nor sleep. It has been scientifically shown that when you meditate properly with full consciousness, watching a relaxed body and unidentified thoughts, your brain waves change. Two minutes of it is said to be as healing as a full night’s sleep. You find that all your problems are just in your mind, and can miraculously evaporate as solutions you never thought of before appear in your consciousness.

Tapes and CDs have been designed to help people get rapidly into the meditative state, using consciousness-altering music with movement and cartharsis to release tensions and induce relaxation. They are called ‘active’ meditation sessions, and are widely available.(7)

What is the evidence base for conventional medicine and CAM?
In conventional medicine, the term ‘evidence based’ has a narrow definition, stemming from drug trials. It means that the efficacy of a product has been rigorously tested in double blind trials, and found statistically to be capable of delivering the claimed outcome to about two out of every three patients who take it. Most people think that all conventional medicine is evidence based, but this is not so. A study 6 years ago showed that between only 10 and 20% of decisions in conventional primary care are actually evidence based. (8) Drugs are recent inventions, the oldest drug, (aspirin) being only a century old.

In the outside world of the market place, the ‘evidence base’ of any product or service is simply whether or not people will buy it. Whether it is judged good or bad by the government is irrelevant. The evidence base for CAM, by the market definition, is that people buy it, it gets a good press, and demand is increasing.. That evidence is strengthened by the fact that the competition to CAM, (the NHS) is available free.

What would the take up be for conventional medicine if patients had to fund it themselves? Probably only a small fraction of the present ‘demand’, judging by the high incidence of missed appointments, and non-cashed prescriptions. This indicates the potential economic benefit to society of integration. Government wants to let the money follow the patient. If they were free to chose between conventional and CAM, (say by giving patients health vouchers, under the Conservatives ‘health passport’) some would chose CAM. This would save the NHS money, as CAM is usually far cheaper than drugs, and has no side effects..

It would also solve the problem of recruitment and retention of staff, which like everything else in the NHS, is in crisis. Wannless (9) estimates that to deliver the NHS plan will require a third more GPs and two thirds more nurses by 2020. Doctors and nurses need healing more than most of us, due to the stress of their jobs, and CAM can deliver this.

Conclusion
The problems of the NHS stem from its mechanistic paradigm, which few still believe, and is being abandoned by science. All regimes that are based on untenable paradigms eventually crumble under the weight of their bureacracies, as communism did, and the NHS is doing. .The superiority of CAM’s holistic paradigm is shown by the fact that conventional medicine has been unable to beat CAM in 56 years, despite being propped up by £trillions of taxpayers money and government propaganda. If you can’t beat ‘em, join,’em.

Integration of CAM into the NHS by a paradigm shift to holism will help heal our society, (as the integration of capitalism and communism did for German society in 1990). Although the transition will be difficult for NHS staff, doctors particularly, ultimately it will be a win win for everyone, (drug companies excepted). Many of the enabling decisions have been made, ie patient choice, money follows the patient, payment by results. It now just needs the re-education courses addressed in this article, and vouchers which patients can spend on CAM.

References
1   ‘Palliative Care Guidelines’ paragraph 17, March 2004.
2   ‘Clinical Governance for CAM in Primary Care’ April 2004, 39 page report by University of Westminster
3   ‘Why doctors make mistakes’ Channel 4 documentary Oct 2000
4   ‘The Field’ by Lynne McTaggart ISBN 0-7225-3764-6
5   ‘Noumen’ was used by the German philosopher Kant, and comes from the greek ‘nous’ meaning the all powerful mind of creation.
6   ‘Diathete’ was coined by Reginald Kapp (author’s father) in ‘ Science versus materialism’, published in 1940 by Methuen, copies of which are available from John Kapp..
7   Osho active meditations are available on a drop in basis at Planet Janet, opposite Hove town hall tel 01273 738389, planet-janet.com
8   Scarfield B. ‘Primary Care: balancing health needs, services and technologies’ New York: Oxford University Press 1998.
9   Wannless D ‘Securing our future Health Taking a long term view.HM Treasury’ 2002.

John G Kapp is a former local politician who believes passionately in integration. He is the founder of Planet Janet alternative therapy centre in Hove, in memory of his first wife, Janet, who died of cancer. He and she benefitted greatly from both conventional and CAM, which is the experience on which this article is based. He wishes to contribute to a local BHMA group. Address for correspondence 22, Saxon Rd, Hove BN3 4LE
Tel: 01273 417997
johnkapp@btinternet.com


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