Alternative medicine

ANDY Field has a vivid image to describe the way the health service operates. "A lot of what we do, so-called 'heroic medicine', is catching people once they've fallen off the trapeze," he says. "My view is that once they've fallen, you're never really going to get them back on. Is that really where we should be focusing our effort? On expensive intervention? We need to be thinking hard about prevention instead."

He's clearly not a great fan of 'heroic medicine' - expensive drugs, expensive operations, poisoning people with toxic drugs or cutting them open in order to make them well. He's much more in favour of a gentler approach: one that focuses on stopping people getting ill in the first place, keeping them out of hospital. And that's despite his five-year training as a surgeon.

Heart patients waiting for those life-saving operations - or cancer patients whose lives depend on the drugs which will kill off their cancer - are unlikely to agree, of course. But what about if they'd never become ill in the first place?

Dr Field became disillusioned with the 'patch 'em up and turn 'em out' approach while working as a surgeon in the South East.

"I realised I was a little bit like the boy with his finger in the dike. Someone comes down, you operate, they leave. Then two people come down. You treat them, they go. Three people come. Same thing. Then eventually you realise you cannot save them all. You've got to start looking at prevention."

The realisation that however much money you throw at the health service you're never going to keep up with demand is beginning to find wider acceptance.

As is the fact that there may be something fundamentally wrong with the way the NHS is organised.

A Public Health Laboratory Service report published earlier this month revealed the NHS spends £1 billion a year treating people for infections they contract while they are in hospital.

Andy Field, who gave up being a surgeon to train as a GP in York believing that would put him at the front-line of preventative work, would add that a lot of money is also being spent on drugs to treat the symptoms caused by other drugs.

It's time, he says, for a change in thinking - away from the knee-jerk prescription of expensive drugs and procedures.

"We tend to focus on Intensive Care beds, high-technology interventions like heart transplants, liver transplants etc. But for every heart transplant you could employ at least one really well-trained nurse or health education worker doing really good work in the community on long-term prevention."

Senior health workers in North Yorkshire insist that there is an increasing emphasis on preventative measures.

Dr Neil Maskrey, a North Yorkshire public health consultant as well as practising GP, admits that £68 million a year is spent on drugs in North Yorkshire alone. But he, and other senior family doctors like York GP Dr Bob Markham, chairman of the York Primary Care Group, point out a significant proportion of that is spent on drugs that do prevent people becoming ill: such as medicines to lower cholesterol levels in those at risk of heart attack.

On top of that, there are plenty of local health improvement and health promotion initiatives to encourage people about the benefits of healthy lifestyles, more exercise, better eating and giving up smoking.BUT Dr Field isn't satisfied. He wants our whole approach to medicine to change and broaden. He'd like health education to begin in primary school - and for a range of 'alternative' or complementary therapies such as osteopathy, acupuncture and homeopathy to be brought within the NHS fold alongside orthodox medicine.

"We live in busy, hectic, toxic times," he said. "People work harder and harder, have less and less time for exercise. Illness is about lifestyle. Health is not purely a scientific endeavour. Human beings are not technical, clockwork machines. They need time and care."

It won't happen overnight, he admits. Many orthodox doctors still reject the idea of complementary therapies, pointing out practitioners aren't always properly trained or accredited, and that there's little scientific evidence that many of the more exotic therapies work.

Andy Field points out that the scientific trials which provide evidence for the effectiveness of expensive, orthodox drugs are often funded by the very drug companies who stand to profit if they are approved for use - a clear conflict of interest, he says. And there is, he insists, real evidence that some complementary therapies do work.

"It is a culture jump for GPs to trust other health providers with their patients," he admitted. "And there are issues of accreditation of some alternative practitioners.

"Many doctors are threatened by it. But they don't need to be. It would give them a much greater range of methods with which to deal with people's health."

Bob Markham admits complementary therapy is a 'difficult one' for many GPs. There is real concern about the lack of experience, training and accreditation of some practitioners, he says.

"But having said that, there is obviously a lot of interest in complementary medicine. People do say that it does help them in some ways, where sometimes orthodox medicine does not."

So maybe, just maybe, with proper regulation, it could one day be brought into the fold.

Don't expect your GP to send you off for a session of aromatherapy on the NHS just yet, though