Evidence Base

Our Intention as a Service Provider

The Sustainable Health Partnerships (TSHP) programmes and activities will be established using the best available information from conventional medicine, preventative medicine, and integrated and holistic healthcare to promote self care in the community.

As the issue of holistic medicine's evidence base is such a contentious one we will handle it in the following way:

First, for a discussion of the general issues of evidence in holistic and conventional medicine click HERE

Second, see below for a summary of the rationale for our therapeutic activities.

Third, we have summarised the evidence base of each of the main therapy modalities in the Therapeutic Modalities section of this web-site. We answer the following questions for each modality:

  • What is it?
  • Who developed it?
  • What is the evidence base that supports its effectiveness?
  • What conditions is it good for treating?
  • How does it work as a self-care tool?
  • Are there any side effects from the treatment?
  • What are the risks and benefits of treatment?
  • How many sessions does it need?
  • How long do sessions need to be?
  • How many practitioners need to be present?
  • Does it need follow-up or support? If so what, how often and by whom?
  • What is the best way for teaching the technique?

Fourth, we will regularly update this discussion via our Update section and series of discussion documents.

The Rationale for TSHP's Therapeutic Activities

Emerging best practice in holistic healthcare

We use holistic therapies as appropriate in the context of personal treatment and group activities. These approaches have all been espoused by organisations as diverse as MIND, The Mental Health Foundation, The Arthritic Association, and the British Holistic Medical Association and have been used in many leading innovative integrative public health projects like the Bromley-by Bow Centre in London, and the Blackthorne GP practice in Maidstone, Kent. Furthermore, they are supported by a growing body of international academic research as published in Peer reviewed professional journals. Where national trials, or on-going local or national data collection has produced evaluation information we will reference that material.

In this context, much of what we do will be mirroring emerging best practice in holistic healthcare nationally and internationally most of which emphasises self care in the community as an important element of healthcare in the future.

Often the British medical profession as a whole is slow to implement either emerging best evidence practice, (e.g. diet as an important factor in coronary diseases) or develop integrated responses to complex health issues like ME/CFS, IBS, arthritis, stress, mental health and Medically Unexplained Symptoms (MUPS), etc.. We would hope to facilitate patients in a more supportive way when conventional medicine cannot, or will not, or is perhaps slower to adopt new thinking on behalf of patients.

Where there is disease or suffering that could be helped through non-medical approaches we feel that as part of our duty of care that this information should be in the public domain to assist the process of informed consent.

Where there are options for treatment, or the management of conditions based on pragmatic evidence, service evaluations or outcome trials, then we feel we patients have a right to know that these options exist as they consider their personal treatment plans.

Also where the risks of medical procedures are not known, or deliberately concealed then as part of a wider risk/benefit analysis on behalf of patients we can contribute information which is not otherwise easy to obtain for people outside of the care professions in order that the process of informed consent can be enhanced.

Low level activities enhancing health

A lot of our interventions will be based on low level, non-medical activities like walking, gardening, relaxation, breathing, eating good food, life-style changes, developing good social support networks and personal coping mechanisms. We will also use education and training in movement, exercise, diet, relaxation, and meditation to encourage self-care and promote personal responsibility.

These activities will be based on documented accounts of their use within community health projects addressing a wide range of community health issues, and whilst backed by evidence from service users, this evidence will not need to be at the same level as clinical trials as required for example for medical interventions. However, some of these simple interventions like life-style modifications have been subject to clinical trials and shown to be clinically effective. Whilst we would not say we are practising medicine, we would say we are providing tuition in thinking about healthcare and well-being in a non-medicalised way. When we are working in an advisory, training or educational role our work will be referenced to key literature and publicly available resources.

Complex health issues

Many of the patients and groups that we have seen in the past, and who will be our clients in the future, have complex, chronic presentations, often involving more than one set of symptoms. They will probably also have long-term conditions that have been unresponsive to conventional treatment and they maybe subject to polypharmacy i.e. cocktails of drugs that have not been tested in combination at all.

Where there is a strong desire on behalf of the patients, or their physicians to explore non-medical interventions or management, either to minimise exposure to drug interactions, limit the long-term use of medication or protect the patient against side effects we feel that we can provide useful information to assist that personal choice.

The role of a second opinion in personal health issues

Sometimes our clients will want a second opinion when confronted with the possibility of serious, or costly medical procedures. Sometimes our clients will be suffering from the after effects of serious surgery, and sometimes our patients will have unexplained medical physical symptoms. Our own practice data suggests we have relevance for these groups, and we will continue to use audit and evaluation data to determine the direction of our work.

We feel that there is a role for developing informed opinion about the risks and benefits of holistic medical practice as compared to conventional medicine. In the name of informed patient consent, this practice that must be one of the essential baseline requirements for the practice of any medical code.

In all cases our treatment options will be based on current available information which we will evaluate as far as is possible and will pass on as is commensurate with the level of intervention being considered. We see establishing informed consent as part of our duty of care to our clients.

Similarly all our partners will be required to take part in regular audit activity. We would want to work with partners in practice and in the research community to continually review clinical best practice in all areas of our work.

In that respect all our interventions will be based on an established evidence base. This will consist of published trial data, outcome studies, service evaluations, best practice and established patient preferences and information available in the current professional literature. We will use published data, service level grey literature, and emerging best practice as disseminated in professional journals and conferences.

The role of prevention in public health

Much of our activity is about prevention rather than cure, modern scientific medical research is focussed on proving the remedial properties of medicine, or the radical correction of pathological conditions through surgery. These procedures in themselves require different forms of evidence of effectiveness, surgery in particular standing out as the exception to the requirement of RCCT level justification. Prevention strategies however do not attract the same level of research and require different time-scales and breadth of evaluation, for example evaluating a vaccination programme would be different from looking at dietary intervention, or an exercise programme for low-back pain, or long term exposure to cigarette smoke, or use of cell phones.

Undoubtedly these are all public health issues and have profound consequences on individual health and well-being and future costs to the health services as we consider the rising incidence of cancers of all descriptions, obesity, diabetes, asthma, stress-related diseases and dementia. We would advocate a switch of resources into properly evaluated prevention projects across these public health issues and until that time comes we will model best practice as based on best available evidence of prevention programmes nationally and internationally.

Conclusion

We hope this section makes clear our position about evidence in the practice of medicine of whatever description, we make no apology that it is a complex and contentious area of debate where assertion and counter-assertion are often based on limited understanding of the complexities involved.

A lot of our activities are not formally medicine but will have an impact on health and well-being so the issues needs to be aired as fully as possible, hopefully we have said enough to articulate our intentions as providers and educators but for those who are interested in a fuller discussion on the problems of establishing a consensual base for holistic medicine please read-on.

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