Your Health: East meets west

By MICHELE HEWITSON

He is rather dapper, Dr Ian McDonald, in his rowdy tie and sober pinstripes. His surgery in Takapuna is a modern building which looks like any suburban doctor's except for the higgledy-piggledy rows of the doctor's own works of art.

Here's a dark oil of a haggard, lined face on the verge of a scream. Alongside it is a watercolour of happy, smiling people picnicking in a field.

Before and after acupuncture, perhaps? That's right, says McDonald.

He is a GP, a practitioner of Western medicine who offers acupuncture at his general practice.

He also offers, although less routinely, a host of treatments which range from homeopathic drainage or detoxification, chelation therapy to bioenergetic medicine.

Acupuncture is his first love. He was converted, if that is the right word, in the late 70s after seeing a film showing Chinese acupuncture administered during heart surgery for pain relief. The patient got up from the operating table and walked away.

"You thought, 'There's something in it'."

On his website McDonald is known as Dr Dart, a nickname bestowed by friends because of his habit of sticking people with needles.

While he is a convert he is hardly evangelical in his enthusiasms. Actually, he is rather gloomy contemplating the future of acupuncture in this country. This is partly because, he says, running a general practice is a complicated enough business without also offering complementary medicine.

It is also an area riven with politics. The problem in New Zealand, says McDonald, is that "anyone can be an acupuncturist.

I could give you a set of needles and you could set up shop". He believes that acupuncturists who are not registered GPs (he is also registered with the NZ Medical Acupuncturists Society) can give the treatment a bad name.

There should, he says, be disciplinary bodies overseeing the practitioners. The difficulty is that practitioners and practitioners who are also GPs have engaged in not a little "head-butting" over the establishment of such a body.

None of which is particularly surprising - the growth of acceptance of alternative methods of treatment can be seen to be a backlash against the authority of conventional medicine. Neither is it particularly reassuring.

Trotting along to the GP for our course of acupuncture - or homeopathy, or Ayurvedic medicine - we want some evidence that what we are having applied, or inserted or what we are ingesting is going to work.

McDonald offers guidelines issued by the Medical Council for doctors offering complementary medicine.

Before you give the go-ahead to McDonald for a course of, say, acupuncture, you will have to sign a disclosure form "as a record of good faith" which outlines those guidelines.

"It is important," reads the form, "that in undertaking the alternative treatment [that] a comparative analysis is given to you so that you can compare [this] with a standard medical practice." And that "in offering alternative medicine, the extent of any scientific evidence, if any, which supports the treatment ... given to you."

Note the "if any".

Medical acupuncture, notes McDonald gives rise to the question: "How does acupuncture work?" The answer is that "scientists have no real answer to this: as you know many of the workings of the body are still a mystery." It is by "an unknown process [that] acupuncture raises levels of triglycerides, specific hormones, white blood counts ... "

But if you consider that much of what your GP hands over for you to swallow contains a variety of substances of which you have no layman's knowledge, what really is the difference between faith in the acupuncturist's needles and the GP's pills?

"Research gives you half the story," McDonald writes in an advice sheet, "and the other half is what acupuncture is all about." And, he says, the World Health Organisation has a list of illnesses which are helped with acupuncture.

This is acupuncture, he stresses, in the hands of a practitioner also trained in Western medicine. "In a doctor's hands you can diagnose from a Western point of view, you can diagnose from an Eastern point of view and come to a reasonable diagnosis. But you have to use both sides."

His starting point is always a Western medicine assessment. Faced with the symptoms of severe depression his course of action is likely to be to prescribe a course of antidepressants, to refer the patient to a psychiatrist for a combination of behaviour therapy and a second opinion. "And then you might begin the acupuncture. It's a complete procedure alongside all the GP knowledge."

The emphasis is on holistic health. And his starting point is more basic than mysterious. "Hug a tree," he recommends.

Dr Jan Raymond, who works out of a comfortable, rambling old villa in Mt Eden, in an office with orchid, Greenpeace posters and a driftwood sculpture adorned with paua shells, is only being slightly self-deprecating when she says that she has been known to hand out prescriptions for sleep.

The GP and homeopath has a "wellness prescription" she gives to patients. It is an acronym script for "healthy and happy long life". W is for water. E for exercise. L for love. N for nutrition. And so on.

It is, again, basic stuff and includes the medical advice that "three good belly laughs daily" are important because "life is too important to be taken seriously".

And if you think that all sounds a bit easy, think again. Raymond has lost patients because her way can be seen as "too challenging, too threatening".

See her for depression and on your first visit she'll likely "prescribe a walking routine, exercise, which has been shown in lots of studies to be just as good or better than antidepressants". Want a flu shot? Oh, she grimaces, "I could get into trouble here. You can do lots to prevent getting the flu: getting lots of sleep, exercise, eating healthily."

Her way is harder for patients. "It puts it back on your shoulders. They want that script. That's our society: 'fix me now'."

She trained as a GP in Alberta, Canada, graduated in 1978 and arrived in New Zealand in 1991. Her disillusionment with Western medicine started much earlier. "I was unhappy with the medical model after I'd been in practice for 10 years. I just saw that the conventional medical model wasn't really helping people recover their health. It's okay with managing the control and symptoms of disease but not with really restoring their health."

Homeopathy looks at "connectedness". It and other holistic types of medicine regard "disease or symptoms as just a local manifestation of a general imbalance".

She concedes that homeopathy "isn't a completely developed art or science as yet. And there are lots of cases where we can't treat or we don't know what the right remedy is. Certainly I'm careful if there is a very accepted form of treatment or if they've got a foreign body in their foot, then to take out the foreign body is more sensible."

She squares its validation with what she sees as the gaps in knowledge of conventional medicine: "depending on which survey you look at, 15 to 30 per cent of what we did was actually evidence based".

A reasonable example, she says is hormone replacement therapy. "HRT was actually prescribed to reduce heart disease and now we've found the opposite, that in fact it contributes to heart disease."

In a major review of homeopathy, produced in 1991, "there was some evidence of positive effects, even though they [the researchers] couldn't explain it".

Despite the scepticism of many in the medical community, Raymond has found that word of mouth is what brings in the patients.

Such interest is perhaps the medical equivalent of the slow food movement. Raymond's patients want more than the quick fix. And if she says that they're a strange lot, she's not being rude.

"You have to be really quite abnormal now in our society. You really have to be quite motivated and abnormal to be healthy."