Book Review ....

	The human effect in medicine theory, research and practice Authors: Michael Dixon and Kieran Sweeney Published by: Radcliff Medical Press ISBN 1 85775 3690
Reviewed by: Jane Staggs Member of BackCare 's Education Committee

This book explores the mystery at the centre of the relationship of mind and body, doctor and patient. But it is anything but a book about magic or quackery. By GPs for GPs, but in easily accessible language, this is a fascinating and well written book. It is thoroughly referenced and reviews the relevant research literature. The subject matter will be of interest to all medical professionals whether orthodox or alternative and to patients

"Modern medicine is founded upon a faulty philosophical premise that isolates body and mind, and therefore leaves the patient out of the equation." The human effect in medicine challenges the supremacy of science and technology and argues that it is the relationship between practitioner and patient that is at the centre of all health care. The authors examine this relationship and the medical consultation for their effect on patient health. All the evidence suggests that patients experience health gains from a positive personal relationship with their doctors, and from a positive consultation. All this has serious implications forthe way healthcare is delivered with five minute appointments and large GP practices where the patient rarely sees the same doctor. Evidence-based medicine is also questioned because it only examines the procedure or drug, and not the effect of the person who delivers these.

A large section of the book is devoted to an exploration of the placebo effect which the authors say should be renamed the 'self-healing effect'. Rather than being considered a problem in medical research, the placebo effect should be encouraged. It is our own innate ability to heal ourselves. There is scientific evidence to show that the placebo effect is beneficial in many organic diseases, depression, stress, and in pain relief. The placebo effect is not all in the imagination, but makes things actually better. It"... must be affecting not only symptoms, but also physiological processes." It is also cheap and free of side effects.

A good physician stimulates the self-healing process in the patient, and in the end, we all heal ourselves. All the evidence from psychiatry and psychotherapy is that it is the therapist, not the therapy that makes for success. The good practitioner helps the patient into 'active mode' where he is self -dependent, not doctor dependent. Information, self help groups, relaxation techniques, positive thinking, visualisation and self-hypnosis are all recommended as ways of doing this.

The last part of the book explores the nature of a good consultation and the qualities of a good practitioner. The good physician is non-judgemental, fosters the patient's self-esteem, allows the patient some control in their medical process, and engenders trust and respect. Complementary and alternative medicine is often referred to as the authors believe that alternative practitioners have the interpersonal skills from which patients benefit, and that the common thread among the different complementary therapies is self-healing.

This book is about turning patients into people and also turning doctors into people. The attitude, motivation, and expectation of both the patient and the practitioner are important in determining the outcome of any treatment. Much of what is advocated, such as information, self-help, patient practitioners, and self dependency is found in BackCare's Think-Back programme which is run by Pete Moore.

Jane Staggs
The reviewer is a professional member of BackCare, a member of the Education Committee and a teacher of the Alexander Technique.