Wednesday 12 May 2010

I’m so glad there’s some else who thinks humour and IBS / IBD treatment go together.

I’ve been euphorically repeating, “Fantastic” over and over for some minutes now, with the odd rejoicing hand clap. Fantastic in a good way – not, “beyond belief”

Why “Fantastic”?

I’ve just had my scheduled conversation with Peter Whorwell, Professor of Medicine and Gastroenterology at the University Hospital South Manchester and whose team undertakes research into functional gastrointestinal disorders as well as caring for large numbers of these patients from all over the UK. Peter Whorwell pioneered the use of hypnotherapy in the treatment of IBS (Irritable Bowel Syndrome) and published his first study on this topic in The Lancet in 1984. The blog that follows is about IBS, not IBD that I usually talk about. Nonetheless, the key idea of communication between the brain and the gut is common to both Peter’s approach and my own.

There are a number of reasons for this event warranting my “Fantastic” outburst:

First, Peter is a most amiable, down to earth, easy-to-talk-to person. Thanks to his lovely manner, we comfortably got down to business very quickly. Peter is a very busy man. He had just completed his ward rounds and hadn’t yet had a chance even to look at his diary for the day and yet he willingly gave me an hour of his time advising me on how to approach the various obstacles that would no doubt present themselves in the course of my research. It was soon apparent how he uses humour equally effectively in his work with patients as with the audiences that flock to hear him speak. To underline this, it resonated well with me when he said, “If I don’t make my patients smile I feel dreadful”. This man is clearly wedded to the wellbeing of his patients, and his exemplary results support that. I have to say I feel exactly the same – in fact, I will bury my usual modesty and say I receive many comments such as, “You can always tell when they’ve been to see Joy – they look transformed”. And indeed this is one of the essential ways in which I measure my effectiveness and I’m always energised when I hear other people’s passion for making patients happy. Peter lamented the fact that scant attention is paid to the patients’ happiness - this most important area of patient care. He related how students are sent on Communication Skills courses and taught how to recite their names and the confidentiality policy, but seemingly very little more in terms of creating rapport etc.

Second, he is so clearly able to communicate ideas in this very complex field in an easy, conversational manner. We covered a lot of ground. One subject was the ways of measuring the effectiveness of behavioural interventions - from using fMRI scans registering changes in the patient’s brain activity - to changes in activity at cellular level. We also talked about the difficulty of isolating the “active elements” in behaviour change programmes responsible for improvements in gut performance. If we can get fMRI’s (brain scans) in the picture and demonstrate real change in processing, this would attract a lot of interest. Now that would be very cool, but it costs £800 per half hour and not many research projects can find funding that stretches to this.

Third, I was absolutely astonished by what he told me about the remaining level of resistance amongst the medical profession to hypnotherapy as a treatment for IBS. I was under the misapprehension that it was an accepted and routinely prescribed modality. Years ago I saw mainstream TV programmes devoted to hypnotherapy and IBS featuring Peter and his team. The BBC website still covers his research findings and I’ve even heard Radio4’s Today programme feature the same topic, and yet many GI’s (Gastrointestinal consultants) remain un-persuaded? Peter referred again to the value of humour in breaking down barriers when talking to groups of sceptical GI’s unconvinced by the high quality scientific research he has led in this area. “I tend to take the p**s out of myself when addressing such audiences so that they don’t think (I’m mad)”. He added, “The problem is that so many of them are up their own bottoms”. My amusement turned to a completely different emotion as Peter went on to talk about the difficulty of gaining approval from the Primary Care Trusts (PCT’s) for hypnotherapy treatments in IBS cases compared with a course of CBT (Cognitive Behavioural Therapy).

He went on to explain how CBT has gained the badge of acceptability. That is to say, many decision makers may not know what CBT is, but its acceptability enables it to be prescribed despite the comparatively weaker evidence to support the effectiveness of CBT, especially in the long term.

This has given me an idea for future blogs – a review of CBT versus other talking therapies. I have to say I laughed out loud years ago when I discovered that CBT was termed “brief therapy” and yet the average duration of treatment was months, but that’s a story for another day.

Towards the end of the meeting I asked Peter whether he would be happy to be quoted on my blog and asked him to review the contents before it was released. “Would you be able to turn this around quite quickly?” I asked. “Oh yes” he said, “If you don’t hear from me within a week I will either not have received it or I’ll be dead!” That started me laughing again. Well thankfully he’s very much alive and kicking butts in the GI profession.

Thank you very much Professor Peter Whorwell. It was fantastic to talk with you and yes I will be delighted to keep you posted with my progress.

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