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introduction
Complementary and alternative medicine is becoming something we take for granted. Think of the vitamin pills we swallow with our cornflakes, the echinacea for a cold, the yoga class, the aromatherapy massage at the health and beauty centre, or the trip to the osteopath for low back pain.
One in five people had used a non-conventional therapy in the previous twelve months, according to a BBC survey in 1999. Another study in 1993 suggested that a third of Britons have tried complementary or alternative medicine at some point, a number that doubles among those with chronic and difficult diseases like arthritis, multiple sclerosis and cancer. And if rising sales of herbal and homeopathic remedies over the last decade are anything to go by, even more of us are turning to unconventional modes of health care.
The term 'complementary and alternative medicine', increasingly known as 'CAM' generally refers to any therapy that is not provided by, or taught to, orthodox health professionals like doctors, nurses and dentists — although a number of techniques like massage therapy are now being introduced into nurses' training.
Today, 'alternative medicine' is understood to mean therapies that are used in place of conventional medicine. For example, when cancer patients choose not to have chemotherapy and radiotherapy and instead follow special extreme dietary regimes or take high doses of nutritional supplements. It can also refer to separate medical systems like traditional Chinese medicine or ayurveda, whose understanding of health and diagnostic methods are very different to that of Western medicine.
'Complementary' describes treatments that can be used alongside conventional treatment. Osteopathy, chiropractic and massage therapy, for instance, or self-help measures like yoga or meditation. Far from having to choose one approach or the other, both patients and complementary therapists expect orthodox medication and procedures to continue. Complementary therapies have even found their way into hospices and NHS cancer units like that at Charing Cross Hospital, London, where nurses and supervised practitioners use 'touch and talk' therapies like aromatherapy, reflexology or visualisation to relieve anxiety and help patients cope with intimidating procedures.
Where complementary therapies are used within a conventional medical setting as part of prescribed treatment, this is known as 'integrated medicine', or 'integrative medicine' in the US.
who uses complementary and alternative medicine and why?
Slightly more women than men consult complementary therapists — though men take the lead for osteopathy. Users tend to be between 35 and 60, better educated and more affluent than average.
Medical science has been almost too successful for its own good. Dramatic breakthroughs in diagnosis and treatment over the 20th century — penicillin, heart transplants, gene therapy — raised a lot of hopes that were almost bound to be dashed. Miracle drugs had alarming side effects, viruses became resistant to antibiotics and promised cures for cancer remained tantalisingly elusive. In recent years, the public's faith in doctors has been shaken by a series of medical scandals that exposed frightening examples of arrogance and incompetence in the profession.
At the same time, higher educational standards combined with ready access to the media and the internet means that people can get their hands on a lot of information — though not all of it is correct. The result is that we want to be more involved in our own healthcare and we're not quite so inclined to leave it all to the medical profession. This is particularly true for those with persistent or recurrent conditions like asthma or back pain that doctors find hard to manage.
what does complementary and alternative medicine offer?
Time, for a start. Initial appointments are usually at least 60 minutes, and subsequent sessions anything from half an hour — more than the many NHS practices can usually offer.
Most therapies have a holistic approach that believes health and well-being flows from the harmonious balance of our physical, psychological and spiritual selves — body, mind and spirit. A disruption in any of these spheres can impact on one or both of the others. For example, grief or another emotional strain may be expressed physically as some sort of bodily symptom: aches, tension, soreness, skin problems or digestive upset. Restoring this internal balance is said to stimulate the body's natural self-healing processes.
In order to uncover the root cause of a symptom, a CAM practitioner will ask detailed questions not only about your medical history, but also about your diet, lifestyle habits, sleeping patterns, relationships, likes and dislikes. While this helps the therapist build up a 'whole' picture, patients also find it gratifying — therapeutic in fact — to have the opportunity to talk at length about themselves.
This sounds ideal — although it's unlikely that every complementary practitioner can deliver such excellent holistic care. Nevertheless it's worth looking for practitioners who are up to this standard. At the very least they should be properly trained, insured and registered through a professional body whose standards are sound and properly enforced.
what do doctors think of complementary and alternative medicine?
With so many people using CAM, either alongside orthodox treatment (complementary) or even instead of it (alternative), the medical profession has been obliged to investigate the phenomenon. Although many doctors are sceptical, others became interested and some even practise as homeopaths, acupuncturists or osteopaths. Nearly 40% of general practices in England provide access (not necessarily free) to some form of complementary therapy for patients and a handful of surgeries have truly integrated conventional and complementary medicine so that therapists are part of the team.
The therapies most acceptable to family doctors are acupuncture, osteopathy, chiropractic, homeopathy, massage therapy and aromatherapy. According to a British Medical Association survey in 2000, almost half (47%) of GPs arrange acupuncture for patients and 79% think it should be available on the NHS, while 86% of NHS pain clinics already offer it.
Complementary therapies have found a place in NHS cancer units and palliative care, but they tend to be 'touch' therapies like aromatherapy and reflexology, or mind-body techniques such as relaxation, visualisation or hypnotherapy that relieve anxiety and help patients cope with intimidating procedures.
does CAM work?
The only way to satisfy doctors that it does is by carrying out clinically controlled scientific trials. This is actually quite difficult, which partly explains why there has been so little research.
Funding is one reason. Trials are expensive and usually carried out by hospitals and universities or by pharmaceutical companies, for whom non-conventional therapies have little appeal. Most herbal remedies, for instance, have been in use for centuries and there is no incentive in the form of financially attractive patents.
The other problem lies in devising rigorous clinical trials of practices or substances that are hard to quantify. CAM treatment is often tailored to individual patients, or counted a success if somebody feels better, rather than proven by laboratory tests to have been cured.
Scientists insist that whatever is being tested must be more effective than the 'placebo effect', the acknowledgement that about 30% of treatments will be successful simply because people believe in them. But some experts say the placebo can be as high as 60% or 90%, and the power of belief — in the therapy or the therapist — is a strong factor in CAM. Complementary therapists also tend to speak a different language from medical science. How can you measure something as subtle as chi or 'healing energy', assuming doctors could be convinced it existed?
Even so, some good quality trials of effectiveness have been carried out, notably in acupuncture and herbal medicine. Studies of herbal remedies are particularly important, as there is mounting evidence that some may have toxic effects or could interact dangerously with prescribed medication.
is it possible to integrate complementary and conventional medicine?
The short answer is yes. In fact, it's happening more and more, and some experts regard integrated medicine (or 'integrative medicine' as it's known in the US) as the healthcare of the future. When you consulted your GP, for instance, he or she might prescribe medication or send you to a specialist, but would also refer you to a complementary therapist attached to the practice. This already happens in at least two NHS practices in the UK, one in Marylebone, London, another in Glastonbury, Somerset.
The Foundation for Integrated Medicine holds Awards for Good Practice in Integrated Healthcare. One of the 2001 winners was the Maternity Acupuncture Service at Derriford Hospital, Plymouth, which provides acupuncture for antenatal and postnatal problems and pain relief during labour.
when could you consider complementary medicine?
- When conventional treatments are not working. Example: osteopathy and chiropractic can often relieve back pain more effectively than medication.
- To enhance conventional treatment. Example: massage therapy helps anxious cancer patients relax so that chemotherapy can be given more easily.
- When there is really good scientific evidence that a complementary treatment might be a good alternative to conventional treatment. For example, saw palmetto in benign prostatic enlargement; chiropractic for acute low back pain.
- If you wish to avoid conventional treatment because of unpleasant side effects. Example: Someone with mild hypertension might avoid medication by adopting a high-fibre, low-salt diet, an exercise programme and stress-management techniques such as t'ai chi or meditation.
» does it work?
(July 2002)
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