Complementary and Alternative Medicine Use
by Pediatric Specialty Outpatients
Pediatrics. 2013 (Feb); 131 (2): 225–232
Complementary and alternative medicine (CAM) use is high among children and youth with chronic illnesses. The most common CAM practices currently used were massage, chiropractic, relaxation, and aromatherapy. Results of this study indicate that CAM use is high among pediatric specialty clinic outpatients and is much greater in the western than in the central hospital. Most respondents felt that their CAM use was helpful with few or no harms associated. Many patients, using CAM alongside their conventional medicines, are still not discussing their CAM use with their physicians and are increasing the likelihood for potential interactions and preventable harms.
The Association of Complementary and Alternative Medicine Use and
Health Care Expenditures for Back and Neck Problems
Med Care. 2012 (Dec); 50 (12): 1029–1036
Adjusted annual medical costs among CAM users was $424 lower (95% confidence interval: $240, $609; P<0.001) for spine-related costs, and $796 lower (95% confidence interval: $121, $1470; P=0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (P<0.001) and $298 lower for total health costs (P=0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users.
A Randomized Controlled Trial of a Multifaceted Integrated
Complementary-alternative Therapy for Chronic Herpes Zoster-related Pain
Alternative Medicine Review 2012 (Mar); 17 (1): 57–68
Participants had a mean age of 69.8 years (SD=11.1) and had had herpes zoster-related pain for a median of 4.8 months (range: 1 month to 15 years). The immediate treatment and control groups had similar pain levels at baseline (treatment = 7.5; control = 7.8; p=0.5; scores based on the 10-point Likert pain scale). At three weeks post-randomization (i.e., after the immediate treatment group completed treatment) pain scores differed significantly (treatment = 2.3; control = 7.2; p<0.001). The observed reduction in pain in the immediate treatment group was maintained at nine weeks and at long-term follow-up (one to two years later).
A Systematic Review and Meta-analysis of Efficacy, Cost-effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-back Pain
Evid Based Complement Alternat Med. 2012; 2012: 953139 ~ FULL TEXT
Reports of 147 randomized trials and 5 non-randomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically non-significant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature.
Neuromusculoskeletal Disorders Following SARS: A Case Series
J Can Chiropr Assoc. 2011 (Mar); 55 (1): 32-39 ~ FULL TEXT
In this case series, three patients with varied neuromuscular complaints reported short-term subjective improvements
in their pain experience and quality of life, and two were able to return to work. Future research should investigate
the role of conservative care and manual therapies for this type of patient population using subjective outcome
US Military Veterans' Perceptions of the Conventional Medical Care System and Their Use of Complementary and Alternative Medicine
Family Practice 2002 (Feb); 19 (1): 57–64 ~ FULL TEXT
Although participants were satisfied in general terms with their conventional care, there were particular aspects of the conventional care system that they criticized. Dissatisfaction with aspects of conventional care, particularly its reliance on prescription medications, was an important component in their motivation to use CAM. Results also suggest that the conventional medical system's lack of holism (inadequate information regarding diet, nutrition and exercise, and ignorance of social and spiritual dimensions) is also an important motivation for turning to CAM in this particular population.
Alternative Headache Treatments:
Nutraceuticals, Behavioral and Physical Treatments
Headache. 2011 (Mar); 51 (3): 469–483
There is a growing body of evidence supporting the efficacy of various complementary and alternative medicine approaches in the management of headache disorders. These treatment modalities include nutraceutical, physical and behavioral therapies. Nutraceutical options comprise vitamins and supplements (magnesium, riboflavin, coenzyme Q(10) , and alpha lipoic acid) and herbal preparations (feverfew, and butterbur).
Perceived Benefit of Complementary and Alternative Medicine (CAM)
for Back Pain: A National Survey
J American Board of Family Medicine 2010 (May); 23 (3): 354–362 ~ FULL TEXT
This new reports on interviews with 31,044 individuals who used CAM for low back pain. The results are quite fascinating:
The top 6 CAM therapies for LBP, starting with the most-used, are chiropractic, massage, herbal therapy, acupuncture, yoga/tai chi/qi gong, and relaxation techniques.
Chiropractic use (76% of respondents) was greater than all the other 5 therapies combined
Chiropractic users scored their satisfaction (and benefits) the highest of all 6 approaches used. (see Table 2). This reconfirms earlier findings from the Archives of Physical Medicine & Rehabilitation 2005, which reported that SMT provided the greatest pain relief (7.33), scoring higher than nerve blocks (6.75), Opioid analgesics (6.37), muscle relaxants (5.78), Acupuncture (5.29), or NSAIDs (5.22).
Back pain was the most frequently reported medical problem (62.3%). While most veterans (76.9%) had used prescription pills to treat their medical problems, 67% of veterans who had not used alternative therapies reported that they would use it if offered by the Veterans Administration (VA).
Intractable Migraine Headaches During Pregnancy
Under Chiropractic Care
Complementary Therapies in Clinical Practice 2009 (Nov); 15 (4): 192–197
The absence of hormone fluctuations and/or the analgesic effects of increased beta-endorphins are thought to confer improvements in headache symptoms during pregnancy. However, for a number of pregnant patients, they continue to suffer or have worsening headache symptoms. The use of pharmacotherapy for palliative care is a concern for both the mother and the developing fetus and alternative/complementary care options are sought. We present a 24-year-old gravid female with chronic migraine headaches since age 12years. Previous unsuccessful care included osteopathy, physical therapy, massage and medication. Non-steroidal anti-inflammatory medication with codeine provided minor and temporary relief. Chiropractic care involving spinal manipulative therapy (SMT) and adjunctive therapies resulted in symptom improvement and independence from medication. This document provides supporting evidence on the safety and possible effectiveness of chiropractic care for patients with headaches during pregnancy.
Chiropractic Care Amongst People With Multiple Sclerosis:
A Survey of MS Therapy Centres in the UK
Clinical Chiropractic 2009 (Mar); 12 (1): 23–27 ~ FULL TEXT
Many of the musculoskeletal symptoms associated with multiple sclerosis (MS) can be managed with physical therapy. Chiropractors are well placed to deliver this, but the extent of their involvement in the team management of multiple sclerosis in the UK is unknown. The present study investigates the level of awareness and use of chiropractic by people with MS in the UK.
Factors Influencing Parents Decisions To Choose
Chiropractic Care For Their Children in the UK
Clinical Chiropractic 2009 (Mar); 12 (1): 11–22 ~ FULL TEXT
The results indicate that mothers are the main decision-makers when chiropractic care is chosen for a child and they are mostly influenced by the family physician and friends. This information could help inform campaigns aimed at dissemination of information about the practice and scope of paediatric chiropractic care.
Complementary and Alternative Medicine: Attitudes and Patterns
of Use by German Physicians in a National Survey
J Altern Complement Med 2008 (Dec); 14 (10): 1255-1261 ~ FULL TEXT
In our sample, 51% were in favor of CAM use (26% were very much in favor, 25% were in favor). Three single CAM techniques and three CAM treatment systems (integrating several techniques and/or covering a wide range of indications) were to be scored on their seriousness,with 4 answers possible: rather credible, rather questionable, undecided, don’t know. Acupuncture was judged rather credible by 394 (76.4%), chiropractic by 373 (73.3%), homeopathy by 257 (49.8%), anthroposophical medicine by 101 (19.6%), electroacupuncture by 183 (35.5%),and autologous blood therapy by 144 (27.9%). The two latter techniques were chosen because of their widespread use in Germany in spite of explicit nonrecommendations given by the Federal Joint Committee, a national board of physicians and insurance providers.
Do Chiropractors Identify with Complementary and Alternative Medicine?
Results of a Survey
J Altern Complement Med 2008 (May); 14 (4): 361–368
Of the total sample of 132, 69% did not agree that chiropractic should be categorized as CAM. Twenty-seven percent (27%) of 132 thought that chiropractors should be classified as IM; 20% of practitioners and 6% of faculty considered chiropractic mainstream medicine. The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%).
Use of Complementary and Alternative Therapies in
Community-dwelling Older Adults
J Altern Complement Med 2007 (Nov); 13 (9): 997-1006
Overall, 62.9% (N = 445) of the respondents reported use of one or more complementary and alternative medicine modalities with an average of three modalities (SD +/- 1.9, range 1-11). The top five CAM modalities used were nutritional supplements (44.3%), spiritual healing/prayer (29.7%), megavitamins (28.3%), herbal supplements (20.7%), and chiropractic (17.8%). Maintaining health and treating a health condition were the primary reasons for CAM use. The most common conditions treated were arthritis (44.4%) and chronic pain (23.3%).
Willingness of Emergency Department Patients with Musculoskeletal Complaints to Participate in Complementary and Alternative Medicine Research
CJEM 2002 (Nov); 4 (6): 401-407
Of 107 eligible patients, 93 participated (87%). Most symptoms began on the day of presentation (44%) or in the previous week (41%). Seventy-six percent of patients had utilized CAM previously during their lives, and 13% were currently using CAM for their presenting problem. The majority of patients stated an informed hypothetical willingness to enroll in a CAM study of the following therapies: traditional Chinese medicine 74%; chiropractic 70%; and other CAM therapies 92%. Of patients asked, 99% stated they would comply with 4 to 6 weeks of outpatient follow-up, and 70% stated they would participate in a placebo-controlled study.
A Large-sample Survey of First- and Second-year Medical Student Attitudes Toward Complementary and Alternative Medicine in the Curriculum and in Practice
Altern Ther Health Med 2007 (Jan); 13 (1): 30-35
Nearly all (91%) students agreed that "CAM includes ideas and methods from which Western medicine could benefit"; more than 83% agreed that "knowledge about CAM is important to me as a student/future practicing health professional"; and more than 73% felt that CAM should be included in the curriculum. Among all students, the most frequently indicated level of desired training was "sufficient to advise patients about use," for 11 of the 15 modalities. The greatest level of training was wanted for acupuncture, chiropractic, herbal medicine, and nutritional supplements. The descriptions of CAM in future clinical practice that occurred most frequently were endorsement, referral, or provision of acupuncture, biofeedback, chiropractic, herbal medicine, massage, nutritional supplements, prayer, and meditation.
Pattern and Frequency of Use of Complementary and Alternative Medicine Among Patients with Epilepsy in the Midwestern United States
Epilepsy & Behavior 2007 (Jun); 10 (4): 576–582
Thirty-nine percent (of those interviewed) reported using CAM; 23% reported using CAM specifically for their epilepsy. Prayer/spirituality was the most commonly used form of CAM (46%), followed by "mega" vitamins (23%), chiropractic care (24%), and stress management (16%). CAM use is common among midwestern patients with epilepsy, although the pattern of use may be slightly different than in other regions of the United States and elsewhere.
Use of Selected Complementary and Alternative Medicine (CAM) Treatments in Veterans with Cancer or Chronic Pain: A Cross-sectional Survey
BMC Complement Altern Med 2006 (Oct 6); 6: 34 ~ FULL TEXT
One of the largest groups to utilize alternative therapies is veterans. A recent mail survey evaluated selected alternative medicine use among 264 veterans. The survey included questions on demographics, health beliefs, medical problems and use of six common alternative therapies (chiropractic, herbs, dietary supplements, massage therapy, acupuncture and homeopathy). Seventy-two patients (27.3%) reported alternative therapy use within the past 12 months. COLOR="#B22222">One-fourth of patients (26%) used chiropractic care to alleviate their pain.
Use of Alternative Therapies by Older Adults with Osteoarthritis
Arthritis Rheum 2001 (Jun); 45 (3): 222–227
More than 47% of participants reported using at least one type of alternative care during the 20-week intervention period. Among alternative care consumers, the most commonly used treatments were massage therapy (57%), chiropractic services (20.7%), and nonprescribed alternative medications (17.2%). Four percent of subjects reported using only alternative care during the study period.
U.S. and Canadian Pharmacists' Attitudes, Knowledge, and Professional Practice Behaviors Toward Dietary Supplements: A Systematic Review
BMC Complement Altern Med 2006 (Sep 19); 6 (1): 31 ~ FULL TEXT
There is strong agreement among pharmacists for the need to have additional training on Dietary Supplements (DS), increased regulation of DS, and quality information on DS. In addition, survey data indicate that pharmacists do not perceive their knowledge of DS to be adequate and that pharmacists do not routinely document, monitor, or inquire about patients' use of DS. Despite this, a large proportion of pharmacists reported receiving questions about DS from patients and other health care practitioners.
How Far Can Complementary and Alternative Medicine Go?
The Case of Chiropractic and Homeopathy
Soc Sci Med. 2006 (Nov); 63 (10): 2617–2627
The data revealed four main strategies: (1) improving the quality of educational programs, (2) elevating standards of practice, (3) developing more peer reviewed research, and (4) increasing group cohesion. Although both groups identified similar strategies, the chiropractors were bolstered by more resources as well as state sanctioned regulation. The efforts of the homeopaths were constrained by scarce resources and the absence of self-regulation.
In both cases the lack of strong structural support from government and the established health professions played an important role in limiting what was possible. In the future, it may be to the state's advantage to modify the overall shape of health care to include alternative paradigms of healing along with conventional medical care.
Insurance Coverage and Subsequent Utilization of Complementary
and Alternative Medicine Providers
Am J Manag Care 2006 (Jul); 12 (7): 397–404
Among more than 600,000 enrollees, 13.7% made CAM claims. This included 1.3% of enrollees with claims for acupuncture, 1.6% for naturopathy, 2.4% for massage, and 10.9% for chiropractic. Patients enrolled in preferred provider organizations and point-of-service products were notably more likely to use CAM than those with health maintenance organization coverage. The use of CAM was greater among women and among persons 31 to 50 years of age. The use of chiropractic was more frequent in less populous counties. The CAM provider visits usually focused on musculoskeletal complaints except for naturopathic physicians, who treated a broader array of problems. The median per-visit expenditures were $39.00 for CAM care and $74.40 for conventional outpatient care. The number of people using CAM insurance benefits was substantial; the effect on insurance expenditures was modest.
The Role of Evidence in Alternative Medicine:
Contrasting Biomedical and Anthropological Approaches
Soc Sci Med. 2006 (Jun); 62 (11): 2646–2657
In this paper, the supposed objectivity of scientific, biomedical forms of evidence is questioned through an illumination of the multiple rhetorics embedded in the evidence-based medicine phenomenon, both within biomedicine itself and in calls for its use to evaluate alternative therapeutic systems. Anthropological notions of evidence are constructed very differently from those of biomedical science, and offer a closer resonance with the philosophy of alternative medicine. Examples are given of the kinds of evidence produced by anthropologists researching alternative medicine.
Complementary Healthcare: A Guide for Patients (Acrobat file)
Prince of Wales’s Foundation for Integrated Health ~ 2005
This report, prepared by the The Prince's Foundation for Integrated Health advises British citizens about the regulated professions of chiropractic and osteopathy, the soon-to-be regulated field of acupuncture, and 12 other unregulated techniques, ranging from Aromatherapy to Yoga.
An Analysis of Sickness Absence in Chronically Ill Patients Receiving Complementary and Alternative Medicine: A Longterm Prospective Intermittent Study
BMC Public Health 2006 (Feb 12); 6 (1): 28
Results of this longterm observational study show a reduction of sick leave in chronically ill patients after a complex multimodal CAM intervention. However, as this is an uncontrolled observational study efficacy of any specific CAM treatment can not be proven. The results might indicate an general effectiveness of CAM in primary care, worthwhile further investigations. Future studies should identify the most suitable patients for CAM practices, the most appropriate and safe treatments, provide information on the magnitude of the effects to facilitate subsequent definitive randomised controlled studies that will help to position complementary and alternative medicine in health care.
Homeopathic Care for the Prevention of Upper Respiratory Tract Infections in Children: A Pragmatic, Randomised, Controlled Trial Comparing Individualised Homeopathic Care and Waiting-list Controls
Complementary Therapies in Medicine 2005 (Dec); 13 (4): 231–238
There was a significant difference in median total symptom score in favour of homeopathic care (24 points) compared to the control group (44 points) (p = 0.026). The difference in the median number of days with URTI symptoms was statistically significant with 8 days in the homeopathic group and 13 days in the control group (p = 0.006). There was no statistical difference in the use of conventional medication or care between the two groups.
Interprofessional Referral Patterns in an Integrated Medical System
J Manipulative Physiol Ther 2005 (Mar); 28 (3): 170–174 ~ FULL TEXT
The data resemble a good news/bad news scenario. For the good news, in this network, of the 42 PCP providers, only 3 are not linked through referrals to at least one CAM provider in the period studied. But the bad news, however, is that for most of the PCPs, the number of referrals is quite low. Any CAM provider relying solely on the referrals to generate a patient flow would not do very well in this network. This finding might reflect either the nature of the patient population, one which does not necessitate referral, or may reflect reluctance or inexperience on the part of the PCPs with the type of CAM therapy offered by DOMs or DCs.
Consumer Reports’ Survey of 34,000 Readers Finds
Hands-on Treatments Most Successful
A press release from Consumer Reports
Readers gave the highest marks to hands-on treatments, which worked better than conventional treatments for conditions such as back pain and arthritis. Chiropractic was ranked ahead of all conventional treatments, including prescription drugs, by readers with back pain.
Is Complementary and Alternative Medicine (CAM) Cost-effective?
A Systematic Review
BMC Complementary and Alternative Medicine 2005 (Jun 2); 5: 11 ~ FULL TEXT
These exemplary studies indicate CAM therapies that may be considered cost-effective compared to usual care for various conditions: acupuncture for migraine, manual therapy for neck pain, spa therapy for Parkinson's, self-administered stress management for cancer patients undergoing chemotherapy, pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery.
Perceptions of Complementary and Alternative Medicine
Amongst Medical Students in Singapore - A Survey
Acupuncture in Medicine 2005; 23 (1): 19–26
Acupuncture was the best known therapy, with 57% claiming to know at least something about it. No students claimed they knew a lot about chiropractic, osteopathy, Ayuverdic medicine, homeopathy and naturopathy, and many had not ever heard of these therapies. Knowledge of commonly held beliefs about the 16 CAM modalities was generally poor, even for modalities which students claimed to know most about. A significant number of students had knowledge about CAM that was erroneous.
Complementary and Alternative Medicine in the United States 2005
Board on Health Promotion and Disease Prevention (HPDP)
This 360 page report states: In determining what CAM care to provide, the goal should be comprehensive care that uses the best scientific evidence available regarding benefits and harm, encourages a focus on healing, recognizes the importance of compassion and caring, emphasizes the centrality of relationship-based care, encourages patients to share in decision making about therapeutic options, and promotes choices in care that can include complementary therapies where appropriate.
Policies Pertaining to Complementary and Alternative Medical Therapies
in a Random Sample of 39 Academic Health Centers
Altern Ther Health Med 2005 (Jan); 11 (1): 36–40
This research documents policies in 39 randomly selected academic medical centers integrating complementary and alternative medical (CAM) services into conventional care. Twenty-three offered CAM services-most commonly, acupuncture, massage, dietary supplements, mind-body therapies, and music therapy. None had written policies concerning credentialing practices or malpractice liability. Only 10 reported a written policy governing use of dietary supplements, although three sold supplements in inpatient formularies.
Complementary and Alternative Medicine:
Personal Preference or Low Cost Option?
LDI Issue Brief 2004 (Feb); 10 (4): 1–4
The reasons that people give for using CAM are as diverse as the CAM therapies themselves: some perceive that conventional health care is ineffective, while others consider CAM to be more consistent with their own values and beliefs about health. As conventional health care costs rise, it is also possible that some people turn to CAM as a low cost alternative. This Issue Brief summarizes research that evaluates the relationship between CAM use and perceived access to conventional health care.
Boundary at Work:
Alternative Medicine in Biomedical Settings
Sociol Health Illn. 2005 (Jan); 27 (1): 20-43
The study uses qualitative methods to examine the nature of this collaboration by calling attention to the ways in which the biomedical profession manages to secure its boundaries and to protect its hard-core professional knowledge. It identifies the processes of exclusion and marginalization as the main mechanisms by which symbolic boundaries are marked daily in the professional field. These processes enable the biomedical profession to contain its competitors and at the same time to avoid overt confrontations and mitigate potential tensions between the two medical systems.
What is the Best and Most Ethical Model for the Relationship Between Mainstream and Alternative Medicine: Opposition, Integration, or Pluralism?
Acad Med 2005 (Mar); 80 (3): 286-290
Pluralism, which has been relatively ignored, calls for cooperation between the different medical systems rather than their integration. As an ethical model, pluralism realizes that physicians must be prepared to disagree with patient choices to pursue alternative therapies, and urge patients not to forgo medically indicated treatment. Pluralism encourages cooperation, research, and open communication and respect between practitioners despite the possible existence of honest disagreement, and preserves the integrity of each of the treatment systems involved.
British Complementary (Alternative)
Britain's Department of Health, in collaboration with the Foundation for Integrated Medicine, the National Health Alliance and the National Association of Primary Care, published Complementary Medicine (Dec 2000), a document that explains the benefits of the top six complementary therapies provided by Britain's National Health Service (NHS). It also explains making referrals to CAM practitioners, employing CAM practitioners, and who to contact to find a CAM practitioner. The President of the Foundation is HRH The Prince of Wales.
Complementary Medicine Information for General Practitioners
20 pages, Adobe Acrobat File (94K)
Complementary Medicine Information for Primary Care Groups
46 pages, Adobe Acrobat File (167K)
CAM: A Briefing by the Foundation for Integrated Medicine on the Report by the House of Lords Select Committee on Science and Technology
This briefing divides CAM practices into 3 categories: Disciplines well-supported by research (Chiropractic, Acupuncture), those lacking firm support, and those which have minimal evidence of efficasy.
Short and Simplified Descriptions of Complementary and Alternative Medicine (CAM) Disciplines
This table, from the Royal College of Physicians, divides CAM practices into 3 categories. The first category is Professionally Organised Alternative Therapies, which are those that have good scientific support, and include Acupuncture and Chiropractic.
Alternative Medicine: Expanding Medical Horizons
A Report to the National Institutes of Health on Alternative Medical Systems and Practices in the United States - Workshop on Alternative Medicine, Chantilly, Virginia September 14-16, 1992
You may enjoy this separate introduction, titled
Expanding Medical Horizons. One of the first goals of the Office of Alternative Medicine (OAM) was to develop a baseline of information on the state of alternative medicine in the United States. To accomplish this, a series of workshops were held in 1992. The first, a public meeting on June 17-18 in Bethesda, Maryland, included presentations from more than 80 speakers who detailed issues and concerns of importance to the alternative medicine community. On September 14-16, a second workshop was convened in Chantilly, Virginia, with a total of more than 200 participants who discussed the state of the art of the major areas of alternative medicine and to direct attention to priority areas for potential future research activities. Cochairs of the workshop working groups organized writing teams to collect and synthesize the available research in their respective fields and to develop recommendations to the National Institutes of Health (NIH). You may also find the section on
Manual Healing Methods of interest.
Complementary and Alternative Medicine Use Among Adults:
United States, 2002 (Acrobat file)
Centers for Disease Control and Prevention (CDC) ~ May 27, 2004
Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, therapies, and products that are not presently considered to be part of conventional medicine. The U.S.
public’s use of CAM increased substantially during the 1990s (1–11). This high rate of use translates into
large out-of-pocket expenditures on CAM. It has been estimated that the U.S. public spent between $36 billion and $47 billion on CAM therapies in 1997 (5). Of this amount, between $12.2 billion and $19.6 billion was paid out-of-pocket for the services of professional CAM health care providers such as chiropractors, acupuncturists, and massage therapists. These fees are more than the U.S. public paid out-of pocket for all hospitalizations in 1997 and about half that paid for all out-of pocket physician services (12). Explanations for this growth in CAM use have been proposed, including marketing forces, availability of information on the Internet, the desire of patients to be actively involved with medical decision making, and dissatisfaction with conventional (western) medicine (13). This FULL TEXT Adobe Acrobat article (617 KB) is one of the most comprehensive to date, with a subject interview base of more than 31,000 U.S. adults.
Integrated Health Care:
Applying Best Practices From Two Medical Models
Nutrition Science News (May 2001)
Allopathic medical practitioners have been ill-prepared to deal with the rapid proliferation of alternative medical therapies and natural supplements, many of which are being used by their patients in conjunction with traditional treatments. While practitioners are justifiably hesitant to begin an integrated practice, there are valid reasons for becoming more knowledgeable about alternative approaches to health care, and more willing to start adding select remedies to their practices.
Alternative Therapies in the Management of Headache and Facial Pain
Otolaryngol Clin North Am 2003 (Dec); 36 (6): 1221–1230
Complementary therapies are now becoming the rule rather than the exception in the management of headache and facial pain. It is incumbent on physicians to be aware of and to have a working knowledge of these increasingly popular modalities.
Alternative Medicine and Leo Galland, M.D.
Two decades ago Leo Galland, M.D., an honors graduate of Harvard University Medical School, left academic medicine to establish a private practice in a small Connecticut town. "As soon as I stopped working with critically ill patients in the intensive care unit and started seeing people who were chronically ill, it became apparent that what worked for emergency situations was not very useful for restoring health. That was 25 years ago, and there wasn't much "alternative" out there. But I found a tremendous amount of scientific research about nutritional and psychological influences on illness and recovery, and about the role of exercise in health. I've always felt most comfortable working from a platform of what's scientific and rational."
The Use of Complementary and Alternative Medical Providers by
Insured Cancer Patients in Washington State
Cancer 2004 (Apr 1); 100 (7): 1522–1530
A substantial number of insured cancer patients will use alternative providers if they are given the choice. The cost of this treatment is modest compared with conventional care charges. For individuals with cancer, CAM providers do not appear to be replacing conventional providers but instead are integrated into overall care.
Student Nurses' Perceptions of Alternative and Allopathic Medicine
West J Nurs Res 2004 (Apr); 26 (3): 356–366
Three themes were identified: (a) "They are not at all alike," (b) "The two can or should be used together," and (c) "Those who practice alternative medicine and those who practice allopathic do not get along very well." The discussion suggests some reasons for these perceptions and considers some implications for future health care.
Complementary and Alternative Medicine:
Use in an Older Population
Journal of Gerontological Nursing 2003 (May): 29 (5): 20–28
Seventy-three percent of the participants reported using some form of CAM. Chiropractic was the most commonly used therapy among elderly patients (61.9 percent), followed by herbal medicine (54.8 percent), massage therapy (35.7 percent) and acupuncture (33.3 percent). Among the reasons for using CAM therapies, 54.8 percent used CAM for pain relief; 45.2 percent used CAM to improve quality of life; and 40.5 percent used CAM to maintain health and fitness.
A Dose of Our Own Medicine: Alternative Medicine, Conventional Medicine,
and the Standards of Science
J Law Med Ethics 2003 (Summer); 31 (2): 222–235
Commentators often argue that complementary and alternative medicine (CAM) should be held to the same scientific standards as conventional medicine. This article argues that medicine is not always as scientific as assumed; reciprocally, it can cause harms and waste money. Although medicine has had remarkable success, its problems and limits justify a relatively tolerant approach toward CAM.
Assessing Alternative Medicine:
Methodological and Research Policy Concerns
Int J Technol Assess Health Care 2003 (Summer); 19 (3): 435–445
Setting funding priorities among research projects for complementary and alternative therapies is especially vulnerable to arbitrary, partisan criteria and opportunistic readings of controversial evidence. Relying on an open, formal procedure for comparing unconventional therapies offers protection against prejudgment in setting funding priorities, especially when weak clinical evidence relates more to a low investment in research than lack of efficacy.
Obstacles to Research in Complementary and Alternative Medicine
Medical Journal of Australia 2003 (Sep 15); 179 (6): 279-280
About half the general population in developed countries uses complementary and alternative medicine (CAM). Yet many conventional healthcare professionals refuse to take CAM seriously — one often-voiced argument is “there is no research in CAM” Certainly, for some modalities there is no compelling evidence base, and some of the research into CAM has methodological flaws and biases. On the other hand, many doctors and medical educators are uninformed about the quality evidence that does exist. In this article, I discuss some of the obstacles to developing an evidence base for CAM.
RESPONSE TO: Obstacles to Research in Complementary and Alternative Medicine
MJA 2004; 180 (2): 95-96
With respect to spinal manipulation therapy as an alternative medical approach to constitutional ailments, such as migraine, the key evidence is the recovery of vision, which occurs with spinal manipulation in appropriately ill patients. In my personal experience, the main obstacle to research of complementary medicine precepts has been the censorship of dissenting data from orthodox medical literature. The most blatant example of this is the studied neglect of the “tunnel vision information”: the knowledge that vision improves in appropriately ill patients when the spine is manipulated.
Chiropractic: A Profession at the Crossroads of
Mainstream and Alternative Medicine
Ann Intern Med 2002; 136 (3) Feb 5: 216–227
Chiropractic is a large and well-established health care profession in the United States. In this overview, we briefly examine the development of chiropractic from humble and contentious beginnings to its current state at the crossroads of alternative and mainstream medicine.
Chiropractors as Wellness Practitioners:
An Idea Whose Time Has Come
In a recent article authored by chiropractors in the Annals of Internal Medicine (perhaps another first for the profession), chiropractic was called a
"profession at the crossroads" of mainstream and alternative care 1. There are several views among DCs on which path to follow at the crossroads. Some would have us be musculoskeletal or back specialists, dealing exclusively with pain management; others would have us be subluxation specialists, limiting our concern to the articulations of the spine - an extreme of reductionism, though perhaps a viable one for many; and yet others would like to see us as primary care providers, differing from medical physicians in our focus on health, rather than disease, and on assisting the body through noninvasive means to restore balance and achieve optimal function.
Visit Our Older Alt-Med Articles
Dealing With Pain:
Time For a Fresh Look at Complementary Medicine
British Medical Journal 2003 (Jun 14); 326 : 1322 ~ FULL TEXT
Lord Baldwin—who chaired the British Acupuncture Accreditation Board 1990-9, was joint chairman of the Parliamentary Group for Alternative and Complementary Medicine 1992-2002, and served on the House of Lords Science and Technology Select Committee inquiry into complementary and alternative medicine in 2000—asks that both complementary and conventional practitioners keep an open mind
Double Standards Exist in Judging Traditional and Alternative Medicine
British Medical Journal 1998 (Jun 6); 313 : 1694 ~ FULL TEXT
The double standards that exist in judging orthodox and alternative medicine should be challenged, and reliable tools that can validate both approaches need to be found. The call came last week in London at a conference on integrated medicine which was organised by the Prince of Wales.
British Medical Journal 1999 (Oct 23); 319 : 1115-1118 ~ FULL TEXT
Homoeopaths treat disease using very low dose preparations administered according to the principle that "like should be cured with like." Practitioners select a drug that would, if given to a healthy volunteer, cause the presenting symptoms of the patient. For example, the homoeopathic remedy Allium cepa is derived from the common onion. Contact with raw onions typically causes lacrimation, stinging and irritation around the eyes and nose, and clear nasal discharge. Allium cepa might be prescribed to patients with hay fever, especially if both nose and eyes are affected.
British Medical Journal 1999 (Oct 16); 319 : 1050-1053 ~ FULL TEXT
The use of plants for healing purposes predates human history and forms the origin of much modern medicine. Many conventional drugs originate from plant sources: a century ago, most of the few effective drugs were plant based. Examples include aspirin (from willow bark), digoxin (from foxglove), quinine (from cinchona bark), and morphine (from the opium poppy). The development of drugs from plants continues, with drug companies engaged in large scale pharmacological screening of herbs.
British Medical Journal 1999 (Oct 9); 319 : 973-976 ~ FULL TEXT
Acupuncture is the stimulation of special points on the body, usually by the insertion of fine needles. Originating in the Far East about 2000 years ago, it has made various appearances in the history of European and north American medicine. William Osler, for example, used acupuncture therapeutically in the 19th century. Acupuncture's recent popularity in the West dates from the 1970s, when President Nixon visited China.
Complementary Medicine and Medical Education
British Medical Journal 2001 (Jan 20); 322 : 121-122 ~ FULL TEXT
Complementary and alternative medicine is no longer an obscure issue in medicine. Our patients are using alternative therapies in addition to conventional care (1, 2) and sometimes do not share this information with us. But even if they did would we know how best to advise them about safety issues or about the effectiveness of a particular therapy for their problem? Surveys indicate that doctors and medical students are increasingly interested in complementary and alternative therapy,3-5 yet lack of knowledge is one of the greatest barriers to its appropriate use.
British Medical Journal 2001 (Jan 20); 322: 119-120 ~ FULL TEXT
Integrated medicine (or integrative medicine as it is referred to in the United States) is practising medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment. The concept is better recognised in the US than in the United Kingdom, but a conference in London next week, organised by the Royal College of Physicians and the US National Center for Complementary and Alternative Medicine, may help to raise its profile in the UK.
Research into Complementary and Alternative Medicine:
Problems and Potential
British Medical Journal 2001 (Jan 20); 322: 161–164 ~ FULL TEXT
The growing use of unsubstantiated complementary and alternative medicine therapies by people in the United States1 along with its increasing coverage by third party payers (2) encouraged Congress to create the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. The centre's mission is "to explore complementary and alternative healing practices in the context of rigorous science; to educate and training CAM researchers; and to disseminate authoritative information to the public and professionals." (3)
What is Complementary Medicine?
British Medical Journal 1999 (Dec 11); 319: 1558–1561 ~ FULL TEXT
Complementary medicine refers to a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided. Complementary medicine is an increasing feature of healthcare practice, but considerable confusion remains about what exactly it is and what position the disciplines included under this term should hold in relation to conventional medicine
Complementary Medicine and the Doctor
British Medical Journal 1999 (Sep 11); 319: 693–696 ~ FULL TEXT
Doctors deal with complementary medicine in a variety of professional situations. Patients may ask for advice about whether to pursue complementary therapies or which therapist to consult; they may request referral or delegation, either privately or on the NHS; or they may want to discuss treatment or advice given by complementary practitioners. Doctors prescribing drugs to patients taking complementary treatments may have concerns about possible interactions. Doctors should therefore consider strategies for minimising risk and facilitating sensible and appropriate discussions with patients and complementary practitioners.
Complementary Medicine and the Patient
British Medical Journal 1999 (Dec 4); 319: 1558–1561 ~ FULL TEXT
In surveys of users of complementary medicine, about 80% are satisfied with the treatment they received. Interestingly, this is not always dependent on an improvement in their presenting complaint. For example, in one UK survey of cancer patients, changes attributed to complementary medicine included being emotionally stronger, less anxious, and more hopeful about the future even if the cancer remained unchanged.
Unconventional Approaches to Nutritional Medicine
British Medical Journal 1999 (Nov 27); 319: 1419–1422 ~ FULL TEXT
Although nutrition, as a science, has always been part of conventional medicine, doctors are not taught, and therefore do not practise, much in the way of nutritional therapeutics. Dieticians in conventional settings tend to work mainly with particular patient groups---such as those with diabetes, obesity, digestive or swallowing problems, or cardiovascular risk factors. Apart from the treatment of gross nutritional deficiencies and rare metabolic disorders, other nutritional interventions generally fall outside the mainstream and can therefore be described as complementary medicine.
The Manipulative Therapies: Osteopathy and Chiropractic
British Medical Journal 1999 (Oct 30); 319: 1176–1179 ~ FULL TEXT
Osteopathy and chiropractic share a common origin. Their roots can be found in folk traditions of "bone setting," and both were systematised in the late 19th century in the United States: Daniel D Palmer, the founder of chiropractic, is said to have met with Andrew Taylor Still, the founder of osteopathy, before setting up his own school. The therapies remain relatively similar, and many textbooks and journals are relevant to both. The term "manipulative therapy" refers to both osteopathy and chiropractic.
Complementary Medicine in Conventional Practice
British Medical Journal 1999 (Oct 2); 319: 901–904 ~ FULL TEXT
The past 10 years has seen a significant increase in the amount of complementary medicine being accessed through the NHS. These services are not evenly distributed, and many different delivery mechanisms are used, some of which (such as homoeopathic hospitals) predate the inception of the NHS. Others depend on more recent NHS reorganisations, like general practice fundholding and health commission contracting, or have been set up as evaluated pilot projects.
Users and Practitioners of Complementary Medicine
British Medical Journal 1999 (Sep 25); 319: 836–838 ~ FULL TEXT
Complementary medicine seems to be becoming more popular in Britain. Media coverage, specialist publications, and numbers of complementary therapists have all increased dramatically in the past 20 years. In this chapter we analyse this phenomenon and review available evidence about the use of complementary medicine.
Complementary Medicine in Europe
British Medical Journal 1994 (Jul 9); 309 (6947): 107-111 ~ FULL TEXT
Complementary or unconventional treatments are used by many doctors and other therapists throughout Europe. The major forms are acupuncture, homoeopathy, manual therapy or manipulation, and phytotherapy or herbal medicine. The relative popularity of therapies differs between countries, but public demand is strong and growing. Regulation of practitioners varies widely: in most countries only registered health professionals may practice, but in the United Kingdom practice is virtually unregulated. Germany and some Scandinavian countries have intermediate systems.
Complementary Medicine and the General Practitioner
British Medical Journal 1986 (Jun 7); 292 (6534): 1498–1500 ~ FULL TEXT
The attitudes to complementary medicine of a random sample of general practitioners in Avon were assessed. A questionnaire was sent to 200 general practitioners, of whom 145 responded. The treatments studied were acupuncture, homoeopathy, herbal medicine, spinal manipulation, faith healing, and hypnosis. Of the 145 general practitioners, 55 (38%) had received some training in complementary medicine and 22 (13%) wished to arrange training.
British Medical Journal's Complementary Medicine Collection