Complementary MedicineComplementary Medicine

Why bother for a whole term?

Complementary or AlternativeComplementary or Alternative

• Which is more acceptable to who?

• Needs complementing?

• Need for alternative?

• Whose need?

• What can we learn from these practitioners?

One image !One image !

Or Another?Or Another?

Caring

Holistic

No iatrogenic problems?

Why Bother?Why Bother?

“Scientific medicine is making big advances in drugs, technology, and genetics, yet more and more patients use complementary therapies. EBM dominates our discourse, yet health professionals increasingly refer to and practice complementary therapies that have little scientific evidence of efficacy.”

•What is the meaning behind these paradoxes?

•What can we learn that will usefully inform our practice of orthodox medicine?

•Why do people go to complementary practitioners?

Why Bother?Why Bother?

• What skills are they using?

• What skills could we borrow?

• What patient needs are they addressing?

• Are they needs we should seek to meet?

• Should we support them?

• Should we attack them?

• How should we respond?

How Many?How Many?

• Over one thousand forms of complementary medicine have been indexed

• About 26 are “common”

• There are at least 40,000 therapists in the UK

How Popular?How Popular?How Popular?How Popular?• Hard data lacking• Relies on survey data• Geographical

variations• Cultural variations• Socio-economic

variation

• Ever used 14-30%• Last year 10-14%• Ever seen practitioner

33%• World wide ever seen

practitioner 20-75%

How Popular?How Popular?• 45% of GPs endorse

or recommend the use of complementary medicine

• 21% of GPs refer patients to complementary practitioners

• 10% of GPs treat patients with complementary medicine themselves

• US (1990) made 425 m. Visits to comp. Practitioners and 388 m. Visits to family physicians

How Popular?How Popular?

• Phenomenal growth

• UK consumption of homeopathic remedies growing at 20% per year

• Number of UK practitioners has doubled every 5 years for the last 15 years

• Growth is occurring right across the west

Which Therapy?Which Therapy?Which Therapy?Which Therapy?1984 survey• Acupuncture• Chiropractic• Herbal

medicine• Homeopathy• Osteopathy

1993 survey• Acupuncture• Chiropractic• Herbal

medicine• Homeopathy• Osteopathy

1989 survey

• Acupuncture

• Chiropractic

• Faith healing

• Homeopathy

• Osteopathy

Who?Who?• 40% of women

• 27% of men

• 33% of people >35years

• 26% of people <35years

• More popular in south and west of UK

• 38% of people use more than one form of complementary medicine at the same time

What Sort of Problem?What Sort of Problem?

• Musculoskeletal - 88%

• Psychological - 3%

• Respiratory - 2%

• Neurological - 2%

• Other - 4%

EvidenceEvidence“Conventional”• Counselling• Ultrasound• Bed rest• Chiropody• Many operations

EvidenceEvidence“Complementary”• 4000 articles in

medline• St johns wort• Manipulative therapies• Eczema

In SummaryIn Summary

• Very popular and growing

• Are we failing?

• What can we gain?

• Should we end any divisions and just go for “good medicine” - anything that works?

Aims of the TermAims of the Term

• Can be divided into the obvious and the hidden

• There are, I now hope many reasons why we should bother

• So that you know where I am coming from my hidden and overt aims are as follows:

Aims of the TermAims of the TermOvert• Learn about

complementary practitioners

• Be able to better advise our patients

• Learn applicable skills

Covert• Improve critical

appraisal skills• Improve EBM skills• Improve presentation

skills• Foster self worth

And Some ObjectivesAnd Some Objectives

• Natural

• Unproved

• Irrational

• Harmless

• Holistic

• Unregulated

• Alternative

Starting PointsStarting Points

www.quackwatch.com/

Maybe a obvious slant but fascinating !

Starting PointsStarting Points

The Which? Guide to Complementary Medicine

Which ? Books

Barbara Rowlands

1997

An excellent fairly balanced introduction

Starting PointsStarting Points

ABC of Complementary medicine

Starting BMJ 319 11/9/99 Page 693

But shouldn’t be all you use!

Starting PointsStarting Points

Medline - 4,000 references to complementary medicine

EMBase

Many books

Internet

The Good

The badAnd

And the ugly