Complementary Medicine

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Complementary Medicine

• Why bother for a whole term?

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Complementary or Alternative

• Which is more acceptable to who?
• Needs complementing?
• Need for alternative?
• Whose need?
• What can we learn from these practitioners?

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One image !

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Or Another?
Caring Holistic No iatrogenic problems?
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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.

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• 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?

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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?

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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

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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

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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

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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

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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

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Who?

• 40 of women
• 27 of men
• 33 of people gt35years
• 26 of people lt35years
• More popular in south and west of UK
• 38 of people use more than one form of
  complementary medicine at the same time

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What Sort of Problem?

• Musculoskeletal - 88
• Psychological - 3
• Respiratory - 2
• Neurological - 2
• Other - 4

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Evidence

• Conventional
• Counselling
• Ultrasound
• Bed rest
• Chiropody
• Many operations

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Evidence

• Complementary
• 4000 articles in medline
• St johns wort
• Manipulative therapies
• Eczema

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In 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?

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Aims 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

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Aims of the Term

• Overt
• 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

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And Some Objectives

• Natural
• Unproved
• Irrational
• Harmless
• Holistic
• Unregulated
• Alternative

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Starting Points
www.quackwatch.com/
Maybe a obvious slant but fascinating !
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Starting Points
The Which? Guide to Complementary Medicine
Which ? Books Barbara Rowlands 1997
An excellent fairly balanced introduction
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Starting Points
ABC of Complementary medicine Starting BMJ 319
11/9/99 Page 693 But shouldnt be all you use!
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Starting Points
Medline - 4,000 references to complementary
medicine EMBase Many books Internet
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The Good

• The bad
• And

And the ugly
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