Integration of Complementary, Alternative and Chinese Medicine - Essay Example

Complementary, Alternative and Chinese Medicine Acceptance and Integration Introduction Complementary and alternative medicine (ALTERNATIVE MEDICINE) is now a major part of the healthcare system in all advanced societies. It is also a common part of discourse in medicine and healthcare. This growth of interest has only partially been matched by academic study of it. Indeed, over recent years there has been an increasing recognition that ALTERNATIVE MEDICINE is essentially under-researched (House of Lords 2000). However, with this recognition has come an increasing concentration on a particular form of research-that geared towards the production of an evidence base and/or an immediate relevance to policy and practice. These research priorities are reflected in much of the work that is published on ALTERNATIVE MEDICINE. In both standard medical journals and in ALTERNATIVE MEDICINE specific publications the emphasis is squarely on the problems of efficacy and of issues to do with practice, most recently integrative practice. Most books written in the field follow this pattern, being either concerned with the demonstrable value of individual therapies (Ernst et al. 2001) or being written as 'how to' guides geared towards practitioners (see, for example, Vickers 1993; Downey 1997; Tanvir 2001). Viewing ALTERNATIVE MEDICINE as a historically contingent and contested social product produces a very complex picture of a diverse field of therapies, products and relationships. Whilst we can note the existence of contestation between orthodox medicine and ALTERNATIVE MEDICINE, we should not fall back on the conventional picture that presents ALTERNATIVE MEDICINE versus orthodox medicine as the key to understanding ALTERNATIVE MEDICINE. Neither orthodox medicine nor ALTERNATIVE MEDICINE is a monolith. There are disputes and boundary claims being made both within orthodox medicine and within ALTERNATIVE MEDICINE. Not all medical practitioners agree on what constitutes orthodox medicine and not all ALTERNATIVE MEDICINE practitioners agree on what constitutes the alternative or the complementary (Tovey and Adams 2001). In these disputes ALTERNATIVE MEDICINE can itself be used to assert boundaries within orthodox medicine, and make claims to particular skills or techniques, as, for example, in the case of nursing and therapeutic touch (Trevelyan and Booth 1994). Similarly, within ALTERNATIVE MEDICINE some practitioners seek alliance with orthodox medicine, using orthodox medical courses as part of the training of their therapists (for example chiropractic). The term 'complementary', and more recently the term 'integrative' medicine, are signals of this complex social interaction. Both orthodox medicine and ALTERNATIVE MEDICINE are constantly changing social products influenced by each other and by other social forces over which they have little or no control. The direction and pace of change is affected by the history of a particular region or country, so that homeopathy is popular among physicians in the UK, Germany, US and France (Wardwell 1994) and acupuncture among physicians in Australia (Easthope et al. 1998), while hydrotherapy is a major modality in Germany and herbal remedies are used both there and in China (Ullman 1993). Other contingencies such as changing state regulation affect which particular therapies are successful. For example, the Netherlands has recently allowed some modalities to receive limited state recognition and funding (Schepers and Hermans 1999) and the state of Victoria, in Australia, has legislated to register traditional Chinese medical practitioners (Willis and White). Less obviously, changing social structures in some countries or regions may create more middle-class consumers seeking preventive health measures through ALTERNATIVE MEDICINE. Orthodox medical practice and ALTERNATIVE MEDICINE trends in late Western societies In advanced modern/postmodern societies, such as Australia, the USA, the UK, Canada and New Zealand, numerous writers and editors (Cohen 2000; Ernst 2000; Vickers 2000) note not only a growing public interest in Complementary and alternative medicine - ALTERNATIVE MEDICINE but also a growing number of orthodox medical practitioners who themselves are using techniques once labelled as 'unconventional therapeutic methods'. The terms 'complementary medicine', or 'integrative medicine', prevail in the literature on the provision of these therapies and medicines by orthodox medical practitioners. On the one hand, this labelling indicates the integration of 'alternative medicine' with 'conventional medicine' in doctors' clinical practice (Vickers 2000). On the other hand, it indicates the entrenched views of segments of the orthodox medical profession that ALTERNATIVE MEDICINE remains 'unscientific' and thereby 'alternative' or at best 'complementary'. However, the term 'complementary medicine' is increasingly associated with bio medically trained practitioners and those ALTERNATIVE MEDICINE therapies and medicines that are supported by the scientific rigours of evidence-based medicine (EBM). Finally, the 'integration' of ALTERNATIVE MEDICINE into primary healthcare in late Western societies, particularly the UK and Australia, has been encouraged by government recommendations that non-medically trained CPs should be involved in integrated primary care service delivery models (Wooldridge 1998; Paterson 2000; Tovey and Adams 2001). The increasing provision of, and interest in, ALTERNATIVE MEDICINE by segments of the orthodox medical profession, specifically GPs, is part of a global trend in late Western societies that has seen growing consumer use of ALTERNATIVE MEDICINE. For example, in 1997, more visits were made by Americans to ALTERNATIVE MEDICINE practitioners (629 million) than to primary care physicians (386 million). Incorporation of ALTERNATIVE MEDICINE into orthodox service provision and tertiary health professional education is also notable. For instance, ALTERNATIVE MEDICINE is taught in 60 per cent of US medical schools. Across the board, there is increased government regulation of ALTERNATIVE MEDICINE and its practitioners, and increased scientific research into the effectiveness of ALTERNATIVE MEDICINE. For example, in the USA a National Centre for Complementary Medicine, with a budget of $US 50 million, has been established (Bensoussan 1999). The status of ALTERNATIVE MEDICINE practitioners in late Western primary healthcare systems Despite the similarities among late Western societies, the status of ALTERNATIVE MEDICINE within them varies. In the USA, for example, osteopaths are no longer considered marginal. Every state now licenses them on an equal basis with medical doctors. By contrast, osteopaths in Canada, the UK, Australia, New Zealand and France have little of the recognition and privileges of medical doctors. In the UK, Germany and the USA, homeopathy has been co-opted and successfully absorbed by orthodox medicine (Wardwell 1994). Conversely, in Australia, homoeopathy has been incorporated into the broader practice of natural therapists as one commonly used sub modality (Willis 1989). In most European countries, herbal medicine can only be legally practiced by doctors. In Germany, an estimated 20 per cent of GPs prescribe homeopathic medicine, 30 per cent use herbal remedies as a regular part of their practice and 77 per cent of pain clinics use acupuncture. Acupuncture has a similarly high usage rate by doctors throughout Europe (Ullman 1993). In 1999, legislation in Australia has paved the way for registration of traditional Chinese medicine (TCM) practitioners. Significantly increased consumer interest in ALTERNATIVE MEDICINE is reflected in a shift in attitude in the British and Australian orthodox medical profession. This shift is evident, first in the British Medical Association's (BMA) publication, Complementary Medicine: New Approaches to Good Practice (1993), second in the use of the term 'complementary' rather than 'alternative' (Vickers 2000), and finally in the policy shift by the Australian Medical Association (AMA) on ALTERNATIVE MEDICINE. In the BMA report (1993), it is noted that doctors should be able to attend seminars and courses on the principles and methods of such therapies in order that their decision-making may be based on an understanding of their benefits and hazards. The BMA have encouraged the incorporation of complementary therapies into undergraduate medical curricula and postgraduate training. Further, the BMA encourages doctors working with accredited CPs (Kotsirilos 1995). Currently, the AMA-the main body that represents Australian doctors-has formulated a policy on ALTERNATIVE MEDICINE recommending that 'we equip our current doctors and future GPs and specialists with working knowledge of the products and therapies'. This policy position is in stark contrast to the AMA's prior stance on ALTERNATIVE MEDICINE that stated that 'a medical practitioner should at all times practice methods of treatment based on sound scientific principle, and accordingly does not recognize any exclusive dogma such as homeopathy, osteopathy, chiropractic, and naturopathy' (Simpson 1992:1). Which ALTERNATIVE MEDICINE modalities are employed by GPs? Despite the differing and rapidly changing positions that ALTERNATIVE MEDICINE occupies in Western primary healthcare systems, studies reveal that medical practitioners across the board are utilising similar ALTERNATIVE MEDICINE procedures. These procedures are acupuncture, chiropractic/osteopathy, herbal medicine, homeopathy, hypnosis, and naturopathy. Willis (1994) refers to these as principal modalities in comparison to more esoteric alternative treatments. Indeed, Willis argues that: the modalities may be thought of as occurring along a continuum of legitimacy with chiropractic and osteopathy, natural therapy and traditional Chinese medicine at one end, shading off into the more esoteric and spiritual modalities of healing at the other end of the continuum. (Willis 1994:58) Nevertheless, even though spiritual healing is not a popular modality with orthodox doctors, studies suggest that GPs, particularly in the UK and the USA, increasingly acknowledge the importance of spirituality in health (Aldridge 1991; Berman et al. 1995). For example, Berman and colleagues' study of family physicians (1995) found that 61 per cent of the sample (n=295) practised ALTERNATIVE MEDICINE, with massage therapy (35 per cent) and hypno therapy and prayer (31 per cent each) the most popular modalities. An earlier study of 160 physicians by Koenig et al. (1989) found that many physicians believe that religion has a positive effect on physical health, that religious issues should be addressed and that older patients may ask their physicians to pray with them. The belief system of the practitioner may influence the willingness of the patient to talk about their religious beliefs. Although 80 per cent of this sample (n=115) never referred patients to spiritual healers, a number of studies (Willis 1994) show that 'general practitioners are willing to entertain the idea of spiritual healing and incorporate it into their daily practice, or as part of their referral network' (Aldridge 1991:426). Interestingly, recent Australian studies have shown GP interest in providing meditation (Pirotta et al. 2000). The incorporation of ALTERNATIVE MEDICINE into orthodox medicine started earlier in the UK and Western Europe as a whole, and therefore there is not the dramatic increase seen elsewhere. Recent UK studies, however, document a stable, continuing trend of the provision of homeopathy, acupuncture, hypnotherapy and manipulation by GPs (Schepers et al 1999). Earlier studies have shown that 37 per cent of GPs in the UK use homeopathy to varying degrees and those who use homeopathy regularly do so in about one-quarter of their consultations, the proportion being higher for hospital and private specialists (Simpson, 1992). British researchers (Wooldridge 1998) surveyed a random sample of 195 GPs, testing their attitudes towards spinal manipulation, acupuncture, hypnosis, herbal medicine, homeopathy and spiritual healing. Over half the GPs surveyed perceived these therapies as either useful or very useful and regularly referred patients to complementary therapists. Approximately half of those referrals were to registered, but non-medically qualified, practitioners (Wooldridge 1998:380). Over one-third of France's 54,400 GPs use ALTERNATIVE MEDICINE (5 per cent exclusively, 21 per cent often and 73 per cent occasionally), 39 per cent of these GPs use homeopathy and 30 per cent use herbal medicine as part of their regular practice. Eighty per cent of homeopathic medicines are dispensed on prescriptions rather than over the counter (Schepers et al 1999). Conclusion A study of Canadian GPs (n=400) found that 56 per cent of GPs believed that ALTERNATIVE MEDICINE incorporates ideas and methods from which conventional medicine could benefit, 54 per cent referred patients to CPs, and 16 per cent practised some form of ALTERNATIVE MEDICINE. Acupuncture, chiropractic and hypnosis were considered the most useful, and reflexology, naturopathy and homeopathy the least useful (Tovey & Adams, 2001). Another Canadian study of GPs in Quebec (n=121) found that 59 per cent referred to physicians who perform complementary health services such as acupuncture, chiropractic and hypnosis. Eighty-three per cent regarded at least one of the three services studied as having some effectiveness. New Zealand surveys have shown that approximately 30 per cent of doctors provide ALTERNATIVE MEDICINE, with acupuncture, osteopathy and homeopathy the most popular treatments. A survey of Wellington GPs (n=226) found that 24 per cent of GPs had received training in a complementary therapy; 27 per cent currently practised at least one therapy and 77 per cent indicated they referred to other medical practitioners for complementary therapies. Overall, data show interest in referral and provision of ALTERNATIVE MEDICINE by GPs. Although interest in the different ALTERNATIVE MEDICINE modalities varies among Western countries, it is clear that acupuncture, chiropractic, osteopathy, hypnosis, homeopathy and herbal medicine are the modalities of greatest interest to GPs. Works Cited Aldridge, D. (1991) 'Spirituality, healing and medicine', British Journal of General Practice 41:425-7. 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