CAM

Question 1

Most popular CAM modalities were found to be

Answer 1

1. Herbal Medicine
2. Homeopathy
3. Aromatherapy
4. Massage
5. Reflexology

Question 2

How to make a homeopathic preparation

Answer 2

Preparations must undergo potentisation: – Serial dilutions of a mother tincture
– Succussion

Question 3

homeopathy Direct harm

Answer 3

– No risk of interactions with ‘high potency’ medicines

Question 4

homeopathy Indirect harm

Answer 4

– Delay in receiving appropriate treatment

– Practitioner attitudes (e.g. vaccinations)

Question 5

No legal regulation of homeopaths in the UK

Answer 5

– Society of Homeopaths
– Faculty of Homeopathy
– British Homeopathic Association

Question 6

Homeopathic products regulated by

Answer 6

EU directive

Question 7

Homeopathy: Vaccinations

Answer 7

not allowed “to provide advice on vaccination or offer or provide homeopathy as an alternative to vaccination for the prevention of serious infectious diseases.”

Question 8

St John’s Wort (Hypericum): major depression - interactions with other drugs

Answer 8

– Hormonal contraceptives 
– Anti-depressives
– Anti-coagulants
– Anti-epilepsy agents
– Heart medications 
– Anti-cancer agents 
– Anti-virals for HIV 
– ... the list continues

Question 9

Herbal medicine: direct harm

Answer 9

– Adverse drug reactions
– Drug interactions
– Quality control

Question 10

Herbal medicine: indirect harm

Answer 10

– Delay in receiving appropriate treatment

Question 11

MHRA regulates herbal medicines in the UK market

Answer 11

• Safety, quality, efficacy as per any regular medicine
  • Marketing Authorisation (MA)
• Safety & quality (not efficacy) based on traditional usage
  • Traditional Herbal Medicines Registration (THR)

The “herbalist exemption”
• Regulation 3 of The Human Medicines Regulations 2012

Question 12

Chiropractic - subluxations

Answer 12

– Block the flow of ‘innate intelligence’
– Use of X-rays or gadgets
• BJPalmerandNeurocalometers

Question 13

Spinal manipulations

Answer 13

(adjustments)

– Including high-velocity, low-amplitude thrusts • Audible‘crack’

Question 14

direct harm of chiropractic and osteopathy

Answer 14

– ~50% of chiropractic patients reportedly suffer a mild to moderate adverse reaction
– Serious side effects reportedly rare (e.g. tearing of artery wall leading to stroke, injury to the spinal cord)
– Chiropractic X rays

Question 15

indirect harm of chiropractic and osteopathy

Answer 15

– Delay in receiving appropriate treatment – Attitudes of practitioner
• Anti-vaccination

Question 16

Only two CAM modalities under statutory regulation

Answer 16

– General Chiropractic Council (GCC)

– General Osteopathic Council (GOsC)

Question 17

Acupuncture - ch’i

Answer 17

as a ‘vital energy’
– Flows through ‘meridians’
– Meridians associated with major organs
– Illness due to disrupted flow of Ch’i

nsertion of needles along meridians
– Restores flow of Ch’i
– 1 – 10cm in depth, with/without rotation
– Left in place for seconds to hours

Question 18

direct harm of acupuncture

Answer 18

– Infections

– Pneumothorax

Question 19

indirect harm of acupuncture

Answer 19

– Delay in receiving appropriate treatment – Attitudes of practitioner

Question 20

Premises and practitioners must be licensed -

Answer 20

– Via local authority (same as tattooing/body piercing)
Voluntary regulation
– Several organisations, e.g. British Acupuncture Council

Question 21

Reflexology

Answer 21

the application of pressure to areas on the feet (or the hands)

Question 22

conditioning - pavlovs dog - placebo theory

Answer 22

bell ring = food = salivation

Question 23

expectancy theory examples

Answer 23

• wine and placebo alcohol

- dopamine and money

Question 24

Why do people use CAM

Answer 24

• Health promotion (e.g. general wellbeing)
• Believe will be more effective than conventional treatment
• Exhausted conventional options
• Conventional options associated with side effects / risks
• No conventional therapy available
• Conventional approach emotionally / spiritually bereft
• Feeling more in control

Question 25

Medical pluralism

Answer 25

Adoption of more than one medical system (beliefs/behaviours/treatments)
For example, think about complexity of interactions in migrants
• Trustindoctors/systemsbackhome • UKsystemmaybeconfusing
• Pragmatism
• Speed of access

Question 26

Many factors can make a treatment appear effective

Answer 26

– Disease-associated
– Patient-focussed
– CAM-based

Question 27

Natural impediments to making valid inferences

Answer 27

Placebo effect
Natural history of disease
Regression to the mean
Causal inferences
Reluctance to admit when wrong – i.e. cognitive dissonance
Respect for authority