CAM Flashcards
Most popular CAM modalities were found to be
- Herbal Medicine
- Homeopathy
- Aromatherapy
- Massage
- Reflexology
How to make a homeopathic preparation
Preparations must undergo potentisation: – Serial dilutions of a mother tincture
– Succussion
homeopathy Direct harm
– No risk of interactions with ‘high potency’ medicines
homeopathy Indirect harm
– Delay in receiving appropriate treatment
– Practitioner attitudes (e.g. vaccinations)
No legal regulation of homeopaths in the UK
– Society of Homeopaths
– Faculty of Homeopathy
– British Homeopathic Association
Homeopathic products regulated by
EU directive
Homeopathy: Vaccinations
not allowed “to provide advice on vaccination or offer or provide homeopathy as an alternative to vaccination for the prevention of serious infectious diseases.”
St John’s Wort (Hypericum): major depression - interactions with other drugs
– Hormonal contraceptives – Anti-depressives – Anti-coagulants – Anti-epilepsy agents – Heart medications – Anti-cancer agents – Anti-virals for HIV – ... the list continues
Herbal medicine: direct harm
– Adverse drug reactions
– Drug interactions
– Quality control
Herbal medicine: indirect harm
– Delay in receiving appropriate treatment
MHRA regulates herbal medicines in the UK market
- 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
Chiropractic - subluxations
– Block the flow of ‘innate intelligence’
– Use of X-rays or gadgets
• BJPalmerandNeurocalometers
Spinal manipulations
(adjustments)
– Including high-velocity, low-amplitude thrusts • Audible‘crack’
direct harm of chiropractic and osteopathy
– ~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
indirect harm of chiropractic and osteopathy
– Delay in receiving appropriate treatment – Attitudes of practitioner
• Anti-vaccination
Only two CAM modalities under statutory regulation
– General Chiropractic Council (GCC)
– General Osteopathic Council (GOsC)
Acupuncture - ch’i
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
direct harm of acupuncture
– Infections
– Pneumothorax
indirect harm of acupuncture
– Delay in receiving appropriate treatment – Attitudes of practitioner
Premises and practitioners must be licensed -
– Via local authority (same as tattooing/body piercing)
Voluntary regulation
– Several organisations, e.g. British Acupuncture Council
Reflexology
the application of pressure to areas on the feet (or the hands)
conditioning - pavlovs dog - placebo theory
bell ring = food = salivation
expectancy theory examples
- wine and placebo alcohol
- dopamine and money
Why do people use CAM
- 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
Medical pluralism
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
Many factors can make a treatment appear effective
– Disease-associated
– Patient-focussed
– CAM-based
Natural impediments to making valid inferences
Placebo effect Natural history of disease Regression to the mean Causal inferences Reluctance to admit when wrong – i.e. cognitive dissonance Respect for authority
