Complementary Alternative Medicine

Question 1

What are the definitions of the following:

• Complementary alternative medicine?
• Complementary medicine?
• Integrative medicine?
• Alternative medicine?
• Naturopathy vs allopathy?

Answer 1

Question 2

Here are the classifications of complementary alternative medicines:

• Alternative medical systems
• Mind-body interventions
• Biologically based therapies
• Manipulative and body-based methods
• Energy therapies

Give examples of each.

Answer 2

Question 3

What are the most popular CAM modalities in the UK?

Answer 3

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

Question 4

Why do people use CAM?

Answer 4

• Health promotion (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
• Do they know or identify it as CAM?

Question 5

What is medical pluralism?

Answer 5

• Adoption of more than one medical system (beliefe / behaviours / treatments).
• For example, think about the complexity of interactions with migrants:
  
  • Trust in doctors / systems back home
  • UK system may be confusion
  • Pragmatism
  • Speed of access

Question 6

Describe how to make a homeopathic preparation.

Answer 6

• Principle of similars (a substance that produces effects resembling the symptoms of particular diseases).
• Preparations must undergo potentisation:
  
  • ​Serial dilutions of a mother tincture
  • Succession
• Homeopathic dilutions are commonly given at 30C dilution = 1 in 100³⁰.

Question 7

What are the risks of homeopathic treatments?

What are the legal regulations?

Answer 7

• Direct harm
  
  • ​No risk of interactions with ‘high potency’ medicines
• 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
• Homeoathic products are regulated by EU directive.

Question 8

What are the interactions of St John’s Wort (hypericum)?

Answer 8

• Hormonal contraceptives
• Anti-depressives
• Anti-coagulants
• Anti-epilepsy agents
• Heart medications
• Anti-cancer agents
• Anti-virals for HIV
• … the list goes on

Question 9

What are the risks of herbal medicines?

What are the regulations?

Answer 9

• Direct harm
  
  • ​Adverse drug reactions
  • Drug interactions
  • Quality control
• Indirect harm
  
  • ​Delay in receiving appropriate treatment
• MHRA regulated herbal medicines in the UK market.
  
  • ​Safety, quality, efficacy as per regular medicine.
    
    • ​Marketing authorisation (MA)
  • Safety and quality (not efficacy) based on traditional usage.
    
    • ​Traditional Herbal Medicines Registration (THR).
  • The ‘herbalist exemption’
    
    • ​Regulation of 3 of The Human Medicines Regulation 2012.

Question 10

Describe chiropractic CAM.

Answer 10

• Spinal manipulations (adjustments)
  
  • Including high-velocity, low amplitude thrusts
    
    • Audible crack
• Detects ‘subluxations’
  
  • Block the flow of ‘innate intelligence’
  • Use of X-rays or gadgets
• Placebo manipulations?
  
  • Comparative treatments e.g. physiotherapy
  • Massage often part of chiropractic asessment

Question 11

What are the risks of chiropractic and osteopathy?

What are the regulations?

Answer 11

• Direct harm
  
  • ​~50% of chiropractic patients suffer an adverse reaction
  • Tearing of artery wall leading to stroke
  • Injury to the spinal cord
  • Chiropractic X rays
• Indirect harm
  
  • ​Delay in receiving appropriate treatment
  • Attitudes to practitioner
    
    • Anti-vaccination
• Only 2 CAM modalities under statutory regulation
  
  • ​General Chiropractic Council (GCC)
  • General Osteopathic Council (GOsC)

Question 12

Describe acupuncture.

Answer 12

• Ch’i as a ‘vital energy’.
  
  • Flows through ‘meridians’
  • Meridians are associated with major organs
  • Illness due to disrupted flow of Ch’i
• Insertion of needles along meridians
  
  • ​Restores flow of ch’i
  • 1-10cm in depth, with / without rotation
  • Left in place for seconds to hours
• Diagnosis
  
  • ​Inspection, auscultation, olfaction, palpation and inquiry.

Question 13

What are the orthodox explanations of acupuncture?

Answer 13

• Gate control theory of pain
• Opioid release
• Placebo effect

Question 14

What are the risks associated with acupuncture?

What are the regulations?

Answer 14

• Direct harm
  
  • ​Infections
  • Pneumothorax
• Indirect harm
  
  • ​Delay in receiving appropriate treatment
  • Attitudes of practitioner
• Premises and practitioners must be licensed
  
  • Via local authority (same as tattooing / body piering)
  • Voluntary regulation - severl organisations, e.g. British Acupuncture Council

Question 15

What is reflexology?

Answer 15

• Reflexology is a type of massage that involves applying different amounts of pressure to the feet, hands, and ears.
• It’s based on a theory that these body parts are connected to certain organs and body systems.

Question 16

What are the theories of the placebo effect?

Answer 16

• Endogenous opiates
  
  • ​Naloxone-sensitive results?
• Conditioning
  
  • ​Pavlov’s dog
• Expectancy
  
  • ​Wine and placebo alcohol
  • Dopamine and money
• Motivation
  
  • ​Hawthorne effect

Question 17

What are the ethical issues surrounding CAM?

Answer 17

• Does it work?
  
  • ​It is nothing more than placebo; is that a bad thing?
  • Do we need to know how a treatment works?
• Is it safe?
  
  • ​Regulation of practitioners / substances
  • Direct vs indirect harm
• How to balance patient choice against YOUR FIRST DUTY AS A DOCTOR:
  
  • ​MAKE THE CARE OF THE PATIENT YOUR FIRST CONCERN
  • Patient autonomy
  • Informed choice