Complementary and alternative medicine

Question 1

WHO definition of CAM (2000)

Answer 1

“A broad set of healthcare practices that are not part of that country’s own tradition and are not integrated into the dominant healthcare system.”

Question 2

GMC guidance on CAM (2009)

Answer 2

“Demonstrate awareness that many patients use complementary and alternative therapies, and awareness of the existence and range of these therapies, why patients use them, and how this might affect other types of treatment that patients are receiving.”

Question 3

Zollman and Vickers’ definition of CAM (1999)

Answer 3

“A group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional healthcare is taught and provided.”

Question 4

WHO definition of traditional medicine (2019)

Answer 4

“The knowledge, skill and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.”

Question 5

Integrative medicine

Answer 5

A holistic approach to medicine, involving the selective incorporation of CAM into conventional practice. There is an emphasis on the patient as a whole, and the importance of their relationship healthcare professionals.

Question 6

Medical pluralism

Answer 6

The availability of different medical approaches, treatments and institutions in healthcare practice.

Question 7

US: NCCIH classification of CAM therapies

Answer 7

• alternative medical systems
• mind body therapies
• natural products
• manipulative and body-based methods
• energy therapies

Question 8

UK: House of Lords’ classification of CAM therapies

Answer 8

• Group 1: Professionally organised alternative therapies
• Group 2: Complementary therapies
• Group 3: Alternative disciplines

Question 9

5 most popular CAM therapies

Answer 9

• herbal medicine (32.4%)
• homeopathy (10.8%)
• aromatherapy (8.1%)
• massage (8.1%)
• reflexology (5.4%)

Question 10

Common characteristics of CAM users

Answer 10

• female gender
• middle age
• higher socio-economic group
• higher level of education
• higher income
• poorer self reported health

Question 11

Patterns of use of CAM

Answer 11

• earnest seekers
• stable users
• eclectic users
• one-off users

Question 12

Concerns about CAM

Answer 12

Patients may:

• see unqualified complementary therapists
• risk missed or delayed diagnosis
• stop or refuse effective conventional treatment
• waste money on ineffective treatments
• experience dangerous adverse effects

Question 13

Positive factors contributing to the use of CAM

Answer 13

• perceived effectiveness
• perceived safety
• philosophical congruences
• control over treatment
• high touch/low tech
• good patient/therapist relationship
• non-invasive nature
• accessibility
• pleasant experience
• affluence

Question 14

Negative factors contributing to the use of CAM

Answer 14

• dissatisfaction with conventional healthcare ; long waiting times, short appointments, poor treatment, bad doctor/patient relationship
• rejection of science and technology
• rejection of the establishment
• desperation

Question 15

Who uses CAM?

Answer 15

Patients with chronic and difficult to manage conditions eg. cancer, HIV, MS, psoriasis, musculoskeletal conditions, use CAM at higher rates.

Over-the-counter (OTC) use is more popular than seeing a therapist, as it is generally cheaper, faster and more convenient.

Question 16

Problems with CAM research

Answer 16

It is difficult to design high-quality studies into CAM, as therapies are often highly individualised, multi-faceted and hard to simulate. Patient randomisation and practitioner blinding are also difficult.