HaDSoc Week 9

Question 1

What is complementary and alternative medicine?

Answer 1

Involves any medical system based on a theory of disease or method of treatment other than the orthodox science of medicine as taught at medical school

Question 2

What is the difference between alternative and complementary medicine?

Answer 2

When first introduced in 1970s/80s - alternative to conventional healthcare - implying rejection of traditional medicine
Now increasingly common to combine with traditional medicine - hence complimentary rather than alternative
Covers very diverse range of practices
Some have more relationship to conventional methods than other:
- osteopathy, chiropractors (regulated)
- acupuncture (evidence-base growing)

Question 3

Give some examples of complementary therapies?

Answer 3

Acupuncture
Aromatherapy
Art therapy
Bach flower remedy
Hypnotherapy
Indian head massage
Reflexology
Relaxation and visualisation

Question 4

What did the review : prevalence of use of complementary and alternative medicine by physicians in the UK: a systematic review of surveys (2012), find?

Answer 4

Used 13 studies of low methodological quality
Average prevalence - 20.6%
Average referral rate - 39%
Recommended by 46% of physicians
Up to 1/3 of people with cancer and 50% of breast cancer patients are using complementary therapy
Most contact probably happens outside the NHS

Question 5

Why do people turn to complementary therapies?

Answer 5

Persistent symptoms not relieved by conventional treatment
Real or perceived adverse effects of conventional treatment
Preference of a holistic approach to their problem
May feel that they receive more time and attention (but they are paying for it)

Question 6

What do patient’s think about complementary therapies?

Answer 6

Aware that there is an increasing availability and demand
High level of satisfaction reported
Common concerns:
- competence
- safety
- guilt e.g. Fighting cancer - time/money spent
- denial - deluding themselves about the effects
- cost
- social factors - inequality in ability to afford it

Question 7

What do doctors think about complementary therapies?

Answer 7

Tend to believe some established forms may be of benefit
Common concerns:
- unqualified and unregulated practitioners
- may risk missed or delayed diagnosis
- may refuse conventional treatment
- may waste money on ineffective treatment
- the mechanism of some complimentary treatments is so implausible it cannot work

Question 8

What is the effect of complementary medicine on the overall picture of healthcare?

Answer 8

Makes care even more fragmented
More going on that the traditional healthcare workers might not know about
Safety concerns
Complementary medicines can interact with traditional medicine

Question 9

What does NICE think about complementary medicine?

Answer 9

Recommended the use of CAM in a limited number of circumstances:
The Alexander technique for parkinsons
Ginger and acupressure for relieving morning sickness
Acupuncture and manual therapy, including spinal manipulation, spinal mobilisation and massage for persistent low back pain

Question 10

What is aromatherapy?

Answer 10

Controlled use of essential oils which have therapeutic properties
Relieve stress, ease tension, improve health and promote a sense of wellbeing
Topical (usually combined with massage) or inhalation - fragrance stimulates limbic system of the midbrain –> releases hormones which influence mood

Question 11

What is acupuncture?

Answer 11

Stimulation of special points on the body - usually by insertion of fine needles
Workings of the human body are controlled by a vital force or energy called “Qi”
The acupuncture points are located along the meridians and provide means of altering the flow of Qi
Acupuncture points correspond to physiological and anatomical features - e.g. Peripheral nerve junctions
Trigger points and referred pain e.g. Tender areas in neck and shoulder muscles which relate to various patterns of headache

Question 12

What standard should the evidence for complimentary therapies meet?

Answer 12

The same standards as conventional medicine

Question 13

What did the systematic review on acupuncture for migraine discover?

Answer 13

22 trials with 4419 participants
Variety of comparisons e.g. ‘Sham’ acupuncture and prophylactic drug treatment
Acupuncture was at least as effective or more effective than the prophylactic drug treatment - with fewer adverse effects
True acupuncture v.s. ‘Sham’ acupuncture results were difficult to interpret
The conclusion was that acupuncture should be considered as a treatment option

Question 14

What did the systematic review on acupuncture for knee pain find?

Answer 14

13 trials with 2,362 patients
8 trials included in a meta-analysis
Range of controls used: true sham and superficial acupuncture, TENS, current drug, education group
Acupuncture was superior to sham for both pain and function in short term and long term
Acupuncture also superior to no additional intervention
Questionable if results reliable - issue with range of controls

Question 15

What are some of the challenges in conducting trials?

Answer 15

Resources - who will fund? (Not big pharmaceuticals)
Trial of single intervention may not reflect reality - the whole “ethos”/ engaging with patients etc. Whole package
Multifaceted intervention trial very complex
Agreement to randomisation
Finding placebos/shams is challenging
Difficult to make double-blind

Question 16

Are complementary therapies an appropriate use of resources?

Answer 16

Don’t have evidence base to support them - e.g. If money spent on aromatherapy for cancer patients will have less for chemotherapy
What kind of value should be placed on improving the patient’s overall experience of treatment - e.g. Think about the woman who said that aromatherapy really helped her mind set in chemotherapy

Question 17

Should NICE evaluate complementary therapies?

Answer 17

Arguments for:

• high public interest
• half GPs provide access
• address inequalities in access/opportunity
• should apply same standards
• stimulates more/higher quality research

Against:

• money in NHS limited
• NICE has higher priorities
• poor quality evidence

Question 18

Is evidence based medicine relevant to complementary medicine?

Answer 18

Issue of assessing effectiveness in ways consistent with EBM principles
Is EBM relevant and applicable to complimentary medicine?
Whose evidence counts?
Practitioners tend to fall back on evidence based on tradition and experience rather than RCT evidence etc.
Argument that the healing potential of these therapies cant be reduced to an RCT/ grasped by western notion of rationalism
Questioning validity of EBM - when the therapies have been around for 2000 years - surely it must be efficacious and of some value otherwise why do people want it

Question 19

What is the relevance of complementary therapies to doctors?

Answer 19

May be able or asked to provide some access to complimentary therapies
Different patients will have different beliefs/approaches
Unlikely to be one universal answer
Need to be aware of the range of therapies available and why patients use them