Models of medicine

Question 1

Where does complementary medicine derive from?

Answer 1

Derives from the folk sector of Kleinmann’s model but is an aspect of all 3 sectors

Question 2

What is the biggest issue with complementary medicine?

Answer 2

Evidence base - there is strong evidence to suggest placebo effect - some people have suggested it doesn’t work unless you believe it will work

Question 3

What is the difference between non-orthodox/alternative medicines and complementary medicines?

Answer 3

Non-orthodox/alternative medicine = practice that is alternative to biomedicine - not carried out at the same time as biomedical approaches

Complementary medicine - carried out at the same time as biomedicine

Question 4

What does CAM stand for?

Answer 4

Complementary and alternative medicine

Question 5

What does integrative medicine mean?

Answer 5

describes situations in which both patient and healthcare profession uses complementary medicine alongside orthodox practice

Question 6

What is “pluralism”?

Answer 6

“extreme system” - system where there are lots of different models of healthcare
e.g. At the GP, GP offers a treatment approach or offers a referral to another system = each system is used to an equal stake

Question 7

How many people use CAM?

Answer 7

Within UK population - 26% = its cheaper and easier sometimes than using orthodox approaches

Consult a therapist - 12%

Over the counter - 26%

Question 8

Which people are more likely to use CAM?

Answer 8

Higher rates of use among patients with chronic and difficult to manage diseases e.g. cancer, HIV, MS, psoriasis

• Among cancer patients 7-64% depending on population surveyed and type of cancer - can help to improve side effects of chemotherapy, can be a remedy of last resort when all hope has gone
  e. g. Breast cancer patients demonstrate high usage

Question 9

What factors have facilitated the growth of interest in and use of complementary and alternative medicine?

Answer 9

Popular dissatisfaction with orthodox medicine - side effects, efficacy, waiting times
Post-modern philosophy-rejection of (scientific authority, increase in consumerism, importance of individual responsibility for health)- healthiest
Widespread availability and access to health information

Question 10

What are the different groups in the NCCAM?

Answer 10

Whole medical system: built upon complete systems of theory and practice e.g. homeopathic medicine, Chinese medicine

Mind-body medicine: uses a variety of techniques designed to enhance the mind’s capacity to affect bodily functions and symptoms e.g. meditation

Biologically based practices: uses natural substances e..g dietary supplements

Manipulative and body based practice: movement of one or more parts of the body e.g. chiropractic

Energy medicine: involves the use of energy fields e.g. reiki

Question 11

Why is prayer classified as a CAM?

Answer 11

There is evidence suggesting it is good for cardiovascular health

Question 12

What are some examples of the house of lords report classification of CAM therapies 2000?

Answer 12

Group 1 - principle disciplines
- Acupuncture
- homeopathy = evidence for this approach is the most controversial - letting like be treated by like e.g. very diluted plant based/chemical substances which in large doses could cause harm
because approaches are so individual it is very difficult to do an RCT

Group 2- have diagnostic skill and often used to complement orthodox medications

• Alexander techniques - tries to improve a person’s posture
• Hypnotherapy
• meditation

Group 3

• Naturopathy
• Chinese herbal medicine
• crystal therapy
• Dowsing - holding a fork twig and looking for source of water

Question 13

What are the most populate therapies?

Answer 13

Herbal medicine = 34%
Aromatherapy = 21%
Homeopathy = 17% 
These are all easy to access over the counter
Acupuncture = 14%
Massage = 6%
Reflexology = 6%
Osteopathy = 4%
Chiropractic = 2% 
These last 2 are less convenient

Question 14

What are the characteristic users of CAM?

Answer 14

Females - women tend to be more educated on health topics
Middle aged - menopause is a key reason due to the numerous detrimental symptoms
Higher socio-economic class
Higher level of education
High income
Regional differences = more likely to take place in rural places - in the 60s those areas tended to be where hippies inhabited
Ethnicity - evidence is poor
Poorer self-reported health

Question 15

What are the recognised patterns (types) of use of complementary medicine?

Answer 15

EARNEST SEEKERS: have an intractable health problem for which they try many forms of treatment

STABLE USERS: Either use one type of therapy of heir healthcare problems or have one main problem for which they use a regular package of one or more complementary therapies

ECLECTIC USERS: choose and use different forms of therapy depending on individual problems and circumstances

ONE-OFF USERS: discontinue complementary treatment after limited experimentation

Question 16

What are the positive reasons why people use CAM?

Answer 16

• Perceived effectiveness
• Perceived safety - because its natural people believe its safe BUT actually there have been many cases where they have not been safe e.g. unclear acupuncture needles
• Philosophical congruence
• Control over treatment
• High touch/low tech
• Good patient / therapist relationship = sufficient time, on equal terms, emotional factors, empathy - surroundings tend to be pleasant because the therapist wants you to come back
• Non-invasive nature
• Accessibility
• Pleasant therapeutic experience
• Affluence

Even in tough times there is no evidence to suggest the rates decrease

Question 17

What are the negative reasons why people use CAM?

Answer 17

• Dissatisfaction with (some aspects of) conventional healthcare - ineffective for certain conditions, serious adverse side effects, poor dr/patient relationship, insufficient time with dr., waiting times, high tech/low touch
• rejection of science and technology
• rejection of the establishment
• desperation

High tech/low touch= Drs. don’t touch patients as often, as you have equipment that will do it instead but actually human touch is a powerful tool

Question 18

What is the process of becoming a CAM user?

Answer 18

1) Individual develops a nature centred and holistic philosophy of health
2) Decision to visit a CAM therapist - chronic illness substance lifestyle change e.g. dietary changes, using herbs. Acute illness decision to visit CAM therapist because orthodox medicine was unsuccessful
3) Patient-practitioner encounter - patient satisfaction with consultation length / belied and competence of practitioner. Patient views therapy as efficacious, feels capable of carrying out prescribed treatment regime
4) Cultivation of a culture of natural health care, further lifestyle changes, learning new practices, experimentation, explaining results to self and others
5) Individual becomes a regular user holds firm belief in therapy, doesn’t completely discard orthodox medicine, belief in its use for certain conditions - useful for diagnosis - most people don’t completely disregard orthodox medicine

Question 19

What are the areas of potential controversy with CAMs?

Answer 19

Rise in popularity - patients/healthcare practitioners / lay therapists
Information widely available to lay public (internet, pharmacists, media)
Treatment widely available to the public - OTC, therapists that have orthodox healthcare qualifications
Training in CAM - in depth lay therapist training vs. short course training for Drs
The effects on dr/patient relationship (health beliefs, disclosure, patient may know more than dr, dr may recommend but patient may be unwilling, patient may want treatment but dr is unwilling)
Adverse effects with orthodox treatment - e.g. st.johns wort
Evidence base- cure vs feeling better