Complementary Medicine
Why bother for a whole term?
www.bradfordvts.co.uk
Complementary or Alternative
• • • • • Which is more acceptable to who? Needs complementing? Need for alternative? Whose need? What can we learn from these practitioners?
One image !
Or Another?
Caring Holistic
No iatrogenic problems?
Why Bother?
“Scientific medicine is making big advances in drugs, technology, and genetics, yet more and more patients use complementary therapies. EBM dominates our discourse, yet health professionals increasingly refer to and practice complementary therapies that have little scientific evidence of efficacy.”
•What is the meaning behind these paradoxes? •What can we learn that will usefully inform our practice of orthodox medicine? •Why do people go to complementary practitioners?
Why Bother?
• What skills are they using? • What skills could we borrow? • What patient needs are they addressing? • Are they needs we should seek to meet? • Should we support them? • Should we attack them? • How should we respond?
How Many?
• Over one thousand forms of complementary medicine have been indexed • About 26 are “common” • There are at least 40,000 therapists in the UK
How Popular?
• Hard data lacking • Relies on survey data • Geographical variations • Cultural variations • Socio-economic variation • Ever used 14-30% • Last year 10-14% • Ever seen practitioner 33% • World wide ever seen practitioner 20-75%
How Popular?
• 45% of GPs endorse or recommend the use of complementary medicine • 21% of GPs refer patients to complementary practitioners • 10% of GPs treat patients with complementary medicine themselves • US (1990) made 425 m. Visits to comp. Practitioners and 388 m. Visits to family physicians
How Popular?
• Phenomenal growth • UK consumption of homeopathic remedies growing at 20% per year • Number of UK practitioners has doubled every 5 years for the last 15 years • Growth is occurring right across the west
Which Therapy?
1984 survey • Acupuncture • Chiropractic • Herbal medicine • Homeopathy • Osteopathy 1989 survey • Acupuncture 1993 survey • Acupuncture • Chiropractic • Herbal medicine • Homeopathy • Osteopathy
• Chiropractic
• Faith healing • Homeopathy • Osteopathy
Who?
• • • • • • 40% of women 27% of men 33% of people >35years 26% of people <35years More popular in south and west of UK 38% of people use more than one form of complementary medicine at the same time
What Sort of Problem?
• • • • • Musculoskeletal Psychological Respiratory Neurological Other 88% 3% 2% 2% 4%
Evidence
“Conventional” • Counselling • Ultrasound • Bed rest • Chiropody • Many operations
Evidence
“Complementary” • 4000 articles in medline • St johns wort • Manipulative therapies • Eczema
In Summary
• • • • Very popular and growing Are we failing? What can we gain? Should we end any divisions and just go for “good medicine” - anything that works?
Aims of the Term
• Can be divided into the obvious and the hidden • There are, I now hope many reasons why we should bother • So that you know where I am coming from my hidden and overt aims are as follows:
Aims of the Term
Overt • Learn about complementary practitioners • Be able to better advise our patients • Learn applicable skills Covert • Improve critical appraisal skills • Improve EBM skills • Improve presentation skills • Foster self worth
And Some Objectives
• Natural • Unproved • Irrational • Harmless • Holistic • Unregulated • Alternative
Starting Points
www.quackwatch.com/
Maybe a obvious slant but fascinating !
Starting Points
The Which? Guide to Complementary Medicine
Which ? Books Barbara Rowlands 1997
An excellent fairly balanced introduction
Starting Points
ABC of Complementary medicine Starting BMJ 319 11/9/99 Page 693 But shouldn’t be all you use!
Starting Points
Medline - 4,000 references to complementary medicine EMBase
Many books
Internet
The Good
The bad
And
And the ugly