How important is the role of complementary therapies and medicines within a modern health service?

Nicci Waterfield Health & Social Care LF

Illustrate your answer with examples and, where possible, consider the impact that the growth of such remedies has had on attitudes within both the general public and the medical profession.

Over the last decade peoples opinions towards medicine have changed, this has made a lot of people consider alternative treatment for illnesses, which before hand they would have been seen as witch craft. Nowadays it is more socially acceptable and is used more widely to treat illnesses or used just as a relaxation method. When investigating any form of medical treatment, whether that be CAM or scientific medicine we need to be asking questions;

Is it effective?

Is it safe?

How is it regulated?

People still make assumptions about complementary therapies, that it is outside the NHS so there is no regulating body to protect the clients or the practitioners, this is true for many areas but with continuing research and the need for more funding I believe that it will gain the recognition that it deserves, and this will open the door for more regulatory bodies to become mandatory. When people say that it is outside “conventional” medical training, this can be true but many practitioners of complementary therapy train for many years degree level, and there are 20 universities which offer degrees in Complementary Medicine, however there are some people who just decide to practice without any form of training and I believe that these are the people who misuse and harm the ideology of complementary therapies. Is it safe? I believe it is safe as long as you go to a reputable practitioner, who would normally have been trained to degree level and has taken out insurance for their clinic. One good point to argue is that it is natural, and with GP’s not wanting to continually prescribe for example antibiotics this is a natural way to treat illnesses without chemical use of tablets. Is it effective?, this has got to be the most crucial question that needs to be answered, practitioners of Complementary Medicine believe that when using therapeutic intervention is effective if it influences the course of a disease in a patient in a beneficial way. When assessing if it effective in treating disease then you would need to compare without any other treatment, as this is very rarely possible then it is hard to gain evidence to support this question fully.

Within are lessons we conducted a survey which asked people if they had used Complementary and Alternative Medicine (CAM), we also asked them whether they considered it to work and if they was referred by their GP or went privately and had to pay themselves. Every person took 10 copies to be filled in by their families and friends then all the data totalling 114 people was collated together, the results indicated that very few people were referred by their GP, but many people said that it worked successfully. The results of this survey are attached to this essay.

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The most commonly used CAM therapies are:

Acupuncture
Chiropractic
Osteopathy
Homeopathy
Herbal medicine
Massage Therapy

There are also many other CAM therapies available, examples of these are, Reflexology, Hypnotherapy, Aromatherapy, Reiki, and Faith or spiritual healing. All of these methods people can find easy access to, if however, they are willing to pay, due to the lack of GP’s who have the funding or believe that it will work, I will talk about this more later. Acupuncture originates from the Far Eastern countries and has been practised there for thousands of years, although many practitioners provide a Western form of medical Acupuncture, which is based on modern understanding involving the body’s nervous system. Osteopathy and Chiropractic are both highly recommended therapies and seem to be the only two who have their own regulatory councils and gives the name ‘primary care practitioners’ to those who carry out the service. Osteopathy is used to treat any age group and it uses soft tissue massage, stretching and manipulation separation techniques, which helps to treat spinal pain, muscle or joint pain or sports related injuries. Chiropractors treat the nervous system and improving skeletal movement, they also use spinal manipulation to help sufferers of migraines, repetitive strain and sciatica. The Royal Family and 1 in 5 of the population, regularly use homeopathy, it treats people by using the method that whatever can make ill you can also make you well, it is more commonly used to treat eczema, arthritis, asthma and PMS. Herbal Medicine is the oldest method of medicine and is used all over the world with sales topping £126 million every year from over the counter therapies. The most common illnesses which it treats are migraines, arthritis, depression, insomnia and lung, stomach, blood and skin disorders. Massage Therapy, is the manipulation of soft tissue for therapeutic purposes, and is commonly used along side cancer therapy and is also popular amongst athletes.

In 1995, Kate J Thomas, J P Nicholl and Margaret Fall, conducted a survey of how many GP’s were referring their patients to CAM. They sent out their questionnaires via the post to 1226 individual GP’s in a random cluster sample or GP partnerships in England, this was 1 in 8 GP partnerships in England in 1995. The method set by them was to assess estimates of the number of practices offering ‘in-house’ access to any form of complementary therapies or if this was not available were they making referrals outside the practice, and if there was any funding available for CAM. The total number of returned questionnaires was 964 (78.6%). Out of those, 760 also gave detailed information. The results showed that an estimated 39.5% of GP partnerships offered some form of access to CAM for their NHS patients. An estimated 21.4% offered it via a member of the primary health care team, 6.1% had employed andindependent’ CAM therapist, and an estimated 24.6% made referrals for CAM. The volume of CAM available within any individual service seemed to be low; acupuncture and homoeopathy are the most commonly available therapies. The number of patients who had to pay for the services of CAM, which were recommended by their GP’s, was 25%. The survey found that fund holding practices were more likely to offer CAM compared to non-fund holding practices, these figures are 45% versus 36%. This proved that fund holding practices had more scope to offer CAM at the primary care level, evidence was also available to show that unless the primary care groups and primary care trusts help to support the provision of CAM to all practices then the level of which it is available will decline within time.

There is always going to be doctors who are opposed to CAM, it was easy to find evidence of this, on the BBC website I found two articles straight away, the first headlined as, ‘Doctors attack bogus therapies’. The article goes on to describe how some of Britain’s leading doctors are urging the NHS to stop using CAM and to only pay for medicine which has been proven with solid evidence that it is successful, there are concerned about the amount of money that the NHS is spending on “unproven or disapproved treatments”, like those used by practitioners of CAM. They talk about Herceptin being of high cost so the NHS don’t regularly fund it, but these ‘bogus’ therapies are being funded. Prince Charles advocates CAM and wants the funding to continue, he also wants it to be integrated with conventional medicine, he told the World Health Assembly in Geneva:

“The proper mix of proven complementary, traditional and modern

remedies, which emphasises the active participation of the patient, can

Help to create a powerful healing force in the world.”

(Prince Charles, BBC News, 2006)

This statement is criticised by doctors as ‘Implausible treatment’, meaning that more than 12 reviews done off CAM have failed to produce any evidence of the effectiveness of CAM. Dr Peter Fisher, of the Royal London Homoeopathic Hospital, says that these doctors opposing CAM seem to be causing a “Medical apartheid” within the NHS. Evidence in this article says that about half of GPs are thought to refer patients to CAM.

My conclusion is that all the evidence points to the fact that general practitioners are just not ready for the change, they have trained at medical school for 5 years learning to use chemical drugs, and have been taught to trust them, which is good, but I feel that they need to be more open to the fact that the methods that CAM offer is beneficial to complement chemical drugs, and sometimes can eliminate the use of chemical drugs where relaxation is more beneficial. Take for example someone with stress, which can lead to depression, in this case anti depressants would be the most common form of chemical drugs, but say however the patient was offered massage therapy or aromatherapy to relax them, this may in the long run be more beneficial to the patients health. The implications of long time chemical drug use has been publicised many of times, yet there is no evidence to suggest that the services that CAM offer would harm with long term use. So why is the funding not available for more research to be done to help gain peoples confidence in CAM? I agree that times are hard with the NHS, but really in the majority of matters with the government it always comes down to funding or rather lack of funding. If we take funding/money out of the equation then is another problem area for CAM that people have closed minds, in that they do not want to try something new? It would be interesting if the ages of the General Practitioners were available who readily refer patients on to organisations that use CAM, because as people get older they become less accustomed to change, and are the new generation of doctors more open to change, whereas the older generation of doctors are more prone to not changing from chemical drugs. I will be interested to see what happens with the introduction of more CAM services within the NHS, will time change things? We can only wait and see, but personally I would like to see more of CAM introduced in the NHS.