In a recent British study that examined the beliefs and behaviours of three groups of complementary medicine and a general practice group of patients (Furnham,Vincent and Wood) (1995)asked patients consulting either a general practitioner or one of three complementary practitioners ( Osteopath, Homoeopath or Acupuncturist )to complete a seven part questionnaire which looked at demographic data ,medical history ,familiarisation with complementary therapies ,health beliefs and lifestyle ,health locus of control, scientific health beliefs and their perception of the consultation style of general and complementary practitioners. The four subject groups did not differ significantly in the demographic variables of sex ,years of schooling ,whether or not they had a degree ,marital status ,or income ,but did differ on age and number of children .The effect of both the significant demographic variables and some aspects of patients medical history were controlled for subsequent analyses because they could have accounted for any different found between the four groups' beliefs and behaviours. Acupuncture patients stood out as having the most different chronic medical history compared to the other three groups who were fairly similar to each other. They were also least satisfied with their general practitioners ,had least confidence in prescribed drugs and were most concerned with leading a healthy lifestyle .The acupuncture patients were most sceptical about orthodox medicine .The main finding was that patients of complementary practitioners are not a homogeneous group but do differ in their views on satisfaction with general practitioners ,healthy lifestyle ,global environment issues ,confidence in prescribed drugs ,faith in medical science ,important of a healthy mind ,harmful effects of medical science and scientific methodology .The result imply that patients consult different practitioners ,general or alternative ,on the basis of a combination of their level of scepticism about orthodox medicine their lifestyle and other health beliefs.
In March 2001, an eight-question module was added to the interview schedule of the ONS Omnibus Survey, sampling 2761 adults in England, Scotland and Wales. Topics included practitioner-based use of 23 named Complementary therapies in the past 12 months. Data were analysed in conjunction with routinely sought demographic and geographical data. The response achieved was 65%. An estimated 10.0% respondents received any Complementary therapy from a practitioner in the past year. An estimated 6.5% used one of the five main therapies (acupuncture, homoeopathy, chiropractic, osteopathy or herbal medicine). Most users had received more than one Complementary therapy. Complementary therapy use was reported in all age groups by both sexes. Complementary and alternative medicine use was similar in England, Scotland and Wales, but within England use was significantly lower in the North. There was a significant positive association between Complementary therapy use and non-manual occupational class, years in education and income. Personal recommendation was the main reason for choosing a Complementary therapy practitioner, followed by a GP recommendation.
Research shows that people with chronic health problems that are either partially or highly debilitating are more than twice as likely to seek out Complementary therapies as those with short-term acute conditions (Zollman and Vickers 1999c, Thomas et al. 2001). Those suffering from musculoskeletal problems such as back pain or osteoarthritis figure highest among the chronic sufferers who seek Complementary therapy in the UK. Those with other chronic conditions, such as depression, skin disorders, and allergies, and those with shorter term conditions such as viral infections and injuries are also users of Complementary therapy (Cerrato 2002, Zollman and Vickers 1999c, Austin 1998).
For those with chronic health conditions, the choice to use Complementary therapy has usually come after they have explored the options offered by mainstream medicine, and have not found a solution or have faced adverse side effects (Rees and Weil 2001, Austin 1998). Research shows, however, that most users of Complementary therapy tend to use therapies in conjunction with orthodox medical care (Hanson 2003, Eisenberg 1998, Sharma 1995). They do so for pragmatic rather than ideological reasons.
NHS not funding complementary therapies because firstly there is a lack understanding within the NHS about complementary medicine and vice versa. This extend even to the language .In the health service, integration means the bringing together of health and social care; for complementary medicine it describes integration with conventional health care .Both need route maps for each other's world, which is why the foundation produced last year the first guide to commissioning complementary medicine in conjunction with the department of health, the NHS alliance and the National Association of Primary Care.
This gave guidance on the most commonly used therapies available within the NHS (Acupuncture ,Aromatherapy ,Chiropractic, Homeopathy ,Hypnotherapy and Osteopathy )including the evidence base ,regulatory arrangements and key contact points for health service commissioners .It has been very well received .Interestingly the public's most popular complementary therapy ,herbalism ,is noticeable by its virtual absence from the NHS
Secondly, the health service is in a state of flux .It is not always apparent to complementary therapy practitioners, generally outside the NHS, who they should talk to.
It is this issue of research which causes problems with Complementary therapy being accepted as part of treatment programmes. 'The normal method is to test the drug, or in this case the therapy, and to repeat the method to produce an identical outcome every time. Complementary therapy needs to be tested on the way they work on people and no two people will have the exact same outcome,' explains HH integrated medicines adviser Paula Marie of the British Complementary Medicine Association. Securing funding from the Government will be difficult until a specific Complementary therapies research model is developed.' A spokesperson for the British Medical Association summed up the contradiction. 'We need scientific proof that Complementary therapies works, but it is difficult for Complementary therapies to get grants for research.' So it's a vicious circle.
The following table show the extent of the use of complementary therapies in Britain and Germany, and most frequently occurring forms:
Source: Sermeus (1987)
Germany is often regarded as having the highest utilisation of Complementary therapies in Europe. Data show that this is not correct for the total Complementary therapies market but only with respect to the reported use of natural remedies. Indeed, the prevalence of utilisation of Complementary therapies practitioners reported in the UK is, depending on the source, equal to or even higher than in Germany.
The type of Complementary therapies practitioners, the services they provide, and their training and regulation differ substantially between the UK and Germany. In both countries physicians practicing Complementary therapies are concentrated in the ambulatory sector/general practice. Very few doctors practice Complementary therapies in UK hospitals, while in Germany more than 10 per cent of qualifications for naturopathy, homeopathy and chiropractic are documented in the inpatient sector. The numbers of registered CAM practitioners have also risen in both countries, but there is very little information on private practice by non-registered practitioners in either country.
In the UK health professionals who practice Complementary therapies do not legally require formal Complementary therapies qualifications. There is, however, growing regulation of Complementary therapies practitioners. The direction is towards specialisation, with individuals having to demonstrate their ability, skill and knowledge in a single therapeutic area, through registration with a professional body. Chiropractics and osteopaths are already statutorily regulated, and proposals for regulation have been put forward for acupuncture and herbal medicine.
In Germany physicians may qualify or specialise in Complementary therapies and are then subject to regulations depending on the qualification or specialisation they take. In addition, there are GPs and other specialists such as gynecologists or pediatricians who practice Complementary therapies without formal qualifications. Other health care professionals such as nurses and midwives are also reported to practice Complementary therapies frequently, but there are no data and no formal regulation.
An important but under-researched area is the extent to which Complementary therapies services and products are covered by public reimbursement. Reports suggest that in the UK the availability of Complementary therapies on the NHS is highly variable geographically and has also fluctuated with changes in purchaser organisations since the early 1990s. German data suggest that reimbursement has declined, with a number of products being removed from the list of reimbursable items by the statutory health insurance funds.
Summary:
Complementary and alternative medicine, as defined by NCCAM, is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.
Cultural ,educational and ideological factors effect choices ,but also access and availability ,as well, of course ,as the acute and chronic nature of their illness ,that is ,in some countries certain types of therapies abound ,which in others they are comparatively rare and highly thought of.
Clearly a substantial and almost certainly growing minority of people consult complementary practitioners in Britain and other industrial countries such as Germany.
The current climate towards CAM is different from a few years ago. The public is calling for broader healthcare choices and the new patient-centred NHS needs to deliver them.
References and Bibliography:
Books:
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Kuhn, M, (1999), COMPLEMENTARY THERAPIES FOR HEALTH CARE PROVIDERS, Lippincott.
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Diamond, W, (2001), the Clinical Practise of Complementary, Alternative, and Western Medicine, CRC Press.
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Ernst, E, (1996), Complementary Medicine: an objective appraisal, Butterworth Heinemann.
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Fulder, S, (1996), The Handbook of Alternative and Complementary Medicine, Oxford University Press.
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Micozzi, M, (1996), Fundamentals of Complementary and Alternative Medicine, Churchill Livingstone.
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Rankin-Box, D, (1995), The Nurses' Handbook of Complementary Therapies, Churchill Livingstone.
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Sharma, U, (1992), COMPLEMENTARY MEDICINE TODAY: Practitioners and Patients, Routledge.
Electronic sources:
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Vickers, A and Zollman ,C (BMJ 1999,November 20),British Medical Journal (Online).ABC of Complementary Medicine :Hypnosis and relaxation therapies.(May 2005)
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Use of Complementary and Alternative Medicine in the NHS [Online] Available: : [April 2005]
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Rasool, I, (The Times 1989.Nov13). Producing Standards for Integrated Complementary Medical Practice [Online] Available: [April 2005 ]
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BBC News,[ Thursday, 4 November, 2004], Public want alternative therapy[Online] Available: [April 2005]
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Saunders,P ,[April 1999], How should we respond to alternative medicine?, [Online] Available: [May 2005]
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Dixon, A ; Riesberg,A ; Weibrenner,S ; Saka,O ; Le Grand ,J and Busse,R ,[2003], Complementary and Alternative Medicine in the UK and Germany: Research and Evidence on Supply and Demand, [Online] Available: [May 2005]
