Understanding

COMPLEMENTARY MEDICINE

By Dr George T Lewith

IMPORTANT NOTICE

This information is intended not as a substitute for personal medical advice but as a supplement to that advice for the patient who wishes to understand more about his or her condition.
Before taking any form of treatment YOU SHOULD ALWAYS CONSULT YOUR MEDICAL PRACTITIONER.
In particular (without limit) you should note that advances in medical science occur rapidly and some of the information about drugs and treatment may very soon be out of date.

Contents

Introduction

CAM versus conventional medicine

Acupuncture

Healing

Herbal medicine

Homeopathy

Manipulative medicine

Massage, aromatherapy and reflexology

Mind–body therapies, hypnosis and other relaxation techniques

Nutritional medicine

Therapeutic diets

Who provides complementary therapies?

Useful addresses

Introduction

Complementary medicine is a term that covers many unrelated therapies. However, many people now prefer to use the term ‘complementary and alternative medicine’ (CAM) instead and this will be used, where appropriate, throughout this book.
In the late 1950s and early 1960s, treatments such as acu­puncture were considered to be fringe medicine. Then, in the 1970s and early 1980s, they began to be called ‘alternative’ because they were thought to represent an alternative to conventional medicine.
During the late 1980s and 1990s, the term changed to ‘complementary’ as doctors and ‘alternative’ therapists began working together, using treatments to complement conventional medical care. In some instances, CAM treatments have now been integrated into conventional medicine – for example, many physiotherapists use acupuncture on their patients.
When complementary medicine is used as part of a complete package of treatment including conventional medicine, the term ‘integrated medicine’ is used – for example, the increasing use of homeopathy by GPs as a part of their ordinary medical practice once a clear conventional diagnosis has been made. In other words, such doctors are integrating the CAM therapy into their conventional care.
The changes in terminology show how much attitudes have changed over the last 40 years – among both the public and the medical profession. From thinking of CAM therapies as quackery in the 1950s and 1960s, we now regard them as techniques that may be used in NHS hospitals and health centres.

The underlying reason for this change is unclear, but it is probably partly because patients and doctors now recognise that there are benefits to be derived from CAM and partly because of changes in the attitudes of doctors to CAM.
How can we define CAM? One way is ‘therapies that are alien to the dominant healthcare system of a specific country’. For example, acupuncture and herbal medicine are considered to be conventional in China, but unconventional in the USA and UK. Another definition is ‘techniques that are not taught in medical school’. However, healthcare systems do change over time and many UK medical schools now offer CAM familiarisation courses.
There is a whole range of complementary therapies and the table represents a broad, but far from comprehensive, list. A number of these therapies are discussed in more detail in this book.

ARE CAM THERAPIES RELATED?

Some therapies are related to one another; acupuncture, acupressure, reiki, shiatsu and traditional Chinese herbal remedies are all used in accordance with traditional Chinese medical concepts. However, most CAM therapies are an unrelated mixture of treatments with entirely different histories, philosophies and uses. Ayurveda (a comprehensive Indian traditional medical approach to illness) involves diet, yoga, massage and herbal remedies and, although many of the Ayurvedic herbal remedies are similar to those used by the Chinese, there are also significant differences.
Both systems, Indian and Chinese, have evolved over the last 2,000 years into complete medical approaches that involve diagnosis and treatment. Homeopathy, on the other hand, is entirely unrelated to any other form of CAM and was developed 200 years ago in Germany. There are many manual therapies, such as osteopathy, chiropractic, massage and the Alexander technique, that are designed to affect the body through various forms of touching or manipulation.
As most CAM treatments are entirely unrelated, in many instances the therapy chosen is dependent on the disorder and the knowledge and beliefs of the patient, doctor and CAM practitioner.

IS CAM SAFE AND NATURAL?

Some patients are made ill by conventional medicine. Estimates suggest that complications occur in as many as five per cent of operations, and many people taking long-term conventional medication experience some side effects. However, conventional drugs are often given to very sick, frail, old people who are more likely to have an adverse reaction.
The media sometimes seem to imply that many complementary therapies have magical properties and, unlike conventional medicines, could not possibly harm you. It is important to remember that ‘natural’ does not always mean safe. Herbal and nutritional products produced in environments where their quality of manufacture is uncontrolled may be dangerously contaminated and far from safe.
In spite of these concerns, CAM treatments seem, on the whole, to be far less likely than conventional medicines to have serious side effects or complications. However, we need to know more about the safety of CAM treatments and the possibility of interactions with conventional medicines. If you are taking a herbal, homeopathic or nutritional product, you must tell your GP so that any adverse reaction to a conventional medicine or any interaction with your prescribed remedies can be identified.
Many CAM therapists claim to be holistic – that is, treating the whole person not just a specific problem. This might suggest that conventional medicine is not ‘whole person’ medicine. In fact, good conventional medicine does take into account the whole person, and some CAM therapies themselves are very narrow and specialised.
An important potential danger with CAM is that a patient may not receive appropriate conventional treatment because the non-medically qualified CAM practitioner is unable to make a proper medical diagnosis. As a result of this, the patient is given inadequate and potentially dangerous advice and may miss out on the best conventional treatments available. Although this may have happened in some instances, specific cases of patients receiving inappropriate treatment have rarely been reported in the medical literature. In fact, most CAM therapists are now over-cautious and are more likely to over-refer you to your GP than under-refer you if they are in any doubt.
If you follow the guidelines and advice about seeking CAM treatment given in the chapter ‘Who provides complementary therapies?’ (page 91), then this should mean that your GP is fully informed about your treatment and that it is both appropriate for you and based on a clear and safe diagnosis.

WHAT DO CAM THERAPIES SHARE?

Many CAM therapies share an unscientific, unproven and possibly unprovable belief that a vital force or vital energy is present in living organisms. This belief underpins many of the CAM approaches to illness, and it is the manipulation of this vital energy that is the main aim of some therapies.
With this approach, chronic illness is thought to be caused by a prolonged disturbance in the body’s energy. This energetic disturbance ultimately leads to disease that can be seen and described in conventional medical terms. Treatment is therefore designed to rebalance the person’s vital energy.
In some therapies, such as osteopathy and chiropractic, the current teaching and practice has completely distanced itself from these unproven assumptions about vital force. Some CAM therapists believe that illness provides an opportunity for the person to change, suggesting that illness has a deeper meaning.
With almost all CAM therapies, the person receiving treatment may find their symptoms or illness is aggravated as part of the healing process. The original condition may become temporarily worse, or the symptoms may revert to those that were apparent when the illness began. These changes are claimed to support the idea of a natural healing process that is stimulated by a particular therapy, although there is no scientific basis for this.
Many CAM therapies, and the individual treatments that are prescribed within each of them, are very ‘empirical’ – this means that they are based on experience of success rather than an under­standing of theory. In conventional medicine, people like to think that they understand much more about the treatments they practise, and indeed they often do, yet even conventional doctors use treat­ments that might be considered empirical.

DOES CAM WORK?

More is known about the clinical effectiveness of CAM now than 10 or 15 years ago. Some particular therapies are known to be safe and effective in certain conditions, but lack of understanding about the specific effects of CAM is still enormous.
For most CAM therapies, we do not understand a great deal about the mechanism of how a therapy works and indeed whether it works better than a placebo (inactive substance used in control trials to establish the specific effectiveness of a treatment). The main reason for this is that not much research has been published on the effectiveness of CAM.
CAM attracts less than one per cent of the research money that goes into conventional medicine, so it is not surprising that not enough is known about these therapies. This lack of information is sometimes seen as a good reason for doctors not recommending CAM. As there is insufficient research information, we can’t predict how well or badly a particular treatment may work for an individual or for a particular condition.
It may seem that conventional medicine uses treatments only if they are supported by clinical evidence. In general practice and some hospital medicine, this is not always the case. A lot of treatments your GP prescribes have limited evidence to support them, yet they are very effective.

DO I NEED TO BELIEVE IN COMPLEMENTARY MEDICINE FOR IT TO WORK?

There have been some suggestions that the only reason that CAM works is because people believe in it. On the few occasions that this assumption has been exposed to proper scrutiny, it has been found that the outcome of treatment is not dependent on whether you believe it is going to work for you.
However, people seeking CAM are more likely to be well-informed about health in general and CAM in particular, and have a greater desire to take control of the factors that affect their health and well-being, such as diet and exercise.

CAN COMPLEMENTARY MEDICINE BE USED WITH CONVENTIONAL MEDICINE?

In spite of the lack of scientific evidence, many people are convinced that CAM may offer approaches to their illness that are relatively safe and potentially effective. Many people are beginning to ask their GPs whether using a complementary therapy can be effective for them. Most people do not wish to reject conventional medicine, but use it in a more considered way while embracing a complementary approach if it is safe and reasonable to do so.
Patients are therefore making their medical practitioners consider whether CAM can be safely integrated into the management of their illness. For example, a patient with arthritis may wish to use acupuncture or a glucosamine supplement to manage pain rather than conventional medication such as anti-inflammatories, while taking a powerful medication to suppress the aggressive inflammation occurring in their joints.
A recent report from the British Medical Association wholly endorsed the use of acupuncture in pain – an unusual event as far as CAM is concerned. CAM should not be seen as a complete alternative to the management of most illnesses, although undoubtedly in some cases (such as the use of manipulative techniques for acute back pain) it is a safe and effective alternative to visiting your GP.

WHICH THERAPIES ARE MOST POPULAR?

There have been a number of surveys assessing the most popular therapies in the UK. They show that acupuncture, chiropractic, osteo­pathy, herbal medicine, homeopathy and, in one survey, faith healing are the most frequently sought CAM treatments. The situation is similar in Europe and the USA.

WHO USES CAM?

Most CAM in the UK is paid for privately, although the NHS does provide some. This means that it is mostly used by those who can afford it. In general, those using complementary medicine are better educated, and 60 per cent are female. Most are in their middle years (between the ages of 40 and 60).
Ethnic communities, particularly Indian and Chinese, tend to use techniques that may be considered complementary in this country but traditional in their country of origin.
Unfortunately, there is not much information in the UK on how ethnic groups use CAM. In the USA, it is known that ethnic groups tend to use traditional remedies such as herbs before going to their family physician.

WHAT GETS TREATED?

Most people seek CAM when they have long-term chronic problems that are poorly managed by conventional medicine, usually with their muscles, bones and joints. They are most likely to seek help for these problems from qualified manipulators such as osteopaths and chiropractors. Sometimes the problems cannot be diagnosed by conventional medical techniques – for example, a general feeling of unwellness or inappropriate exhaustion – or sometimes they can only be managed and not cured, like arthritis.
More and more people are seeing complementary practitioners so that they can maintain their health and develop their own culture of wellness and balance, rather than waiting for illness to strike unexpectedly. As yet there is no clinical evidence for the success of this approach.