Complementary Medicine In The Community

Okay, now Flintoff's holed out to deep mid-wicket. It just gets worse and worse. I think I'm going to cry. This is all too much, coupled with yesterday's "history-making" first UK number 1 on downloads only. So says the England cricket-supporting, vinyl-loving plenary-goer.

8.3.06

Why complementary medicine?
• Patients ask for information and referral.
• Should understand patients' choices.
• To broaden scientific horizon.
• Part of medical curriculum, so subject is assessed.

Conventional medicine
• Disease focus: organ.
• One local cause → specific symptoms.
• Mind and body = separate entities.
• Treatment = eliminating symptoms.

Complementary medicine
• Complex system.
• Multiple factors → systemic symptoms.
• Mind and body = two sides of one coin.
• Treatment = reinforcing the system.

Conceptual link: complexity
A complex system
• Contains many elements: multifactorial.
• Non-linear dose-response effects.
• Emerging properties unexplainable from properties of each element.
• Adaptative, self-organising.
• Memory established [Plesk and Greenhalgh, 2001].

Why do people use complementary medicine? They have:
• Poorer health.
• Higher education → autonomy for treatment choice.
• Profound life experiences transformed their world view: "Illness is part of my existence, rather than a disturbing factor" [Astin, 1998].

Main complementary therapies
• Acupuncture - traditional Chinese medicine.
• Homeopathy - within NHS (since 1948).
• Herbal medicine.
• Manipulative therapies: chiropraxy, osteopathy.
• Smallwood report (2005):
Complementary therapies → £480million possible savings on drugs prescriptions.

Referral pattern
Referral initiated by
1. GPs.
2. Patients.
3. Hospital doctors.
4. Others.

Reasons for choice of complementary medicine
• Conventional treatment not effective.
• Worries about side effects.
• Personal preference.
• Problems with side effects.

Changes other aspects
• Satisfaction ~90%.
• Secondary problems better ~ 33%.
-Mental: anxiety, depression.
-Pain, arthritis.
-Skin.
-Digestive.

Effect of RCT in homeopathy
• Otitis media.
• Osteoartritis.
• Childhood diarrhoea.
• Fibrositis.
• Hayfever, flu.
• Pain.

Evidence for acupuncture
• Conclusive.
-Dental pain.
-Nausea, especially postoperative.
-Migraine.
• Nonconclusive.
-Asthma.
-Back pain.
-Drug dependency.
-Tension headache, neck pain.
-Osteoarthritis.
-Stroke.

Integrative medicine
Organ and system approach combined
Type I → Type II ← Type III
Illness Reaction Person