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Complementary and Alternative Medicine and Patient Choice in Primary Care Helen Barnett Bpharm Msc Licac Mbacc Medical Editor/Writer and Acupuncturist, London, UK

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Complementary and Alternative Medicine and Patient Choice in Primary Care Helen Barnett Bpharm Msc Licac Mbacc Medical Editor/Writer and Acupuncturist, London, UK Quality in Primary Care 2007;15:207–12 # 2007 Radcliffe Publishing Patient perspective Complementary and alternative medicine and patient choice in primary care Helen Barnett BPharm MSc LicAc MBAcC Medical Editor/Writer and Acupuncturist, London, UK ABSTRACT Complementary and alternative medicine (CAM) is the CAM practitioner relationship; and health views widely used in addition to or instead of conven- in line with the CAM model.This paper discusses tional medicines for positive or negative reasons. how complementary and alternative therapies may Negative reasons are a poor outcome from conven- be used to address important gaps in NHS provision tional treatment; unwanted effects from drugs; a not amenable to conventional therapy. negative experience of the general practitioner re- lationship; and health views not in line with the conventional medical model.Positive reasons are a Keywords: complementary and alternative medi- good outcome from CAM treatment; being an active cines, patient-centred care, quality improvement, participant in health care; a positive experience of therapy How this fits in with quality in primary care What do we know? Access to and use of complementary and alternative medicines (CAM) and therapies are important areas for quality improvement in primary care. What does this paper add? This paper describes positive and negative reasons for patients using CAM therapies and explains why these therapies may address important gaps in conventional medicine. Introduction Complementary and alternative medicine (CAM) is century, such as patient choice and involvement in more popular in the UK today than ever before, with decision making.However, there is much we do not an estimated 5 million adults seeing a CAM prac- know about why CAM has become so popular at this titioner each year.1 Around 10% of these consultations time.Even as recently as the 1960s, CAM was a fringe take place within the NHS, at a cost of about £50 interest in the UK; before then there was not even a million in 2001.1 Among the most popular CAM ther- general name by which these therapies were known.In apies are acupuncture, aromatherapy, chiropractic, fact, it was not until the 1980s that interest in CAM herbal medicine, homeopathy, hypnotherapy, oste- really started growing, not only from patients and opathy and reflexology, and up to one-third of people the general public but also from doctors and other use complementary self-help techniques such as medi- healthcare professionals.Many theories have been put tation and relaxation, and over-the-counter remedies.2 forward, such as disillusionment with certain aspects What has created this apparent public and patient of conventional medicine or the claim that many enthusiasm for CAM? The reasons for the increase in people have benefited from CAM.Research suggests acceptability and use of such therapies reveal a great that most people tend to use CAM therapies alongside deal about social trends in the latter part of the 20th conventional medicine, rather than as an alternative to 208 H Barnett it, sometimes for different complaints, sometimes Why the increase in popularity? together for the same complaint.This article explores the growth of CAM use in the UK, and looks at why and how people are using CAM, particularly within There are probably many reasons why CAM therapies the NHS. have increased in popularity.Up until the late 1960s, most people still had complete faith in conventional medicine; doctors were respected members of the post-war community, and they had the time to talk What do we mean by CAM? to and visit their patients.A substantial shift in atti- tudes has taken place since then.This has, in part, been due to a growing disillusionment with conventional Broadly speaking, CAM includes those healthcare medicine and a real or perceived negative harm: practices that are not currently an integral part of benefit ratio for some of its treatments, and may also conventional medicine.What therapies are considered be partly due to the desire for more equal relationships to be complementary or alternative is not fixed.New between patients and healthcare providers that is therapies are constantly being developed and, as a embodied in the new consumerism of the 20th cen- therapy is shown to be effective and safe, it can become tury.6 A person-centred, person-empowering approach accepted as a conventional healthcare practice (e.g. as to health and self-care is now also intricately linked to is happening with acupuncture, chiropractic and public health strategy.In their Choice Matters docu- osteopathy). ment, the Department of Health states: ‘Giving people The Cochrane Collaboration defines CAM as in- more choice and control over their treatment and cluding: services is one of our key priorities in the NHS – because ... all such practices and ideas which are outside the people want it’.7 domain of conventional medicine in several countries One qualitative study, involving 49 semi-structured and defined by its users as preventing or treating illness, or interviews in eight locations across England providing promoting health and well being.These practices comple- CAM therapy services within primary care, looked at ment mainstream medicine by 1) contributing to a com- satisfaction with CAM among patients receiving treat- mon whole, 2) satisfying a demand not met by conventional ment funded within the NHS.8 The researchers found practices, and 3) diversifying the conceptual framework of that CAM therapies were experienced at ameliorating medicine.3 and curing conditions, including chronic problems, and that patients perceived CAM practitioners as being caring and valued the development of a therapeutic The growth in CAM use relationship within which they were encouraged to take an active part in looking after their health.The interviewees contrasted their positive experiences of One study conducted in England in 1993 found that CAM use with either a failure of conventional medi- about 8.5% of the adult population had received at cine or a dislike of the conventional treatments avail- least one of the following main CAM therapies in the able to them.Very few negative aspects of CAM were previous year: acupuncture, chiropractic, homeopathy, reported, and patient satisfaction was consistent across hypnotherapy, herbal medicine or osteopathy.4 Five settings and type of therapy received.Another quali- years later, this had increased to 10.6% of respondents tative study looked at complementary therapy use by (n = 283) and, if reflexology and aromatherapy were patients and parents of children with asthma, and the included, it increased to 13.6% (n = 363).4 Applying implications for NHS care.9 Fifty semi-structured the assumption that all non-respondents were non- interviews of 22 adults and 29 children were carried users reduced the estimate of use to 6.6%.4 In another out.The CAM therapies were usually used alongside UK survey in 1999, an estimated 20% (n = 245) of conventional asthma treatment, and motivating fac- respondents had used some type of CAM therapy or tors included concerns about conventional NHS care bought an over-the-counter remedy in the previous 12 and attractive aspects of CAM therapies, such as months.5 Also, 78% of respondents said that they respondents’ empowerment to take greater personal were, or felt that other people were, using CAM control over their condition and enabling them to therapies more than they were 5 years ago.5 In a survey explore a broader range of possible causes of their conducted by the Consumers’ Association in 1995, asthma.A third qualitative study was carried out to nearly 9000 subscribers to the magazine responded, help rheumatologists understand why patients with and almost one in three reported having used CAM at rheumatoid arthritis chose to use a CAM therapy.10 some time in their lives.2 Of those who had used it, one Five unstructured interviews were conducted.The in five had done so during the preceding year. incentives given as to why the patients used CAM Complementary and alternative medicine in primary care 209 included dissatisfaction with conventional treatment, CAM therapies embrace the idea that the body, mind often due to unwanted effects and drug ineffectiveness. and spirit are all maintained by an underlying ‘energy’ Perceived benefits were either physical or psycho- or vital force, and associate its depletion or imbalance logical, and associated with aspects of choice and with ill-health and its restoration or balance with control. health.This ‘energy’ or ‘vitalism’ is referred to vari- Overall, patients and the public consistently report ously, as Qi in Traditional Chinese medicine, prana by four negative and four positive reasons for using Ayurvedic practitioners and yogis, subtle energy by CAM.12 The negative reasons are: a poor outcome healers, dynamis by homeopaths, vital force by herb- from conventional treatment; unwanted effects from alists and osteopaths, innate or universal intelligence by drugs; a negative experience of the general practitioner chiropractors, and vis medicatrix naturae by naturo- (GP) relationship (possibly due to a decline in per- paths, to name but a few.What this ‘energy’ is, whether sonal doctoring); and health views not in line with the it really exists or is used simply as a metaphor for, conventional medical model.The positive reasons are: or model of, health and illness, is not known.CAM a good outcome from CAM treatment; being an active therapists often say that their aim is to allow or participant in health care; a positive experience of the stimulate a person’s capacity for self-healing and CAM practitioner relationship; and health views in they largely see their role as providing the right line with the CAM model.1 conditions for this to occur and to promote the body’s own self-regulating mechanisms.In many CAM ther- apies, the patient is seen as an active participant rather than a passive recipient of treatment.Often CAM Patients’ beliefs and therapists include advice about lifestyle changes in expectations of CAM their treatment, and an attraction can be this self-help aspect that encourages and helps people to take control of their health.
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