Lecture 3701-lecture 32 26 November 2010
Complementary medicine refers to a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided.
Complementary medicine is an increasing feature of healthcare practice, but considerable confusion remains about what exactly it is and what position the disciplines included under this term should hold in relation to conventional medicine
In the 1970s and 1980s these disciplines were mainly provided as an alternative to conventional health care and hence became known collectively as "alternative medicine."
The name "complementary medicine" developed as the two systems began to be used alongside (to "complement") each other.
Over the years, "complementary" has changed from describing this relation between unconventional healthcare disciplines and conventional care to defining the group of disciplines itself.
Some authorities use the term "unconventional medicine" synonymously.
This changing and overlapping terminology may explain some of the confusion that surrounds the subject.
Complete systems of therapy that have evolved independently and often prior to biomedical approaches.
Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.
Systems of therapy used in conjunction with traditional western medicine which is based on biomedical approaches.
Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery.
Complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period.
CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being.
Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed."
Many people seek out alternative therapies because:
-they distrust standard medical practices
-desire more natural treatments
However, the hope is often ill founded as there is little or no scientific evidence
-recall that the scientific method the best way to get scientific evidence is to conduct a double blind, randomized cross-over study with large numbers of patients
-investigational new drug
-phase I, II, III IV trials
Factors limiting research in complementary medicine
Lack of fundingIn 1995 only 0.08% of NHS research funds were spent on complementary medicine. Many funding bodies have been reluctant to give grants for research in complementary medicine. Pharmaceutical companies have little commercial interest in researching complementary medicine
Lack of research skillsComplementary practitioners usually have no training in critical evaluation of existing research or practical research skills
Lack of an academic infrastructureThis means limited access to computer and library facilities, statistical support, academic supervision, and university research grants
Insufficient patient numbersIndividual list sizes are small, and most practitioners have no disease "specialty" and therefore see very small numbers of patients with the same clinical condition. Recruiting patients into studies is difficult in private practice
Difficulty undertaking and interpreting systematic reviewsMany poor quality studies make interpretation of results difficult. Many publications in complementary medicine are not on standard databases such as Medline. Many different types of treatment exist within each complementary discipline
Methodological issuesResponses to treatment are unpredictable and individual, and treatment is usually not standardised. Designing appropriate controls for some complementary therapies is difficult, as is blinding patients to treatment allocation. Allowing for the role of the therapeutic relationship also creates problems
Biological based therapies
Use of untested dietary regimes, herbal preparations and other substance based therapies for treating physical illnesses or symptoms
Chelation-use of ethylene diamine tetraacetic acid (EDTA), supposedly to heal the body by binding with metallic ions and removing toxic metals
Dietary regimes- rationale behind Atkins diet and problems with the Atkins diet
Herbal preparations-use of herbs and other natural substances with the intention of preventing or curing disease
-aspirin from willow bark
-resin called myrrh contains an an analgesic
-senna leaves have a powerful laxative
-showing up on over the counter shelves as functional foods
-based on hearsay and folklore in some cases and prescribed by people who have little understanding of botany, pharmacology or human physiology
-mistaken identity- especially when translated from one language into another- especially if one is not familiar with the original language
-safety during pregnancy
Orthomolecular medicine-the administration of large doses of vitamins to attempt treatment of chronic disease
Substance based therapies-eg dietary supplement therapy-functional foods or nutraceuticals- we have looked at number of these in terms of the diseases we have examined