Book

Traditional, Complementary and Alternative Medicine and Cancer Care: An International Analysis of Grassroots Integration

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Abstract

Drawing on comparative fieldwork in the UK, Pakistan and Australia, this book provides the first systematic assessment of pathways and access to CAM and how it is used in health practice and by individuals with cancer. Giving fresh and invaluable insights into how differing health and societal structures influence the use complementary and alternative medicine, the book explores: the empirical, theoretical, and policy context for the study of CAM/TM and cancer. The history and character of the eight support groups in which fieldwork took place in the UK, Australia and Pakistan. The nature and structure of patient support groups' history, affiliation and evolution. How groups function on a day-to-day basis. The extent to which what is being offered in these CAM-oriented groups is in any way innovative and challenging to the therapeutic and organisational mainstream. The value of sociological work in the field which is not tied to immediate and narrow policy objectives. This is an essential resource for those studying complementary and alternative medicine sociologically, to those involved in the provision of cancer care on a day-to-day basis, and to those looking to establish a more informed (evidence-based) policy. © 2007 Philip Tovey, John Chatwin and Alex Broom. All rights reserved.
... Traditional healers exist in all cultures, and their widespread presence in developing countries is well documented (WHO, 2002). In fact it's been estimated that "80% of the world's population continues to use their own traditional systems of medicine despite the increasing presence of allopathic medicine" (Tovey et al., 2007). Western allopathic medicine views disease as chemically and physiologically based, whereas traditional systems attribute illness to social, spiritual and psychological disturbances, and treatment consists of natural and spiritual remedies that restore harmony to the system. ...
... Despite the prevalence of traditional healers in the developing world, only a few studies could be found that investigated traditional healers and cancer diagnosis and treatment. The most extensive research appears to have been conducted in Pakistan by Tovey and colleagues (Tovey et al., 2005a;2005b;2007;Broom and Tovey, 2007). They surveyed 362 cancer patients and interviewed 46 patients as to patients' experiences with both indigenous traditional medicine and Western allopathic medicine. ...
Article
Background: For a number of reasons from cultural compatibility, to accessibility, to cost, traditional healers are a major source of health care in developing countries. In Malaysia, 'en estimated that upwards of 80% of the population consult traditional healers even if simultaneously seeking treatment from the Western medical system. Partially as a result of the widespread practice of visiting traditional healers, cancer diagnosis and treatment in Malaysia is often delayed or interrupted resulting in late presentation, advanced stage diagnosis, and a higher mortality rate than in Western countries. However, there is very little research on the role of traditional healers in cancer treatment in Malaysia. Materials and methods: This qualitative study was designed to identify the roles traditional healers play in cancer diagnosis and treatment, with an eye to alleviating the cancer burden through educational responses with four publics in mind-policy makers, Western medical personnel, traditional healers, and the general public. In-depth interviews were conducted with 14 Malay traditional healers, 13 cancer survivors who had seen both traditional healers and Western doctors, and 12 cancer medical specialists. Results: Analysis of the data from these 39 participants revealed four roles traditional healers play in cancer treatment-medicinal healer, emotional comforter, spiritual guide, and palliative caregiver. Conclusions: Three roles (emotional, spiritual, palliative) can be seen as complementary to the allopathic system. Emotional and spiritual roles may augment the effectiveness of biomedical treatment. Cancer awareness and education programs need to position traditional healers as complementary, rather than an alternative to Western medical treatment; Validating the roles Traditional Healers can play in cancer treatment in MY through health promotion and education will contribute to alleviating the nation's cancer burden.
... De acordo com estudos internacionais, embora seja inegável o progresso científico e tecnológico da medicina moderna ocidental, contraditoriamente nota-se o crescimento exponencial do uso de práticas terapêuticas não biomédicas. É nesse contexto de ampliação de possibilidades terapêuticas que as medicinas alternativas e complementares vêm despertando o interesse de acadêmicos, profissionais, gestores de serviços de saúde, que buscam estudos com abordagem qualitativa, expandindo as fronteiras das informações quantitativas, quase sempre empenhadas em descrever: o uso das técnicas, a população consumidora e a evidência científica produzida sobre essas práticas (Tovey, 2007). ...
... De maneira geral, se a biomedicina tem seu paradigma pautado na redução biológica, as MAC trazem contribuições para: a reposição do sujeito doente como centro do paradigma médico; a relação médico-paciente passa a ser fundamental para a terapêutica; busca de meios terapêuticos simples, ou seja, não baseados em grandes tecnologias; busca da autonomia do paciente; busca da saúde, e não mais a doença como centro do paradigma médico (Tesser, Luz, 2002;Barros, 2000). Segundo Tovey (2007), esses são elementos da tensão dialética intrínseca à relação entre biomedicina e MAC, uma vez que, por um lado, há uma individuação proposta pelas MAC e, por outro, o processo de despersonalização trazida pelo cuidado biomédico. ...
Article
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It was sought to learn about the meanings within complementary and alternative medicine (CAM) use among patients undergoing treatment at the oncology service of the Clinical Hospital of Unicamp. For this, the following were analyzed: 1) how patients dealt with health/ disease; 2) the motivations and processes underlying the decision to use CAM; and 3) the sociability networks that influenced decisions regarding conventional and/ or unconventional cancer treatments. From the discourse of the eight patients interviewed, it was seen that CAM and religious services were important for constructing meanings for the following: the biological dimension of the illness, possibilities for cure, filling the void promoted by the biomedical model and searching for expanded care. Thus, religious practices were experienced by patients such that they constituted a strategy that legitimized and softened the uncertainty regarding questions of a moral, personal, social and physical nature, in relation to chronic oncological conditions.
... More than 80% of the world's population uses traditional medicine for cultural, economic, or accessibility reasons [121]. Several studies worldwide have confirmed the importance of this medicine in the treatment of cancers in general and those of the oral cavity in particular [122][123][124]. ...
Article
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Oral cavity cancers are part of the upper aerodigestive tract cancers and represent a significant burden worldwide. Its epidemiology varies from country to country with high frequencies in South East Asian countries. Tobacco and alcohol are the main risk factors. Survival of oral cancer is low i.e., less than 40% in the advanced stage (stage III and IV), diagnosis of oral cavity cancer is based on a complete clinical examination of the oral cavity complete with biopsy, bio-markers are an adjunct to screening and diagnosis of oral cavity cancers, surgery, radiotherapy, chemotherapy and immunotherapy are part of the therapeutic armamentarium of oral cancer but also have limitations. Traditional medicine is an important and proven alternative in the treatment and support of patients with oral cavity cancer. Prevention of oral cavity cancers includes not only early detection of precancerous and cancerous lesions but also control of risk factors and education of the population. Surgery, radiotherapy, chemotherapy and immunotherapy are part of the therapeutic strategy of oral cancer treatment but also have limitations. Traditional Medicine is an important and proven alternative in the treatment and support of patients with oral cavity cancer. It is thus desirable to scientifically validate phytochemicals in order to integrate alternative medicine as part of national cancer management strategy. In silico advanced studies on secondary metabolites of medicinal plants traditionally used to treat oral cancer are in progress.
... There were only two male participants enrolled in the IWP, which is consistent with previous research that indicates female cancer patients and survivors are 2.1 times more likely to engage in CAM practices than males [50]. An effort to recruit and retain male participants may be enhanced by using male recruiters [51] and providing more direct and primary education from trusted health professions for males to increase awareness and interest [52]. Another limitation was lack of objective assessments. ...
Article
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The Integrative Wellness Program (IWP) at the University of Miami Sylvester Comprehensive Cancer Center (SCCC) sought to provide integrative wellness education to cancer patients, survivors, and caregivers by offering instruction in exercise, nutrition, and complementary and alternative medicine. The objective of this study was to assess the impact of the IWP on the overall wellness of the individuals participating in the program. Three different 10-week versions of the IWP were conducted over a 1-year period. Each session focused on a different wellness topic presented through interactive lectures and applied activities. A series of self-report questionnaires were administered at baseline and again at the completion of the program to assess improvements in physical activity levels, dietary habits, sleep hygiene, and quality of life. Participants were generally older, Caucasian, female, had higher levels of education, and still currently receiving treatment. Significant changes were observed in two measures: Starting the Conversation (-2.0 ± 2.40, p = .037) and the Sticking To It subscale of the Self-Efficacy and Eating Habits Survey (1.7 ± 1.22, p = .0013). A trend for improvement in the Reducing Fat subscale of the Self-Efficacy Eating Habits (0.44 ± 0.60, p = .056) was also observed. Participant satisfaction surveys indicated high levels of satisfaction and applicability of the material presented. The significant improvements detected related to dietary habits, combined with the responses from the participant satisfaction surveys, suggest that the IWP was well received and can positively impact the overall wellness of cancer patients, survivors, and their caregivers.
... A colon cancer model gave seminal evidence for cancer genetic and histological multistage progression (Volgestein et al. 1988 ) . Age is the biggest risk factor for cancer (Tovey et al. 2007 ) . The following six cell-markers differentiate cancer cell behavior from normal cells: (1) Evasion of apoptosis. ...
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Information obtained from traditional use and scientific studies can help establish the value of honey in cancer treatment. Animal models and clinical trials with honey administered alone or in combination with other natural products or targeted therapy, are often difficult to interpret because honey contains major sugary and watery plant components, polyphenols, organic acids, and other secondary metabolites and structures, collected and/or transformed by the bees from thousands of plants. Similarly, cancer includes over 100 forms of metastitized tumors. Antiproliferative action of pot honey from Frieseomelitta, Melipona, Scaptotrigona, and Tetragonula on human ovarian cancer cell lines, reported here from our recent work, suggests cisplatin resistance in ovarian cancer may be effectively diminished by honey.
... A colon cancer model gave seminal evidence for cancer genetic and histological multistage progression (Volgestein et al. 1988 ) . Age is the biggest risk factor for cancer (Tovey et al. 2007 ) . ...
... Seven mediation practitioners, separate from the surveyed subjects, were engaged as volunteers to participate in informal in-depth interviews, considered by Denscombe (2010) as semi-structured, and which were conducted by the investigator. As it was considered important to discuss with participants their understanding of the process and its mechanisms and explore the meaning of their role, the by guest on October 28, 2015 Downloaded from utilization of this method of data collection was similar to the reasons defined by Tovey, Chatwin, and Broom (2007) where a range of conceptualizations and meanings was elicited. The 7 interviewees in the current study were from a pool of 19 experienced practitioners known professionally to the investigator through shared involvement in family mediation. ...
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This article describes a qualitative study of the co-mediation process from the perspective of mediation practitioners, and what salient features distinguish it from sole mediation. The study examined the nature and character of the interactive patterns of communication performed by all participants as central features of the process. Forty-seven mediators were surveyed by questionnaire in relation to the co-mediation process. A further seven mediators were subjected to in-depth interviews. Their combined responses revealed co-mediators as ?agents of change? tasked in a distinctive way with facilitating fair and just outcomes to family disputes. Exploration of the characteristics unique to co-mediation revealed a dynamic reflexive monitoring interplay with interconnected functions comprising a complex ?dance? that involved all participants.
... Several estimates have put global use at about 80% of total population (e.g. Tovey et al. 2007;Chawla et al. 2013;Chege et al. 2015;Aziato and Antwi 2016). At the same time, traditional medicine is overwhelmingly provided in the private sector. ...
Article
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Globally, traditional medicine has long been used to address relatively common illness, mental ill health and during childbirth and post-natal care. However, traditional medicine is primarily provided by the private sector and it is unclear how far expenditures on traditional medicine contribute to household impoverishment. A life history method was used to understand the health seeking experience of 24 households over the last 60 years in Cambodia, a country with high out-of-pocket expenditures for health. The life histories suggest that traditional medicine in Cambodia has been undergoing a process of commercialization, with significant impacts on poor households. In the earlier lives of respondents, payments for traditional medicine were reported to have been flexible, voluntary or appropriate to patients' financial means. In contrast, contemporary practitioners appear to seek immediate cash payments that have frequently led to considerable debt and asset sales by traditional medicine users. Given traditional medicine's popularity as a source of treatment in Cambodia and its potential to contribute to household impoverishment, we suggest that it needs to be included in a national conversation about achieving Universal Health Coverage in the country.
Article
The essay is controversial. The argument that Sufi-inspired transpersonal experiences, practices and processes are widespread does not match the popular view of Pakistan as a major homeland of Islamic 'fundamentalism' and militancy. Neither does the argument match the views of all those Islamists who bind Sufism to the transcendent theism of tradition. In various ways and to varying degrees, the most illustrious of Sufi saints move away from tradition and the alterity of the Godhead. For this reason Sufi saints can serve as a powerful font of transpersonal humanism, a universal humanism of humanity which plays a critical role in holding the nation together. Exploration of 'transpersonal Pakistan' also serves to illustrate a way of working as a transpersonal sociologist, and what the approach has to offer.
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Homoeopathy is one of the most widely used forms of complementary medicine in the West. However, its methods and philosophical underpinnings are basically polarized in relation to those of conventional medicine. Many homoeopathic patients choose to continue using conventional medicine while they receive homoeopathy, but from a homoeopathic perspective, these treatments are often regarded as undesirable or even damaging. This article will utilize the principles of conversation analysis (CA) to explore points in homoeopathic consultations where practitioners address their patients' use of conventional medications. It will be suggested that approaches which display a degree of incorporation are preferred to those which imply categorical rejection. By not emphasizing the underlying tensions between conventional and homoeopathic paradigms, and displaying an adaptive and inclusive approach, homoeopathy essentially sets itself up as a parallel (i.e. equal) system, rather than one that is purely in opposition to the dominant medical model.
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Z Amaç: Geleneksel ve tamamlayıcı tıp (GETAT) uygulamaları ve ilişkili enfeksiyonlar konusunda sağlık hizmetleri meslek yüksekokulu öğrencilerinin bilgi düzeyini tespit etmek Yöntem: Tanımlayıcı kesitsel türde olan çalışmaya online anket aracılığıyla Temmuz 2021-Eylül 2021 arasında eğitim gören 599 öğrenci katıldı. Bulgular: Katılımcıların büyük bölümü GETAT kelimesini okuldan (%37,5), internetten (%31,2) duyduğunu belirtirken; akupunktur en çok bilinen yöntem oldu. Öğrencilerin %70,6'sı GETAT ile ilgili eğitim almak isterken en sık öğrenmek istenilen yöntemler akupunktur ve hipnozdu. GETAT yöntemini daha önce kendiniz için uyguladınız/uygulattınız?" sorusuna %25,2 katılımcı hipnoz cevabını verdi. "GETAT ilişkili bakteriyal/viral hastalık bulaşabilir" fikrine 410 kişi; "GETAT sağlık kuruluşunda hijyenik koşullarda yapılmalıdır" fikrine 529 kişi katıldı. GETAT uygulamalarının etkinliğine dair inanç %77 oranındaydı. GETAT yöntemi uygulama yerine 161 katılımcı (%56,3) sağlık kuruluşu cevabını verdi. GETAT uygulaması sırasında hijyen koşullarına uyuldu mu?" sorusuna 185 kişi evet yanıtını verdi. Uygulamada 182 kişi invaziv girişimler olmadığını belirtti. Uygulama sonrası komplikasyon gelişen 75 (%26,2) kişiydi. "Sağlık eğitimi GETAT hakkında eğitim içermelidir" yönergesi cevapları arasında bölümler bazında anlamlı farklılık bulunmamaktadır (p<0,05).
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Amaç: Geleneksel ve tamamlayıcı tıp (GETAT) uygulamaları ve ilişkilienfeksiyonlar konusunda sağlık hizmetleri meslek yüksekokulu öğrencilerininbilgi düzeyini tespit etmekYöntem: Tanımlayıcı kesitsel türde olan çalışmaya online anket aracılığıylaTemmuz 2021- Eylül 2021 arasında eğitim gören 599 öğrenci katıldı.Bulgular: Katılımcıların büyük bölümü GETAT kelimesini okuldan (%37,5),internetten (%31,2) duyduğunu belirtirken; akupunktur en çok bilinen yöntemoldu. Öğrencilerin %70,6’sı GETAT ile ilgili eğitim almak isterken en sıköğrenmek istenilen yöntemler akupunktur ve hipnozdu. GETAT yönteminidaha önce kendiniz için uyguladınız/uygulattınız?” sorusuna %25,2 katılımcıhipnoz cevabını verdi. “GETAT ilişkili bakteriyal/viral hastalık bulaşabilir”fikrine 410 kişi; “GETAT sağlık kuruluşunda hijyenik koşullarda yapılmalıdır”fikrine 529 kişi katıldı. GETAT uygulamalarının etkinliğine dair inanç %77oranındaydı. GETAT yöntemi uygulama yerine 161 katılımcı (%56,3) sağlıkkuruluşu cevabını verdi. GETAT uygulaması sırasında hijyen koşullarınauyuldu mu?” sorusuna 185 kişi evet yanıtını verdi. Uygulamada 182 kişiinvaziv girişimler olmadığını belirtti. Uygulama sonrası komplikasyon gelişen75 (%26,2) kişiydi. “Sağlık eğitimi GETAT hakkında eğitim içermelidir”yönergesi cevapları arasında bölümler bazında anlamlı farklılıkbulunmamaktadır (p<0,05).
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Z Amaç: Geleneksel ve tamamlayıcı tıp (GETAT) uygulamaları ve ilişkili enfeksiyonlar konusunda sağlık hizmetleri meslek yüksekokulu öğrencilerinin bilgi düzeyini tespit etmek Yöntem: Tanımlayıcı kesitsel türde olan çalışmaya online anket aracılığıyla Temmuz 2021-Eylül 2021 arasında eğitim gören 599 öğrenci katıldı. Bulgular: Katılımcıların büyük bölümü GETAT kelimesini okuldan (%37,5), internetten (%31,2) duyduğunu belirtirken; akupunktur en çok bilinen yöntem oldu. Öğrencilerin %70,6'sı GETAT ile ilgili eğitim almak isterken en sık öğrenmek istenilen yöntemler akupunktur ve hipnozdu. GETAT yöntemini daha önce kendiniz için uyguladınız/uygulattınız?" sorusuna %25,2 katılımcı hipnoz cevabını verdi. "GETAT ilişkili bakteriyal/viral hastalık bulaşabilir" fikrine 410 kişi; "GETAT sağlık kuruluşunda hijyenik koşullarda yapılmalıdır" fikrine 529 kişi katıldı. GETAT uygulamalarının etkinliğine dair inanç %77 oranındaydı. GETAT yöntemi uygulama yerine 161 katılımcı (%56,3) sağlık kuruluşu cevabını verdi. GETAT uygulaması sırasında hijyen koşullarına uyuldu mu?" sorusuna 185 kişi evet yanıtını verdi. Uygulamada 182 kişi invaziv girişimler olmadığını belirtti. Uygulama sonrası komplikasyon gelişen 75 (%26,2) kişiydi. "Sağlık eğitimi GETAT hakkında eğitim içermelidir" yönergesi cevapları arasında bölümler bazında anlamlı farklılık bulunmamaktadır (p<0,05).
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Drawing on in-depth interviews with Australian cancer patients, this article examines their experiences of utilizing complementary and alternative medicine (CAM) within disease and treatment processes. Results illustrate the complex and often contradictory roles played by CAM within patients' therapeutic trajectories. On the one hand, their accounts illustrate the liberating and positive impacts of CAM engagement, including perceived increases in feelings of control, power and individual autonomy within therapeutic processes. However, the interviews also revealed problematic notions of self-healing and hyper-positivity engendered in much CAM practice, involving the imposition of restrictive notions of self-discipline on these cancer patients. On the basis of the results it is argued that CAM sociology must refocus on the grassroots experiences of different patient groups, rather than grandiose notions of wider socio-cultural shifts in therapeutic practice.
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Whilst much research into alternative and complementary medicine use indicates that these practices enable experiences of control, agency and empowerment, few theoretically informed answers have been given to why and how consultations with alternative and complementary health practitioners facilitate experiences that are felt to be ‘healing’.This article utilizes theories of recognition in order to reflect on the healing experiences of women seeking health and wellbeing through varied forms of alternative and complementary medicine. I analyse the empowering and agency-giving aspects of alternative and complementary medicines, in particular in relation to wider societal conceptualizations of the self. This article is based on qualitative interviews with both practitioners and clients of varying alternative and complementary medicines.
Article
This article discusses some aspects of the practice of complementary and traditional medicine in urban Mexico through a transcultural paradigm, hence it focuses on how medical knowledge(s) are commodified as well as how a `travelling' medical knowledge acquires agency in a transculturation process. This study, while analysing different practices of Chinese and Japanese medicine, argues that oriental medicine is translated in at least two ways - a popular and a cosmopolitan form - that shape particular expressions of citizenship. The popular form is carried out in low-income neighbourhoods and it focuses around a `Mexicanization' of oriental medicine and the reaffirmation of the popular as part of the national. Cosmopolitan medicine, on the other hand, is particularly practised in exclusive health spas and seeks to purge the popular out of the national and to incorporate `traditional' medicine as one of the multiple components of cosmopolitan consumption. The article argues that both popular and cosmopolitan expressions are important to understanding how complementary and oriental medicine have become not only part of a global market, but also part of a particular history of national and popular medical systems.
Article
Many health policy interventions reflect implicit assumptions of cause and effect, contestable values and partial rationales - particularly in healthcare systems based on notions of entitlement and obligation. The objective-oriented nature of policies and the potential cacophony of narratives that underpin such interventions are not, though, explicable solely in terms of the achievement of particular ends envisaged by different policy actors. These ends reflect, often opaquely, notions of responsibilities, rights and ideas of social justice - issues central to perennial debates around 'welfare citizenship'. But, just as notions of entitlement, rights and obligations are open to challenge and change, so too are discourses around the meaning and implications of far more fundamental phenomena: the individual and individualism. In this paper we focus on the evolution of primary healthcare in the UK in order to demonstrate that changing ideas of the 'individual' and individualism are central to the implicit and explicit narratives and parameters that underpin the formulation of health policy. The individual and individualism are seen as malleable phenomena that can act as the focus for renegotiations of the relationship between systems of healthcare and the patient-citizen at a personal and collective level. Contestable and contested notions of the individual are thus, at one level, fundamental to the meanings and thus the ultimate nature and outcome of health policy interventions.
Article
The popularity of alternative therapies in the past two decades has been accompanied by a proliferation of sociological works investigating different aspects of this phenomenon.1,2 A major strand of the literature in ‘the sociology of alternative medicine’, which concerns three social actors: users of alternative therapies; practitioners of alternative therapies; and physicians (the orthodoxy). Research on users of alternative medicine has mainly investigated the causes of people’s use of these modalities and has focused on three questions: Why do people use alternative medicine? Why has alternative medicine become popular in recent times? and, What is the sequence of events that leads to alternative medicine use? Research on alternative practitioners has mainly investigated the issue of professionalization of these practitioners. Research on physicians has mainly investigated: physicians’ views on and professional relationships with alternative therapists; physicians’ views on the efficacy of alternative therapies; the orthodoxy’s views on the knowledge base of these therapeutic systems; and physicians who use alternative techniques. The article argues that a paucity of empirical research is a major weakness of the present state of the sociology of alternative medicine and thus several research possibilities are delineated. Its aim is to provide a critical review of the literature on each of the above topics and suggest future research possibilities.
Article
Facilitating user involvement is regarded as a significant factor in advancing the overall quality of health care provision. The wish to develop user involvement is present in White Papers, government reports and policy guidance. The reform of cancer services consequent on the implementation of the Calman Hine Report creates opportunities for meaningful user involvement in cancer care. Draws on research conducted in the Trent Region of the NHS and examines how far user groups have been involved, which groups may be excluded and what remains to be done to elevate user views in planning and evaluation of cancer services. Many commissioners and providers of health care are currently establishing the infrastructure to encourage the development of user involvement. Suggests the experience in relation to cancer can offer a model for others.
Article
This paper gives the results of one of the first studies of non-biomedical health care services in the State of Morelos, Mexico. The socio-cultural matrix of the population of Morelos has attracted many practitioners of medical models which have no foundation in the rationale of the biomedical-scientific model. There is a considerable variety of non-biomedical therapists in the area of study which may be categorised in three groups: (a) traditional medicine (b) alternative medicine, and (c) faith healing. There are marked differences regarding the academic background of practitioners, the reasons why they engage in their practice, the types of financial strategies they use to provide care, the creation and utilisation of therapist networks, and, finally, in the type of population for whom they provide care. We strongly recommend further research on non-biomedical health care models in the state and in Mexico, since the importance of these models is growing as a result of the increasing demand for health care by a diversity of population groups.
Article
This paper examines the arguments presented at the Royal Commission of Inquiry into chiropractic, which took place in New Zealand in 1978. Drawing on the work of Potter, it suggests that the protagonists in the debate, the medical profession and its allies on one side and the chiropractic profession on the other, developed rhetorical strategies to counter competing versions of the world. An unusual feature of this debate was that it took place before ‘impartial’ judges. The paper demonstrates the delicate process of negotiation performed by chiropractic groups when confronting medicine in an open forum. The paper concludes that in order to resolve the competing rhetorics, the Commissioners sought for a compromise, which at once embedded chiropractic within the public health service in New Zealand and ‘de-radicalised’ its claims.
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This article looks at the growth and use of homeopathic medicine in the city of Oaxaca, Mexico. Based on interviews with 174 male and female patients from half of the homeopathic clinics in the city, this research examined attitudes toward disease causation and how one stays healthy. Findings suggest that women are better at monitoring and trying to improve their health than are their male counterparts. Although homeopathy enjoys a strong and almost devoted following, women seem to be more convinced of the overall efficacy of homeopathic medicine than do men. [medical pluralism, homeopathy, complementary/alternative medicine, Mexico, gender differences]
Health professionals tend to consider that they are in the best position to decide treatment options for cancer patients despite research evidence that a feeling of powerlessness can affect health outcomes and the inclusion of patient empowerment within government policy. This article describes a focus group study, carried out in collaboration with the University of Warwick, aiming to elicit the needs of people with cancer and their carers/supporters, the reactions to these needs and the strategies adopted to obtain support and self-management skills. The methodology was 11 two-stage focus groups carried out in four English cities in 1998, involving 54 people with cancer and 14 supporters. The main study findings identified a parallel ‘journey’ to the previously described emotional and medical cancer journey in the form of an epistemological journey of ‘identity shifts’ as people progressed through their disease. People required additional emotional and psychological support when these shifts were taking place and used a variety of strategies to obtain this, including the use of complementary therapies and other strategies designed to increase their sense of control. The article concludes by describing a ‘holistic’ approach to cancer care which supports patient empowerment and recommendations for implementing the research findings into practice.
Article
This paper describes naturopathic practitioners with two different world views--holistic and scientific, and explores the relationship of practitioners' socialization experiences and practice patterns with these two world views. Data were gathered by a variety of methods including: (1) a 14-page questionnaire mailed to all 296 naturopathic practitioners licensed in Canada; (2) a participant observation study at the Canadian College of Naturopathic Medicine (CCNM); and (3) open-ended interviews with 16 students attending CCNM and 41 naturopathic practitioners which were audio-taped and transcribed verbatim. Individuals with both holistic and scientific world views entered naturopathic training and none of the practitioners who were interviewed reported a change in world view while at naturopathic college. However, practitioners reported a new-found appreciation of the "other" world view on completion of their training, indicating the occurrence of a socialization effect. Many decisions involved in setting up a practice and seeing patients were affected by the practitioners' world views. For example, there were distinct differences in the way the practitioners with different world views who were interviewed chose treatment modalities. Practitioners with scientific world views reported choosing treatments based on the available "scientific evidence", while practitioners with holistic world views included a careful exploration of the patient's spirituality and their own intuition in their treatment decisions. In addition, practitioners with holistic world views reported significantly longer patient visits than practitioners with scientific world views. The data presented here suggest that one's world view influences one's perceptions of socialization experiences and social situations, and modulates the effects of both on practice patterns.
Article
The purpose of this paper is twofold: to describe Tswana medicine as a system of thought and to show how traditional medical roles are acted out in the encounter with Western biomedicine. I want to draw attention to the contrast between the intellectual systems of African traditional thought and Western science as applied to health and illness (medicine). I do not argue that biomedicine is more open and adaptable to change than folk medicine, or vice versa. Rather, I want to show that both integration ('openness'), as well as rejection ('closeness'), occur when Tswana medicine meets biomedicine. How do the Botswana make sense of a new body of knowledge and ideas of contagion in a context of medical pluralism? How are medical roles adapted to the situation of medical pluralism and the predicaments that flow from such a situation. In conclusion I will briefly discuss some of the elements that may determine the future outcome of the integrative health policy: Is it possible to obtain mutual understanding and cooperation among the various practitioners--in the context of medical pluralism--when their knowledge is built on such different medical explanations and modes of though as those of biomedicine and folk medicine?
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This paper describes the integration of modern and traditional obstetric practices in a provincial hospital in the Maithili-speaking area of southern Nepal. The doctors and nurses consciously distance themselves from the traditional practices of their obstetrical patients, whom they view as 'ignorant'; but because hospital resources are insufficient to impose the normative form of modern medical organization, patients and their relatives assert a more active role in providing hospital-based care. In consequence, mothers are delivered according to both modern, clinical as well as local cultural practices. Recent WHO policy has cast modern medicine as the agent in the integration of traditional healing within national health systems. This essay shows that in poor countries the powers of agency may not be exclusively in the hands of the medical profession. Patients, and others in their social networks, have become agents, constraining and negotiating the terms on which modern medicine is to be integrated within their traditional obstetric practices.
Article
This essay examines three popular ethnomedical institutions in Brazil: faith healers, Protestant evangelicals, and the practitioners of one of the Japanese new religions. In particular, I compare the relative degrees of diagnostic specificity in their practices. Medical anthropologists have neglected the analysis of this aspect of practice, although I show in the present paper its utility for comparative work. Also, I show that diagnostic specificity is congruent with an ontological view of illness and an active role for the healer, while lack of diagnostic specificity is congruent with a very general form of therapy, such as is found in the Seicho-no-Ie religion. Traditional rezadores, in contrast, use a high degree of diagnostic specificity.
Article
Practitioners of modern medicine in Bolivia are often ignorant of traditional health practices among Andean peasants in the Department of Oruro. This ignorance makes them less effective agents for improving health. The author describes a method for teaching traditional concepts of health and disease to practitioners of modern medicine (doctors, nurses, and assistant nurses). He discusses workshops offered to these practitioners, where the participants were guided through a series of exercises which assisted them in deciding what aspects of the traditional system to change and what aspects to leave alone. He finally shows how Andean myths can be used as a method for teaching them how to cure disease. The objective is to educate modern medical practitioners in traditional beliefs and to use these beliefs for teaching peasants about modern medicine.
Article
In much of Thailand animistic curing practices have lost ground to great tradition herbal medicine and modern scientific medicine as more people achieve literacy. Especially in urbanizing areas, Buddhist and Muslim Thais hold in the highest esteem traditional curers whose knowledge derives from patient experimentation and the study of ancient texts. However, among Malay-speaking Muslims in south Thailand, the most respected therapeutic knowledge is revelatory in nature. Southern Muslim curers are generally mystics or spirit-mediums whose direct channels of communication with the supernatural convey remedies for afflictions but also provide guidelines for maintaining sociocultural separatism.
Article
This study examines the extent of utilization of unorthodox therapies and marginal practitioners among patients with one broad category of chronic disease, rheumatic disorders. Almost all respondents (94%) had tried some unorthodox remedy or practitioner, and several had used 13 different unorthodox remedies or practitioners. There was no relationship between age, sex, race, geographic location and magnitude of usage of treatments. There was no statistically significant relationship between education and income and amount of usage, although there was some variation by income group in which unorthodox remedies were employed. Thus, this study provides evidence that some elements of folk medicine practice continue to exist among most segments of the American population and this issue deserves further research. An important role for medical sociologists is to examine disease and disease treatment from the perspectives of the lay culture, as well as that of the medical community.
Article
Support groups have been introduced in medicine since a number of years and several studies indicate that these groups can be beneficial for cancer patients. This article reviews the concept and types of support groups in cancer care. The demands on facilitators and patients in these groups are discussed and potential problems are emphasized. Ground rules for the establishment of a successful support group for cancer patients are described.
Article
Complementary techniques can provide symptom control, improve patient's well being, and enhance cancer medicine. They provide a desired addition and balance to technologically sophisticated patient care.
Article
The paper explicates "practiced medicine" as an operative cross-cultural analytic concept by locating it within previous major developments and directions of study within anthropological studies of medicine in India, and medical anthropology more generally. Practiced medicine in India, for example, allows us to see better how India manages not only multiple traditional and modern medical approaches, languages, therapeutic regimens, and materia medica, but it also leads us to a sustained moral, social and material criticism from within. The study of such diversity leads to a loosely shared, and ethnographically attestable, cultural reasoning, practice and practical ethos across the traditional and modern medical worlds. Also appearing before us are the usually hidden cultural assumptions, negotiations and compromises of diverse Indian medical practitioners, and the strengths and weaknesses of modern medicine under "normal" and "disastrous" situations in contemporary India. As India today grapples with issues of availability, affordability, equity, and distributive justice in medical care, its practiced medicine raises issues of "critical consciousness" for modern (and traditional), state supported medicine.
Article
Little is known of the experiences of oncology patients who abandon biomedicine to use alternate therapies. This ethnography provides insights into the experiences of eight estranged informants. Six main themes emerging from the analysis are (a) expressed stress: emotions such as anger and fear, (b) taking control, (c) belief in a cure, (d) social group association, (e) cost considerations, and (f) mystical insights into health care. Conducted over 3 years, the study includes a network sample and longitudinal case study with one key witness. Individual interviews and one focus group were included. Insights are provided for health professionals who may encounter biomedical abandonment.
Article
THE LACK OF relevant high-quality scientific research has often been given as a reason1,2 to explain why a large number of health care practices are termed alternative. However, the fact that it required congressional intervention3,4 for the National Institutes of Health (NIH) to earmark 0.02% ($2 million) of its $10.7 billion 1992 budget to evaluate practices used by more than 35% of the US population suggests that issues beyond the scientific were involved. Nonscientific factors have played a major role in limiting scientific exploration of these areas, have discouraged potential investigators, and have dictated greater profitability elsewhere. This article examines current definitions of alternative medicine and proposes a new one, outlining those factors, sociological (academic), political, regulatory, and economic, that must be considered when exploring this field.
Article
The osteopathic medical profession was founded in the late 19th century and has become an accepted part of the medical establishment in the United States. Throughout its history, the osteopathic medical profession has attempted to define itself in a way that differentiates osteopathy from other alternative therapies and situates the profession as responsive to the changing health care needs of the American public. This article examines identity within the osteopathic profession by examining the ways in which the profession has created, maintained, and changed its identity in its over century-long existence. The case analysis presented here involves the examination of identity statements culled from several osteopathic data sources. The identity statements represent four specific time periods within the osteopathic profession: the founding statements of A. T. Still, statements from 1915 through 1935 when the scope of osteopathic identity was expanding, statements from 1954 through 1974 in which the osteopathic profession dealt with internal and external threats in developing a "separate but equal" identity, and recent statements from a osteopathic student web site that illustrate current and future views of osteopathic identity. The results of this case analysis highlight the role of the social environment in establishing and changing professional identity, the importance of an occupational founder in shaping the articulation of identity, and the tension between identity and practice within the osteopathic medical profession.
Article
Little is known about nurses' attitudes towards alternative medicine. The purpose of this study was to describe attitudes towards alternative medicine among nurses working on oncology wards in three university and one central hospital in Finland. The data were collected with a questionnaire specifically developed for this project. The response rate was 68.1% (n = 92). The nurses did not regard alternative medicine as a safe and natural method in the treatment of cancer. On the contrary, many nurses believed that alternative therapies are offered by quack doctors for financial gain. However, the nurses considered it important that cancer patients have the opportunity to talk about their use of alternative medicine both with nurses and physicians. Overall the results indicated that nurses' attitudes are for the most part negative. An interesting question that deserves further attention is whether this attitude is reflected in nursing practice.
Article
The legacy of 19th-century social theories applied to the study of non-mainstream treatment use continues to affect contemporary research into complementary and alternative medicine (CAM). Quantitatively based studies of CAM use have been hindered by the lack of an adequate lexicon, inaccurate characterizations of the people who use CAM, and underestimates of the prevalence of usage. Results from a qualitative prospective cohort study challenge previous stereotypes by indicating that CAM usage does not increase dramatically with the initial diagnosis of cancer and that younger women are more likely to use CAM than older women. Qualitative research methods are uniquely appropriate for obtaining accurate information about health practices that, despite growing acceptance in some areas of society, are still viewed as outside of the mainstream.
Article
Acupuncture gained considerable attention in anglophone countries in the 1970s. As part of that popularity many medical practitioners became interested in the therapy and learned acupuncture techniques. A number of studies have indicated that medical practitioners were able to take up the practice of acupuncture without threatening the cultural authority of medicine so long as they limited the scope of its practice and redefined acupuncture concepts in Western biomedical terms. These analyses tend to present the medical profession as monolithic and emphasize a dichotomous relationship between biomedicine and alternative therapies such as acupuncture. This study examines the ways in which acupuncture has been represented in different medical forums, suggesting that in order to understand the relationships between biomedicine and alternative medicine we need to be more aware of the changing nature of these representations and their dependency upon the context of the representation. Rather than emphasizing a duality between orthodox medicine and alternative medicine, it is argued here that there are pluralities of medical and healing worldviews.
Article
Most of the studies related to the use of unconventional methods of therapy by cancer patients have been carried out in the developed countries. This study was conducted to ascertain the frequency, type, and duration of use of unconventional methods of therapy by cancer patients in Pakistan. We also wanted to identify individuals who are most likely to use these methods and to compare the findings with those reported from the developed countries. Between 1 April and 30 May 1994, all patients with histologically proven cancer who visited the oncology unit were interviewed. A printed questionnaire with questions and options was used as an interview guide. Informed consent was obtained. One hundred and ninety-one patients were interviewed, on average, for 25 minutes each. Use of unconventional methods of therapy by cancer patients was widespread (54.5% of all patients). The majority (83.7%) were influenced by family members to use these methods. Traditional herbal medicines (70.2%) and homeopathy (64.4%) were the most commonly employed methods. Thirty-six percent of the users employed these methods before receiving any conventional therapy. Only 15% used these methods after conventional therapeutic options had been exhausted. Patients generally perceived these methods as useful, non-toxic and inexpensive. Age, marital status, socio-economic background, education level and status of underlying neoplasm did not influence the frequency of use of unconventional methods. The use, however, was influenced by gender, family size, and type of underlying malignancy. Patients aware of their diagnosis were less likely to use these methods. This study suggests that use of unconventional methods by cancer patients in Pakistan is widespread. Unlike western countries, these methods are often employed before receiving any conventional therapy. This probably results in a significant delay which can be expected to adversely influence the subsequent disease management and survival. Public education, reduction of cost and easy availability of conventional therapy may be helpful in reducing the use of methods which otherwise may have no proven value.
Article
Amidst the substantial change currently gripping primary health care are two developments central to contemporary debate regarding the very nature, territory and identity of general practice - the integration of complementary and alternative medicine (CAM) and the rise of evidence-based medicine (EBM). This paper reports findings from a study based upon 25 in-depth interviews with general practitioners (GPs) personally practising complementary therapies alongside more conventional medicine to treat their NHS patients. The paper outlines the GPs' perceptions of EBM, its relationship to their personal development of CAM, and their notions of good clinical practice more generally. Analysis of the GPs' accounts demonstrates how CAM can be seen as a useful resource with which some GPs defend their clinical autonomy from what they perceive to be the threat of EBM.
Over recent years a sporadic, but not insignificant, sociology of complementary and alternative medicine (CAM) has begun to emerge. However, to date, the systematic sociological study of the apparent affinity between CAM, nursing as a profession and its practitioners has been absent from it. In this paper we argue for the need for a rigorous sociology of nursing and CAM and set out a provisional framework through which this might be operationalized. Three broad themes, as well as cross-cutting issues, are outlined. The way in which the challenges of CAM are mediated at the level of the individual and the profession are pivotal to analysis. An understanding of this mediation is crucial both as a means of extending knowledge, and as a means of engaging with complex issues such as the role of evidence, and the equity of provision, that are likely to accompany any extension of CAM mainstreaming.
Article
This study describes the use of complementary therapies (CTs) among breast (women) and prostate cancer patients (men) in Finland. The data were collected using a self-administered postal questionnaire. Responses were received from 216 women (response rate 54.9%) and 190 men (response rate 55.4%). Data analysis was based on descriptive statistics, the chi-square test and Fisher and Wilcoxon tests. Interpretation of the responses to the open-ended questions used the method of content analysis. Half the respondents (women 53%, men 50%) were interested in CTs. Women (59%) had seriously considered using CTs significantly (P = 0.006) more often than men (44%). Among the women and men who had considered the option, CT use was not started because there was not enough scientific evidence (women 56%, men 77%) or because conventional treatments had worked well enough (women 45%, men 70%). Almost one-third of all women (30%) and men (28%) either continued to use or started using CTs after they had fallen ill with cancer. They resorted to CTs in order to restore their hope in the future (women 36%, men 36%) and to do as much as they could for themselves (women 46%, men 29%). The results indicate that cancer patients are interested in CTs and use them quite frequently. This presents a major challenge to official health care: how should cancer patients be supported in the care relationship to make an informed decision about using CTs; what kind of advice should they be given; and how can patients' individual requirements be adequately met in nursing care?
Article
The inadequate use of pharmaceuticals continues to be a severe problem in most parts of the world. Developing nations waste very large amounts of scarce health resources on medicines of doubtful therapeutic value, and many persons do not comply with physicians advice or engage in risky self-medication practices contributing to additional misuse of resources and iatrogenia. This paper examines the few scientifically designed interventions at the community and patient s levels to improve the appropriate use of pharmaceuticals in developing nations. The authors analyze the contribution made by these studies and identify several limitations including the absence of independent evaluations of outcomes, lack of sufficient information to judge the quality and adequacy of the instruments used, problems relating to replicability of interventions at regional or country level, or outside the cultural context within which they took place, lack of information on costs of interventions, a crucial variable in poor countries, and the absence of standardized outcome measures that makes comparative analysis very difficult.
Article
The use of complementary therapies in combination with conventional medicine is increasing. In cancer care, as at the Cavendish Centre for Cancer Care in Sheffield, the range of therapies offered can include aromatherapy, massage, reflexology, shiatsu, acupuncture, homeopathy, counselling, visualization, hypnotherapy, relaxation, healing and art therapy. Before offering any therapy careful assessment of patients' needs is important as patients seeking complementary therapies may present with unrealistic hopes and expectations of benefit. There are wide variations in provision of services offering complementary cancer care throughout the United Kingdom but few offer a comprehensive assessment which is used as a baseline for both planning treatment and evaluating its outcome and which is conducted by a trained and objective practitioner who has no investment in any specific therapy. We describe the model of care developed at the Cavendish Centre with particular emphasis on the assessment process. Our model of assessment provides an opportunity for patients to tell their story, make sense of the illness experience, construct meaning from it and set realistic expectations for the chosen intervention. It also offers patients involvement and choice in decisions about their care. In addition we present evaluative data from a case series of 157 patients, 138 of whom (88%) reported improvement in their main concern on MYMOP (Measure Your Medical Outcome Profile).
Article
In recent years what can loosely be described as a sociology of complementary and alternative medicine (CAM) has begun to emerge. Although work has been conducted with lay therapists, orthodox practitioners, and consumers, overall, research in this area remains patchy and underdeveloped. Despite its role at the forefront of integration, the sociological study of the apparent affinity between nursing and CAM is virtually non-existent. This paper provides an exploratory analysis of how writers within the CAM nursing sub-world adopt a recourse to history (nostalgic and nostophobic referencing) as a strategy to authenticate the relationship between nursing and CAM and so facilitate continuing integration. A text analysis, of articles written on CAM in four nursing journals, was conducted. Eighty papers satisfied the inclusion criteria. Evidence is presented of the way in which writers attempt to authenticate integration of CAM through reference to its apparent interconnectedness with the historically grounded core of nursing values, and more specifically, with the key historical figure of the nurse Florence Nightingale (1820-1910). It is argued that these rhetorical strategies can be understood in the context of the need to engage in (primarily) intra-professional persuasion: to protect and develop the values of their nursing sub-world over alternatives. The findings are preliminary. Themes identified are illustrative of the potential offered by an analysis of nostalgic and nostophobic referencing in this context, and not a definitive account of it. Further research should examine individually produced texts from other sources, and documents produced by relevant professional bodies.
Article
The use of complementary and alternative medicine (CAM) in the general population has grown considerably in recent years. However, little is known about the prevalence of CAM use amongst women with cancer. Our research provides the first step in addressing this gap in knowledge by reporting on a survey of 9375 Australian women aged 73-78. We found that, for all cancers combined, 14.5% of women with cancer consulted an alternative practitioner. This percentage varied depending on the type of cancer: skin (15.0%), breast (11.5), bowel (8.8%), and other (16.5%). Our findings suggest that CAM is now a significant practice issue for those delivering cancer-patient care and management.
Article
This study investigated self-reported dietary attitudes and changes, and use of complementary approaches among breast cancer patients in relation to age, education and time since diagnosis. Australian (ABC, N=215) and Finnish (FBC, N=139) breast cancer patients were surveyed at the university cancer centres with voluntary participation. Logistic regression models were used to adjust for differences in demographic patient characteristics between the groups. The influence of demographic variables was further studied separately or combined. In all, 30% of FBC patients and 39% of ABC patients reported having changed their diet (P=0.033). Higher education, younger age and longer time from diagnosis were significantly associated with the probability of changes. The main changes reported included reduced consumption of animal fat, sugar and red meat, and increased consumption of fruits and vegetables. In all, 6% of ABC and 4% of FBC patients had stopped smoking and 24% of ABC and 27% of FBC patients reported to have increased their level of physical exercise. Choices were associated with age (P<0.007), length of the disease history (P <0.01) and level of education (P <0.002). One-third of breast cancer patients surveyed reported to have changed their dietary habits. Both populations reported a need for dietary and lifestyle counselling. This need was experienced as poorly recognised by the physicians at present, and warrants future studies in dietary behaviour of breast cancer patients.
Article
This paper examines how caregivers' medicinal discourse serves as an indirect critique of modernization, urbanization and development in the Brazilian Amazon. When caregivers in two peri-urban neighborhoods, Triunfo and Bairro da Luz, discuss medicinal plants they highlight the positive aspects of phytotherapy and associate it with traditional rural lifestyles. In contrast, they tend to emphasize the shortcomings of pharmaceuticals, which they link to modernity and urbanization. This discourse, which juxtaposes plants/tradition/positive with pharmaceuticals/modern/negative, contains counterhegemonic commentary about the failures of modernization, urbanization and development. While state sponsored development was supposed to bring prosperity to the Amazon, for many residents, like those in Bairro de Luz and Triunfo, it did not. In fact, some say development made their lives worse, claiming that poverty and poor health are among the prices they have paid. Due to the shortcomings of modernization and urbanization in other areas of their life, caregivers are ambivalent about biomedicine and the pharmaceuticals they associate with it. Moreover, because medicinal plant remedies embody traditional values, asserting they are stronger, more potent, better and more effective, especially in an urban context, is a moral commentary on the shortcomings of modernity. Finally, by insisting that traditional plant remedies are better at curing the health problems that result from modern, urban lifestyles, they are subtly asserting the superiority of tradition over modernity.
Article
In this article I focus on how individuals living with Parkinson's disease manage safety and risk in their participation in alternative and complementary health care. I take a qualitative approach in this research, using semi-structured interviews and grounded theory techniques as means of generating and analysing data. My analysis centres on how these informants construct certain therapies as risk free and therefore safe, and others as risky and thus, inherently unsafe. I discuss the knowledge bases these informants draw on in their evaluations and describe the social contexts in which these assessments take place. While there is a substantial literature on risk in general, as well as the risk society, there has been less interest in micro-level analysis of risk. This article therefore contributes to knowledge through its focus on management of safety and risk in individuals' health-seeking behaviour.
Article
To determine the interreferral patterns among physicians and complementary and alternative medicine (CAM) providers in an independent practice association integrated medical system. Data from a 1-year period were collected on referral patterns, diagnosis, number of visits, cost, and qualitative aspects of patient care. The independent practice association provided care for approximately 12,000 patients. In the selected integrative network, there are those primary care physicians (PCPs) who refer and those who do not. Among those PCPs that refer to CAM, a preference is shown for a limited number of providers to whom they refer. Although doctors of chiropractic get more referrals, they are also more concentrated among selected providers than are doctors of oriental medicine. This study shows the interreferral patterns among the PCP and CAM providers working within an integrated medical system. One effect of being in the network for doctors of chiropractic and doctors of oriental medicine might be the possible interreferrals between each other.
Article
During the past 2 decades, the study of complementary and alternative medicine (CAM) in general, and the sociological study of CAM in particular, have developed apace in richer countries. In addition to data on use levels and the nature of provision, there is now increasing research on issues such as motivation for use, decision-making processes, and so on. The integration of nonorthodox therapies into cancer care has been an important focus for such work. However, this interest has yet to be matched by work in poorer countries. While the nature of traditional medicine (TM) has long been of interest to anthropologists, the new context (marked by the globalized nature of CAMs existing alongside TM and allopathic treatment) has yet to be examined in any depth. In this article, the authors discuss the structural and cultural context of the first sociological research to be conducted into the role ofCAMandTMin cancer care in Pakistan. They identify some potentially important processes (ie, those identified in the limited existing literature and in anecdotal commentary), which are being tested by the new empirical study. The specific foci of the work are outlined. It is argued that research in poorer countries is essential both to ensure that an existing academic imbalance is addressed and to underpin more informed policy making in complex medically pluralistic (poorer) countries.