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The Mainstreaming of Complementary and Alternative Medicine in Social Context
... In the United Kingdom, this pressure was intensified by an influential House of Lords (2000) select committee review into the regulation and state registration of complementary and alternative medicine (CAM). These developments express a move towards increased mainstream acceptability, professionalism, licensure and legitimacy (Boon et al, 2004;Smallwood, 2005), a process described as an economic and socio-cultural mainstreaming of CAM (Tovey et al, 2004). ...
Across the UK and other Western nations, complementary health care has become big business, with pressure to commercialise and technologise its goods and services. Economic liberalisation and the democratisation of health care have encouraged the increased commodification of complementary health services. This paper focuses particularly on more personalised forms of complementary health care such as folk healing, but equally highlights the importance of a whole healthcare systems analysis when thinking about commodification and marketisation. We develop an exploratory synthesis of recent empirical data in the UK, in which we theorise the significance of money for complementary health care, and folk healing. Four mutual themes and questions emerge and are presented here, with a discussion of their contribution to wider theoretical debates about money, the community, and social and healthcare systems.
... El uso creciente de las CAM Las medicinas complementarias y alternativas (CA.l\1) -homeopa- tía, acupuntura, naturismo, terapias manipulativas y un largo etcé- tera-han recibido en los últimos lusrros una atención creciente, tanto en el entorno de 1a Unión Europea como en Norteamérica y Oceanía (Salmon, 1984;Lewith, Aldridge, 1991;S harma, 1992;Fisher y Ward, 1994; Cant y Sharma, [ 996; Kelner et al. 2000;Tovey et al., 2003;Ruggy, 2004, Johannsen y Lázár, 2006. No sólo se han llevado a cabo estudios en los países más ricos, sino, también, otros centrados en otros ámbitos del planeta (Bodeker y Kronenberg, 2002 1999;Eisenberg, 2001), así como la creación de un subconjunto dedicado a la materia en MEDLIN E, la base de daros de la < <National Library of Medicine» de los Estados Unidos, que recoge la produc- ción tanto de revistas médicas de todo tipo como de otras dedicadas íntegramente a las CMvL Este interés ha sido generado por la constatación del uso crecien- te de las CAM en las sociedades en las que la medicina científica- occidental se encuentra más desarrollada. ...
La importancia que el fenómeno de las medicinas alternativas y complementarias
(CAM en sus siglas inglesas) tiene en los países más ricos,
y la necesidad de allegar todo tipo de recursos asistenciales y
terapéuticos para luchar contra la enfermedad y la muerte en los países
del sur social y político ha reavivado el interés por el estudio del
pluralismo asistencial y terapéutico. Sin entrar de momento en mayores
precisiones terminológicas entendemos por pluralismo asistencial
la existencia en una sociedad dada de diversas instancias
asistenciales y terapéuticas que son utilizadas por sus miembros para
resolver sus problemas de salud. La definición y valoración de los
propios problemas de salud y su relación con el contexto social económico,
político y cultural entra, por supuesto, en el ámbito de estudio
del pluralismo asistencial. En este capítulo se analiza como los
modelos teóricos utilizados para estudiar el comportamiento de
la población cuando trata de recuperar su salud (comportamiento
frente a la enfermedad, proceso de búsqueda de salud, itinerarios terapéuticos,
etc.) han impedido o favorecido el estudio del fenómeno
del pluralismo asistencial.
... Nonetheless a potential limitation is that more non CAM using medical practitioners were not represented. This should be considered in relation to the general trend toward mainstreaming some complementary medicines (Tovey 2004). This trend is highlighted by increasing interest in and integration of CAM therapies by biomedical healthcare practitioners (Pirotta 2002, Baer 2008, signs of convergence (McCabe 2000) and blurring of boundaries between some CAM and biomedical modalities (Parker 2003). ...
In a multi-phase mixed method interdisciplinary study known as CAMELOT, we explored why people under treatment for type 2 diabetes and/or cardiovascular disease also presented to and used complementary or alternative medicine (CAM) practitioners or therapies in order to establish the relationship with adherence to their prescribed treatment. The project drew on the advice of a reference group of consumers, CAM and biomedical providers. Phase I consisted of ethnographic research with participant observation and in depth interviews with 69 consumers and 20 healthcare providers (CAM and biomedical) recruited through
support groups, advertising and social networks. Interviews focused on common sense (lay) models of type 2 diabetes and cardiovascular disease; reasons for and patterns of use of prescribed medication and CAM; choice and frequency of use of different modalities; and how economic considerations, social networks and information pathways influenced this. The research took advantage of an interdisciplinary approach in novel ways to explore areas of health and society that have so far received limited attention. The ethnographic approach taken for Phase I and the results of recruitment are described here.
... They often have some background information on the chosen modalities, are casually familiar with the tools and techniques involved, have heard testimonials and other encouraging advice and commence treatment with a belief and an expectation that it will be of benefit to them. Worldwide surveys of CAM consumers find them to be a more empowered, educated and affluent cohort [30]. As a result many practitioners aware of this fact assume that patients may have " done their homework " prior to entering the office. ...
The objective of this study was to examine complementary and alternative medicine (CAM) practitioners' (i) attitudes toward informed consent and (ii) to assess whether standards of practice exist with respect to informed consent, and what these standards look like. The design and setting of the study constituted face-to-face qualitative interviews with 28 non-MD, community-based providers representing 11 different CAM therapeutic modalities. It was found that there is great deal of variability with respect to the informed consent process in CAM across providers and modalities. No unique profession-based patterns were identified. The content analysis yielded five major categories related to (i) general attitude towards the informed consent process, (ii) type and amount of information exchange during that process, (iii) disclosure of risks, (iv) discussions of alternatives, and (v) potential benefits. There is a widespread lack of standards with respect to the practice of informed consent across a broad range of CAM modalities. Addressing this problem requires concerted and systematic educational, ethical and judicial remedial actions. Informed consent, which is often viewed as a pervasive obligation is medicine, must be reshaped to have therapeutic value. Acknowledging current conceptions and misconception surrounding the practice of informed consent may help to bring about this change. More translational research is needed to guide this process.
... 1 There is strong evidence of its popularity among users, 2 and despite evidence of conflicting positions among orthodox practitioners, 3 integration into the mainstream is a hot topic among policy makers and academics alike. 4 Focusing largely on the importation of the "exotic" into late/postmodern societies, 5 a sociology of CAM is developing. It has produced empirical and theoretical work on CAM as consumption, 6 professionalization processes, 7 demarcation disputes, 8 CAM globalization, 9 and the intersection of social worlds. ...
Complementary and alternative medicine (CAM) has become increasingly high profile in prosperous countries over the past 2 decades. Alongside this has been a renewed interest in the use of traditional medicine (TM) in poorer countries. Academic attention has tended to focus on either CAM in rich countries or indigenous TM in poorer ones. However, such a differentiation leads to a potential to gloss over global complexities, such as the study of countries where both CAM and TM are a potentially significant part of health options. Brazil is just such a country. Brazil is marked by massive socioeconomic inequalities; cancer is its second highest cause of death. To date, there has been little research on CAM/TM in cancer care in Brazil.
The purpose of this study is to provide the first exploratory data on the proportion of the use of CAM and/or TM among low-income cancer service users in Brazil.
A survey of cancer patients was conducted in November 2004 in a public-sector hospital in a major city in Brazil. A random sample (n = 92) was generated from a list of all appointments scheduled during that month (n = 570). Eighty-nine of the 92 patients contacted (97%) completed the questionnaire.
Of the sample, 62.9% had used at least 1 form of CAM or TM. However, this headline figure is potentially misleading. The data reveal an almost total absence of use of non-indigenous international CAM; it also shows prayer to be a major contributor to the relatively high use rate.
On the basis of this small-scale exploratory study, there is no evidence that those international CAMs ubiquitous in the West are spreading to low-income cancer service users in Brazil (despite anecdotal evidence of its increasing presence in the country generally). Moreover, when excluding prayer, use of indigenous traditional medicine was found to be relatively low. Further research is needed to examine these findings on a larger scale and to explore the relative importance of social, cultural, and economic factors behind them.
Two studies examined how political ideology relates to attitudes towards opposing scientific and nonscientific perspectives on apolitical topics. Participants read an article excerpt containing quotes from a researcher debunking a common misconception, such as the existence of lucky streaks in games of chance. They also read the perspective of someone who rejected the researcher in favor of personal experience, either in the form of a quote in the article from a relevant professional (e.g., a casino manager, Study 1) or a comment from a purported previous respondent with no clear expertise (Study 2). In both studies, conservatives, compared to liberals, evaluated the views of the scientist and the person rejecting the science as closer in legitimacy. Differences in evaluation of the science rejecter were mediated by conservatives' heightened intuitive thinking. By spotlighting how partisans evaluate nonscientific perspectives alongside science and by focusing on apolitical topics, these results bring new clarity to the debate on whether conservatives are more biased than liberals in attitudes towards science.
A key dimension of the institutional response to sexual assault is the forensic medical examination of a victim's body conducted for purpose of documenting, collecting and testifying to corroborative evidence. Drawing upon in‐depth interviews with forensic examiners and forensic nurse practitioners in one region of England, this study addresses a gap in the existing research on medico‐legal processes, and critically examines the nature and dynamics of the relationship between doctors and nurses involved in this intervention. Using an analytic framework based on Thomas Gieryn's notion of ‘boundary‐work’, we explore how this historically gendered dyadic relationship is experienced and understood in a context influenced by both medicine and law. We demonstrate very clear boundaries demarcating (i) physicians as experts and nurses as non‐experts in the collection and representation of medical evidence, and, (ii) physicians as equated with technical competence and nurses with ‘caring’ duties. We conclude by positing implications that may stem from these professional relations with respect to sexual assault evidence, professionals and victims.
Background:
Extracts of Hypericum perforatum, more commonly known as St John's wort (SJW), have good evidence for treating depression. The herb is easily accessible and widely used by consumers, although it has potential for interaction with other medicines. Consumers' use of SJW is often not discussed with their general practitioners (GPs). It is unclear how GPs perceive use of SJW in practice and the implications for consumers and pharmacists.
Objective:
Explore GPs' perception of SJW use in practice.
Methods:
Scoping review.
Key findings:
Few studies explore GPs' perceptions of SJW for depression, but they appear to recommend it infrequently, except in Germany. Reasons for limited use in practice include lack of knowledge, particularly regarding which preparations and dosages have trial evidence, and lack of standardisation of active ingredients. Guidelines either do not mention SJW or advise against its use.
Conclusions:
Consumers drive SJW use but often do not disclose to their GPs, which is concerning due to issues about safety. Pharmacists could play an important role here. Improved education about SJW is required for both GPs and consumers, including the need for communication between them and their pharmacists. Lack of adoption of evidence-based therapy for depression should be explored further.
Many Australians manage their health through the combined use of conventional medicine and complementary and alternative medicine, with substantial direct and indirect costs to government and consumers. Our interest was in the varied health practices of people with type 2 diabetes and cardiovascular disease, which are among the most prevalent chronic conditions in Australia. Qualitative data collected in the fi rst phase of the study informed the design of a self administered questionnaire, for people with cardiovascular disease or diabetes, to investigate care seeking, complementary therapy use and the relevance of social, locational, economic and cultural factors to health behaviour. Valid survey returns totalled 2915 (290 online and 2625 postal), providing a rich data set on health status, health care and costs, demographic and social information, and quality of life. In the 12 months prior to the survey, 43% of all respondents had used CAM products or practitioners, including 11% who used Western herbal medicines. The data offers considerable opportunities to tease out the drivers, costs and benefi ts of CAM use by people with chronic disease. Although fi ndings will be published across a number of articles, here we profi le the demographic and health status characteristics of survey respondents and compare the characteristics of users of naturopathy and Western herbal medicine practitioner with this.
Athletes are high achievers who may seek creative or unconventional methods to improve performance. The literature indicates that athletes are among the heaviest users of complementary and alternative medicine (CAM) and thus may pioneer population trends in CAM use. Unlike non-athletes, athletes may use CAM not just for prevention, treatment or rehabilitation from illness or injuries, but also for performance enhancement. Assuming that athletes' creative use of anything unconventional is aimed at "legally" improving performance, CAM may be used because it is perceived as more "natural" and erroneously assumed as not potentially doping. This failure to recognise CAMs as pharmacological agents puts athletes at risk of inadvertent doping.The general position of the World Anti-Doping Authority (WADA) is one of strict liability, an application of the legal proposition that ignorance is no excuse and the ultimate responsibility is on the athlete to ensure at all times whatever is swallowed, injected or applied to the athlete is both safe and legal for use. This means that a violation occurs whether or not the athlete intentionally or unintentionally, knowingly or unknowingly, used a prohibited substance/method or was negligent or otherwise at fault. Athletes are therefore expected to understand not only what is prohibited, but also what might potentially cause an inadvertent doping violation. Yet, as will be discussed, athlete knowledge on doping is deficient and WADA itself sometimes changes its position on prohibited methods or substances. The situation is further confounded by the conflicting stance of anti-doping experts in the media. These highly publicised disagreements may further portray inconsistencies in anti-doping guidelines and suggest to athletes that what is considered doping is dependent on the dominant political zeitgeist. Taken together, athletes may believe that unless a specific and explicit ruling is made, guidelines are open to interpretation. Therefore doping risk-taking behaviours may occur because of the potential financial, social and performance gains and the optimistically biased interpretation (that trying alternatives is part of the "spirit of sport") and doping risk-taking behaviours may occur.This discussion paper seeks to situate the reader in a world where elite level sports and CAM intersects. It posits that an understanding of the underlying motivation for CAM use and doping is currently lacking and that anti-doping rules need to be repositioned in the context of the emerging phenomenon and prevalence of CAM use.
Has mind–body spirituality become a significant resource within the National Health Service (NHS) in the UK? And, to the extent that it is a growing presence, how is this to be explained? This paper looks at the expansion of complementary and alternative medicine (CAM) in the NHS, and explores its connection to spirituality. In addition, the effects on healthcare professionals are examined, concentrating on the example of nursing. To introduce the argument, cultural factors, influencing nurses and patients, work together with policy directives to ensure that mind–body spirituality is an attractive way of articulating the value the NHS attaches to the patient-centred, the whole person and ‘spirituality’.1 To pave the way, I first provide a brief summary of a recently completed research project – a project that helps explain my interest in developments within the NHS, the approach adopted in this article, and – critically – what is meant by holistic ‘mind–body spirituality’. The research by the author and his colleague (Heelas and Woodhead, 2005) was reviewed in Volume 6, No. 3 of Spirituality and Health International. Copyright © 2006 John Wiley & Sons, Ltd.
Complementary and alternative medicines (CAM) have become increasingly popular over recent decades. Within bioethics CAM has
so far mostly stimulated discussions around their level of scientific evidence, or along the standard concerns of bioethics.
To gain an understanding as to why CAM is so successful and what the CAM success means for health care ethics, this paper
explores empirical research studies on users of CAM and the reasons for their choice. It emerges that there is a close connection
to fundamental principles of medical ethics. The studies also highlight that CAM’s holistic ontology of health and illness
has an empowering effect on people in caring for their health, and on an even deeper level, safeguards against biomedicine’s
reducing image of oneself as biological body-machine. The question is raised what lessons bioethics should draw from this
emancipatory social movement for its own relationship with biomedicine.
KeywordsBioethics-Complementary and alternative medicine (CAM)-Biomedicine-Ontology-Holistic-Ethical principles-Patient experience
Despite recent developments in the sociology of complementary and alternative medicine (CAM), a critical analysis of the apparent affinity between CAM and nursing has, to date, remained essentially undeveloped. An empirical project is currently being conducted as an initial step to address the absence of such important critical research. A total of 30 written life history narratives were obtained from nurses working with and using CAM to explore such matters as professional boundaries and nurses' authentication strategies and conceptualisation and operationalisation of CAM. This paper addresses questions and conflicts that arose as the analytical tools were considered for these narrative accounts. Specifically, the paper explores whether the storied narrative sits easily with a critically oriented sociology of CAM; the differences between the role of "storyteller" or "story analyst"; and ask whether there is potential for developing a critical sociology of CAM nursing that retains the essence of personal stories.
The present study explored how community nurses and managers constituted changes towards generalist working.
Following international trends moving from acute care towards community care, changes within community nursing in the United Kingdom have been subject to debate in recent years. Sociological insights into 'boundary work' in professional disciplines are informative for understandings about proposed new roles in community nursing. Recently, radical changes to the role of the community nurse from specialist disciplines to a generalist community health nurse model were proposed in Scotland and tested in four health boards.
Focus group discussions were held with 27 community nurses and semi-structured interviews with three managers during January-March 2009 in a purposive sample from one health board. Discussions were audio-recorded and transcribed verbatim. Initial thematic analysis was used to highlight key themes from the data and later a discursive analysis focused on the rhetorical strategies used by participants.
Four key themes were identified along with the rhetorical devices associated with these including: the undermining of the generalist model through the 'jack of all trades, master of none' metaphor through associations of loss of specialisms; how the re-establishment of specialist discipline boundaries occurred; how current roles were validated and how managers and nurses accounted for future changes to the profession.
The qualitative study explored here has implications for discussions about future role change debates within community nursing as well as the specialist-generalist debate internationally. Managers and policy-makers involved in organizational changes are required to give greater credence to the perceived professional status of community nursing.
ABSTRACTOBJECTIVE
To develop a classification of complementary and alternative medicine (CAM) practices widely available in Canada based on physicians' effectiveness ratings of the therapies.DESIGNA self-administered postal questionnaire asking family physicians to rate their "belief in the degree of therapeutic effectiveness" of 15 CAM therapies.SETTINGProvince of Alberta.PARTICIPANTSA total of 875 family physicians.MAIN OUTCOME MEASURESDescriptive statistics of physicians' awareness of and effectiveness ratings for each of the therapies; factor analysis was applied to the ratings of the 15 therapies in order to explore whether or not the data support the proposed classification of CAM practices into categories of accepted and rejected.RESULTSPhysicians believed that acupuncture, massage therapy, chiropractic care, relaxation therapy, biofeedback, and spiritual or religious healing were effective when used in conjunction with biomedicine to treat chronic or psychosomatic indications. Physicians attributed little effectiveness to homeopathy or naturopathy, Feldenkrais or Alexander technique, Rolfing, herbal medicine, traditional Chinese medicine, and reflexology. The factor analysis revealed an underlying dimensionality to physicians' effectiveness ratings of the CAM therapies that supports the classification of these practices as either accepted or rejected.CONCLUSION
This study provides Canadian family physicians with information concerning which CAM therapies are generally accepted by their peers as effective and which are not.
TOVEY P. (2003) European Journal of Cancer Care12, 374–375 Group mediation of complementary and alternative medicine in cancer care in the UK and Pakistan
A retrospective audit was carried out on 58 patients with chronic health problems who were referred by 22 general practitioners (GPs) for acupuncture, aromatherapy, homeopathy, massage and osteopathy, or a combination. Costs of GP consultations, prescriptions, secondary care referrals, and diagnostic tests from records of 33 of these patients were compared pre (24 months), during (mean 4.3 months) and post (mean 5.7 months) complementary medicine (CM) treatment. Patient centred outcome data included the Measure Yourself Medical Outcome Profile (MYMOP) and content analysis of patient and practitioner comments. Costs of GP consultations/patient/month were significantly higher during (20.10 pounds, p<0.001) and post (17.53 pounds, p<0.01) CM treatment compared with pre-treatment costs (11.27 pounds). Total prescription costs were not significantly higher during and post-treatment than pre-treatment. Prescription costs for referred conditions were lower during (2.26 pounds) and higher post-treatment (3.75 pounds) compared with costs pre-treatment (3.24 pounds). Pre- and post-treatment MYMOP scores indicated significant improvements in health and well-being. Longer follow up, is required in order to demonstrate significant cost savings related to CM provision. Cost comparisons with conventional medicine should consider quantitative and qualitative data to capture the wider benefits experienced by patients.
Integrative medicine (blending the best of complementary and alternative medicine (CAM) with conventional medicine) is becoming increasingly popular.
The objectives of this paper are to compare and contrast the development of two teams that set out to establish integrative medical clinics, highlighting key issues found to be common to both settings, and to identify factors that appear to be necessary for integration to occur.
At St Michael's Hospital (an inner-city teaching hospital in Toronto, Canada), a total of 42 interviews were conducted between February 2004 and August 2006 wi18 key participants (4 administrators, 2 chiropractors, 2 physiotherapists and 10 family physicians). At the CARE (Complementary and Alternative Research and Education) Program at Stollery Children's Hospital, Edmonton, Canada, 44 interviews were conducted with 24 people on four occasions: June 2004, March 2005, November 2006, and June 2007. Basic content analysis was used to identify the key themes from the transcribed interviews.
Despite the contextual differences between the two programs, a striking number of similar themes emerged from the data. The five most important shared themes were: 1) the necessity of "champions" and institutional facilitators to conceive of, advocate for, and bring the programs to fruition; 2) the credibility of these champions and facilitators (and the credibility of the program being established) was key to the acceptance and growth of the program in each setting; 3) the ability to find the "right" practitioners and staff to establish the integrative team was crucial to each program's ultimate success; 4) the importance of trust (both the trustworthiness of the developing program as well as the trust that developed between the practitioners in the integrative team); and 5) the challenge of finding physical space to house the programs.
The programs were ultimately successful because of the credibility of the champions, institutional facilitators and the staff members. Selection of excellent clinicians who were able to work well as a team facilitated the establishment of trust both within the team itself as well as between the team and the host institution.
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