Complementary Medicine Comment Killing the goose that laid the golden egg? Complementary and alternative medicine might best be kept separate from conventional treatments Sales of herbal, homoeopathic, and other complementary remedies are growing fast, and increasing numbers of people are visiting complementary practitioners.1 The international market for complementary and alternative medicine is now worth a considerable amount of money—an estimated $21.2bn in the United States in 1997, more than half of which was paid directly by patients,2 and £450m in Britain in 1998, with 90% purchased privately.3 Two articles in this issue illustrate the suspicion of complementary medicine that still exists among many medical practitioners and the potential for integrating complementary and orthodox treatments.4 5 Complementary medicine is marginalised in the healthcare systems of many countries, but calls for a more integrated approach are growing louder and seem to be having an effect.6–8 Hostility to complementary medicine among doctors is starting to erode. Basic courses in various complementary therapies are now available in many medical schools in Britain9 and the United States,10 albeit on an optional basis. Some doctors go on to do more advanced training, enabling them to offer complementary therapies alongside orthodox ones. In response to growing popular demand, certain complementary therapies no longer have to be paid for by patients in some countries. For example, in Germany, where complementary medicine is used regularly by more than half the population, many conventional practitioners offer complementary therapies, and some of these are reimbursable by insurance schemes.11 In Switzerland, Sweden, Denmark, and Finland non-medically trained therapists can apply for official authorisation to practise. In Austria, Belgium, France, Spain, and Italy, however, complementary therapies such as chiropractic and osteopathy can be provided only by registered medical practitioners. Are we seeing the start of a takeover by orthodox practitioners, and, if so, how will this affect the popularity of complementary medicine? What will happen if integration becomes the norm and complementary medicine is brought into the fold of scientific evaluation and regulation? Will it lose its appeal? The trend towards official recognition of complementary medicine comes at a time when evidence based medicine is in the ascendancy and professionals and patients are more aware than ever before of the need for critical evaluation of the effects of medical interventions. Efforts are increasing to ensure that safety is not compromised and that public money is not wasted on ineffective or harmful treatments. Moves are afoot in many countries to tighten regulatory procedures for all types of practitioner and medical product, but these have not always been greeted with enthusiasm by proponents of complementary medicine. Though there are still glaring gaps in the evidence base for many orthodox treatments, the evidence base for complementary medicine is even weaker.12 So what is the basis of its popular appeal? Does it reflect public disdain for, or mistrust of, orthodox science or concerns about the way in which medical care is delivered? Complementary and alternative therapies are usually used alongside conventional treatments, rather than as a substitute. The typical European user of complementary medicine is a young or middle aged woman who is well educated and health conscious.13 Users are often looking for help with problems such as back pain, asthma, arthritis, migraine, menopausal symptoms, and anxiety or stress, for which conventional medicine has been tried and found wanting, but these therapies are also resorted to by people with life threatening diseases such as cancer and AIDS.14 Complementary therapies are seen as more "natural" and having fewer side effects than conventional treatments. The enthusiasm for complementary medicine shows people's desire to help themselves, as well their frustration with the limitations of conventional medicine. The holistic and patient centred approach of many complementary therapists appeals, as does the sense of identification and empowerment gained from their explanations and philosophies of care.15 Users appreciate the greater amount of time devoted to the consultation than is usually the case with conventional practitioners, the attention to individual personality and preferences, the opportunities for involvement and choice, the attention to their emotional state and coping style, and the empathy provided by complementary medicine practitioners.16 For some users, the appeal of complementary medicine lies in its dissimilarity from conventional medicine and the fact that complementary therapists are untrammelled by the bureaucracies of public health systems. Once complementary medicine is integrated with conventional medicine, it is likely that complementary therapies will be added to the therapeutic armamentarium of orthodox practitioners, who will then control access to them. This may enhance their acceptability to the medical profession, especially if these treatments pass the efficacy test, but it could reduce their distinctiveness, and hence their appeal, to patients. Ultimately, however, for most patients this power struggle between health professionals and therapeutic philosophies is less important than its potential impact on the overall quality of health care. Progress in this arena must be judged by the extent to which proponents of complementary medicine are willing to accept evaluation and regulation and the extent to which orthodox practitioners are prepared to improve their interpersonal skills. Angela Coulter, chief executive Picker Institute Europe, Oxford OX1 1RX (angela.coulter@pickereurope.ac.uk) Competing interests: AC has received research funds and has been reimbursed for speaking engagements by various manufacturers of prescription-only and over the counter medicines. Picker Institute Europe has been paid by health care providers to carry out surveys of their patients' views and experiences. References 1. Ernst E. Prevalence of use of complementary/alternative medicine: a systematic review. Bull World Health Organ 2000;78: 252-7.[ISI][Medline] 2. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998;280: 1569-75.[Abstract/Free Full Text] 3. Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complement Ther Med 2001;9: 2-11.[CrossRef][ISI][Medline] 4. Berman BM. Integrative approaches to pain management: how to get the best of both worlds. BMJ 2003;326: 1320.[Free Full Text] 5. Baldwin E. Time for a fresh look at complementary medicine. BMJ 2003;326: 1322.[Free Full Text] 6. Prince of Wales Foundation for Integrated Health. Setting the agenda for the future. London: Prince of Wales Foundation for Integrated Health, 2003. 7. Bodeker G. Lessons on integration from the developing world's experience. BMJ 2001;322: 164-7.[Free Full Text] 8.World Health Organization. WHO traditional medicine strategy 2002-2005. Geneva: WHO, 2002. 9. Owen DK, Lewith G, Stephens CR. Can doctors respond to patients' increasing interest in complementary and alternative medicine? BMJ 2001;322: 154-7.[Free Full Text] 10. Wetzel MS, Eisenberg DM, Kaptchuk TJ. Courses involving complementary and alternative medicine at US medical schools. JAMA 1998;280: 784-7.[Abstract/Free Full Text] 11. Tuffs A. Three out of four Germans have used complementary or natural remedies. BMJ 2002;325: 990.[Free Full Text] 12. Vickers A. Complementary medicine. BMJ 2000;321: 683-6.[Free Full Text] 13. Coulter A, Magee H, eds. The European patient of the future. Buckingham: Open University Press, 2003. 14. Barnett H. The Which? guide to complementary therapies. London: Which, 2002. 15. Paterson C, Britten N. `Doctors can't help much': the search for an alternative. Br J Gen Pract 1999;49: 626-9.[ISI] 16. Zollman C, Vickers A. ABC of complementary medicine: Complementary medicine and the patient. BMJ 1999;319: 1486-9.[Free Full Text] BMJ 2003;326:1280-1281 (14 June) Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.