Chapter 73 Complementary therapies

‘Complementary therapies’ is the term used to include complementary and alternative medicine (CAM). The Cochrane Collaboration (www.cochrane.org) defines CAM as ‘a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health systems of a particular society or culture in a given historical period’. Complementary therapies are usually, if not invariably, complementary to conventional medical treatment and so the term ‘alternative’ is less appropriate. They may be described as being in the folk sector of medicine (see pp. 100–101). CAM’s popularity has led to suggestions that medical curricula should include awareness of CAM (Cumming, 2007).

The use of complementary therapies

The use of complementary therapies has become very popular in recent years. In a survey of over 1200 British adults, 20% had used CAM in the previous 12 months, of whom 34% had used herbal medicine (Ernst & White, 2000). Sales of CAM-related products in the UK are predicted to rise to over £125 million by 2002 (House of Lords, 2000). A survey of first-year medical students found that 37% had had previous experience of CAM and, of those who used it, 82% said that they had found it helpful (Greenfield et al., 2002).

Patients may ask doctors and other health professionals about the wisdom of trying complementary therapies or may conceal their interest because of a fear of disapproval. They may not perceive CAM as medicine and not report its use. An open discussion of the costs and benefits is essential so that the practitioner is aware of other therapies that the patient may be having. Many have no adverse effect but some may interact with conventional therapy (see Case study). Complementary therapies or remedies may not all be safe and could be toxic (Burton, 2003). There is likely to be increasing government legislation on safety and the ‘yellow card’ system to monitor adverse events is used by professionals (Ross, 2007).

The popularity of CAM is increasing across the westernized world. Increased concern over ecological and environmental issues may have helped to fuel interest in ‘natural’ healing systems. Astin (1998) identifies key points in society that represent this shift towards alternative medicine, which are linked to holistic beliefs in perceiving the body, mind and spirit in an integrative manner. This is totally different from conventional medicine, where disease is treated by looking specifically at organs or tissue of the body. Other identifiable reasons for this movement are related to patients’ rights, a more active role in consumer health, self-care and fitness, and dissatisfaction with conventional medicine (Cassileth, 1998). Many people seek complementary therapy because: they want to use all options in health care; they want a cure without side-effects or pain; they are disappointed with the traditional orthodox consultation; they believe in holistic care; they perceive conventional medicine to be ineffective; or they may be concerned about the side-effects of powerful drugs (Vincent & Furnham, 1997).

Consultations are generally longer and concentrate on a person’s overall well-being and own subjective experience. Complementary therapists undoubtedly have well-developed communication skills (see pp. 96–97). It is possible that the efficacy of some complementary therapies may occur because of the placebo effect (see pp. 92–93).

Complementary therapists are often active listeners and are perceived as being ‘low-tech’ (Fig. 1). In the UK, more GPs are becoming trained in complementary therapies such as homeopathy and hypnotherapy.

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