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Alternative Medicines
Research conducted by the BBC has shown that alternative
medicines are becoming increasingly popular. Yet their
effectiveness is yet to be proven to the majority of medical
practitioners in the UK and there are concerns over safety as
many of the treatments remain untested. Defining alternative
medicine is notoriously difficult, with some practitioners
refusing to accept there is anything alternative about such
therapies in the first place. For some, it is simply medicine
that has not been proven to the clinical standards of modern
western medicine.
For others, it consists of undervalued therapies that have been
used successfully for millennia. Nevertheless, medical bodies
have sought to establish a workable definition - some to
determine which areas need more research, others to guide doctors
on what they should and should not offer patients.
The US has the most
thorough definition.
A recent European Commission report says the accepted definition in the US is: "A broad
domain of healing resources that encompass all health systems,
modalities and practices, and their accompanying theories and
beliefs, other than those intrinsic to the politically dominant
health system of a particular society or culture in a given
historical period.
"It includes all such products and ideas self defined by
their users as preventing or treating illness or promoting health
and well-being. "Boundaries within complementary and
alternative medicine and between complementary and alternative
medicine and the domain of the dominant system are not always
sharp or fixed."
European view
The EC-sponsored group that
produced the report shied away from any such all-encompassing
definition, and simply defined it as those areas of medicine not
covered by the medical syllabus. This, however, is far from
satisfactory as many medical schools now offer modules on
homeopathy, acupuncture or other alternative medicines.
Dr Jonathan Monckton, director of the UK Research Council for
Complementary Medicine, said the growing inclusion on medical
courses was because of a general feeling that future doctors
should have some understanding of the field.
He says alternative medicine is often better considered as
complementary medicine, as much research shows people use them
alongside conventional western medicine.
Regulation
Another
problem in defining the field is the lack of regulation in many
areas - so while conventional medicine can only be practised by a
doctor who can prove they have been to medical school and passed
all their exams, in many cases anyone can call themselves an
alternative practitioner and set up shop. This is, however,
changing. The UK Government has introduced legislation to force
chiropractors and osteopaths to register with a statutory body,
meaning they cannot practise unless they can prove they are
qualified. In the smaller disciplines of homeopathy and yoga,
voluntary regulation is preferred, with professional councils
accounting for the competency of practitioners. Professional and
statutory accountability ensure that practitioners are competent,
not that the medicine works, but increased regulation brings the
therapies more into line with conventional medicine.
Evoling Science
Dr
Monckton says that whichever way one looks at the area, it is
difficult to draw a firm line. "It's a process of evolution
so what is yesterday's fringe is today's alternative, tomorrow's
complementary and ultimately it becomes conventional," he
said. "For example - take dentistry. At the turn of the
century, dentistry was complete fringe medicine, but look at it
now - wholly conventional."
Acupuncture:
An
ancient Chinese art based on the theory that Qi energy flows
along meridians in the body, and can be stimulated by inserting
fine needles at specific points. Acupuncture is used to treat
asthma, addiction, arthritis, depression, anxiety, blood pressure
disorder and problems with the digestive system.
Herbal medicine:
It is believed that as much
as 80% of the world outside the industrialised countries relies
on herbs for health. In fact, many commercially produced
pharmaceutical products are derived from herbs, but herbal
medicine uses the whole plant rather than an extract. Used to
help most illnesses including migraine, arthritis, depression,
insomnia, lung, stomach blood and skin disorders.
Homoeopathy:
Works on the principal that
what makes a healthy person unwell can be used to treat the same
symptoms in someone who is unwell. But homeopathic medicines are
diluted to a high degree.
Doctors Views:
Many doctors feel that
patients seeking alternative medicine could be misled into
believing they are being cured when little or no scientific
evidence exists to support the effectiveness of the treatments on
offer. Others believe that alternative medicine is seeped in bad
science and is practised by charlatans or the deluded. In
response, practitioners of alternative medicine are using the
conventional medical establishment's own weapons of clinical
trials and peer-reviewed studies to undermine its wall of
scepticism. The results have, in some cases, rocked the
preconceived notions of many doctors, with more papers showing
the success of therapies such as homeopathy and herbal medicine.
Best bet
The gold standard of modern
western medical research is the randomised controlled trial.
Acupuncture is one of the techniques with a growing base of
evidence.Once a treatment has been shown to be safe, these trials
look at whether or not it actually works. One group of subjects
is given a medicine with the active ingredient, while another is
given dummy preparations - placebos. Neither group knows which
they are getting.
Difficulties in
establishing reliability
However, some researchers put
the efficiency of herbal remedies and homeopathic medicines down
to the placebo effect - in which patients' health improves after
a dummy treatment because of their belief that they have received
a proper medicine - and this adds to the difficulty of conducting
a reliable study. Dr Jonathan Monckton is director of the UK
Research Council for Complementary Medicine, an independent
charity that is trying to build a database to point people in the
direction of reliable evidence on the subject. Establishing the
usefulness of alternative therapies was a question of applying
conventional standards to unconventional treatments. However, it
was important not to overlook people's own experiences, and
scientists would have to strike a balance between clinical and
anecdotal evidence when assessing a treatment's use, said Dr
Jonathan Monckton.
Safety fears
Although there are fears that
without proper evidence some of the treatments could do more harm
than good, the main dangers are, inappropriate use of therapies
and practitioners ignoring conventional medicine when it was
necessary.
The danger lies not so much with the herb as with the
practitioner in some cases. "Just because it's natural
doesn't mean it's safe - there are dangers of using acupuncture
needles inappropriately, and there are dangers in using Chinese
herbs that have hypoxins in them that will damage your liver, but
there are also dangers in conventional medicine. In May, Chinese
and British doctors set up a centre to test the safety of herbal
medicines, and this will add to the ever increasing base of
knowledge on the safety and effectiveness of alternatives.
Growth area
"The exclusion of
conventional treatment is the danger in these cases, not the
therapy itself," "It's the greatest gift a therapist
can have - to know when he doesn't know and refer to a different
authority." Despite the fears and the uncertainties, what is
for sure is that along with the increase in use of alternative
medicine, there has been a boom in research, meaning that in time
doctors will feel as confident prescribing or not prescribing
today's alternatives as they are today's conventional treatments.
A combination of reduced faith in conventional treatments and the
growth in availability of alternative remedies has led to the
rise in people turning to alternative medicine. Years ago
conventional medicine was seen to be infallible, but the new age
of communication has shown that certain chronic conditions may
best be served by the more palliative effects of complementary
therapies. Studies have shown that about 80% of those who use
alternative therapies stick to their conventional treatments and
are happy with them, he said.
Empowerment
One theory is that the
increasing use was also a sign of social change, he said.
"People aren't content to be told what to do, they prefer to
be more responsible for their own health and their own
well-being. "It's about autonomy and empowering the
individual and the paternalistic form of medicine of 20 to 30
years ago has now given way to this partnership in health
care." The Internet has had a huge impact in this respect,
with research published last February suggesting that 60% of
Web-users look for health information - mainly in relation to
mental health issues, chronic conditions, allergies and cancer.
Hospital services
For the newly-empowered
public, there is now freer access to alternative medicine through
the NHS, although most is still available only privately. There
are two big homeopathic hospitals in the UK - in London and
Glasgow - as well as three smaller units around the country.
Added to this is GPs' greater willingness to refer patients to
alternative practitioners, especially after the introduction of
the GP fundholding. Under that scheme, individual practices set
their own budgets and could choose which additional services to
offer their patients - some saw it as an opportunity to save
money on drug budgets.
All change in the NHS
However, the current Labour
government has abolished the scheme, and replaced it with primary
care groups, which will involve up to 50 GPs setting budgets
across an area. Whether alternative medicine on the NHS continues
to prosper in this set up remains to be seen. Another concern is
that with the current government's emphasis on accountability in
the health service, there will be room for therapies that to many
are unproven and which are practiced in many cases by unregulated
individuals.
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