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Complementary Medicine. Why bother for a whole term? Complementary or Alternative. Which is more acceptable to who? Needs complementing? Need for alternative? Whose need? What can we learn from these practitioners?. One image !. Or Another?. Caring Holistic

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complementary medicine

Complementary Medicine

Why bother for a whole term?

complementary or alternative
Complementary or Alternative
  • Which is more acceptable to who?
  • Needs complementing?
  • Need for alternative?
  • Whose need?
  • What can we learn from these practitioners?
or another
Or Another?



No iatrogenic problems?

why bother
Why Bother?

“Scientific medicine is making big advances in drugs, technology, and genetics, yet more and more patients use complementary therapies. EBM dominates our discourse, yet health professionals increasingly refer to and practice complementary therapies that have little scientific evidence of efficacy.”


What is the meaning behind these paradoxes?

  • What can we learn that will usefully inform our practice of orthodox medicine?
  • Why do people go to complementary practitioners?
why bother7
Why Bother?
  • What skills are they using?
  • What skills could we borrow?
  • What patient needs are they addressing?
  • Are they needs we should seek to meet?
  • Should we support them?
  • Should we attack them?
  • How should we respond?
how many
How Many?
  • Over one thousand forms of complementary medicine have been indexed
  • About 26 are “common”
  • There are at least 40,000 therapists in the UK
how popular
Hard data lacking

Relies on survey data

Geographical variations

Cultural variations

Socio-economic variation

Ever used 14-30%

Last year 10-14%

Ever seen practitioner 33%

World wide ever seen practitioner 20-75%

How Popular?
how popular10
45% of GPs endorse or recommend the use of complementary medicine

21% of GPs refer patients to complementary practitioners

10% of GPs treat patients with complementary medicine themselves

US (1990) made 425 m. Visits to comp. Practitioners and 388 m. Visits to family physicians

How Popular?
how popular11
How Popular?
  • Phenomenal growth
  • UK consumption of homeopathic remedies growing at 20% per year
  • Number of UK practitioners has doubled every 5 years for the last 15 years
  • Growth is occurring right across the west
which therapy
1984 survey



Herbal medicine



1993 survey



Herbal medicine



Which Therapy?
  • 1989 survey
  • Acupuncture
  • Chiropractic
  • Faith healing
  • Homeopathy
  • Osteopathy
  • 40% of women
  • 27% of men
  • 33% of people >35years
  • 26% of people <35years
  • More popular in south and west of UK
  • 38% of people use more than one form of complementary medicine at the same time
what sort of problem
What Sort of Problem?
  • Musculoskeletal - 88%
  • Psychological - 3%
  • Respiratory - 2%
  • Neurological - 2%
  • Other - 4%


  • Counselling
  • Ultrasound
  • Bed rest
  • Chiropody
  • Many operations


  • 4000 articles in medline
  • St johns wort
  • Manipulative therapies
  • Eczema
in summary
In Summary
  • Very popular and growing
  • Are we failing?
  • What can we gain?
  • Should we end any divisions and just go for “good medicine” - anything that works?
aims of the term
Aims of the Term
  • Can be divided into the obvious and the hidden
  • There are, I now hope many reasons why we should bother
  • So that you know where I am coming from my hidden and overt aims are as follows:
aims of the term19

Learn about complementary practitioners

Be able to better advise our patients

Learn applicable skills


Improve critical appraisal skills

Improve EBM skills

Improve presentation skills

Foster self worth

Aims of the Term
and some objectives
And Some Objectives
  • Natural
  • Unproved
  • Irrational
  • Harmless
  • Holistic
  • Unregulated
  • Alternative
starting points
Starting Points

Maybe a obvious slant but fascinating !

starting points22
Starting Points

The Which? Guide to Complementary Medicine

Which ? Books

Barbara Rowlands


An excellent fairly balanced introduction

starting points23
Starting Points

ABC of Complementary medicine

Starting BMJ 319 11/9/99 Page 693

But shouldn’t be all you use!

starting points24
Starting Points

Medline - 4,000 references to complementary medicine


Many books


the good

The Good

The bad


And the ugly