1. Complementary Medicine
Why bother for a whole term?
Taken from
Bradford VTS Web Pages for General Practice
ONLINE RESOURCES
Non-clinical Tutorials for GP Registrars
ALLIED SERVICES & COMPLEMENTARY MEDICINE

2. Complementary or Alternative
Which is more acceptable to who?
Needs complementing?
Need for alternative?
Whose need?
What can we learn from these practitioners?

3. One image !

4. Or Another?
Caring
Holistic
No iatrogenic problems?

5. 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.”

6. 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?

7. 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?

8. 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

9. 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%

10. How Popular?
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
45% of GPs endorse or recommend the use of complementary medicine
21% of GPs refer patients to complementary practitioners

11. 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

12. Which Therapy? 1984 survey Acupuncture Chiropractic Herbal medicine
Homeopathy
Osteopathy
1993 survey
Acupuncture
Chiropractic
Herbal medicine
Homeopathy
Osteopathy
1989 survey
Acupuncture
Chiropractic
Faith healing
Homeopathy
Osteopathy

13. Who? 40% of women 27% of men 33% 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

14. What Sort of Problem? Musculoskeletal - 88% Psychological - 3%
Respiratory - 2%
Neurological - 2%
Other - 4%
BJGP, 1999,
Interviews with therapists

15. Evidence “Conventional” Counselling Ultrasound Bed rest Chiropody
Many operations

16. Evidence “Complementary” 4000 articles in medline St johns wort
Manipulative therapies
Eczema

17. 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?

18. 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:

19. Aims of the Term Overt Covert Learn about complementary practitioners
Be able to better advise our patients
Learn applicable skills
Covert
Improve critical appraisal skills
Improve EBM skills
Improve presentation skills
Foster self worth

20. And Some Objectives Natural Unproved Irrational Harmless Holistic
Unregulated
Alternative

21. Maybe a obvious slant but fascinating !
Starting Points
Maybe a obvious slant but fascinating !

22. An excellent fairly balanced introduction
Starting Points
The Which? Guide to Complementary Medicine
Which ? Books
Barbara Rowlands
1997
An excellent fairly balanced introduction

23. Starting Points ABC of Complementary medicine
Starting BMJ /9/99 Page 693
But shouldn’t be all you use!

24. Medline - 4,000 references to complementary medicine
Starting Points
Medline - 4,000 references to complementary medicine
EMBase
Many books
Internet

25. The Good
The bad
And
And the ugly