2. Complementary Medicine Why bother for a whole term?

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

4. One image !

5. Or Another? Caring Holistic No iatrogenic problems?

6. 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.

7. 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?

8. 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?

9. 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

10. 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%

11. How Popular? 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

12. 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

13. 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

14. Who? 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

15. What Sort of Problem? Musculoskeletal-88% Psychological-3% Respiratory-2% Neurological-2% Other-4%

16. Evidence Conventional Counselling Ultrasound Bed rest Chiropody Many operations

17. Evidence Complementary 4000 articles in medline St johns wort Manipulative therapies Eczema

18. 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?

19. 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:

20. Aims of the Term Overt 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

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

22. Starting Points www.quackwatch.com/ Maybe a obvious slant but fascinating !

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

24. Starting Points ABC of Complementary medicine Starting BMJ 319 11/9/99 Page 693 But shouldnt be all you use!

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

26. The Good The bad And And the ugly