Carol
Robson
Should complementary therapies be provided
as part of the NHS? What are the
barriers to this happening?
Is there a place
within the National Health Service (NHS) for complimentary and alternative
medicine (CAM)?
Can complementary therapies halt the crisis in the NHS? Perhaps there is a place for the more
recognised forms of CAM.
That in certain areas of traditional medicine there is a place for
alternative therapies to work alongside with them. Can the basic education of people, in eating
well and reduce their stress levels.
These should be seen as the simple rules for overall good health levels. As it says in the article (Here’s Health CAM
and the NHS) ‘These are the basic principles of a complementary approach to
health, where a prescription is more likely to mean taking an active interest
more in health and lifestyle than just taking a pill’.
In an article from
(bcma.co.uk) there is a belief that the NHS should start making full use of the
talents and services of complementary and alternative medicine (CAM) practitioner to help reduce the current overload
on the NHS. It may not be the therapist’s
job to recognise what medical condition a patient has, and some may not have
the knowledge to do so. This is the
doctor’s areas of expertise.
Nethertheless, when a diagnosis has been made for a patient, there could
be a host of benefits that CAM
practitioners could provide.
So, how can CAM be seen within the NHS structure? It should be seen that CAM within the NHS is the practice of integrated
medicine. This practice incorporates the
best effective complementary and alternative medicine treatments alongside the
orthodox methods of diagnosis and treatments.
This concept is a more commonly accepted practice in the USA.
Through this integrated approach of treating a patient, the individual
is treated as a whole. This for the
patient brings in the wider issues of health and would relate to their
emotional needs, lifestyle and relationships.
This also gets the patient to promote their own self-healing and they
must be encouraged to take responsibility for their own health, thus enhancing
their own quality of life.
In Britain back in November 2000, a House of Lords
Select Committee on Science and Technology acknowledged that the use of CAM is increasing in the industrialised western
nations. The Select Committee
highlighted the issue of integration.
They suggested that three main areas within CAM should be addressed:
1. Education, in particular familiarisation courses for professionals.
2. Research into treatment effects.
3. The future regulation of the multitude of CAM modalities and
practitioners. (Royal College of Physicians. 2001)
The medical
perception of CAM was addressed by Dr George Lewith in a
survey of the members of the members and fellows of the Royal College of
Physicians (RCP); the RCP has taken a lead in the medical development and
understanding of CAM within the UK.
Physicians were open to their patients’ wishes to use CAM, however, the physicians perceived the use of CAM on the NHS as too expensive. There was a significant minority (at least 1
in 10) of hospital-based doctors, however, do use CAM irrespective of whether it is provided through the
NHS or privately. It does seem that the
use of CAM by physicians at present is largely
localised to palliative care, pain control and rheumatology. Nethertheless, it is worrying that of these
physicians practising CAM or
referring on to CAM practitioners, only 14% were trained to
do so.
This has to be
seen as a definite barrier in how do they get traditional health professionals
especially doctors to accept that some forms of CAM can have a role alongside orthodox medicine. It may be seen as the 21st century gets older
and you get a new breed of doctor that these will be accepted and more doctors
will train in CAM treatments. It can be seen as Zollman and Vickers state;
‘recent
trends in the provision and the public usage of complementary
medicine dictate that conventionally trained health professionals now
need
to be conversant with the main complementary therapies’.
(Zollman and Vickers. 2000)
Therefore, what
is a definition of complementary medicine.
This definition is the one adopted by Cochrane Collaboration;
“Complementary and alternative medicine (CAM) is a broad domain
of
healing resources that encompasses all the 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. CAM includes all such
practices and ideas self-defined by their users as preventing or treating
illness or promoting health and well-being. Boundaries within CAM
and
between the CAM domain and that of the dominant system
are not
always sharp or fixed” (Zollman
and Vickers, p1)
It seems that at
the moment the most prominent users of CAM come in the age-group 35-60 and that 55-65% who
consult CAM practitioners are female. Most of these users will be found outside the
sphere of traditional medicine. However,
the current position within the NHS for provision of CAM is that most of it is being provided at the primary
care level. Therefore, for this direct
provision in primary health at present, there is only just over 20% of these
healthcare teams that provide some form of complementary therapy. (Zolman and
Vickers, p9)
A problem here
seems to lie in the length of time that is available for a complementary
treatment within an NHS setting. This
seems particularly relevant in the primary care setting where funding is always
the main issue for primary care managers, thus causing time restrictions for
the practitioner.
A main area of
orthodox healthcare and medicine where CAM seems to be used alongside, is cancer care. This is something seen at the Cavendish Centre
for Cancer Care in Sheffield.
They have an integrated cancer care programme. That a more holistic view is taken for the
needs of the cancer patient. This also
relates to the patients spiritual needs and those of their families, which at a
certain stage of cancer treatment is more relevant. (Seminar. 16-10-02)
This is also
relative to the Nick Fox lectures and seminars.
It relates to what the body and mind can really do. It can be seen that through certain CAM therapies that the body and mind can be more than
the body/self that is disciplined by medical knowledge. (Seminar.13-11-02)
Is there an
evidence base for CAM?
According to Fiona Mantle who writes to provide evidence for nurses,
midwives and health visitors, that it can be seen that there are serious
problems in the standard of research for some CAM therapies.
That the nursing profession should decide for itself what its own ‘gold
standard’ for research is, using the methods for research of CAM that suits their needs. (Mantle,F.1999) The problem here is that across the field of
orthodox healthcare and medicine it could create a problem if different health
professionals have their own ‘gold standard’.
Surely it would it be better for an integrated model to work that
national policies are in place. That
there would be evidence available to all levels of
Medicine and
health treatment delivery.
This may be
coming from the likes of the Cochrane Library.
The Cochrane centre prepares systematic reviews of the best available
evidence to assess whether an intervention is effective. The usefulness of systematic reviews in CAM has been addressed by a Dr Linde. Currently the Cochrane complementary
medicine field holds 58 reviews on
herbal medicine, 39 on acupuncture and 18 on homoeopathy. Dr Linde suggests that the Cochrane is the
best place for the evidence on a defined topic.
However, that the results of systematic reviews should be interpreted
with caution, particularly in CAM where few good quality primary studies exist.
There is
research in regards of the role of CAM in the care of cancer patients. The NHS Research and Development Programme have
recognised the public interest in CAM and that on average a third of cancer
patients had used some form of CAM. That
also there is the potential for even higher demand in the future. However, Ernst writes that hard evidence is
scarce whether CAM does more good than harm. That it is going to need well designed
clinical investigation to establish whether CAM works or not.
Ernst relates that CAM is
largely opinion based.
The problem
surrounding the idea of integrating orthodox medicine and CAM seems to be around funding, time constraints and
most important one, the education of health professionals and patients that
there is a place for some CAM therapies. Integration can be achieved through
education, in particular through familiarisation for health professionals in
the medical schools. Issues such as that
there could be more ways of procuring effective treatment than the orthodox
method and showing the safety aspects of CAM. That if
doctors show an interest what qualifications are needed. Currently many UK medical schools offer some training
programmes but the approach is varied and limited.
The stumbling
blocks for integration also surround the delivery mechanism. The issues that may be applicable to both CAM and orthodox medicine that could hinder
integration, such as innate prejudice, hypocrisy and poor science. This is where the role of education and high
quality research would hopefully overcome these problems. In some NHS centres these problems have
already being overcome. Lucy Bell from
the integrated cancer care unit at Hammersmith Hospital describes the evolution of their
unit. It was established ten years ago,
it is now a fully operational full-time service with secured NHS funding for
eight team members. Patients are offered
a choice of four out of five CAM modalities (massage, aromatherapy, art therapy,
relaxation and reflexology) alongside their conventional treatment. At this unit they have seen significant
reductions in anxiety and depression levels, and the control of side effects
have been clearly demonstrated, in addition to the improved care and emotional
support given to these vulnerable patients.
This is an area
where integration is a success and this seems to be one of the main areas of
conventional treatment that allows CAM to work at its best. There does seem to be many hurdles to be
overcome for the five major therapies of CAM to be successfully integrated into the NHS. The fact that the new breed of health
professionals coming through may well accept CAM as an alternative more readily, therefore the
education will have worked in this instance.
Nethertheless, there are still many doctors who qualified before medical
schools taught about alternative medicine.
This is an area where education of alternative medicine is needed and
that they should listen to their patients who suggest alternative therapies,
for they are more educated these days about what is available. This is very important for the health
professionals to take on board as this Government is pushing more patient
empowerment.
However, there
are many GPs who are now beginning to realise that their first priority in
healing is specifying treatment with the patient. That this will achieve a clear understanding
of what is going on in their lives.
Therapists could help them to achieve this. Making the time to assess a patient as a
whole and really get to the root of their problem, rather than just patching up
symptoms. Therefore, in the bigger
picture this may well go a long way to
reducing the costs of prescriptions, which take up the largest part of the
National Health Service funding. A
recent report supporting acupuncture links to this conclusion, in that they
wholly endorse the use of acupuncture in the treatment of arthritis and pain
management. That CAM should not be seen as a complete alternative to the
management of most illnesses, although undoubtedly in some cases, such as the
use of manipulative techniques for acute back pain, it is a safe and effective
alternative to orthodox treatments.
Again here is an area where a condition is a major drain on the GPs time
and cost to the state. The benefits here
of integrating a CAM therapy releases funds and the GPs time to spend
with a patient where a CAM
therapy is not suitable. Therefore,
should there be any barriers?
BIBLIOGRAPHY
1. Mantle,F.1999.
Complementary therapies: is there an
evidence base? NT Monographs. NT Books. London.
2. Zollman, C.
and Vickers,A. 2000. ABC of Complementary
Medicine. BMJ Books. London.
3. Ernst,E.
2000. The role of complementary and
alternative medicine. Journal. BMJ Vol 321.
4. NHS Research
and Development Programme. Research on
the role of complementary and alternative medicine in the care of Cancer
patients.
http://www.doh.gov.uk/research/documents/rd3/commissioningbrief.doc (20-12-02)
5. A Family
Doctor publication in association with the BMA. Understanding complementary medicine.
http://www.mypharmacy.co.uk_books/books/u/understanding (20-01-03)
6. Royal College of Physicians. 2001. Why are you Doctors? The importance of care
and compassion.
http://www.replondon.ac.uk/pubs/ClinicalMedicine/03_may_conf2.htm (20-12-02)
7. Here’s Health
Cam and the NHS. Could complementary
therapies save the NHS?
http://www.bcma.co.uk/HHCamandNHS.html (19-12-02)
8. Seminar.
16-10-02. Cavendish Cancer Care Centre.
9. Seminar.
13-11-02. Nick Fox Lecture and Seminar. Embodiment, Self and Subjectivity.