Health Studies 301 Complementary and Alternative Therapies

Study Guide: Unit 1

Introduction

Asclepius (/æsˈkliːpiəs/; Greek: Ἀσκληπϊός Asklēpiós [asklεːpiós]; Latin Aesculapius) is the god of medicine and healing in ancient Greek religion. Asclepius represents the healing aspect of the medical arts; his daughters are Hygieia (“Hygiene,” the goddess/personification of health, cleanliness, and sanitation), Iaso (the goddess of recuperation from illness), Aceso (the goddess of the healing process), Aglæa/Ægle (the goddess of beauty, splendour, glory, magnificence, and adornment), and Panacea (the goddess of universal remedy). He was associated with the Roman/Etruscan god Vediovis. He was one of Apollo’s sons, sharing with Apollo the epithet Paean (“the Healer.”) [2] The rod of Asclepius, a snake-entwined staff, remains a symbol of medicine today. Nina Aldin Thune, 2004, CC BY-SA 3.0

Complementary and alternative medicine (CAM) therapies have attracted a great deal of attention in recent years. A substantial proportion of Canada’s population uses the services of alternative therapy practitioners, particularly for the treatment of chronic disease.

Health Studies 301: Complementary and Alternative Therapies surveys CAM therapies commonly encountered in Canada. It reviews reasons that CAM therapies have become popular, the research base and methodologies used to evaluate the effectiveness of any medical therapy, and the information related to the benefits and contraindications of using particular CAM therapies. For the purposes of this course, we will consider CAM as health care that, for the most part, is outside the mainstream of conventional medicine practised in North America.

Complementary and alternative medicine is also often known as alternative medicine or complementary medicine. The term complementary and alternative medicine is preferred for two reasons: first, it is currently the most commonly used term; and second, it embraces both therapies that are used in addition to conventional therapy (i.e., complementary) and those that are used as an alternative.

The authors of this course have approached the topic of CAM in a scientific manner and have attempted to present a balanced discussion. While some might view the bent of this course as sympathetic, others might see the course as being overly critical. The main intent, however, is to provide you with knowledge of CAM therapies currently practised in Canada to enable you to make your own objective evaluation.

For each therapy discussed, the course addresses the following questions:

• In what situations is the therapy commonly used?
• What research supports the use of the therapy?
• What trends and issues are related to the use of the therapy?

There are no simple answers to these questions. In this course, you will need to be open minded about CAM, yet be able to critically assess the outcome of treatments.

We assume that you have a basic knowledge of human biology (such as anatomy and physiology) and of health. If you come across something that you are not familiar with, perhaps a word or a particular disease, then stop and consult a reliable source of information. Several reliable websites are listed at the end of Unit 2.

Learning Objectives

Upon completion of Unit 1, you should be able to

• define complementary and alternative medicine or therapy.
• describe the popularity of CAM and the persons most likely to use CAM.
• describe some of the philosophical attractions of CAM.

Defining CAM

It is difficult to provide a clear-cut definition of complementary and alternative therapies (CAM). What is thought of as an alternative therapy in one country may be considered to be conventional medicine in another. Acupuncture, for instance, is seen as a complementary or alternative therapy in Canada, but it is part of mainstream medicine in China. The common definition of CAM is that which is outside conventional medicine.

There is no clear dividing line between complementary and alternative therapies. If a therapy is used in addition to conventional medicine, then it is a complementary therapy; if it is used instead of conventional medicine, then it is an alternative therapy. The same therapy might be used by some patients as a complementary therapy and by others as an alternative therapy. In this course, we will use this broad definition and include some therapies, such as chiropractic, that are accepted by most conventional medicine practitioners.

One might decide to give credence to only those therapies that have a scientifically sound rationale and have withstood scrutiny by researchers. However, some therapies have no sound rationale and are not supported by independent research, yet still prove to be of value. Acupuncture is one such case. Physicians and scientists in Western countries had not paid much attention to this treatment until the 1970s. Consequently, there was little scientific evidence in support of the therapy.

Even today, although the rationale for acupuncture cannot be fully explained according to our understanding of physiology, there is evidence that acupuncture may be an effective treatment in certain circumstances. Similarly, treatments used in herbal therapy and alternative diet therapy have proven effective. Therefore, it would be a mistake to assume that alternative therapies should be rejected merely because strong supporting evidence is not available.

Learning Activities

Study Questions

As you complete the activities for Unit 1, keep the following questions in mind. You may want to use the Personal Learning Space wiki on the course home page and answer these questions as a way of keeping notes to focus your learning.

1. What is a basic definition of CAM?
2. What is it about CAM therapies that attract people?
3. Why is it difficult to evaluate CAM therapies?

Unit 1 Discussion Forum

When you have completed the other activities for this unit, answer at least one of the questions in the Unit 1 Discussion Forum and respond to at least one post by a fellow learner.

The more questions you answer, the better prepared you will be for the final exam!

Read

In addition to the notes provided here, read in the textbook:

Micozzi, M. (2019). Fundamentals of Complementary, Alternative, and Integrative Medicine

• Pages 3–7 (from the heading “One Way” to the heading “Some Fundamentals of Medical Science”).
• Pages 12–18 (to the heading “Ayurveda”).

Prevalence of Complementary and Alternative Therapies

In North America, there appears to be a growing interest in the use of complementary and alternative therapies; however, it is unclear whether the numbers indicated in surveys are real or merely a result of the type of survey being done.

The Canadian Community Health Survey (CCHS), conducted between 2001 and 2005 on 400,000 Canadians across the country aged 12 or over (Metcalfe, Williams, McChesney, Patten, & Jetté, 2010), published results on the use of CAM in Canada. Highlights of the report are as follows:

• 12.4% of the population had used a CAM therapist in the previous year. By contrast, 78% of the population reported seeing a family physician.
• The most common types used by individuals who had reported visiting a CAM practitioner were for massage therapy (62.9%), acupuncture (18.3%), homeopathy (18.2%), chiropractic care (11.3%), herbalism (5.2%), reflexology (2.4%), and spiritual healing (1.0%).
• Use of CAM was twice as common among women as among men.
• Use increased with household income, education, and residence in a Western province.

Surveys in other countries, such as the United States and the United Kingdom, have often reported much higher numbers using CAM (Stevinson & Ernst, 2006). Surveys across different countries also found that persons with chronic conditions (mainly musculoskeletal problems) are especially likely to use CAM.

Why Do People Use Complementary and Alternative Therapies?

Studies that investigate why patients seek CAM have found that factors range from dissatisfaction with conventional medicine to the holistic treatment philosophy of alternative therapies and encouragement of self-help measures (LaValley & Verhoef, 1995; Stevinson & Ernst, 2006). Buckman and Sabbagh (1993) outlined some philosophies that attract patients who seek CAM:

• Energies and forces. An inherent life force is a simple and appealing concept in contrast to complex medical science.
• Self-healing. Properties of one’s body, mind, or spirit are capable of combating both chronic and acute disease and illness.
• Holistic (wholistic). The entire patient is treated, including the mind, body, and spirit.
• Unifying hypothesis of disease. Proponents of some types of CAM advocate a universal theory concerning the cause of human disease. For practitioners of traditional Chinese medicine, the cause is an imbalance between the yin and yang; for many chiropractors, diseases can be traced to spinal misalignment; and naturopaths often claim that disease is caused by a buildup of toxins.
• Natural. Natural is an appealing basis advocated for alternative therapies. However, “natural” does not mean “safe”: snake venom is natural but deadly; poison oak and poison ivy contain natural substances that cause severe dermatitis; many natural minerals from metals (lead, mercury) are toxic; a large number of carcinogens are naturally present in plants (Ames, Magaw, & Gold, 1987).
• Traditional. Many therapies are appealing because they have been used for hundreds of years. This approach contrasts with conventional medicine, which discards past practices in favour of recent advances. For example, routine bloodletting and the application of leeches, two practices used for centuries in conventional medicine, were discontinued after evidence demonstrated their lack of value as well as their harmful effects.
• Exotic. The attraction of something exotic could be summarized as follows: “Magic is more enthralling than the mundane, hope is better than reality, and there is a deep need in all human beings—particularly those afflicted with terrible disease—to seek miracles” (Fitzgerald, 1994).
• Individual attention: CAM practitioners purportedly are more attentive to their patients than conventional medical practitioners. As Barrocas (1997) explained, “Whether real or perceived, the failure of conventional practitioners to understand and practice preventive medicine and to communicate effectively and efficiently with patients and the public at large, has fueled the flames of disappointment in traditional medicine.” The time, personal involvement, empathy, and acceptance imparted by the practitioner help the patient feel important and valued.
• David and Goliath, or the little guy takes on the bully: “persecution by the authorities is perceived by believers as a badge of credibility” (Buckman & Sabbagh, 1993).
• Hope and belief in treatment. The ethics and training of practitioners of conventional medicine require them to inform patients about their condition. This obligation to be honest and to share the risks and benefits of treatments might be interpreted as a lack of faith in the treatment. Some patients may equate a loss of hope for cure as a loss of hope for care. In contrast, CAM practitioners are said to be more optimistic in their prognosis.
• Control. Conventional medicine historically has taken a paternalistic approach to patient care although now it is involving the patient more as an active participant in care. Buckman and Sabbagh (1993) suggested that control by the patient is one reason that CAM therapies remain popular.
• Non-toxic. The perception of CAM therapies as being non-toxic is attractive. The difference in approach between conventional medicine and CAM is embodied in such terminology as “painkillers” and “anti-inflammatory” compared to “restore balance” and “enhance” (Chung, 1996).

Several common characteristics are often seen in CAM therapies. These include integration of individuals into the stream of life; the importance of religious and spiritual values to health; attribution of a causal, the independent role to the various manifestations of consciousness; maintaining the Hippocratic injunction of first do no harm; and the use of whole substances.

Other factors that influence the decision to use CAM therapies include dissatisfaction with conventional medicine, belief in CAM therapies, and exploration of treatment options (Dobi, 1997). A survey of patients in Europe reported that disenchantment with conventional medicine was not the only motivator for choosing CAM therapies. Wanting to try all options and hoping to be cured without side effects were more important reasons (Ernst, Willoughby, & Weihmayr, 1995).

Eisenberg (1997) gave additional reasons that patients pursue CAM therapies:

• Patients seek health promotion and disease prevention.
• Conventional therapies have been exhausted. No conventional therapy is known to relieve the patient’s condition, and the patient therefore feels he or she has nothing to lose.
• Conventional therapies are of indeterminate value or are associated with side effects and significant risk.
• The conventional approach is perceived to be emotionally or spiritually without benefit.
• Many people choose a health practitioner based on word of mouth and previous experience.

Critics of CAM therapies have often been quick to attack those therapies if evidence of harm appears. It is true that a CAM therapy may cause harm. This can occur directly, for example, as a side effect from a herbal treatment, or indirectly by causing the person to avoid conventional medical treatment that is of value. But it is important to keep things in perspective: conventional medicine also carries much risk, as revealed by the study described below.

The boast is often heard that “America has the best medical system in the world.” The hollowness of this statement was exposed by an analysis published in the Journal of the American Medical Association (Starfield, 2000). The researcher estimated that 225,000 people die in the United States each year from iatrogenic causes (conditions caused inadvertently by medical treatment). The major types of iatrogenic deaths are nosocomial infections (infections contracted in hospitals) and non-error adverse effects of medications. Incredible as it may seem, if this estimate is correct, this would make iatrogenic causes the third leading cause of death in the United States, well ahead of cerebrovascular disease.

Evaluating the value of different forms of CAM presents major challenges. We often find that supporting evidence is weak. Those advocating CAM therapies are often motivated by a quest for revenue: more patients mean more income. The therapist may have invested a great deal of time and money in gaining training and certification, and will therefore be highly motivated to earn a good income. Another common motivation is a sincere belief in the therapy. Just as those who join a particular religion or political party accept a shared belief, so do those who became practitioners of CAM therapies. Whether the therapist’s motivation is money, a sincere belief in the therapy, or both, the therapist is likely to boldly claim that the therapy is highly effective. This creates challenges for people who may be considering the services of a CAM practitioner.

In this regard, it is instructive to compare conventional medicine with CAM. Practitioners of conventional medicine (i.e., physicians) must undergo long and vigorous training. They can lose their medical licence for serious misconduct. Likewise, a drug can only be prescribed after it has been thoroughly tested and then approved by an independent agency. With CAM therapies, in stark contrast, standards are often much lower. As we shall see in later units, with some therapies, such as chiropractic, high professional standards are upheld. But, with several others, almost anyone can become a practitioner, perhaps after taking only a short training course.

Moreover, CAM practitioners have more or less complete freedom to administer treatments with virtually no interference by government departments, even though there may be little or no evidence of their effectiveness. However, the comparison between conventional medicine and CAM is not black and white. The pharmaceutical industry is one of the world’s most profitable industries and earns billions of dollars a year. This gives it a huge incentive to boost sales by any means—and this it regularly does, even when the consequence is that people die.

Unit 2 looks at how to evaluate evidence regarding the effectiveness of various types of medical treatment.

Summary

Complementary and alternative therapies remain popular. Millions of people use these therapies, and the reasons they do so are as varied as the therapies themselves.

It is not possible to generalize about the effectiveness of CAM therapies. Books, articles, and papers on the subject have often made sweeping conclusions, either in favour of or against the therapies. While the basis for CAM therapies may or may not be scientific, there can be no substitute for careful investigation and an open mind, which are the central themes of this course.

Learning Activity

Self-test Quiz

Do the self-test quiz for Unit 1 as many times as you wish to check your recall of the unit’s main points. You will get a slightly different version of the quiz each time you try it. The quizzes are not marked or checked by your Academic Expert and do not count toward your final grade. The computer does not do word recognition on your quiz answers. For that reason, all answers are marked as wrong.

If you have difficulty finding an answer or trouble understanding the material, please contact your Academic Expert.

References