Beverly Wellman

Complementary and Alternative Medicine : Challenge and Change

Preface: The Challenge of CAM Introduction 1. Conceptions of the Body and CAM 2. The Fitness Movement and the Use of CAM 3. The Psychology of the Use of CAM 4. The Therapeutic Relationship and the Use of CAM 5. Psychosocial Determinants of CAM Utilisation 6. Changes in Characteristics of CAM Users Over Time 7. The Diffusion of CAM 8. Partners in Illness: Who helps You When You are Sick? 9. Investigating Symbolic, Experimental and Social Realities 10. Assessing the Evidence Base for CAM 11. Rethinking Models of Illness Behaviour 12. Medical Pluralism and the Re-emergence of CAM 13. Professionalisation, Politics and CAM 14. Strategies for Future Research

Domestic Affairs and Network Relations

We examine how spouses and community members provide social support: companionship, emotional aid and services for dealing with domestic situations. Torontonians engage their networks from their homes; there is no Bottian tendency for networks to lure people away from their spouses. Spouses exchange a wide range of support, but most community members provide specialized support. We develop a typology based on the extent of support that people receive from spouses and networks. Networkers, with much spousal and network support, tend to be in their thirties, parents of preschoolers, with wives who are home much of the time, have larger networks and more contact with network members. Householders, with spousal support but little network support, tend to be in their forties, with both spouses doing paid work, have the smallest networks and do not have much contact with the members of their small networks. Self-Reliants, getting little support from spouses and networks, tend to have no children living at home, small networks and little contact with network members.

Complementary and alternative groups contemplate the need for effectiveness, safety and cost-effectiveness research.

OBJECTIVE To examine the views of complementary and alternative medicine (CAM) groups on the need to demonstrate the effectiveness, safety and cost-effectiveness of their therapies and practices. DESIGN Qualitative interviews were conducted with 22 representatives of three CAM groups (chiropractic, homeopathy and Reiki). Qualitative content analysis was used to identify similarities and differences among and across groups. SETTING Ontario, Canada. RESULTS There were striking differences in the views of the three sets of respondents. The chiropractors agreed that it was essential for their group to provide scientific evidence that their interventions work, are safe and cost-effective. The leaders of the homeopathic group were divided on these points and the Reiki respondents showed virtually no interest in undertaking such research. CONCLUSIONS CAM groups that are more formally organized are most likely to recognize the importance of scientific research on their practices and therapies.

Older Adults' Use of Medical and Alternative Care

This article reports on a study of 77 older adults, 35 of them patients of family physicians and the other 42 patients of alternative practitioners. We compare the two groups along a number of dimensions and identify differences in health problems, social characteristics, practitioners consulted, reasons for choice of therapy and practitioner, pathways taken to care, and length and frequency of practitioner visits. The data show that few older adults sought care fromalternative practitioners and that those who did so had distinctive social and health characteristics. All the older adults began their search for care with conventional medical doctors. Most remain within the medical system. Those who moved beyond it had not found relief from their chronic problems and also had access to wider sources of information about alternatives, provided mainly by family and friends. The pathways followed by patients of alternative practitioners were complex and varied, but these patients did not forsake medical care.

Opening the Door to Complementary and Alternative Medicine: Self-Regulation in Ontario

This paper examines the steps that three complementary and alternative medicine (CAM) groups - naturopaths, acupuncturists/traditional Chinese medicine practitioners, and homeopaths - are taking to achieve statutory self-regulation in the province of Ontario. The regulatory framework created by the Regulated Health Professions Act of 1991 is outlined, and the differing approaches taken by each of the three groups to gain inclusion under its umbrella are compared and contrasted. The paper assesses the influence of current regulatory and socio-political environments, and queries the extent to which the paradigms of health and health care of these different groups can be accommodated in a regulatory regime heavily reliant on the conventional medical model.