Merrijoy Kelner

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

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.

Integrative health care in a hospital setting: Communication patterns between CAM and biomedical practitioners

Research in the area of collaboration between complementary and alternative medicine (CAM) and biomedical practitioners often describes their relationships as fraught with power struggles. This paper explores communication among the various stakeholders at an integrative health clinic for artists located in a university hospital. Qualitative research methods were used, in-depth interviews and semi-structured focus groups, to facilitate the gathering of information about patterns of communication among stakeholders involved at the clinic. The findings describe the challenges to communication and integration at the clinic. The lack of communication is described as a scheduling issue, or lack of consistent presence of CAM practitioners, and a lack of formal methods of communication (patient charting). The consequences of these gaps were felt mostly by the CAM practitioners, as their scope of practice was not well understood by other practitioners. CAM practitioners stated that this had a direct effect on their confidence levels. CAM practitioners were relegated to the periphery of the hospital in their role as part-time, contract employees. Their lack of consistent presence at the clinic lead to a lack of understanding of their scope of practice, hence, a lack of referrals from other health-care practitioners, particularly those who were biomedically-oriented.

Ethical Dimensions in the Borderland Between Conventional and Complementary/Alternative Medicine

Consumer enthusiasm for complementary and alternative medicine presents complex challenges for conventional Western biomedically dominated health care systems and for those who practice within them. In particular, this trend forces new ethical dilemmas related to how we create consensus about the nature of ethical clinical practice and what constitutes evidence sufficient for public health policy. In this paper, we examine the historical context into which complementary and alternative medicine has been introduced, and consider the ethical and scientific challenges with which it confronts mainstream health systems.

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.

Postgraduate medical training, stress, and marriage.

In a pilot study, 20 interviews were conducted with married female interns and residents and their spouses in order to explore both positive effects of spousal support and negative effects of additional role obligations during medical training. The marital state has been shown to be related to lowered levels of stress. Past studies of medical marriage have focused on male physicians and their wives. However, marriage and parenthood impact differently on women than men, and thus on women physicians. To explore these differences, our findings are contrasted with findings on male medical students and their wives by R. Coombs. Compared to our subjects, Coombs found spouses were either housewives or held lower level jobs rather than demanding careers, and consequently our subjects experienced greater difficulty meeting demands of everyday life (cooking, cleaning, child care). Coombs’ wives showed greater vicarious identification with the goals and satisfactions of the physician in-training; greater feelings of obligation to nurture, support and make sacrifices on behalf of their spouses; and less resentment toward the current system of medical training. They stressed the nurturing aspect of marital support rather than instrumental aspects. Subjects in both studies feared growing apart but while Coombs’ wives feared being outgrown intellectually, our husbands were critical of their wives’ narrowness of interests. Subjects in both studies believed marriage provided benefits (intimacy, support, affection, sex) but also complained of the negative impact of exhausting and emotionally draining medical training. Implications of findings for reducing the stress of medical training are discussed.

The Organizational Support Necessary for Integrative Health Care (IHC): A Clinic for Artists in a Hospital Setting

Background: In 1994, a grassroots group of Canadian artists from diverse disciplines met to investigate the possibility of creating a specialized health-care facility for professional creative artists and performers. The project grew into an outpatient clinic serving professional artists, in a large urban teaching hospital in Canada. This article focuses on the financial limitations of creating and sustaining such an integrative health care (IHC) clinic for artists. Methods: Qualitative in-depth interviews and focus groups were used to gather information about IHC at the clinic. Results: The findings describe how the expense of implementing IHC directly affected the overall sustainability of the clinic, including such aspects as existing subsidy programs, fundraising, and the integration and scheduling of contract practitioners. Strategies for sustainability included using aspects of business and insurance models to inform the current management of clinic funds. Conclusion: An IHC clinic needs financial resources, and the rationale for its development needs to be made explicit to all stakeholders. Its success will ultimately depend upon the support and commitment of all staff involved.

Strengthening medical research through an integrated approach.

No abstract available.

Towards Integration: Opinions of Health Policy Makers on Complementary and Alternative Medicine

BackgroundThis qualitative study describes what the integration of complementary and alternative medicine (CAM) means to healthcare policy makers in Canada and examines their recommendations and concerns with regard to the increased integration of CAM in the conventional healthcare system.MethodThe study employed face-to-face interviews with ten provincial government policy makers from Alberta and British Columbia, Canada. The interviews consisted of open-ended questions that focused on the barriers and solutions to the integration of CAM.ResultsContent analysis of the transcribed interviews revealed seven major themes. Participants highlighted the issues that need to be addressed for CAM integration to proceed: the prevention focus in CAM; economic issues; the need for scientific evidence; accreditation and education of CAM practitioners; professional boundary issues; the role of advocacy and strategic planning; and a suggested mechanism for CAM service delivery.Discussion and ConclusionThe findings indicate policy makers hold a positive view for the integration of CAM at the clinical and primary care level of practice. Policy makers support movement towards integrative health services, but emphasise that the issues of evidence-based CAM research, standards of accreditation and training for CAM practitioners, as well as the issue of who pays for these services, need to be addressed to ensure the improved health and well-being of Canadians.