Simon Mills

Regulation in complementary and alternative medicine

Complementary and alternative therapies have become more widely used over the past two decades, but many practitioners in the United Kingdom are largely unregulated. One of the recommendations of last years report on complementary and alternative medicine by the House of Lords Select Committee on Science and Technology was that “in order to protect the public, professions with more than one regulatory body make a concerted effort to bring their various bodies together and to develop a clear professional structure.”1 That some health professions remain unregulated in a developed country seems extraordinary, and I shall review how this situation has arisen before considering the prospects for change. In the United Kingdom the common law right to choose ones own treatment for illness has been barely constrained by law.2 It is thus legal for practitioners to set themselves up in a wide variety of healthcare professions, as long as they do not claim to be registered medical practitioners and do not practise protected disciplines such as dentistry, midwifery, and veterinary medicine or supply medicines limited to prescription. By contrast, in most other European Union countries, as well as the United States, there are few healthcare activities that are allowed without state authorisation. Acupuncturists, herbalists, osteopaths, and naturopaths have been prosecuted for practising without medical qualifications, and the technical illegality of much complementary practice has meant that it has been pursued informally and disparately, with less opportunity for professional organisations to develop. The increasing demand for alternative health care across the developed world has, therefore, sometimes been met by practitioners outside the law and without recognisable training qualifications, professional standards, or insurance. #### Summary points Practitioners of complementary and alternative medicine in the United Kingdom are free to practice as they wish Most therapies have set up professional bodies, but the educational standards …

Continuous PC6 wristband acupressure for relief of nausea and vomiting associated with acute myocardial infarction: a partially randomised, placebo-controlled trial.

OBJECTIVES To assess the effectiveness of continuous PC6 acupressure as an adjunct to antiemetic drug therapy in the prevention and control of nausea and vomiting in the first 24h after myocardial infarction (MI). DESIGN Partially randomised, partially blinded placebo-controlled, exploratory clinical study. SETTING Coronary Care Unit, Torbay Hospital, Torquay, Devon. PARTICIPANTS A total of 301 consecutive patients (205 males, 96 females) admitted following acute MI. INTERVENTION The first 125 patients recruited received no additional intervention. Subsequent patients were randomised to receive either continuous PC6 acupressure or placebo acupressure. OUTCOME MEASURES (1) Incidence of post-MI nausea and/or vomiting, (2) severity of symptoms, (3) use of antiemetic drugs, over 24h. RESULTS There were no significant differences between the groups for the whole 24-h treatment period. However, the PC6 acupressure group experienced significantly lower incidence of nausea and/or vomiting during the last 20h (18%), compared with the placebo (32%) or control (43%) groups (P<0.05). The severity of symptoms and the need for antiemetic drugs were also reduced in the acupressure group, but these differences were not statistically significant. CONCLUSIONS Continuous 24-h PC6 acupressure therapy as an adjunct to standard antiemetic medication for post-MI nausea and vomiting is feasible and is well accepted and tolerated by patients. In view of its benefits, further studies are worthwhile using earlier onset of treatment.

The development of the complementary medical professions

Abstract This paper presents a guide to the development of the major professions ∗ of complementary medicine in the UK over the last three decades, with brief introductions to the most prominent organisations and individuals that have shaped the present landscape.

Safety awareness in complementary medicine

Summary Questions are raised about the extent of awareness of safety among the complementary healthcare professions. Specific measures to increase the appreciation of the risks of complementary treatment are proposed for incorporation into the curricula of training establishments and an adverse reporting scheme for practitioners is also recommended.

Chemotherapy-induced nausea

Abstract The rubric complementary medicine covers a variety of approaches that may seem alike only in their being outside conventional care and training. We have asked experienced practitioners to present their own pieces of this jigsaw, realising that these clinical fragments, when seen together, create excitement but also confusion. Of course, this forum is not intended to be a comprehensive review of relevant complementary treatments, and often the individual apporaches to clinical problems will appear totally unrelated, while their apparent effectiveness stretches the biomedical model and conventional research methodology beyond their capacity. With this in mind, we intend that forthcoming articles and reviews will expand on the therapies themselves, and discuss the evidence supporting them.

The EXTRACT database at the University of Exeter

Summary Work towards the development of a specialist information resource on herbal remedies is described. After piloting and early commercial applications, there are prospects for a role in illuminating the issues of herb safety.