Perspectives on Complementary and Alternative Medicine

Tom Heller, Geraldine Lee-Treweek, Jeanne Katz, Julie Stone, Sue Spurr

• Publisher: Routledge
• Year: 2005
• eBook ISBN: 9781134265336
• Edition: 1
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

This book explores the challenging issues associated with complementary and alternative medicine in the context of the social, political and cultural influences that shape people's health.Divided clearly into three sections, this book:

• sets out the general context of social change, consumption and debate around the rise of public interest in CAM
• argues for and against different classifications of CAM
• critically assesses the importance of ethics and values to CAM practice and how these inform what practitioners do
• focuses on the question of what people want, the changing and contested nature of health, and the nature of personal and social factors associated with the use of CAM, leading to a focus on 'therapeutic relationships'
• examines the diversity of settings in which CAM takes place and the social, political and economic milieu in which CAM is provided and used.

Together with its accompanying text, Complementary and Alternative Medicine: Structures and Safeguards, it forms the core text for the Open University course K221 Perspectives on Complementary and Alternative Medicine.

1
Complementary and Alternative Medicine in Context

Edited by Jeanne Katz and Geraldine Lee-Treweek

Chapter 1
Changing perspectives

Geraldine Lee-Treweek

AIMS

• To show how complementary and alternative medicine is evolving as part of the process of social change in which there are competing sets of knowledge, diverse lifestyles, more choice for some members of society and a rise in consumerism.
• To contextualise complementary and alternative medicine in the western health care system in terms of changing patterns and challenges to the dominance of medical knowledge and ideology.

1.1 Introduction

Contemporary society is continuously changing and increasingly complex. Along with this change there is also greater choice about lifestyle and belief At the same time, many sets of knowledge and ideas about the world coexist and compete for attention—different accounts of how things are. This is the case with choice and knowledge about health, illness and wellbeing. Complementary and alternative medicine (CAM) offers a vast array of choices in dealing with issues of health and wellbeing. This chapter invites you to consider CAM in a critical way and to see what it can offer to society. It outlines some of the debates and issues that highlight the social changes, which include popular interest in CAM.

The chapter begins by introducing CAM as a fascinating and fast-changing area of social life. It also discusses the concepts that are often seen as underpinning CAM and some of the assumptions people make about what it involves. It highlights the debates within CAM about how these forms of treatment and therapies should be defined and understood. In many ways the issue of what CAM is can be considered contentious and open to debate. You will be encouraged to engage with such debates and reach a view about how you understand such contentious issues.

This chapter goes on to contextualise CAM as part of much broader changes in modern western society. To understand CAM in contemporary society, the social trends and structures that allow it to flourish and grow must be considered. In particular, the chapter discusses where differing opinions, or world views, of health and healing come from and why increasing numbers of people want to use different types of therapy. It is also useful to consider why the number of people offering CAM in the UK has grown so much since the 1980s. These new ‘experts’ on health and wellbeing are highly visible in the media, on the high street and even in people’s bathroom cabinets (in the complementary therapy products they buy to treat themselves). In the last 100 years, priorities in life and expectations of health have changed dramatically, as have people’s ideas about appropriate ways of managing illness and lack of wellbeing. This chapter will involve drawing on your own experience to examine how you see your health and think about the impact of CAM on society.

The chapter title highlights changing perspectives. Change also incorporates a struggle between different paradigms as well as competition. There is competition between and among a variety of groups: between CAM and orthodox medicine, but just as likely between different types of CAM. Issues of power, knowledge and change permeate the contemporary study of CAM. Indeed, the diversity within CAM makes it such an interesting topic. As well as considering this issue, the focus is on various integrations and collaborations. That is to say, the emphasis here is on the way in which not only is CAM continually developing but also some people who, at first sight, might be expected to be negative towards it. In particular, not only are the medical profession and members of professions allied to medicine moving towards greater acceptance but also many medically qualified practitioners are now training in CAM as an adjunct to their orthodox skills (Zollman and Vickers, 1999).

1.2 Defining complementary and alternative medicine (CAM)

The term ‘complementary and alternative medicine’ (CAM) is used in a variety of places: pharmacies, local newspapers, Yellow Pages, television and radio, general practices, the high street, complementary health clinics, etc. As with many other terms, CAM has different meanings for different people. Most people have assumptions about what the term means and, from these assumptions, expectations about what CAM can offer in terms of treatment. Sometimes such assumptions can lead people to overestimate or underestimate a particular CAM: viewing it with suspicion or open acceptance. To understand this subject you need to examine your own assumptions and consider how they might affect your views of CAM and whether you choose to use it.

‘USERS’, ‘PATIENTS’ AND ‘CLIENTS’: A NOTE ON TERMINOLOGY

In this chapter the term ‘user’ refers to people who use CAM. In many CAM disciplines you will hear different terms for the service user. For instance, you may read or hear the terms ‘patient’ or ‘client’ in leaflets about different forms of CAM, on websites, or when practitioners discuss their work. Here ‘user’ is the most common term. However, when a specific CAM is discussed, the term chosen will be the one most often used by practitioners in that field. In this way, the term used in this text will always be the most authentic to that particular CAM discipline.

ACTIVITY WHAT ARE YOUR ASSUMPTIONS ABOUT CAM?

Allow 10 minutes

List five words you associate with CAM and what it is about. You may not have much personal experience of CAM, in which case list terms you have seen in the media or heard friends or family use.

Comment

There is a range of words and ideas you might associate with complementary and alternative medicine, including natural, mumbo jumbo, weird, relaxing, hippy, healthy, unscientific and traditional. Certainly a diversity of words spring to mind when thinking about CAM! Quite often they depend on people’s personal experience of the area or the information gathered from friends, relatives and the media.

Commentators with a variety of perspectives on CAM have tried to identify what key concepts can be associated with it. For instance, Anthony Campbell, a consultant physician at the Royal London Homoeopathic Hospital, argues that there are four assumptions underpinning many CAMs (Campbell, 2002, pp. 3–12).

CAM as natural

Campbell (2002, p. 3) notes that the idea of particular forms of medicine or health care being natural is a fairly new concept that developed and gained strength during the 20th century. Nowadays the concept relates not just to the idea of particular remedies or treatments as being ‘more natural’ than pharmaceutical or orthodox ones but also to the growing social idea that the body heals naturally. The human body is seen as having a natural ability to repair itself and so CAM is there to help this process along.

CAM as traditional

CAM medicines are often claimed to have a long history of healing or links and connections with allegedly older ideas of medicine and health. Some forms of CAM, such as traditional Chinese medicine (TCM) demonstrate a heritage of healing going back thousands of years. Campbell (2002, p. 6) draws attention to how tradition and the appeal to the idea of tradition is often a key feature of many types of CAM. Thinking critically about the use of the term ‘traditional’ in relation to health practices raises important questions. Just because something is ‘traditional’, does that necessarily mean it is safe or effective? Are treatments from the past or with a long history better than newer treatments? The term ‘traditional’, while used to justify some types of CAM, does not really help to answer such questions.

CAM as holistic

There is a widespread view that different types of CAM (or modalities) try to understand illness in the context of the whole person (Campbell, 2002, p. 7). That is, a person is not just a physical body but can be seen as having several levels—mind, body and spirit— which need to be considered together to understand and treat illness and disease. Many CAM practitioners believe that consultations should include more time to discuss with an individual not only health and illness but also how they feel ‘in themselves’, their background, and their emotions and thoughts. Holistic treatment tries to tailor the whole treatment experience to suit the user as a unique person. Another way of understanding this is to consider the opposite of holism, which is reductionism. A reductionist approach sees illness and disease as being associated with a particular part of the body—in the cells of the body for instance—and deals with that problem without considering the needs of the whole person with the ailment. Modern orthodox medicine is often said to take a reductionist view of health and illness, treating only the diseased part and taking less interest in the individual as a whole. This way of viewing medicine, although undoubtedly true in some settings, is a generalisation that ignores the way in which many aspects of medicine are moving towards being more holistic and person-centred.

CAM as energy

CAM often refers in some way to the notion of energy. Campbell (2002, p. 11) maintains that the idea of people having a vital force or energy is shared by many CAMs. This often relates to energy flowing around the body in a particular pattern. Different therapies use different names for energy: you may hear the terms qi, chi, prana or life force, depending on the type of practitioner Many CAM practitioners see at least part of their role as getting energy moving properly around the body, helping to remove blockage, or rebalancing problems in the energy field. Normal flowing energy is usually considered a prerequisite to health as, allegedly, the body can heal itself better if energy moves through it correctly.

Other ideas about the features of CAM

Campbell (2002) discusses what he views as the key assumptions of CAM. However, other people emphasise very different features or identify more differences than similarities between CAMs (Sharma, 1992). For instance, it could be argued that the way the practitioner treats the user varies across the different CAMs. Hypnotherapy involves using deep states of relaxation or trance to attempt to modify users’ behaviour. The practitioner’s role is to facilitate the trance state and, allegedly, to use suggestion to help the user attain their goal, such as to stop smoking or to be more confident. Here the practitioner often sees the user only two or three times. In other CAMs, such as massage, the user may return for treatments repeatedly. Clearly, the practitioner’s role is different in such CAMs: they involve different styles of treatment—touching the body and talking. It is important to recognise that, as well as key similarities between CAMs, distinctions can also be drawn between different ones by focusing on aspects of treatment and approach.

Challenging assumptions

Given the assumptions people make about CAM, it is important to establish a set way of using the term in this book. It will become apparent that different groups, individual writers and organisations have a preference for (and tend to use) the terms ‘alternative’ or ‘complementary’. For instance, ‘alternative’ implies separation or a complete difference from other types of medicine, whereas ‘complementary’ suggests working alongside or with other types of medicine. Some commentators, such as Sharma (1992), argue that CAM represents such a broad range of practices that have so little in common with one another that it is very difficult to talk of them as a whole. In this book CAM means forms of health care and treatment that are commonly regarded as non-conventional at present. This does not mean some CAMs will not be, and indeed are not being, integrated into more orthodox health settings and services. The definition and understanding of CAM used here focuses on how particular therapies or medicines are regarded by the majority of people.

There are many non-conventional types of medicine. The most common ones are:

• Osteopathy and chiropractic—the ‘hands-on’ treatment and manipulation of the muscular and skeletal system.
• Homoeopathy—the treatment of illness with very small doses of medicines. The medicine used is chosen because it can cause the symptoms being treated if taken in larger doses.
• Medical herbalism—the use of herbal preparations to aid the individual.
• Acupuncture—the insertion of needles into the body to treat a range of problems.

These types of CAM are often collectively referred to as the ‘Big Five’ because of their popularity and high levels of usage (House of Lords Committee, 2000). However, there are many other types of CAM, which are introduced and explained briefly in Section 1.3.

It is important to note that a type of medicine or treatment considered to be a CAM today may become an accepted mainstream treatment tomorrow. In the field of CAM there is a high level of change, which is one reason why it is so interesting to study. There are changes in the public acceptance and use of CAM, and how the medical profession perceives it, in terms of regulation, in the types of training involved, and in the patterns of integration of CAM into conventional health care settings. Such change makes categorising CAM more challenging. It is worth noting here that people working in a particular CAM often find their work categorised by others—the media, groups within orthodox health care, other CAM organisations, etc.—in ways that run counter to how they see themselves. In Chapter 2 the difficulty of trying to categorise CAM is examined in more detail, along with the broader debates around using the terms ‘alternative’ or ‘complementary’. Throughout this book it is important to remember that CAM is a highly contested field, in which there are often disputes and disagreements about what it is and its efficacy and role in contemporary society.

Why study CAM and why now?

Clearly, CAM is a contentious area. Its rapid change is enough to make it a fascinating area for scholarly investigation. However, some other issues also make it important to study this area.

• CAM is increasingly popular and more people use it today than in the recent past. Estimates suggest that in the UK between 6.6 percent and 2 percent of the population use CAM (Ong and Banks, 2003, p. 23). A study by Thomas et al. (2001) showed that people who consulted CAM practitioners for six of the most established CAMs rose from 8.5 percent of the population of England in 1993 to 10.6 percent by 1998. This may be an underestimate as it does not include the use of some ‘less established’ CAMs.
• People are choosing to buy CAM products over the counter at a range of outlets—from high street retail stores to health food shops and over the internet. Statistics from Mintel (2003) show that £130 million was spent in the UK in 2002, the prediction being that the CAM market will be worth £200 million by 2008. This includes sales of such products as herbal remedies, homoeopathic preparations and aromatherapy oils.
• The rise in public interest in CAM is mirrored by a rise in the interest of medicine, nursing and professions allied to medicine. In particular, orthodox health services now increasingly integrate CAM as part of their range of services (Zollman and Vickers, 1999).

ACTIVITY THE CONSEQUENCES OF GREATER CAM USE

Allow 5 minutes

Think about the reasons why, and for whom, it might be important to know that people are increasingly using CAM for health and wellbeing.

Comment

The greater use of and interest in using CAM has consequences in terms of provision. CAM organisations need to know whether more training is necessary to meet public needs. As public interest grows, public pressure will also grow for health services to offer more CAM in hospitals, primary care services and other settings. Information about growing public demand will be needed for planning and organising such services. There are important issues around the safety of CAM and its efficacy (whether it works or produces the desired effect). People use CAM in their homes, as well as seeing practitioners, so it is important to know what they are self-treating and how they use the products, as well as being sure that the products work and are safe. Therefore, the different groups of people who might want information about the move towards the greater use of CAM include: health policy makers, hospital and primary care managers, doctors or members of the allied health professions and retail managers (who may like to know whether people want to buy aromatherapy oils in their stores, etc.).

CAM offers a range of services in the contemporary health marketplace. However, while there is more choice, there is also more need to ensure that people using CAM can make an informed c...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Contributors
• Acknowledgements
• Introduction
• Part 1 Complementary and Alternative Medicine in Context
• Part 2 People and Complementary and Alternative Medicine
• Part 3 Complementary and Alternative Medicine in Different Settings
• Index