Despite the increasing use of complementary and alternative medicine (CAM) in Britain in recent years and its acceptance by some practitioners of "orthodox" medicine, the future of such therapies in the United Kingdom remains uncertain.
The Cochrane Collaboration defines CAM as "a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health systems of a particular society or culture in a given historical period." As in the United States, the demand for recognition of CAM in the United Kingdom began with a small minority of patients using complementary therapies with or without their physicians knowledge.
A British survey in 2000 reported that the overall number of people using CAM had doubled over the previous 6 years. According to another U.K. survey in 1999, one-third of those who used complementary therapies were cancer patients, and many oncology units and hospices offer at least one form of CAM to their patients, said Michelle Kohn, M.B.B.S., medical adviser to the Macmillan Cancer Relief, London, an organization that provides information, institutional support, and palliative care for cancer patients.
Kohn summarized recent events in Britain that have reflected the interest in incorporating CAM interventions as part of health care when she spoke earlier this year at a meeting in Washington, D.C., on comprehensive cancer care held by the Center for Mind-Body Medicine, Washington D.C., and the University of Texas Medical School, Houston.
There have been some fundamental changes in the approach to CAM in Britain over the last few years, Kohn noted. "In 1986, the British Medical Association published a report on CAM associating it with witchcraft," she said. But in 1993, with mounting evidence that more and more people were seeking complementary therapies, the association issued a less critical report focusing on steps needed to assess and guide safe CAM practices.
Another move was the establishment in 1996 of the Foundation for Integrated Medicine, initiated by Charles, Prince of Wales. The foundation set up four working groups covering research and development, education and training, regulation, and delivery mechanisms. In a report published in 1998, the group issued recommendations for statutory or voluntary regulation of complementary medicine and, with the aid of a grant from the Kings Fund, is working on forming central regulatory bodies and increasing the capacity and quality of research in CAM. Last year, the foundation changed its name to the Foundation for Integrated Health, "so theres more focus on wellness," Kohn said.
In 2000, a committee of the House of Lords published a report on CAMin itself a sign of the interest in the subject. "The report classified CAM into three main aspects according to the amount of research and regulation that was available," Kohn said. The first group of principal disciplinesthe most organized and regulated interventions that claim to have a diagnostic approachincluded acupuncture, chiropractic, herbal medicines, homeopathy, and osteopathy. The second group, which the report defined as those therapies used to complement conventional medicine that do not include a diagnostic component, included aromatherapy, hypnotherapy, massage, meditation, counseling, and stress therapy. The third group includes therapies that purport to offer diagnostic information and treatment, but for which there is no credible evidence: crystal therapy, iridology, kinesiology, and radionics.
Finally, in 2001, there was a conference in London held by the Royal College of Physicians in association with the U.S. National Center for Complementary and Alternative Medicine. "The conference demonstrated that much of CAM was entering medical practice and showed that many physicians were practicing such techniques as homeopathy, acupuncture, and other complementary procedures," said Kohn.
With this evidence of increasing interest in CAM, Macmillan Cancer Relief conducted a survey on a sample of Macmillan oncology nurses and physicians of the CAM services provided to cancer patients. The survey found that their patients had asked 97% of l45 nurses and 96% of 25 physicians about complementary therapies. The majority said they also had volunteered information about CAM to their patients at some point. The survey also found that 15% of the nurses and 20% of the physicians in these centers provided complementary therapies to patients, and 50% of the nurses and physicians surveyed said they would like to practice some form of complementary therapy. Doctors cited acupuncture and hypnotherapy as the most popular techniques, and nurses listed aromatherapy and massage as their preferred offerings.
From the point of view of the proponents of CAM, these were welcome findings, said Kohn. At the same time, she warned that regulation was needed. With the interest in complementary therapies it is necessary to ensure that these therapies are practiced safely, she said. Similar calls have come from the British Medical Association and in the House of Lords report, which recommended that "Only those CAM therapies which are statutorily regulated or have robust mechanisms of voluntary self-regulation should be available through public funding." But acceptable regulations have to be based on evidence, and this means adequate research. In Britain, unlike the United States, there is no specific public funding of CAM research.
The 1999 Health Act, which put in place a mechanism for monitoring and improving the quality of health care, heightened this need for adequate research in CAM and presented two major challenges to complementary medicine, said Kohn. First, through the National Institute for Clinical Excellence, there is an emphasis on efficacy. The institute provides "best practice" guidance and sets quality standards throughout the National Health Service. Second, the act made changes in the way health services resources are spent. Funds are now allocated through primary care groups in conjunction with health authorities. As Kohn warned: "Based on the current evidence, this twin emphasis on finance and efficiency may lead to a reduction in complementary therapy. Provision [of CAM services] in the near future is likely to be determined by prioritization in a budget-conscious system."
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