CAM versus conventional medicine

Ultimately, medicine that has been proved to be both safe and effective is the kind of medicine that all doctors would like to practise, and indeed all patients would like to receive. This must include not only whether the therapies work, but also the risks and benefits of a particular treatment. For instance, the risk of using acupuncture to help back pain is far smaller than the risk of an operation on the back.

In good-quality integrated medicine, the doctor considers safe, low-risk options first, provided that there is some evidence that they work. For procedures that are more invasive and have greater risk, the evidence for their effectiveness would have to be stronger before they are recommended.

Complementary alternative medicine (CAM) largely involves low-tech and safe treatments, so the medical profession has become increasingly more sympathetic towards it. This is particularly so for chronic conditions or situations in which conventional medicine either carries a high risk or has little to offer.

A DIFFERENT VIEW OF ILLNESS

Many CAM therapies embrace the view that an illness starts off as a sustained imbalance in the patient’s vital energy. They may be suffering from symptoms of irritable bowel syndrome (tummy pain, abdominal distension, flatulence and diarrhoea), possibly because of stress or because their digestive system does not tolerate a particular food.

If these symptoms persist or come on very rapidly, they may be a sign of a more serious illness that may need detailed investigation. In conventional medicine, the GP may not consider the problem to be serious until more symptoms, such as bleeding or weight loss, occur. However, in most complementary medical treatments, this may be less important as the practitioner may be trying to treat the energy imbalance and symptoms first, and thereby return the patient to a sense of well-being.

In general, the CAM practitioner will try to understand the cause of the illness rather than just treat the symptoms. Irritable bowel syndrome may respond to a specific diet or some form of relaxation technique if food intolerance or stress is the main trigger, and this may avoid the long-term use of conventional medical treatments.

The disadvantage of this view of illness is that the CAM practitioner may not be aware of the development of a serious problem, such as cancer, and therefore may not give the best advice. It is therefore vital that you have a proper medical diagnosis before seeking CAM treatment so that as much information as possible is available before treatment starts.

THE VALUE OF MODERN MEDICINE

The advances made in modern medicine over the last 50 years have been of enormous value in both acute (rapid onset) and chronic (long-lasting) illness. Modern management of heart attacks has vastly improved life expectancy, and the use of hip replacements has been of huge benefit for people with arthritis in this joint.

Unfortunately, a few people fail to recognise this and consider that various CAM therapies have the potential to replace conventional medicine in life-threatening conditions. This is a false assumption and one that may lead to inappropriate and unsafe treatment.

AN INDIVIDUALISED APPROACH

Conventional medicine is very firmly based on thinking about how a particular illness, or a particular intervention, may affect patients in general. For instance, you may be told that the chances of success from a particular procedure are 50 or 80 per cent. A particular diagnosis will have several possible treatments, each with their own risks and probabilities of success.

The aim in CAM treatment is to individualise the approach. For example, a patient with a headache consulting a homeopath may be prescribed any one of 30 or 40 remedies, depending on their general constitution and their detailed symptoms. To arrive at a prescription, the homeopath spends time with the patient finding out about the individual’s symptoms in great detail.

This personalised approach is found in many CAM therapies and may contribute to patient satisfaction.

HOLISM?

Holism is the name given to the treatment of the ‘whole person’. Both conventional medicine and CAM try to use a holistic approach.

If you have a persistent headache, your GP will consider whether it is triggered by a small tumour or, far more likely, by stress, sinusitis or difficulties with your neck. By looking at both physical and psychological options, the GP is being holistic – taking into account the whole person and their social and emotional environment.

Most CAM approaches are holistic but some can be very specialist and focused. For example, if you approached a chiropractor with a headache, he or she might manipulate only your neck, which in many ways would be a very specialist and non-holistic approach.

The claim therefore that complementary medicine is the same as holism is not necessarily true but, by and large, the example previously given of the homeo­pathic approach to treating a headache is far more common than the example of chiropractic treatment directed at the neck.

CHRONIC CONDITIONS

Most people seeking help from CAM do so because they have chronic conditions. These condit­ions are often not in themselves life threatening. They are frequently managed conventionally with long-term medication that may result, over a period of years, in some form of adverse reaction, as can happen with drugs used for arthritis.

People with these conditions may be drawn to CAM partly because such treatments generally have a low risk of serious adverse effects. The limited evidence available suggests that the CAM treatments in themselves rarely cure the illness, but may help the patient cope with it more easily and, therefore, may improve his or her quality of life.

Treatments with conventional medicine are often dramatic and immediate – for example, treating acute arthritis with conventional drugs can result in remarkable improvement over a period of a week or two. This almost never occurs in complementary medicine - the effects of a treatment are usually slow to appear. It may take some months before a real and consistent benefit emerges.

You should have a realistic expectation of what CAM may achieve for you. If you have long-term arthritis and take a homeopathic or herbal remedy and after four to six months of treatment there is no obvious benefit, you should consider whether the approach you are using has any value. CAM treatments may take a long time to work, but this should not be an excuse for your practitioner to ask you to visit every month or two for ever!

TIME AND MONEY

In this country, most com­plementary medicine is within the private sector and only a small proportion of it is covered by medical insurance. This means that most people visiting a com­plementary therapist pay for their consultation themselves. They also will usually have more time spent with them than if they saw their GP.

These two factors – payment and length of consultation – may contribute to the success of CAM. It has been suggested that CAM may not have a specific therapeutic benefit but that the environment in which it is practised and the payment involved are really what provides the clinical effect. Researchers describe this as a non­specific, or placebo, effect, which is a general effect not related to treatment. However, the evidence that time and money are significant factors in the effectiveness of complementary medicine is not available, although these suggest­ions are not unreasonable.

AM I TREATED AS AN EQUAL BY THE CAM PRACTITIONER?

Patients who seek CAM feel that the whole consultation process is much more equal and therefore more satisfying than consultation with a GP or consultant. Patients are making the choice about which kinds of therapies they would like to consider for their particular problem and are then discussing these issues with a CAM practitioner.

They feel empowered by choosing CAM whereas their perception of conventional medicine is that they, as the patient, have less input and indeed less control over the treatments prescribed. Most complementary practitioners are prepared to listen to all their patient’s symptoms. This process of listening, understanding and then involving the patient in the decision-making process is what seems to be attractive.

So it is not just whether homeopathy works better than painkillers for headaches. An important part is taking control of your headaches, understanding why they may occur and then receiving a treatment that is based on that understanding.

MODELS OF ILLNESS

The assumptions within CAM seek to develop our own intuitive under­standing of the illness process. For example, we may think a cancer developed because of a particularly stressful divorce or that the shock of the sudden death of someone near and dear caused our migraines. Although this may not be a cause of a particular problem as far as conventional medicine is concern­ed, it is helpful when using some of the assumptions that relate to CAM.

In general, the models of illness and thinking processes within complementary medicine are often far closer to our own intuitive models and processes. This is why we may find them easier to accept, even though they may be scientifically unproven.

HANDS-ON THERAPIES

Many of the CAM therapies, particularly acupuncture, massage, healing and the manipulative therapies, mean that practitioners actually put their hands on their patients. This, in conventional medicine, has often been replaced by a careful history, investigations and the prescription pad.

It is interesting to observe that doctors who have taken up acupuncture frequently find enormous personal satisfaction in doing something manual that relieves their patients’ pain. This creates practitioner satisfaction with the therapy as well as enhancing the doctor’s belief in acupuncture. If the doctor then approaches patients with a technique about which he or she is very enthusiastic, this will inevitably be transmitted to those receiving the treatment and will, in all probability, improve the effects of that treatment.

DO PEOPLE GET WHAT THEY EXPECT FROM CAM?

By and large, people seek out complementary practitioners through a series of informal networks. In practice, this often means asking friends and family, and sometimes their own GP, about a suitable practitioner. Recom­mendations are usually based on someone’s previous experience of effective therapy.
The few surveys that have looked at consumer satisfaction with the treatment they have received have been positive. Most people receiving treatment appear to be very satisfied. This undoubtedly makes people in general view CAM more positively.