CAM Providers Research Articles

Using a behavioral model to identify factors associated with choice of provider for neck and low back pain: A systematic review

BackgroundIt remains unclear as to what factors influence a patient's choice to seek care from a specific healthcare provider for low back and neck pain. ObjectiveUtilize Andersen's Behavioral Model of Health Service Utilization as a conceptual framework to identify the predisposing, enabling and need factors associated with choice of healthcare provider for back and/or neck pain. MethodsPubMed, CINAHL, EMBASE, and SCOPUS databases were searched for studies that included 1) patients seeking care for acute or chronic low back or neck pain; 2) patients at least 18 years of age; 3) reported any healthcare provider type chosen to be seen. Significant factors addressing a patient's choice of provider seen for back pain, neck pain, or both were extracted from studies and analyzed under the Behavioral Model of Health Service Utilization. Results20 studies were included in this review: 17 quantitative studies and 3 qualitative studies. Provider types identified were medical physicians, chiropractors, physical therapists, acupuncturists and CAM providers. Age and sex were the most commonly reported predisposing factors; financial and personal factors were the most common enabling factors; patients’ duration of pain and self-reported level of functioning were the most commonly reported need factors. ConclusionsWhile predisposing and need factors are important, enabling factors also have an influence in choice of healthcare provider for back and/or neck pain.

Comparison of Dietary Supplements Use Between Receivers and Refusers of Adjuvant Breast Cancer Treatments

Purpose: The goal of this study was to compare dietary supplement use between women who received all recommended conventional breast cancer treatments (Receivers) with those who did not (Refusers). We sought to understand commonly used supplements, use frequency, and prescribers. Methods: A secondary analysis was conducted using baseline data of Breast Cancer Integrative Oncology Study, which recruited 369 women with breast cancer from integrative oncology clinics and Cancer Surveillance System registry in Western Washington State. Self-reported data and registry data were analyzed using descriptive statistics, t-tests, and X2 tests to compare Receivers and Refusers in their demographic and disease characteristics and supplement use. Results: Refusers used more supplements than Receivers did after diagnosis, 5.43 ± 5.29 vs. 2.66 2.88, F = 26.32, p < 0.001. Refusers used more fish oil and garlic before diagnosis, and more green tea, vitamin C, melatonin, coenzyme Q10, turmeric, and garlic after the diagnosis than Receivers. Most Receivers and Refusers took supplements 5 or more days per week. Most of the supplements were self-prescribed except vitamin D and Melatonin, which were prescribed by medical doctors or CAM providers. Conclusions: Receivers and Refusers generally used the same top ten supplements, often antioxidants, although the frequency of use differed slightly, and Refusers took more supplements. Receivers, who are undergoing chemotherapy or radiotherapy need to know that taking antioxidants may influence treatment effectiveness. Refusers need to be informed that there is no strong evidence that the use of dietary supplements reduces recurrence or mortality.

The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey

BackgroundHeadache management is common within chiropractic clinical settings; however, little is yet known about how this provider group manage headache sufferers. The aim of this study is to report on the prevalence of headache patients found within routine chiropractic practice and to assess how chiropractors approach key aspects of headache management applicable to primary care settings.MethodsA 31-item cross-sectional survey was distributed to a national sample of chiropractors (n = 1050) to report on practitioner approach to headache diagnosis, interdisciplinary collaboration, treatment and outcome assessment of headache patients who present with recurrent headache disorders.ResultsThe survey attracted a response rate of 36% (n = 381). One in five new patients present to chiropractors with a chief complaint of headache. The majority of chiropractors provide headache diagnosis for common primary (84.6%) and secondary (90.4%) headaches using formal headache classification criteria. Interdisciplinary referral for headache management was most often with CAM providers followed by GPs. Advice on headache triggers, stress management, spinal manipulation, soft tissue therapies and prescriptive neck exercises were the most common therapeutic approaches to headache management.ConclusionHeadache patients make up a substantial proportion of chiropractic caseload. The majority of chiropractors managing headache engage in headache diagnosis and interdisciplinary patient management. More research information is needed to understand the headache types and level of headache chronicity and disability common to chiropractic patient populations to further assess the healthcare needs of this patient population.

Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system

ABSTRACTComplementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.

The use of CAM providers and psychiatric outpatient services in people with anxiety/depression: a cross-sectional survey.

BackgroundDepression has been identified as one of the most frequent predictors of CAM use. However, limited data exist about the use of CAM providers among people with anxiety/depression in Norway. The aim of this study was to investigate the use of CAM providers, and the use of CAM providers and psychiatric outpatient services in combination, among people with self-reported anxiety and/or depression.MethodsWe used questionnaire data from 12,982 participants (30–87 years) in the cross-sectional sixth Tromsø Study (conducted in 2007-8). Eligible for analyses in our study were 1685 participants who reported suffering from anxiety and/or depression. By descriptive statistical methods, we estimated the use of CAM providers, psychiatric outpatient services, and the combination of these. By logistic regressions we studied the association between the use of these services and gender, age, income, education, and self-reported degree of anxiety/depression.ResultsDuring the previous year, 17.8 % of people with anxiety/depression visited a CAM provider once or more, 11.8 % visited psychiatric outpatient services, and 2.5 % visited both. Men with anxiety/depression were less likely to visit CAM providers compared to women (odds ratio [OR] 0.40, confidence interval [CI] 0.30–0.55), whereas higher educated people were more likely to visit compared to the lowest educated (OR 1.47, CI 1.02–2.13). The use of CAM providers was not associated with the degree of anxiety/depression. For those who used both CAM providers and psychiatric specialist services during the previous year, severe anxiety/depression was strongly associated with use compared to moderate disease (OR 7.53, CI 2.75–20.65).ConclusionsPeople with severe anxiety/depression seem to use CAM providers and psychiatric services additionally, whereas those with moderate disease seem to use these services more as alternative pathways. CAM provider treatment might be a substitute for conventional care, particularly in patients with moderate disease.

Alternative, Complementary or Orthodox: What is real medicine?

The division between orthodox and CAM approaches to musculoskeletal (MSK) problems is blurred. Manipulative medicine and acupuncture are recognized treatment options for some MSK conditions. These therapies are increasingly evidence based with well-defined mechanisms and are provided by a number of registered professional practitioners, whose ethics and practice is overseen and ultimately regulated, by the Professional Standards Authority. Some practitioners may be considered historically as CAM providers (Osteopaths, Chiropractors and Acupuncturists) and some orthodox practitioners (Physiotherapists and Doctors). If both CAM and orthodox practitioners are providing the same therapies for the same conditions, we believe that this represents good evidence based medical practice. Consequently in this situation, the historical and artificial boundaries between CAM and orthodox medicine cease to be meaningful either clinically or ethically. We should reasonably assume that CAM and orthodox practitioners, in this context, are practicing ethically.

Should acupuncture play a greater role in healthcare?

s / European Journal of Integrative Medicine 7 (2015) 432–438 437 back pain. Available evidence may not facilitate guideline development for integration into best clinical practice. Practitioner perception of the evidence base is equally important. TCM practitioners in the EU and China vary in their perceived need for research evidence, and the evidence gaps. The complexity and plurality of traditional Chinese medicine theory and practice, informed by comparative effectiveness studies, personalized medicine and TCM pattern differentiation should be incorporated into future research if it is to be effectively integrated into health care provision. Steps are needed to promote the development and implementation of academic training and research programs that support progress in this direction. It is vitally important that competent professionals, both clinically skilled and trained in research are involved in the development of the evidence base to ensure that it is appropriate and ongoing. Otherwise studies will be designed and conducted by researchers who do not understand traditional systems of medicine or by practitioners who do not fully understand research practices. If this persists, good quality effectiveness data will continue to be lacking and compromise integration into any healthcare system. With advances in biomedical, chemical and computational technology, plenty of opportunities exist to provide multidisciplinary approaches to investigate evidence-based aspects of TCM practice. An integrative approach is crucial to connect the multiplicity of expertise, scientific innovation and investigations. http://dx.doi.org/10.1016/j.eujim.2015.07.039 Acupuncture as part of the health care system: Some key facts from European and a national point of view Wolfgang Weidenhammer 1,∗, Dieter Melchart 1,2 1 Competence Centre for Complementary Medicine and Naturopathy, Klinikum rechts der Isar, Technische Universitat Munchen, Munich, Germany 2 Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland E-mail address:wolfgang.weidenhammer@lrz.tu-muenchen.de (W. Weidenhammer). The presentation will follow two approaches to give some insight into the situation of medical acupuncture as applied by doctors in Europe and specifically in Germany. The current status as well as the development over the previous years will be demonstrated. Between 2001 and 2006, three groups of German statutory sickness organizations funded three large reimbursement and research programs on acupuncture. One of them was conceptualized and conducted by the Competence Centre for Complementary Medicine and Naturopathy at TU Munich. Apart from the well-known controlled trials to investigate the specific effects of acupuncture the program also includes a description of routine care and therapeutic safety. Between June 2001 and November 2005, approximately one million patients insured by the participating sickness funds received acupuncture with systematic documentation. Data of about 450,000 patients were analyzed complemented by a more detailed longitudinal dataset from a subsample of about 5000 patients. Moreover, a survey on the participating acupuncturists enabled the analysis of relations between indicators of therapist’s qualification and the outcome of the treatment. As a result of the acupuncture research programs the German health authorities decided in 2006 to restrict the reimbursement by social health insurance funds to low back pain and osteoarthritis of the knee. Additionally, the conditions for certified physicians changed. The consequences of these decisions for the routine medical care with acupuncture were far-reaching. Although not focused on any specific CAM modality, the EU-funded project CAMbrella (2010–2012) could reveal some key points for acupuncture. In Europe, acupuncture is mostly regulated as a treatment that may or may not be provided by regulated health professionals or other CAM practitioners. 25 countries have acupuncture treatment regulations while 12 have no specific acupuncture regulations. A systematic analysis of the provision of CAM in Europe showed that approx. 305,000 registered CAM providers (47% are medical practitioners) can be identified in the EU. Acupuncture is reported as the most available therapeutic method for both, medical (80,000) and nonmedical providers (16,380). Beyond acupuncture, the presentation will end with a brief detour on research in CAM in Europe, with the focus on research promotion by the European Commission. Possibilities for the field of CAM and issues will be demonstrated, exemplified by the Horizon 2020 program. http://dx.doi.org/10.1016/j.eujim.2015.07.040 The cost-effectiveness of acupuncture

Interface, interaction and integration: how people with chronic disease in Australia manage CAM and conventional medical services.

To understand the extent to which conventional and complementary health care are integrated for CAM users with chronic conditions. In-depth interviews and a self-administered questionnaire were used to collect data on care-seeking, self-management and CAM use among people with type 2 diabetes and/or cardiovascular disease living in Victoria, Australia. Many participants reported regular, frequent and long-term use of CAM therapies to maintain their health or assist in the management of their chronic condition. They generally managed the interface between convention and complementary health care on their own, as the perceived or expressed negative attitudes of some doctors, or the belief that the doctor did not need to know, were barriers to the disclosure of CAM use. For a smaller group, there was interaction between conventional and CAM providers, which limited the extent of uncertainty and conflicting information being (mis)interpreted by consumers. Greater interaction between CAM and medical providers would be beneficial to consumers. Structural barriers, related to financing and service organization, need to be addressed. Attitudinal shifts of some health-care practitioners also need to be addressed, in the context of workforce development.

Pressure to Perform: CAM Providers' Perceptions of Pressure to Demonstrate CAM Effectiveness

Pressure to Perform: CAM Providers' Perceptions of Pressure to Demonstrate CAM Effectiveness

Complementary Alternative Medicine Use Among Female Oncology Patient: Literature Review

The importance to know about uses of complementary and alternative medicine has been increased, especially among oncology patients because of the growing community interest in natural or holistic therapies. Although there is no clear information about improved survival among the use of CAM. From the 18 articles analyzed, it could be concluded that goals of CAM use in women with cancer are therapeutic and psychological: i.e. to reduce symptoms, to show greater control over their life and express hopefulness over there disease and life. Furthermore, its use plays an important role in the identity construction of cancer patients, helping them to make decisions related to conventional treatment. Among the many findings of the review, biologically based practices were noted as the types of CAM most used by women with cancer, followed by mind-body medicine, whole medical systems, and energy medicine. Sources of information about CAM use for women with cancer vary widely, including family, friends, media, healthcare providers, CAM providers, and self-help groups. Sociodemographic factors that appear to be related to CAM use were younger age, higher education, higher income, married status, involvement in a support group, and health insurance. Oncology nurses should learn more about CAM use among women with cancer. Open communication about CAM use helps ensure that safe and holistic care is provided. Additional research in this particular area is needed.

A Community of Healing: Psychosocial Functions of Integrative Medicine Perceived by Oncology Patients/Survivors, Healthcare Professionals, and CAM Providers

ObjectiveA whole systems research approach was used to explore the psychosocial functions attributed to an Integrative Medicine oncology program. Field research was conducted at a cancer clinic to answer the following questions: (1) what meanings do the participants attribute to the Integrative Medicine oncology program; (2) what contributes to sustaining the Integrative Medicine program; and (3) what role does the Integrative Medicine program play in the lives of the participants. MethodsParticipant observation and in-depth interviews were conducted at a community-based cancer clinic that offers various complementary modalities along with conventional cancer treatments. ParticipantsThe data were obtained from a total of 23 participants including cancer patients/survivors, caregivers, volunteers who provided the complementary therapies, and healthcare professionals at the clinic. ResultsResults indicated that the Integrative Medicine program had three major psychosocial functions for those involved. Participants viewed the Integrative Medicine program as a place (1) to exchange health/medical information and learn from others' experiences and expertise, (2) to give and receive emotional support, and (3) for the individual to act on his/her transformed new identity and new life goals through serving others. ConclusionsThe results illustrate the positive psychosocial impacts an Integrative Medicine program may bring to individuals involved in it and suggest the value of using a whole systems research (WSR) approach to Integrative Medicine research.

30B. An Integrative Systems-biology Approach to Autoimmune Disease: Leaving the Era of Reaction and Entering the New Proactive Era of Prediction

Focus Area: Integrative Approaches to CareAutoimmune disease is growing at epidemic proportions, and standard interventions are based on symptom control and immune suppression. This presentation with review a proactive integrative systems biology approach to disease prediction, prevention, and treatment, including various evidence-based modalities. Presentation elements will include an exploration of the role of the GI microbiota, food immune reactions, stealth infections and molecular mimicry in autoimmune disease pathogenesis and how these may serve as leverage points for clinical interventions. The hygiene hypothesis and changes in early environmental antigen exposue also will be explored. New opportunities for proactive screening for at-risk subjects for autoimmune disorders such as rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel diseases, diabetes, multiple sclerosis, lupus, and others using emerging predictive antibody testing also will be reviewed and discussed. Integration of CAM providers with rheumatologists and other primary specialist also will be addressed.

Working at the coalface: Using action research to study ‘integrative medicine’ in the NHS

Aim of the studyThis research considered the clinical and organisational issues for integrative medicine from the multiple viewpoints of its primary stakeholders: GPs, Clinics, Patients and the CAM therapist, studying the interface between complementary and orthodox practitioners working together. MethodologyTwo National Health Service (NHS) primary care clinics were recruited and remedial massage therapy was made available to patients referred by their GPs. Action research methods then provided opportunities to study the working relationships through reflexive, inter-professional problem solving in clinic situations. Data collection included questionnaires, recorded interviews and meetings, case notes, field notes, reflexive journals, pictures, emails and letters. ResultsThe reflexive cycles of action research identified practical problems and collaborative solutions within the clinic. Data highlighted aspects of IM relationships, for example clinical decision-making, organisational effects, inter-professional dynamics, and patient input. Whilst outcomes included improved patient satisfaction and enhanced GP-patient relationships, cycles of learning also suggested overarching barriers, particularly noting the mainly unstructured, ‘ad hoc’ relationships between CAM and orthodox professionals, and the lack of opportunities for meaningful inter-professional dialogue. Discussion and conclusionsThis research contributes an experiential perspective to the field of integrative medicine through action research, a collaborative and participative approach to investigate the complexities of best practice. Data indicate that CAM providers need to upgrade their dialogue with NHS practitioners and policy-makers and to negotiate structures that support IM within the NHS. Without the underpinning of more ‘structure’ and ‘dialogue’, working models of IM can be unstable and lacking in accountability.

Back pain amongst mid-age Australian women: A longitudinal analysis of provider use and self-prescribed treatments

To analyse use of conventional and complementary and alternative (CAM) practitioners and self-prescribed CAM amongst mid-age Australian women with back pain. Self-completion postal surveys completed in 2004 and 2007, of the mid-age cohort of the Australian Longitudinal Study on Women's health. Questions asked for written responses about the use of conventional practitioners, CAM practitioners and self-prescribed CAM for treatment of back pain. Analysis of cross-sectional and longitudinal survey data (n=9820), conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH), which was designed to investigate multiple factors affecting the health and well being of women over a 20-year period. Women were asked if they had sought help for back pain in the previous twelve months. The prevalence of back pain was 54.8% (n=5383). The percentage of women who sought help for their back pain was 17.3% (n=1700). Of the women who sought help for back pain, 2% consulted with a CAM practitioner only, 35% consulted a conventional practitioner only and 63% with both a conventional and CAM practitioner. Back pain is prevalent amongst mid-age Australian women, although only one third sought help. Women who sought help for their back pack were high users of CAM (practitioners and self-prescribed) and conventional care providers, consulting a CAM practitioner in complement with conventional biomedical consultations rather than as an alternative. Further research is needed to explore the complex contemporary landscapes of back pain negotiation and management.

OA16.01. Patients, physicians, and CAM providers regard communication as central for integrating conventional and CAM therapies for chronic pain

Methods Primary care providers (PCPs) were recruited, stratified on their rates of patient referral to CAM therapies. Acupuncturists and chiropractors were recruited from among those who treated MCO patients, stratified on numbers of MCO patients seen. Patients were recruited from among 11,960 respondents to a questionnaire on use of acupuncture and chiropractic for chronic pain, stratified on patterns of acupuncture and chiropractic use. Providers (CAM and conventional) participated in individual qualitative interviews. Patients participated in focus groups and individual interviews following similar structured guides. Audio from interviews and focus groups were transcribed, and coded. This poster addresses communication and interaction among PCPs, CAM providers, and patients.

Notkun óhefðbundinnar heilbrigðisþjónustu á Íslandi

Westerners increasingly use complimentary and alternative (CAM) methods for curing illness and promoting health. The central ideas of CAM appear to resonate with large segments of the general public. Little is known about CAM use in Iceland. The purpose of the study was to assess the scope of utilization of CAM providers and the likely explanatory factors.The data come from a national postal health survey that took place during the Fall of 2006. A sample of Icelandic adults, age 18-75, was randomly drawn from the National Register. 1532 individuals responded to the survey yielding a 60% response rate.Almost 32% of the respondents had used a CAM provider in the past 12 months, an estimated increase of 6% since 1998. Women and high income individuals were more likely to use a CAM provider than men and lower income individuals. Physical and mental distress was also related to the likelihood of CAM use. Individuals having negative or positive attitude toward physician services were more likely to use a CAM provider than those expressing a neutral attitude. Finally, repeated physician visits were related to an increased likelihood of CAM use.Icelanders use CAM providers to a considerable degree, and CAM use has increased in recent years. It appears that some clients regard the care they receive in the general health system as insufficient. Most CAM users appear to use CAM treatments as a supplement to the care received in the general health system.

Medical Skepticism and the Use of Complementary and Alternative Health Care Providers by Patients Followed by Rheumatologists

Our understanding of the determinants of use of complementary and alternative (CAM) providers is limited, especially in regard to medical skepticism (ie, doubt in the ability of conventional medical care to appreciably alter health status). To determine whether medical skepticism was associated with CAM provider use in patients with arthritis and to explore the association between medical skepticism and demographic and health-related characteristics of persons with arthritis. A cross-sectional analysis of data from patients (N = 721) with osteoarthritis, rheumatoid arthritis, or fibromyalgia who completed a questionnaire about their health, health care use, and health-related attitudes/behaviors, including medical skepticism. Patients were recruited from 14 rheumatology practices in North Carolina. A multiple logistic regression analysis was conducted to examine the relationship between medical skepticism and the use of any CAM providers. Multiple linear regression analysis was conducted to examine relationships between medical skepticism and demographic and health-related measures. Fifteen percent of the sample used one or more CAM providers. Medical skepticism was positively associated with CAM provider use. A one point increase in skepticism increased the probability of CAM provider use by approximately 70% (odds ratios =1.70; 95% confidence intervals [1.13-2.56]). Individuals, who were younger, had better perceived health, and had a diagnosis of osteoarthritis or fibromyalgia had greater skepticism. By knowing more about medical skepticism and other determinants of CAM provider use, conventional practitioners can target patients to improve their uptake of appropriate conventional care, while also monitoring patients alternative therapy use.

Communication between CAM and mainstream medicine: Delphi panel perspectives

Healthcare practitioners' models of health affect their patient interactions and services. We surveyed mainstream (MM), integrative (IM) and CAM providers to investigate their models of health. This study generated ideas for actions to improve MM/CAM communication based on survey findings. Through the Delphi technique, a panel of 14 MM, IM and CAM experts participated in two rounds of questioning regarding survey findings. MM panel members were less supportive of almost all suggestions for actions than IM and CAM members. Suggestions most likely to be implemented were enabling the patient to take an active role in care, establishing understanding between patient and practitioner of treatment and its goals, fostering patients' taking responsibility for their health and communicating about patient assessment in ways understandable to others. Actions to foster better MM/CAM communication promote focus by a team of providers on the patient's goals, functioning and involvement in their care.

Issues in credentialing CAM providers

Issues in credentialing CAM providers

Ethics and Complementary and Alternative Medicine

Letters3 June 2003Ethics and Complementary and Alternative MedicineKaren E. Adams, MDKaren E. Adams, MDOregon Health and Science University; Portland, OR 97201Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-11-200306030-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Professor Ernst raises an important question: How can we improve communication with CAM providers to promote our patients' understanding of their situation and options? Clearly, in the case of Ms. P., surgery would be life-saving, and ideally her CAM providers as well as her allopathic providers would encourage that choice. But as Professor Ernst notes, CAM providers are not always open to allopathic treatments or to partnering with allopathic providers, just as allopaths can be resistant to collaboration with CAM providers.A truly integrative health care system would encourage such collaboration to the benefit of all concerned, and ... Author, Article, and Disclosure InformationAuthors: Karen E. Adams, MDAffiliations: Oregon Health and Science University; Portland, OR 97201 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEthical Considerations of Complementary and Alternative Medical Therapies in Conventional Medical Settings Karen E. Adams , Michael H. Cohen , David Eisenberg , and Albert R. Jonsen Ethics and Complementary and Alternative Medicine Edzard Ernst Metrics Cited byEthical and legal issues at the interface of complementary and conventional medicine 3 June 2003Volume 138, Issue 11Page: 940KeywordsComplementary and alternative medicineHealth careHealth care providersSurgery ePublished: 3 June 2003 Issue Published: 3 June 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...