Integration Of Complementary And Alternative Medicine Research Articles

Musical Healing in Eastern Tajikistan: Transforming Stress and Depression through Falak Performance

Musical Healing in Eastern Tajikistan:Transforming Stress and Depression through Falak Performance Benjamin D. Koen (bio) The present article falls within the burgeoning area of medical ethnomusicology, which has emerged over the last several years as a bona fide specialty within the realm of ethnomusicological studies. The field has increasingly attracted the attention of researchers, scholars, and practitioners across diverse disciplines in biomedicine, the social and health sciences, physics, ICAM (integrative, complementary, and alternative medicine), medical anthropology, religious studies, and of course, music and the humanities.1 Additionally, this article emerges from a long-term research program within the understudied region of Badakhshan, Tajikistan, where certain genres of music, prayer, and related practices that are central expressions of cultural identity and religious belief function in individual and complementary ways to promote health or facilitate healing. Among the multiple applications of specialized music that fall under the broad, local categories of musiqiye shafâi (healing music) or musiqiye darmâni (music medicine, remedy, healing) is the role of music to assuage one's pain or even cure a person afflicted with the ills of stress or depression. A vast body of research across disciplines in the humanities, social, and health sciences shows that stress and depression are pervasive throughout the world, pose major health risks, and can cause the development of numerous conditions and diseases.2 After more than a generation of Soviet control and oppression, a subsequent devastating civil war, and a decade of slow struggle to begin the process of rebuilding, Tajikistan is no exception to the ills of psychological distress and depression. One of the most important musical responses to stress and depression in Badakhshan is the performance of falak. Initial Thoughts on Falak Broadly, falak (lit. "heaven," "universe," "fortune") is a musical-poetic genre of lament that is intimately linked to local religious beliefs and the related genre [End Page 58] of maddâh (lit. "praise"), which is the foremost religious music among the Isma'ilis of Badakhshan.3 It should be mentioned at the outset of this article that there are many types of falak, which are performed in a host of different contexts and serve many different functions in Badakhshani culture, only one of which is to promote health and facilitate healing by modulating stress and depression. For instance, as a remnant of the politically constructed folkloric ensembles that were used as propaganda during the Soviet era, today, falak can be found performed on stage as entertainment or at formal and informal social gatherings, parties, and celebrations. As a particular kind of musiqiye khalqi (folk music, music of the people), as opposed to musiqiye asil (classical music) or musiqiye dini (religious music), which have specific, sometimes strict rules that govern performance, falak is much more flexible in its rules and requirements for performance. Hence, one might find falak being performed in vastly different situations, with varying degrees of seriousness, in both secular and religious contexts. This article focuses on one type of falak that is approached as a spiritual practice by certain performers who carry the title falakkhân (here khân means "singer" or "reciter"), which most often refers to male performers, but is also a general term for any performer; or falakzan (zan means woman), which is an equivalent title that specifically refers to women performers. The title falakkhân or falakzan usually indicates that a performer has a high level of expertise and fills a social role in the community by performing falak on certain occasions. There are also many performers who do not have these formal titles but who also perform falak as a regular practice of prayer. The falak participants (singers, instrumentalists, and listeners) with whom I worked describe the type of falak that is the focus of this article as being centrally spiritual in nature, and functioning in ways that can promote health and healing by lessening or eliminating stress and depression. Some Concerns of Medical Ethnomusicology By building upon local views and interpretations of falak, an equally important concern of this article is to explore principles and processes that underlie this culture-specific genre, which can contribute to the broader discourse in medical ethnomusicology and provide insight to...

Negotiating the Holistic Turn – the Domestication of Alternative Medicine

Negotiating the Holistic Turn – the Domestication of Alternative Medicine

Developing CAM Research Capacity for Complementary Medicine.

This article describes initiatives that have been central to the development of complementary and alternative medicine (CAM) research capacity in the United Kingdom, Canada and the United States over the last decade. While education and service delivery are essential parts of the development of CAM, this article will focus solely on the development of research strategy. The development of CAM research has been championed by both patients and politicians, primarily so that we may better understand the popularity and apparent effectiveness of these therapies and support integration of safe and effective CAM in health care. We hope that the perspective provided by this article will inform future research policy.

A review of the use of CAM therapy and the sources of accurate and reliable information.

To describe how pharmacists can answer the call by the Institute of Medicine (IOM) of the National Academies to become more involved in evaluating complementary and alternative medicine (CAM) and to suggest resources pharmacists can access to be better prepared to advise their patients about these therapies. Information published by the IOM in January 2005 clearly indicates that the American public considers CAM therapies increasingly to be .conventional. lifestyle choices rather than .alternative. practices. Some managed care organizations (MCOs) have offered CAM services for at least 8 years, and one of the nation.s largest MCOs created a network of CAM providers in 2003 with a 30% discount on provider fees. Pharmacists report an increase in questions regarding the use of herbal products and dietary supplements. As experts in drug-drug interactions, there is the expectation that pharmacists are a source of information for drug-herb interactions. Yet some surveys show pharmacists are uncomfortable answering questions about these products because, although there is an increase in the integration of CAM and conventional medicine, there are few scientific studies available to guide the clinical decisions that are necessary. The Office of Dietary Supplements (ODS) and the National Center for Complementary and Alternative Medicine (NCCAM) have increased funding of CAM research. There is a particular need for clinicians to become involved in assessing the safety and efficacy of these products. At least one health plan has created, through its pharmacy and therapeutics committee, a scientifically based, pocket-sized CAM guide that clinicians rated as somewhat to very helpful as a counseling aid. With the increasing volume of information on CAM aimed at consumers by the press, television, Internet, and other media, it is critical for pharmacists to remain current in their knowledge. Pharmacists should know what the IOM is saying about CAM and develop relationships with the CAM providers in their communities. Pharmacists should know what reliable information resources are available and be able to evaluate the literature to help patients and providers interpret what they read and hear. It is important for pharmacists to have access to and be involved in ongoing evaluation of CAM therapies being used by so many people.

Future Direction of Complementary and Alternative Medicine (CAM) Education and Research

To identify key educational and scientific tasks for the incorporation of complementary and alternative medical therapies (CAM) into conventional health care. Journal articles, government and special health report, book chapters, and curriculum guidebooks. Nursing education programs are rapidly adding curricula on the practice and research of CAM therapies. The next priority is to facilitate consistency and quality of educational programs by developing standards of practice and a core curriculum. Educational standards agreed upon by the nursing profession and set at the undergraduate, graduate, and professional levels will help guide the safe and effective integration of CAM into conventional health care. Setting educational standards and developing consistent curricula for CAM will help students emerge from academic programs prepared for safe and effective practice and with skills to evaluate the effectiveness and participate in the research of CAM therapies.

Mainstreaming Complementary Therapies: New Directions In Health Care

Within the past decade, complementary and alternative medicine (CAM) has penetrated mainstream U.S. health care. Major medical journals are publishing research on the efficacy of specific CAM therapies, physicians are attending oversubscribed continuing medical education courses on CAM, and hospitals are offering CAM services, sometimes through outpatient integrative medicine clinics. This paper presents factors behind the growth of CAM, analyzes its relationship with conventional medicine, and suggests how the integration of CAM and conventional medicine can be more effectively guided.

Racing Toward The Integration Of Complementary And Alternative Medicine: A Marathon Or A Sprint?

Health care opinion leaders concur that integration of complementary and alternative medicine (CAM) into the U.S. health care system must be based on strong supporting evidence of safety and efficacy. As others have pointed out, integration is under way, despite the lack of reliable, rigorous science supporting the use of most CAM treatments. We contend that optimal integration of CAM is a long-term endeavor--a marathon rather than a sprint. The evidence base does not now support its wholesale assimilation; market forces, although compelling, should not be the primary consideration in integration.

A Self‐Report Measure of Clinicians' Orientation toward Integrative Medicine

Patients in the U.S. often turn to complementary and alternative medicine (CAM) and may use it concurrently with conventional medicine to treat illness and promote wellness. However, clinicians vary in their openness to the merging of treatment paradigms. Because integration of CAM with conventional medicine can have important implications for health care, we developed a survey instrument to assess clinicians' orientation toward integrative medicine. A convenience sample of 294 acupuncturists, chiropractors, primary care physicians, and physician acupuncturists in academic and community settings in California. We used a qualitative analysis of structured interviews to develop a conceptual model of integrative medicine at the provider level. Based on this conceptual model, we developed a 30-item survey (IM-30) to assess five domains of clinicians' orientation toward integrative medicine: openness, readiness to refer, learning from alternate paradigms, patient-centered care, and safety of integration. Two hundred and two clinicians (69 percent response rate) returned the survey. The internal consistency reliability for the 30-item total scale and the five subscales ranged from 0.71 to 0.90. Item-scale correlations for the five subscales were higher for the hypothesized subscale than other subscales 75 percent or more of the time. Construct validity was supported by the association of the IM-30 total scale score (0-100 possible range, with a higher score indicative of greater orientation toward integrative medicine) with hypothesized constructs: physician acupuncturists scored higher than physicians (71 versus 50, p<.001), dual-trained practitioners scored higher than single-trained practitioners (71 versus 62, p<.001), and practitioners' self-perceived "integrativeness" was significantly correlated (r=0.60, p<.001) with the IM-30 total score. This study provides support for the reliability and validity of the IM-30 as a measure of clinicians' orientation toward integrative medicine. The IM-30 survey, which we estimate as requiring 5 minutes to complete, can be administered to both conventional and CAM clinicians.

CAM in Canada: places, practices, research

This paper reflects on the practice and research of complementary and alternative medicine (CAM) in Canada. Although certain trends in use, as well as the regulation and integration of CAM, are mirrored in many other developed countries, some are highlighted as uniquely Canadian with distinct political and economic geographies. Similarly, although like in other countries the research of CAM is growing rapidly, Canadian scholars have been particularly productive in terms of providing unique disciplinary perspectives and the ways in which they have organized their research training and collaborations. CAM is clearly not a fully integrated and researched option in Canadian health care, yet Canada exhibits the foundations for an integrated CAM practice, supported by a growing, wide-ranging and well-articulated research evidence-base.

Preferred Models of Integrative Care

The opinions of healthcare providers play a crucial role in the debate around integrating complementary and alternative medicine (CAM) into the current healthcare system. The aim of this study is to explore the issue of CAM integration from the provider viewpoint by determining (a) what working relationship CAM practitioners and general practitioners (GPs) prefer or find acceptable, (b) whether there is agreement in the responses of CAM practitioners and GPs and (c) whether expressed opinions differ by CAM modalities. A cross-sectional random sample of CAM practitioners (acupuncturists, chiropractors, massage therapists, naturopaths, homeopaths and herbalists; n = 1112) and GPs (n = 413) from Alberta and British Columbia, Canada, were mailed a questionnaire at three timepoints in 2003. In total, 457 questionnaires were returned from CAM practitioners (41% response rate) and 85 from GPs (21% response rate). Participants were asked to rate four models of integration (independent model, collaborative model, supervised model, assimilation model) for six CAM therapies (acupuncture, chiropractic, massage therapy, naturopathy, homeopathy and herbology). The collaborative model was rated as the most acceptable by all CAM practitioners and GPs, across all therapies. The least acceptable model, for both CAM practitioners and GPs, was the assimilation model. CAM practitioners and GPs disagreed on the acceptability of the independent model and the supervised model, and these differences were statistically significant. A collaborative working relationship is preferred by both CAM practitioners and GPs. An integrative healthcare system would need to faciliate such working relations.

The Role of Optimal Healing Environments in Patients Undergoing Cancer Treatment: Clinical Research Protocol Guidelines

Integrative cancer care (ICC) is the treatment of patients with cancer, under physician supervision, with appropriate conventional treatments in a healing context based on insights from research on nutrition, biochemistry, exercise, and psycho-oncology. It uses validated techniques and practitioners of complementary and alternative medicine (CAM), and strategies for enhancing treatment and side-effect management such as chronomodulated chemotherapy, therapies to reduce treatment resistance, and innovative assessments for individualizing treatment plans. The elements of ICC align well with the concepts of optimal healing environments (OHE). Expectations of well-being are fostered; transformative self-care practices are common therapeutic tools; development of healing presence among staff and therapeutic alliances with patients are emphasized; instruction in health-promoting behavior is standard; and collaborative integration of CAM in the practice is typical. Based on the authors' clinical experience, an O...

The Role of Optimal Healing Environments in Patients Undergoing Cancer Treatment: Clinical Research Protocol Guidelines

Integrative cancer care (ICC) is the treatment of patients with cancer, under physician supervision, with appropriate conventional treatments in a healing context based on insights from research on nutrition, biochemistry, exercise, and psycho-oncology. It uses validated techniques and practitioners of complementary and alternative medicine (CAM), and strategies for enhancing treatment and side-effect management such as chronomodulated chemotherapy, therapies to reduce treatment resistance, and innovative assessments for individualizing treatment plans. The elements of ICC align well with the concepts of optimal healing environments (OHE). Expectations of well-being are fostered; transformative self-care practices are common therapeutic tools; development of healing presence among staff and therapeutic alliances with patients are emphasized; instruction in health-promoting behavior is standard; and collaborative integration of CAM in the practice is typical. Based on the authors' clinical experience, an OHE for patients with cancer is described and suggestions for meaningful research are identified.

Providing Complementary and Alternative Medicine in primary care: the primary care workers’ perspective

Background: The use of Complementary and Alternative Medicine (CAM) in primary care is growing, but still not widespread. Little is known about how CAM can/should be integrated into mainstream care. Objectives: To assess primary care health professionals’ perceptions of need and of some ways to integrate CAM in primary care. Method: Questionnaire survey of primary health care workers in Northwest London. General Practitioners (GPs) were targeted in a postal survey, other members of the primary care team, such as district and practice nurses, were targeted via colleagues. The questionnaire assessed health care professionals’ perspective on complementary medicine, referrals, ways to integrate complementary medicine into primary care and interest in research on CAM. Results: Responses were obtained from 149 GPs (40% response rate after one reminder) and 24 nurses and 32 other primary care team members. One hundred and seventy-one (83%) respondents had previously referred (or influenced referral) for CAM treatments, the main reasons cited were: patients request (68%), conventional treatments failed (58%) and evidence (36%) (more than one reason could be given). Acupuncture and homoeopathy were the therapies for which patients were most frequently referred, followed by manual therapies. There was a significant interest in more training/information on CAM (66%). Only 12 respondents (6%) were against any integration of CAM in mainstream primary care. Most respondents felt that CAM therapies should be provided by doctors (66%) or other health professionals trained in CAM (82%). Twenty-six percent of respondents agreed with provision of CAM by non-state-registered practitioners. It was felt that the integration of CAM could lead to cost savings (70%), particularly in conditions involving pain, but also cost increases (55%) particularly in ‘poorly defined conditions’. Fifty-six percent of respondents would consider participating in studies investigating CAM. The greatest interest was in acupuncture (41% of those who expressed an interest in research), homoeopathy (30%) and therapeutic massage/aromatherapy (26%). Conclusions: There is considerable interest in CAM among primary care professionals, and many are already referring or suggesting referral. Such referrals are driven mainly by patient demand and by dissatisfaction with the results of conventional medicine. Most of our respondents were in favour of integrating at least some types of CAM in mainstream primary care. There is an urgent need to further educate/inform primary care health professionals about CAM.

The prevalence, patterns of usage and people's attitude towards complementary and alternative medicine (CAM) among the Indian community in Chatsworth, South Africa.

BackgroundThe purpose of this study was to determine, among the Indian community of Chatsworth, South Africa, the prevalence and utilisation patterns of complementary and alternative medicine (CAM), attitudes associated with CAM use and communication patterns of CAM users with their primary care doctors.MethodsFace-to-face structured interviews were conducted in Chatsworth, a suburb of Durban in which South Africans of Indian origin predominantly reside. Participants were 200 randomly selected adult English-speaking Indian residents.ResultsThe prevalence of CAM usage for period 2000/2001 was 38.5% (95% confidence interval 31.7% to 45.6%). Spiritual healing and herbal/natural medicines, including vitamins were the most common types of CAM used, accounting for 42.8% and 48.1% respectively of overall CAM usage. People used CAM to treat conditions including diabetes mellitus, headaches, arthritis and joint pains, stress, skin disorders, backaches, hypertension and nasal disorders. Half of the CAM users used allopathic medicines concurrently. The cost of CAM utilization over this 1-year period, incurred by 80.5% of users for the duration of therapy for their most troublesome condition was below R500 (approximately US$50). Age, sex, marital status, religion, level of education and income were shown not to influence the use of CAM. Greater than half (51.9%) of CAM users did so either upon the advice of someone they knew, or after noticing a CAM advertisement in the local press. Seventy-nine percent of CAM users indicated that they had positive outcomes with their treatments. Fifty four percent of CAM users (excluding those using spiritual healing only) failed to inform their doctors that they used CAM. The main reason given by half of this group was that informing their doctors did not seem necessary.ConclusionThe prevalence of CAM in Chatsworth is similar to findings in other parts of the world. Although CAM was used to treat many different ailments, this practice could not be attributed to any particular demographic profile. The majority of CAM users were satisfied with the effects of CAM. Findings support a need for greater integration of allopathic medicine and CAM, as well as improved communication between patients and caregivers regarding CAM usage.

Assessing local market and organizational readiness for the integration of complementary and alternative medicine into ambulatory care centers.

Complementary and alternative medicine (CAM) is one of the fastest growing segments of the health care industry today, with studies suggesting that between 30% and 50% of the adult population in the United States uses some form of CAM. Many ambulatory care centers are considering integrating CAM into their clinical services. This article will review some of the national trends and present a framework for assessing local market demand for CAM in order to help prioritize an organization's CAM integration strategy.

On the integration of complementary and conventional medicine within health maintenance organizations.

The integration of complementary and alternative medicine (CAM) with conventional medicine continues across practice settings and modalities. Managed care is of particular interest to practitioners, policy makers, and researchers concerned with the evolution of CAM integration. Within health maintenance organizations (HMOs), availability, coverage, and support of CAM are variable. We present an organizational model within which we identify factors that influence the degree of CAM integration within HMOs. We describe avenues through which CAM is currently available within the Northwest Region of Kaiser Permanente (KPNW). We also describe research methods applicable to the study of CAM integration within HMOs.

Complementary and alternative medicine in mainstream public health: a role for research in fostering integration.

In light of the increased utilization of complementary and alternative medicine (CAM) in recent years, there is an increased possibility that CAM approaches could prove to be important factors in public health, particularly if used within an integrative framework together with mainstream medicine. There exists a defined need for research to explore the integration of conventional health care and CAM approaches, as well as define mechanisms of CAM-based therapies to facilitate such integration. Essential to these goals is the accumulation of a database derived from outcomes-based clinical and basic science investigations. We posit that that CAM clinicians need to be more thoroughly trained as researchers, skilled in developing and recording results of pragmatic studies that could provide credible evidence for the use of CAM in the public sector health care. It is proposed that this may be best achieved through a three-tiered system in which (1) clinician-scientists of both mainstream and alternative disciplines recognize the value of research designed to foster such integration; (2) educational and health care institutions must develop academic and clinical training programs that examine and delineate each disciplines' respective strengths and weaknesses; and (3) such programs are attractive to, and receive continued extramural subsidy. In the broadest sense, such a paradigmatic approach to CAM integration could create a common basis for scientific dialogue, encourage exchanges between medical communities, and establish policies for the development of a true multidisciplinary health care cooperative that is consistent with the current public health model.

The positive gains of integration: a qualitative study of GPs' perceptions of their complementary practice

An increasing number of general practitioners (GPs) are personally practising complementary and alternative medicine (CAM) to treat their NHS patients. While research on CAM is beginning to emerge we still know very little about CAM practice in primary care. Researchers have largely concentrated upon exploring CAM consumption and broad orthodox CAM provision. A small body of work has begun to examine CAM practice from the GP therapist's perspective and this work has highlighted the constraints and difficulties associated with CAM integration in general practice. Despite such limitations, direct integration continues apace and this raises the question: what clinical and practice benefits are GPs possibly gaining from CAM integration? This is an area that still lacks focused research attention and this paper, exploring the positive gains of integration as perceived by GP therapists, provides a first stage towards filling this research gap. A study, based upon 25 in-depth interviews with GPs practising CAM, was undertaken to explore GP therapists' understandings and experiences of their complementary practice. This paper presents one area of findings produced from the analysis of the GPs' accounts. Analysis reveals that GP therapists identify a number of positive clinical gains associated with their direct integrative practice. These are: filling gaps and successfully treating conditions for which conventional medicine proves ineffective; providing safer techniques in medical cases where the practitioner suspects or anticipates potential side-effects from conventional treatments; and helping maintain job satisfaction and relieve boredom for the practitioner. These findings are discussed within the context of contemporary CAM provision and consumption and recent circumstances affecting general practice. Set within this context, the findings provide an important addition to our current understanding of the increasingly close relationship between CAM and general practice. In conclusion, it is argued that the positive gains experienced by GPs practising CAM should not be ignored by those considering the future provision and practice of CAM within the general practice environment.

State of CAM Education in U.S. Schools of Pharmacy: Results of a National Survey

The purpose of this study was to identify experiences and perception of conventional (Western, allopathic) medical practitioners toward integrative, complementary, and alternative medicine (ICAM).There are approximately 1200 conventional medical doctors in Mangalore, India. In February 2017, semistructured self-administered questionnaires were distributed to 200 medical practitioners. The association between categorical variables was analyzed using a χ2 test and those involving continuous variables using unpaired t test, analysis of variance, and Karl Pearson’s coefficient of correlation. A P value ≤ .05 was considered statistically significant.Of the surveys, 163 were returned and 129 were satisfactorily completed, giving a response rate of 64.5%. Mean age was 39.9 ± 11.9 years, and most 94 (72.9%) were male. A majority, 96 (74.4%), recommended ICAM to their patients. Nine had some training in ICAM modalities, and 76 (58.9%) participants reported personal usage of ICAM. Regarding perception toward effectiveness of ICAM, 33 (25.6%) felt that it was effective or somewhat effective. However, 82 (63.6%) participants felt that lack of sufficient scientific evidence was a major drawback of ICAM. However, 39 (30.2%) participants felt that ICAM should be part of Bachelor of Medicine and Bachelor of Surgery curricula. Favorable perception toward ICAM (P < .001) and personal usage of ICAM (P < .001) was associated with participants recommending any ICAM for their patients. Elderly practitioners (aged above 65 years) (P = .003) and practitioners with favorable perception regarding effectiveness of ICAM (P = .033) recommended a higher number of types of ICAM to their patients. Favorable perception toward effectiveness of ICAM was associated with favorable perception toward inclusion of ICAM in medical curriculum among participants (P = .002).Most participants recommended ICAM to their patients and also reported personal usage of the same.

The Polarized Debate Over Complementary and Alternative Medicine

Debate about the place and scientific of complementary and alternative medicine (CAM) has increased markedly in 2002 following the release of the report of the White House Commission on Alternative and Complementary Medicine Policy. Arguments for and against the integration of CAM into mainstream medicine that have been made are discussed. Positions taken by organizations opposed to CAM are described as are arguments to study the place of CAM further.