Complementary And Alternative Medicine Practitioners Research Articles

Abstract P5-14-05: Use of complementary and alternative medicine in cancer patients receiving chemotherapy in Ireland

Abstract Introduction: The use of complementary and alternative medicine (CAM) in cancer patients has been documented in major cities across USA, Canada, Europe, Nigeria, and Saudi Arabia. These studies suggest that cancer patients on chemotherapy simultaneously use CAMs. In Ireland, there have been two studies in pediatric cancer centers that have documented the use of CAM. To our knowledge, no study has examined the use of CAM in the adult population in Ireland. Method: A cross-sectional survey was conducted at a single adult cancer center over a three-week period. The survey was offered to all oncology and hematology patients attending the medical day unit. Results: The survey was completed by 81 patients, 51 of them were females (63%). The majority (93.8%) of the patients in our sample were in the age range of 41-80. 47 (58%) of the patients reported using CAM concurrently with conventional chemotherapy. The average cost of CAM was under €20 per month, but five patients (6.2%) spent over €100 per month. The major reasons for taking CAM were to enhance quality of life (23.5%), improve psychological/emotional wellbeing (17.3%), improve immunity (16%), relieve side effects of cancer (9.9%), relieve side effects of treatment (8.6%), and to directly treat/cure cancer (2.5%). Patients using CAM reported their source of information as healthcare professionals (30.9%), family/friends (19.8%), media (13.6%), and CAM practitioners (2.5%). Out of 81 patients, only 27 (33.3%) discussed the use of CAM with a healthcare professional involved in their care, of which 18.2% asked regarding interactions with the conventional therapy, 18.2% asked regarding CAM effectiveness and the type to use, 16.7% asked advice whether to pursue it, and 15.2% asked regarding safety of CAM. From the 26 patients using CAM who did not discuss with HCP the reasons cited were that they were never asked by the HCP (25.9%), did not think it was important to discuss with the HCP (13.0%), and 61.1% did not specify their reason. Of the 81 patients, 18 consumed herbal products (13.6% green tea, 8.6% flax seed, 3.7% evening primrose, 2.5% soy supplements), 34 used dietary supplements (28.4% vitamins, 12.3% minerals, 3.7% fish oils), and 21 used other CAMs (8.6% massage, 7.4% meditation/mind-body technique, 7.4% acupuncture, 6.2% reflexology, 2.5% reiki). Conclusion: The use of CAM in adult cancer patients has not been well documented in Ireland. As demonstrated from the pilot study, adult cancer patients in Ireland do seek out CAMs when simultaneously receiving chemotherapy, highlighting the importance for physicians to explicitly ask all patients regarding their intentions of CAM in order to provide safe and evidence-based options. This cancer center appeared to not have patients pursuing ayurvedic or Chinese medicine. However, similar conclusions cannot be made for other urban centers with more diverse population mixes with differing cultural experiences and attitudes to CAM. Citation Format: Karmali S, Markey G, Killian M, Ahmed G, Bird BR, Murphy CG. Use of complementary and alternative medicine in cancer patients receiving chemotherapy in Ireland [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-14-05.

Devices of Difference: On the Socio-Material Forms and Effects of Technologies in Complementary and Alternative Medicine

ABSTRACTDespite the widespread view that complementary and alternative medicine (CAM) is a ‘natural’ and low-tech form of healthcare, by contrast with biomedicine, there are numerous devices used in the field of CAM that employ electricity as a diagnostic and therapeutic agent. These devices bring together different types and sources of knowledge, Western and Eastern theories, and expert and lay hands. They foreground complex psychosomatic, social, and environmental relations in which the patient’s body and well-being are constituted. They are used to address biomedicine’s iatrogenic effects and its indifference to specific bodily processes and entities (such as meridians or parasites). In effect they challenge, extend, and reinterpret biomedicine, thereby becoming one of the mediators between it and CAM. Although these devices are sought out by patients and used effectively by CAM practitioners, their ontological choreography and radius can become precarious in a healthcare system dominated by biomedicine. Different CAM devices then deal with the realities of biomedicine in different ways. While some modes of practising CAM devices are inclusive of biomedicine and carefully experiment with the realities it has inscribed in patients’ bodies, others reject biomedicine altogether.

The development of a survey instrument to measure the barriers to the conduct and application of research in complementary and alternative medicine: a Delphi study

BackgroundAs Complementary and Alternative medicine (CAM) grows in popularity, there is overt recognition for research evidence to inform clinical practice. While various strategies have been trialed to overcome the barriers to such progress, it is important to first understand the extent to which these barriers impact the conduct and application of CAM research. This study aimed to garner consensus and agreement among CAM researchers and practitioners in refining and validating a preliminary survey instrument for measuring these barriers.MethodsA three-round Delphi study was undertaken with 22 international experts of CAM research and practice. Round one gathered consensus on 30 statements listing barriers to the application and conduct of CAM research. Only rounds two and three sought consensus on revised statements. Any statement demonstrating ≥ 70% agreement on a four-point Likert scale was determined to have reached consensus.ResultsConsensus and agreement was achieved for all 30 statements listing the barriers to the application and conduct of research in CAM. Additional commentary by the Delphi participants directed whether a statement had to be split into two parts or reworded. This process resulted in the generation of the “BarrierS To the Application and Conduct of rEsearch” (oBSTACLES) instrument.ConclusionThis study, the first of its kind on this topic, identified consensus and agreement on a series of evidence-informed statements to measure the barriers to the conduct and application of research in CAM. The uniqueness of the oBSTACLES instrument is its ability to measure barriers across the evidence-based continuum.

Complementary medicine use, views, and experiences: a national survey in England.

BackgroundIn 2005,12% of the English population visited a complementary and alternative medicine (CAM) practitioner.AimTo obtain up-to-date general population figures for practitioner-led CAM use in England, and to discover people's views and experiences regarding access.Design & settingA face-to-face questionnaire survey was commissioned. A nationally representative adult quota sample (aged ≥15 years) was used.MethodTen questions were included within Ipsos MORI’s weekly population-based survey. The questions explored 12-month practitioner-led CAM use, reasons for non-use, views on NHS-provided CAM, and willingness to pay.ResultsOf 4862 adults surveyed, 766 (16%) had seen a CAM practitioner. People most commonly visited CAM practitioners for manual therapies (massage, osteopathy, chiropractic) and acupuncture, as well as yoga, pilates, reflexology, and mindfulness or meditation. Women, people with higher socioeconomic status (SES) and those in south England were more likely to access CAM. Musculoskeletal conditions (mainly back pain) accounted for 68% of use, and mental health 12%. Most was through self-referral (70%) and self-financing. GPs (17%) or NHS professionals (4%) referred and/or recommended CAM to users. These CAM users were more often unemployed, with lower income and social grade, and receiving NHS-funded CAM. Responders were willing to pay varying amounts for CAM; 22% would not pay anything. Almost two in five responders felt NHS funding and GP referral and/or endorsement would increase their CAM use.ConclusionCAM use in England is common for musculoskeletal and mental health problems, but varies by sex, geography, and SES. It is mainly self-referred and self-financed; some is GP-endorsed and/or referred, especially for individuals of lower SES. Researchers, patients, and commissioners should collaborate to research the effectiveness and cost-effectiveness of CAM and consider its availability on the NHS.

Kas İskelet Sistemi Hastalıklarında Tamamlayıcı ve Alternatif Tıp Yöntemleri Kullanım Sıklığının Değerlendirilmesi

Amac: Tamamlayici ve alternatif tip yontemlerinin kullanim sikligi ve en sik tercih edilen yontemin belirlenmesidir. Gerec ve Yontemler: Bu calismaya hastanemize 30.09.17-30.12.17 tarihleri arasinda basvuran hastalar dahil edildi. Calismaya 18 yas ustu kronik kas iskelet sistem hastaligi olan sorulari cevaplayabilecek olan 512 kadin ve erkek hasta alindi. Hastalarin tamamlayici ve alternatif tip (TAT) yontemlerini kullanma formu ile veriler toplanmistir. Anket formu icerisindeki sorulara cevap vermesi istendi ve hekim tarafindan not edildi. Arastirmalarin verileri sayi, yuzde dagilimlari ve ki-kare testi kullanilarak degerlendirilmistir. Bulgular: Arastirmaya katilan hastalarin yas ortalamasi 53,25±14,61, 367 (%71.7) kadin, 145 (%28.3) erkek idi. Calismaya katilanlarin %65.8’inin komorbid hastaligi vardi. %87.9 TAT kullanimi mevcuttu. TAT uygulayanlarin %19.6’si doktor,%13.2 fizyoterapist, %4.2 hemsire, %9.1 din gorevlisi,%53.9 diger kisilerden olusmaktadir. En cok tercih edilen yontem sifali su %73,9 olarak tespit edildi. Yas ile TAT yontemlerinden fayda gorme, hacamat ve yoga arasinda pozitif yonlu korelasyon saptandi. Tartisma ve Sonuc: Kronik kas iskelet sistemi hastaligi olan hastalar siklikla TAT yontemlerine basvurmaktadir. Ancak basvuranlarin cogu hekim onerisi disinda aile, cevre gibi yakin kisilerin onerisiyle gerceklesmektedir. Ayrica bu calismada hastalarin yaridan fazlasina alaninda egitilmemis kisiler tarafindan uygulandigi tespit edilmistir. Bunun yaninda, komorbid hastaliklarda yas ilerlemesi ile TAT kullanimin arttigi belirlenmistir. Aim: To determine the frequency of use of complementary and alternative medicine and the most preferred method Material Method: Patients who applied to the hospital between 30.09.17-30.12.17 were included in this study. A total of 512 male and female patients with chronic musculoskeletal disease over the age of 18 who were able to answer questions were included in the study. The form of using complementary and alternative medicine (CAM) methods and data were collected. It was requested by the physician to answer the questions in the questionnaire and it was noted by the physician. Data were evaluated using the number, percentage distributions and chi-square test. Results: The mean age of the participants was 53,25 ± 14,61, 367 (71.7%) were female and 145 (28.3%) were male. 65.8% of those participating in the study had comorbid disease. 87.9% CAM usage were recorded. CAM practitioners are 19.6% physicians, 13.2% physiotherapists, 4.2% nurses, 9.1% religious officers and 53.9% others. The most preferred method was 73.9% of mineral spring. Benefit from age and CAM methods, positive correlated between hajamat and yoga. Discussion and Conclusion: Patients with chronic musculoskeletal disease frequently refer to CAM methods. However, most of the applicants, apart from the physician's suggestion, take place with the suggestion of close family members and the environment. It was also found that more than half of the patients in this study were practiced by persons not trained in the field. In addition, age progression and TAT use increased in comorbid diseases.

Gender specific association between the use of complementary and alternative medicine (CAM) and alcohol consumption and injuries caused by drinking in the sixth Troms\xf8 study

BackgroundAlcohol is consumed almost worldwide and is the most widely used recreational drug in the world. Harmful use of alcohol is known to cause a large disease-, social- and economic burden on society. Only a few studies have examined the relationship between CAM use and alcohol consumption. To our knowledge there has been no such research in Norway. The aim of this study is to describe and compare alcohol consumption and injuries related to alcohol across gender and different CAM approaches.MethodsThe data used in this study is based on questionnaire data gathered from the sixth Tromsø Study conducted between 2007 and 2008. Information on CAM use and alcohol consumption was available for 6819 women and 5994 men, 64.8% of the invited individuals. Pearson chi-square tests and independent sample t-tests were used to describe the basic characteristics of the participants and to calculate the differences between men and women regarding these variables. Binary logistic regression analyses were used to investigate the associations between the different CAM approaches and alcohol consumptions and injuries caused by drinking.ResultsWomen who drank alcohol more than once a month were more likely to have applied herbal or “natural” medicine and self-treatment techniques (meditation, yoga, qi gong or tai-chi), compared to those who never drank, and those who only drank monthly or less. For women, an association was also found between having experienced injuries caused by drinking and use of self-treatment techniques and visit to a CAM practitioner. No association was found between amount of alcohol consumed and use of CAM approaches. For men, an association was found between injuries caused by drinking and use of herbal or “natural” medicine.ConclusionThe findings from this cross-sectional study suggests that women who drink frequently are more likely to use “natural” medicine and self-treatment techniques. Both men and women who had experienced injuries because of their drinking were more likely to have used CAM approaches.

Spiritual and Religious Healing Practices: Some Reflections from Saudi National Center for Complementary and Alternative Medicine, Riyadh.

Traditional practices constituting spiritual and religious (S/R) healing are an important component of the holistic healthcare model and are used in health, well-being, and treating a variety of diseases around the world. The main focus of this review is to summarize the Complementary and Alternative Medicine (CAM) studies that especially target S/R healing practices in Saudi Arabia (SA) and discuss the results in light of relevant international literature. From year 2013-2017, electronic searches of PubMed, OvidSP, Google Scholar, and two publishing housing Web sites (Sciencedomain.com and Dove Medical Press.com) were made using key words and Boolean operators and retrieved thousands of published papers from peer-reviewed journals. Two independent reviewers decided to include a total of 108 articles: 48 from SA and 60 from other international literature. The sociodemographic variables of the participants varied in local studies and were comparable with international data. The frequency and types of religious and spiritual practices reported in local and international zones varied in accordance with religious belief, gender, age, education, and prevalent chronic diseases. Most of professionals and practitioners showed fairly good knowledge and positive attitude toward spiritual and religious practices used in diverse clinical and non-clinical situations across the world. Furthermore, it was observed that in the international scenario, S/R researches using specific religious screening tools have been conducted on different aspects of clinical application including self-care, social cohesion, negative impact, and child development, whereas regional studies targeting varied participants mainly focused on the epidemiological trends of S/R therapies in Saudi Arabia. CAM practitioners and public tend to show great interest in prescribed and self-use of religious and spiritual therapies across the world because of multiple dynamic forces, including positive effects on health, sense of well-being and disease control, cost-effectiveness, easy access to services, and improvement in quality of life. Further studies are needed to assess the effectiveness of different types of religious and spiritual therapies and practices used in specific diseases, their role in promotion of health and well-being, and prevention of diseases nationwide and across the world. Besides integration of S/R into mainstream treatment modalities, medical education curriculum, continuous medical education, and training programs are needed for bridging the knowledge, attitude, and practice gaps concerning CAM in targeted population groups such as medical professionals, CAM practitioners, medical students, public and traditional healers, not only in SA but also around the world.

An overview of the history and development of naturopathy in South Africa.

BackgroundA huge growth in complementary and alternative medicine (CAM) took place in South Africa in the 1960s which paralleled what was happening in other parts of the western world. Naturopathy has been practised in South Africa for over 60 years, and the history of naturopathy is entwined with the broader history of CAM. No laws existed at that stage to regulate the curriculum, education and training of CAM practitioners. With the passage of time, various statutes were introduced which eventually led to changes in legislation and the establishment of a recognised training programme. Naturopathy became a legally regulated profession, the full history of which has never been documented.ObjectiveThis article explores the history of naturopathy in South Africa.MethodA two-phase qualitative research design was used, consisting of a document search and semi-structured interviews with key informants who were identified through a process of snowballing. Information collected from the naturopaths who participated in the interviews was triangulated with documentation uncovered in the archives of the Allied Health Professions Council of South Africa (AHPCSA) and other literature available.ResultsThe result is a history of events which took place and reveals the effect of various legislations on the profession.ConclusionChanges in the political system paved the way for changes in legislation which allowed for the registration and training of naturopathic practitioners. However, the lack of a functioning association and the small number of naturopathic graduates have hampered the growth of the profession, preventing it from becoming a significant contributor to the health care system.

Complementary and Alternative Medicine Provider Knowledge Discourse on Holistic Health

Complementary and alternative medicine (CAM) promises a wide array of therapies employed increasingly by consumers for disease prevention and health promotion. Despite this increasing use, however, CAM and biomedical paradigms are often not combined effectively in the US. The lack of coordination negatively impacts several aspects of patient care including CAM and biomedical provider-patient relationships and the practice of integrative medicine. The goal of this study is to understand how CAM providers position their knowledge and practice of holistic health within the healthcare landscape in the US. In-depth interviews with CAM providers (N=17) sampled from practices in the mid-Atlantic region of the US were analyzed for provider descriptions of holistic health. Discourse analysis of CAM provider interviews identifies the three themes employed by CAM providers to describe holistic health as comprising the: (a) epistemologies of legitimization and identity, (b) epistemologies of sense and intuition, and (c) epistemologies of environment and community. The three epistemologies define holistic health by organizing diverse knowledge foundations through reconciling and integrating differences, including diverse modes of evidence such as non-empirical forms of whole body experiences, and privileging the relational praxis through integrating the individual’s biological and sociocultural environment. The epistemologies illuminate how CAM knowledge and practice is positioned as alternative within the sociocultural context of the participants and reflect CAM providers’ challenges in carving out a distinct knowledge space reflecting their professional identity. CAM providers’ discourse encompasses the ontological and experiential-relational praxis to foreground health as a mutually constitutive, ongoing process of granting legitimacy to diverse sense-making ontologies of medicine within a continuum of provider-patient meaning-making. Theoretically, CAM knowledge of holistic health integrates the experiential praxis of the patient’s spiritual and physiological self and the relational praxis of the patient’s biological-sociocultural-epigenetic relationships in the conceptualization and delivery of health outcomes. The study findings recommend including CAM knowledge discourses to inform the epistemological foundations of basic medicine. Pragmatically, the study recommends support for efforts to include credentialing of CAM practitioner teaching within allopathic healthcare institutions, faculty development within existing allopathic health professional schools, and incorporation of CAM content in allopathic medical education and practice.

Anti-vaccination and pro-CAM attitudes both reflect magical beliefs about health

We examined the relationship between complementary and alternative medicine (CAM) use and vaccination scepticism; and specifically whether a person’s more general health-related worldview might explain this relationship. A cross-sectional online survey of adult Australians (N = 2697) included demographic, CAM, and vaccination measures, as well as the holistic and magical health belief scales (HHB, MHB). HHB emphasises links between mind and body health, and the impact of general ‘wellness’ on specific ailments or resistance to disease, whilst MHB specifically taps ontological confusions and cognitive errors about health. CAM and anti-vaccination were found to be linked primarily at the attitudinal level (r = −0.437). We did not find evidence that this was due to CAM practitioners influencing their clients. Applying a path-analytic approach, we found that individuals’ health worldview (HHB and MHB) accounted for a significant proportion (43.1%) of the covariance between CAM and vaccination attitudes. MHB was by far the strongest predictor of both CAM and vaccination attitudes in regressions including demographic predictors. We conclude that vaccination scepticism reflects part of a broader health worldview that discounts scientific knowledge in favour of magical or superstitious thinking. Therefore, persuasive messages reflecting this worldview may be more effective than fact-based campaigns in influencing vaccine sceptics.

Combining and Using the Utrecht Method and the Analytic Hierarchy Process to Facilitate Professional and Ethical Deliberation and Decision Making in Complementary and Alternative Medicine: A Case Study among a Panel of Stakeholders.

Background In daily practice, healthcare practitioners face many challenges in ethical and professional decision making. Currently, little is known on the ethical and professional deliberations and weighing benefits against risks in daily complementary and alternative medicine (CAM) practice. The aim of this study was to combine the Utrecht method and the Analytic Hierarchy Process (AHP) in deliberations, weighing benefits against risks of using ginger for a pregnant woman suffering nausea and vomiting of pregnancy (NVP) along with other comorbidities. Methods A hypothetical case was constructed using the twelve tips for constructing dilemma case-based assessment. Three CAM practitioners, two physicians, three pharmacists, and two patients were recruited, and the Utrecht and the AHP methods were combined and used to deliberate and weigh benefits against risks of using ginger for the presented case. Results Responses from the ten panelists were obtained. Priority ratings showed significantly higher scores (p-value < 0.001) for alleviating symptoms of NVP (30.7% ± 16.6%) compared to other potential benefits. Increasing the risk of bleeding was given significantly higher (p-value < 0.0001) weight scores (24.7% ± 13.5%) than other potential side effects. Potential risk of spontaneous abortion and risk of impairment of fetal development were given higher (p-value < 0.001) weight scores than risk of fetal hypoglycemia. When benefits were compared against side effects and risks to the fetus and pregnancy, potential benefits were given higher (p-value < 0.001) weight scores (72.3% ± 5.2%). Conclusions Considering the anticipated benefits and risks, a shared decision was made to use ginger in the case presented. The woman should also be informed of the potential side effects and risks of using ginger. The use of this combined method might promote openness and transparency in making shared decisions for healthcare providers and patients.

Understanding cancer survivors' information needs and information-seeking behaviors for complementary and alternative medicine from short- to long-term survival: a mixed-methods study.

ObjectiveThe research examined complementary and alternative medicine (CAM) information-seeking behaviors and preferences from short- to long-term cancer survival, including goals, motivations, and information sources.MethodsA mixed-methods approach was used with cancer survivors from the “Assessment of Patients’ Experience with Cancer Care” 2004 cohort. Data collection included a mail survey and phone interviews using the critical incident technique (CIT).ResultsSeventy survivors from the 2004 study responded to the survey, and eight participated in the CIT interviews. Quantitative results showed that CAM usage did not change significantly between 2004 and 2015. The following themes emerged from the CIT: families’ and friends’ provision of the initial introduction to a CAM, use of CAM to manage the emotional and psychological impact of cancer, utilization of trained CAM practitioners, and online resources as a prominent source for CAM information. The majority of participants expressed an interest in an online information-sharing portal for CAM.ConclusionPatients continue to use CAM well into long-term cancer survivorship. Finding trustworthy sources for information on CAM presents many challenges such as reliability of source, conflicting information on efficacy, and unknown interactions with conventional medications. Study participants expressed interest in an online portal to meet these needs through patient testimonials and linkage of claims to the scientific literature. Such a portal could also aid medical librarians and clinicians in locating and evaluating CAM information on behalf of patients.

Blood pressure control and associated factors among hypertensive patients in university of Port Harcourt teaching hospital in South-South Nigeria

Background: Hypertension a controllable disease is responsible for about 45% of deaths due to heart diseases and 51% of deaths due to stroke globally as at 2013. In Nigeria, a prevalence of 8-46.4% was reported depending on the population of interest. This study was to determine the level of BP control and associated factors among hypertensive patients in University of Port Harcourt Teaching Hospital in South-South Nigeria.Materials and Methods: Sequel to requisite ethical approval this study was conducted among 423 hypertensive patients who were attending specialist clinics in University of Port Harcourt Teaching Hospital in Rivers State, South-South Nigeria. The patients were selected by systematic sampling technique. A pre-tested close ended interviewer-administered questionnaire and sphygmomanometer were used to collect data. The data was analyzed using Epi Info Version 7.02 statistical software with descriptive and analytical statistics used.Results: The results showed that BP control was 36.69% with mean systolic and diastolic blood pressure of 147.28 ± 21.76 mmHg and 88.27 ± 15.18 mmHg respectively. BP control was significantly associated with being female (OR: 1.98; 95% CI= 1.29-3.05; p = 0.001), current alcohol consumption (OR: 2.42; 95% CI = 1.28-4.80; p = 0.006). Other factors were adherence to medications, consulting a CAM practitioner and use of CAM products.Conclusion: The low level of BP control required physicians to counsel their patients on the need for medication adherence, avoidance of alcohol consumption and use of complementary and alternative medicine (CAM) which this study has identified as predictors of poor BP control.Key words: Hypertension, blood pressure control.

Complementary, Alternative and Integrative Medicine for Childhood Atopic Dermatitis.

Atopic Dermatitis (AD) is a chronic relapsing dermatosis associated with itch, sleep disturbance and poor quality of life. Treatment of AD includes the use of emollients, and topical and systemic immunomodulating agents. Many patients also use complementary and alternative medicine (CAM). This article reviews the pathophysiology of AD, clinical trials and recent patents involving various modalities of CAM in the treatment of AD. A Medline/Pubmed search was conducted using Clinical Queries with the key terms "Chinese Medicine OR Complementary and Alternative medicine" AND "Eczema OR Atopic dermatitis". The search strategy included meta-analyses, Randomized Controlled Trials (RCTs), clinical trials, reviews and pertinent references. Patents were searched using the key term "atopic dermatitis" from www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. Only a few RCTs evaluated the efficacy of Chinese medicinal herbs in treating AD. There was some evidence for other modalities of CAM. Integrative Medicine (IM) usually refers to the various forms of CAM that combine conventional western medicine and Chinese medicine. Supporting evidence for the efficacy of IM in the treatment of AD is presently lacking. Integration is difficult. Western medicine practitioners are often ignorant about CAM and IM. Parents are concerned about the potential side effects of Western medicine and will tend to be non-compliant with the conventional Western component of IM. Recent patents on CAM and IM are reviewed. Most CAM patents are herbal compositions, evidence on their efficacy is generally lacking. AD is a complex disease. The psychodynamics of the child and his/her family is the reason for the often suboptimal outcomes. Both Western and CAM practitioners should collaborate to create a mutually encouraging environment for the advances of IM. CAM and IM publications and patents are reviewed. Evidence of their efficacy is generally lacking. Further research is needed.

Defining Health: Do Practitioners from Different Complementary and Alternative Medicine (CAM) Disciplines Focus on Different Patient Outcomes?

Purpose: To determine whether practitioner-endorsed and practitioner-suggested items for a patient-centered complementary and alternative medicine (CAM) outcomes questionnaire that became the Self-Assessment of Change instrument (developed under the NIH-NCCAM grant R01AT0033214) differ by CAM discipline.Methods: In-depth semi-structured interviews (n=24), one focus group (n=4), and two group discussions (n=108) were conducted with a convenience sample of CAM practitioners, including naturopathic physicians, Traditional Chinese Medicine practitioners, massage therapists, homeopaths, and energy healers. Qualitative analysis focused on patient outcomes practitioners said they observed in their practice. Outcome items and related comments by practitioners were further distilled for similarities and contrasts by practitioner type. These were then organized into the following pre-existing domains established by the research team: Physical, Cognitive, Emotional, Social, Spiritual, and Whole Person (outcomes that transcend any single outcome domain or construct). Overarching themes that encompassed outcome items were derived when possible.Results: Considerable overlap was observed among practitioners from different CAM disciplines with regard to types of patient outcomes assessed.Conclusions: Practitioner data assembled from multiple sources suggest outcome measures derived from a single CAM tradition are likely to overlap considerably with other CAM systems, with some non-generalizable items possible. These data enhance our understanding of diverse issues in questionnaire development, and suggest the need for a few tailored items to capture outcomes for specific CAM disciplines.

“Do-it-yourself”: Vaccine rejection and complementary and alternative medicine (CAM)

In this article, we elucidate a symbiotic relationship between complementary and alternative medicine (CAM) and rejection of, or hesitancy towards, vaccination. In Fremantle, Western Australia, and Adelaide, South Australia, we conducted in-depth interviews from September 2013–December 2015 with 29 parents who had refused or delayed some or all of their children's vaccines. Our qualitative analysis found that for many, their do-it-yourself ethic and personal agency was enhanced by self-directed CAM use, alongside (sometimes informal) CAM practitioner instruction. Reifying ‘the natural,’ these parents eschewed vaccines as toxic and adulterating, and embraced CAM as a protective strategy for immune systems before, during and after illness. Users saw CAM as harm-free, and when it came to experiences that non-users might interpret as demonstrating CAM's ineffectiveness, they rationalised to the contrary. They also generally glossed over its profit motive. CAM emerged as part of an expert system countering Western medicine. CAM's faces were trusted and familiar, and its cottage capitalism appeared largely free from the taint of “Big Pharma.” A few parents employed a scientific critique of CAM modalities – and a minority were dubious of its profit motive – but others rejected the epistemology underpinning biomedicine, framing CAM as a knowledge not poisoned by avarice; a wisdom whose very evidence-base (anecdote and history) was demeaned by an arrogant scientific process only permitting belief in that which could be quantified. However, all parents engaged with Western medicine for broken bones and, sometimes, medical diagnoses. Our analysis suggests that pro-vaccination health professionals, policymakers and information-providers seeking to address the role of CAM in vaccine rejection face significant challenges due to the epistemic basis of some parents' decisions. However, we make some suggestions for professional practice and policy to enhance trust in vaccination.

A truly complementary approach: A qualitative exploration of complementary and alternative medicine practitioners' views of treating ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease in which individuals experience a long delay to diagnosis. Prior to diagnosis, individuals report frequent use of complementary and alternative medicine (CAM) therapies. While popularly used, there is a dearth of knowledge concerning the experiences of CAM practitioners in terms of treating individuals with AS. Addressing this knowledge gap, the present study provides a detailed exploration of how UK-based CAM practitioners treat individuals with AS. Semi-structured telephone interviews were conducted with eight UK-based CAM practitioners, (four males), aged 45-69years. CAM practitioners were recruited across a range of CAM therapies and years of CAM practice experience (8-46years). Thematic analysis resulted in the identification of three themes to characterize the data. Themes comprised: (i) the whole picture; (ii) alarm bells; and (iii) a common language. Themes highlighted CAM practitioner adoption of a holistic, yet individualized approach to treating individuals with AS, despite a general sense of lack of knowledge concerning AS among CAM practitioners. Notably, results indicated a desire of CAM practitioners to work more collaboratively with mainstream health providers to provide more joined-up care for individuals with AS. CAM practitioners emphasized the benefits of CAM to focus on providing effective symptom management when used in conjunction, rather than in opposition to, mainstream healthcare. Adoption of a more holistic approach to AS management by CAM practitioners may empower clients to become more aware of symptoms, thus potentially reducing delays in receiving a formal diagnosis of AS.

Risk of anaphylaxis in complementary and alternative medicine.

Complementary and alternative medicine (CAM) use is widespread across the world. Patients with asthma and allergy regularly use CAM therapies. Allergic and anaphylactic reactions to CAM have been reported. Recent attempts to regulate and monitor adverse reaction to these therapies have given us further insight into potential causes of severe allergic reactions. Several culprits identified including Andrographis paniculata, Echinacea species, bee products, Ginkgo biloba and Ginseng are discussed here. Knowing the factors that increase the risk of anaphylaxis allows reactions to be recognized, reported and further investigated. Research to identify key causative allergens is necessary in the future. Collaboration between the allergy community and CAM practitioners can allow better understanding of allergy to these therapies.

Nurses’ communication regarding patients’ use of complementary and alternative medicine

Background: Many people integrate complementary and alternative medicine (CAM) into their health care. Nurses potentially play a significant role in communicating with patients about their CAM utilisation. Aim: The study aimed to explore whether, how and why nurses working in Australia communicate about patients’ CAM use. Methods: This paper reports on phase one of a mixed methods study. Qualitative data was obtained, via interviews, with nineteen registered nurses who work in a wide variety of clinical environments across all states of Australia. Findings: Four themes related to nurses’ communication with patients about CAM, were developed from the qualitative data; engaging with patients about CAM, communication with doctors about patients’ use of CAM, connecting with CAM practitioners and barriers to CAM communication. Discussion: Despite their positive attitudes, nurses are often not comfortable discussing or documenting patients’ CAM use. Furthermore, nurses perceive that patients may be apprehensive about disclosing their use. CAM communication with colleagues is moderated by the workplace culture and the perceived attitude of co-workers. There is very little evidence of nurses referring or collaborating with CAM practitioners. Professional expectation, time restraints and the nurses’ lack of relevant CAM knowledge all have a powerful effect on limiting CAM communication. Conclusion: Communication about patients’ use of CAM is imperative to support safe therapeutic decisions. Currently, this is limited in the Australian healthcare workplace. The nursing professional needs to consider introducing basic CAM education and flexible guidelines to enable nurses’ to respond appropriately to the patient driven demand for CAM.

Cyclic Perimenstrual Pain and Discomfort and Australian Women's Associated Use of Complementary and Alternative Medicine: A Longitudinal Study.

To examine the longitudinal change in Australian women's prevalence of cyclic perimenstrual pain and discomfort and the association between their symptoms and use of complementary and alternative medicine (CAM). Data on endometriosis, premenstrual syndrome (PMS), irregular periods, heavy periods, and severe period pain were collected over a 7-year period from the Australian Longitudinal Study on Women's Health, for women aged 28 to 33 years in 2006, and at 3-year follow-ups. Changes in symptoms and patterns of CAM practitioner and therapy/product use associated with these symptoms were analyzed using longitudinal regression modeling. Over the 7-year period, prevalence rates of PMS and heavy periods increased, while prevalence rates of endometriosis, irregular periods, and severe period pain remained stable. The most common use of CAM longitudinally associated with the perimenstrual symptoms was use of vitamins/minerals, yoga/meditation, massage therapy, herbal medicine, and aromatherapy. Excluding consultation with a naturopath/herbalist, over the 7-year survey women's use of all other CAM practitioners increased as did their use of vitamin/minerals, yoga/meditation, and Chinese medicines, while aromatherapy use declined. Only the prevalence of PMS and heavy periods increased with aging in this sample of women. While overall use of CAM practitioner and self-prescribed products/therapies increased over time, CAM was chosen by women mainly to treat endometriosis and PMS. The extent to which this use reflects treatment efficacy is uncertain.