Conventional Medical Practitioners Research Articles

Knowledge, perception, attitude, and practice of complementary and alternative medicine by health care workers in Garki hospital Abuja, Nigeria

BackgroundHealthcare workers are currently making efforts to offer services that cater to the holistic care needs of their patients. Previous studies have shown that some healthcare workers encounter challenges when advising patients about Complementary and Alternative Medicine (CAM), even though its use is widespread. Many health care workers may not have received formal education or training in CAM and consequently are unable to address their patients’ questions about it. This study explored the knowledge, perception, attitude and practice of CAM by healthcare workers in Garki Hospital, Abuja, Nigeria.MethodsThis was an institution-based cross-sectional study, design and a convergent parallel, mixed methods design was used for data collection. Five (5) healthcare workers were purposively selected as participants for the key informant interviews, while two hundred and fifty (250) selected using a simple random sampling method completed the questionnaire. The data collection instruments used were a key informant interview guide and a 35-item self-administered questionnaire. Knowledge was assessed with a 4-item scale with a maximum score of 8. Perceptions and attitudes were assessed using Likert scales with a maximum score of 45 and 20, respectively. Practice was assessed with a 6-item scale with a maximum score of 18. Qualitative data was analysed using framework analysis. Quantitative data was analysed using descriptive and inferential statistics. Data acquired from both methods were integrated to form the findings.ResultsThe average age of respondents for the quantitative study was 34.0 ± 7.8 years, and they were predominantly females (61.2%) with one to ten years of work experience (68.8%). The mean knowledge, perception and attitude scores were 1.94 ± 1.39, 13.08 ± 2.34 and 32.68 ± 6.28, respectively. Multiple linear regression result showed that knowledge (t = 2.025, p = 0.044) and attitude (t = 5.961, p = 0.000) had statistically significant effects on the practice of CAM. Qualitative data revealed that the majority of the participants perceive CAM favourably, provided it is properly introduced into mainstream medicine with evidence of safety and research to prove its efficacy.ConclusionThe study has shown the gaps in knowledge and the practices of CAM by conventional medical practitioners. This has implications for their ability to counsel and refer patients who may require CAM therapies. Policy, research and programmatic initiatives that seek to enhance their knowledge of CAM, and improve collaboration with CAM practitioners are recommended.

The State of 21st Century Acupuncture in the United States.

The term "acupuncture" commonly refers to a non-pharmacologic therapy that is increasingly employed by diverse segments of the population for a wide variety of complaints including pain, insomnia, anxiety, depression, frozen shoulder, and other issues. The term is also used as a short-hand for the wider medical system from which the placement of needles into the skin for therapeutic benefit and related techniques evolved. Thus "acupuncture" refers both to the therapeutic technique and the therapeutic system of Acupuncture and Herbal Medicine (AHM). The other modalities included within AHM include a wide variety of physical and mechanical manipulations, herbal medicines, dietary recommendations, and lifestyle modifications. Clinically, acupuncture is increasingly offered in a variety of conventional medical settings such as hospitals, medical school clinics, veterans' healthcare centers, oncology facilities, and rehabilitation centers, and its safety profile is excellent overall. Barriers to further incorporation of acupuncture into biomedical sites include insurance coverage of acupuncture, education of conventional medical practitioners and other stakeholders about the utility, efficacy, and evidence base of acupuncture. Acupuncturists in the United States are skilled practitioners who are highly educated in the complex therapeutic system from which acupuncture arose and in the technical aspects of its utility as a treatment modality. The training, certification, licensure, and regulation of acupuncturists is similar to that of conventional providers such has physician's assistants, advanced practice nurses, and medical and osteopathic doctors. While clinical use and acceptance of acupuncture continues to grow, there is to date no definitive composite document explaining the utility of acupuncture in various healthcare settings, the current understanding of how acupuncture works, and the training, professional regulation, and certification of acupuncture practitioners. This article will address these topics and strive to create a reference for practitioners, administrators, legislators, insurance providers, patients and their families, and other stakeholders.

Evaluating the barriers to the utilization of complementary and alternative medicine (CAM) in the United States: An exploratory study

IntroductionThe utilization of certain forms of complementary and alternative medicine (CAM) is prevalent among adults in the United States. While researchers have extensively studied the factors influencing CAM use in Western countries, significant barriers to its adoption remain. This paper draws attention to the obstacles faced by individuals in their journey to using CAM. MethodsQualitative interviews were conducted with 21 patients who had turned to CAM for managing a chronic illness/condition. These in-depth, face-to-face interviews occurred in Miami, USA, during 2014–15. The sampling, data collection, and analysis processes of this study adhered to the principles outlined in Charmaz’s constructivist grounded theory approach. ResultsFrom the data, three central barriers to CAM utilization in the US emerged: 1) Financial barriers: A significant portion of CAM treatments is not covered by insurance, making them cost-prohibitive for many. 2) Skepticism and discouragement: Both conventional medical practitioners and a segment of the public exhibited a noticeable trend towards discouraging CAM use. 3) Evaluation challenges: Patients expressed difficulty in assessing the efficacy and benefits of various CAM treatments compared to their costs. DiscussionDespite the widespread interest in and use of CAM in the US, numerous barriers hinder its broader integration into mainstream healthcare. These obstacles not only restrict healthcare choices for the general public but also appear to favor a select demographic, potentially based on income and availability of information.

Use of traditional medicines among conventional medicine practitioners in Burkina Faso

The integration of traditional medicine into biomedical health care practice is highly dependent on its acceptability by conventional medical practitioners. Its use by conventional practitioners was previously unknown in Burkina Faso. The purpose of this study was to estimate the prevalence of traditional medicine use and the frequency of occurrence of adverse events associated with this use among conventional medical practitioners in Burkina Faso. The majority of the practitioners surveyed were women (56.1%) and the average age was 39.7±7 years. Nurses (56.1%), midwives (31.4%) and physicians (8.2%) were the most represented professions. The prevalence of the use of traditional medicines in the 12 months preceding the survey was 75.6%. Malaria was the main medical reason for using traditional medicines (28%). The frequency of reported adverse events was 10% and mainly concerned gastrointestinal disorders (78.3%). The majority of conventional medical practitioners in Burkina Faso use traditional medicines for their health problems. This finding suggests the effective integration of traditional medicine into biomedical health care practice which could benefit from good acceptability by these professionals.

Knowing the entire story – a focus group study on patient experiences with chronic Lyme-associated symptoms (chronic Lyme disease)

BackgroundHealthcare providers frequently struggle to provide effective care to patients with chronic Lyme-associated symptoms (chronic Lyme disease, CLD), potentially causing these patients to feel misunderstood or neglected by the healthcare system. This study is the first to use a combined medical and communication science approach, and aims to assess patients’ experiences with CLD & CLD-related care, identify themes and repertories in these patients’ narrations, and provide potential ways to improve communication with them.MethodsInformed by the principles of ‘clean language’, we conducted focus groups with self-identified CLD patients (N = 15). We asked participants about their experiences with CLD and CLD-related healthcare. We performed thematic analyses using a bottom-up approach based in discourse analysis. We also sought to identify specific types of verbalizations (repertoires) across themes.ResultsParticipants thematised a heterogeneous set of CLD-associated symptoms, which they frequently labelled as ‘invisible’ to others. Their illness significantly affected their daily lives, impacting their work, social activities, relationships with loved ones, hobbies and other means of participating in society. Negative experiences with healthcare providers were near-universal, also in patients with short-lived CLD-associated symptoms. Verbalizations were notable for frequent use of communicative modes that implicitly create common ground between participants and that give a certain validity to personal experiences (impersonal ‘you’ and other forms of presupposition).ConclusionCentral themes found in CLD patients’ communication are 1. the experience of significant symptoms, 2. for which adequate relief is only rarely found from conventional medical practitioners, and 3. that are largely invisible to the outside world. Verbalizing these themes, patients use various repertoires for their shared experiences, such as a feeling of abandonment or not being heard by the medical system, feelings of loss with respect to their previous health, and the idea that they might have been better off had they been diagnosed sooner. Working with these repertoires will enable healthcare providers to establish a shared perspective with their CLD patients, thus engaging in more fruitful doctor-patient communication. We hypothesize that these findings are not unique to CLD, but may also be applicable to other conditions with an uncertain aetiology, such as Long COVID.

Qualitative Study of Mental Health Improvements with Traditional Cultural Healers in North America

Introduction Traditional cultural healers -- their methods and their results -- are often invisible to conventional medical practitioners. When confronted with a result that does not make sense, we often ignore it.ObjectivesWe wanted to understand the process that happened between people and traditional cultural healers when these people experienced substantial improvement in mental health without psychiatric treatment.MethodsWe collected 56 case stories from people who consulted traditional cultural healers instead of conventional medical practitioners for serious mental health problems. We confirmed the stories with family members and interviewed the healers as well. We used constructivist grounded theory to explore commonalities in the stories from the clients’ points of view and from the healers’ perspectives. The context is indigenous people in North America.ResultsPatients had a range of diagnoses, including psychotic disorders (12), bipolar disorder (28), and evere unipolar depression (16). Co-morbid anxiety disorders were common (22). Improvement in mental health was associated with participation in ceremonies within a community, building relationships with members of that community, engaging in prescribed daily practices endorsed by that community, with a resulting report of feeling increases in social and spiritual connectedness. The healers believed strongly that the embeddedness in community contributed to the results and that spirit beings played important roles in helping people feel better. The use of psychiatric medications was minimal.ConclusionsPsychiatry can acknowledge that people can have substantial improvements in mental health when working with traditional cultural healers outside of conventional settings. Studying these settings and results can improve conventional practice.DisclosureNo significant relationships.

Physician Office Visits That Included Complementary Health Approaches in U.S. Adults: 2005-2015.

Introduction: The Institute of Medicine has described the need for comparing models of care delivery involving complementary health approaches and conventional medical practitioners. As a step toward addressing this need, we used a nationally representative 11-year sample of office-based visits to physicians from the National Ambulatory Medical Care Survey (NAMCS), to examine a comprehensive list of factors believed to be associated with visits where complementary health approaches were recommended or provided. Methods: NAMCS is a national health care survey designed to collect data on the provision and use of ambulatory medical care services provided by office-based physicians in the United States. Patient medical records were abstracted from a random sample of office-based physician visits. We examined several visit characteristics, including patient demographics, physician specialty, documented health conditions, and reasons for health visit. We ran chi-square analyses to test bivariate associations between visit factors and whether complementary health approaches were recommended or provided to guide development of logistic regression models. Results: Of the 550,114 office visits abstracted, 4.43% contained a report that complementary health approaches were ordered, supplied, administered, or continued. Among complementary health visits, 87% of patient charts mentioned nonvitamin nonmineral dietary supplements. The prevalence of complementary health visits significantly increased from 2% in 2005 to almost 8% in 2015. Returning patient status, survey year, physician specialty and degree, menopause, cardiovascular, and musculoskeletal diagnoses were significantly associated with complementary health visits, as was seeking preventative care or care for a chronic problem. Conclusion: We present an overview of the first study of office-based physician visits where complementary health approaches were recommended or ordered to their patients. These data confirm the growing popularity of complementary health approaches in the United States, provide a baseline for further studies, and inform subsequent investigations of integrative health care.

A Case Study of Complementary Alternative Medicines in Primary Healthcare in Ghana

Background: The embryonic field of complementary alternative medicine in Ghana is gradually taking shape. Alternative medicine in Ghana is an important system of medical practice with legislation currently pending for promulgation.
 Objectives: To support this embryonic industry for potential role into our primary healthcare and public health system, there is a need for robust health care policy in the area of standardization coupled with strong political willpower and research in Ghana. The aim of this case study is to reflect the role of complementary alternative medicine in primary healthcare in Ghana.
 Methods: The study incorporates a mixed method engaged in integrated data analysis to investigate the challenges of practitioners of complementary alternative medicines as primary healthcare givers. Additionally, it evaluates the pull factors that drive consumers to complementary alternative remedies from the perspectives of the practitioners and finally, to evaluate the opinions of practitioners on consumers’ push factors from mainstream medicine using Ghana as a case model.
 Results: This study demonstrates that there is a role of complementary alternative medicine in primary healthcare delivery as well as the public health system. However, there are multifactorial challenges in the sector as respondents outlined lack of standardization, disunity and mistrust between complementary alternative medicine and mainstream medical practice. Some of these opposing forces prevent recognition of these remedies into the national healthcare delivery system. 
 Conclusion: While our findings demonstrate that there is a role of complementary alternative medicines in our public health and primary healthcare in Ghana, we recommend collaboration between complementary alternative and conventional medical practitioners for improvement of quality of life the consumers. We are of the view that, unhealthy competition between the two medical systems should be controlled.

Experiences and Perceptions Toward Integrative, Complementary, and Alternative Medicine Among Conventional Medicine Practitioners of Mangalore, India

ObjectivesThe purpose of this study was to identify experiences and perception of conventional (Western, allopathic) medical practitioners toward integrative, complementary, and alternative medicine (ICAM). MethodsThere 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. ResultsOf 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). ConclusionMost participants recommended ICAM to their patients and also reported personal usage of the same.

Are personal values associated with preferences in seeking health advice or treatment in Europe?

ABSTRACTThis study examined the associations of personal value priorities and country-level personal freedom with individuals’ preferences to seek health advice or treatment from either conventional medical experts (doctors) or practitioners of complementary and alternative medicine (CAM). Data came from the European Social Survey round 2 (14 countries, N = 21,810) and round 7 (12 countries, N = 20,903). Valuing conservation (vs. openness to change) was positively associated with preferring to consult doctors and negatively associated with preferring to consult CAM practitioners and the use of CAM treatments. Valuing self-transcendence (vs. self-enhancement) was positively associated with CAM use. Living in countries characterised by a higher level of personal freedom was negatively associated with preferring doctors’ consultations, and positively associated with preferring CAM practitioners and CAM use. The results highlight the importance of considering individual-level motivational factors and context-specific factors when aiming to understand healthcare utilisation.

Profiles of traditional healers and their healing practices in the Eastern Cape province of South Africa

BackgroundDespite the widespread use of traditional healers in the management of mental health problems among South Africans, there is a knowledge gap in their practices that needs to be narrowed in order to develop a more collaborative and integrated mental health system. There is a need to better understand traditional practices from the perspective of the healers themselves and how these align with Western approaches.AimWe specifically explored the journey towards becoming a traditional healer, the types of interventions and key practices in the management of mental disorders, and the extent to which traditional healers collaborate with conventional medical practitioners.MethodsThis mixed-methods study involved 77 traditional healers who practice in the Eastern Cape province of South Africa. We administered semi-structured interviews to gather data on healer training, experiences and practices. The Patient Health Questionnaire (PHQ-9) was used to screen for depression. All interviews were conducted in isiXhosa at participants’ homes.ResultsMost of the healers were female (80.5%) and only half (49%) had a traditional healing certificate. Healer training typically consisted of six key steps and was mostly facilitated by a non-family member or trainer, as directed by the ancestors. Most healers treated physical illnesses (86%) and called on their ancestors to assist with diagnoses (90%). Only 40% of healers treated mental illnesses. While some healers revealed tensions in working with Western practitioners, the majority were open to collaboration (71%).ConclusionTraditional healers may have an important role to play in the development of culturally-relevant mental health care in South Africa. This study contributes to a greater understanding of what it means to be a traditional healer, and the types of treatment provided. The findings emphasise that conventional mental health practitioners need to make equal effort to collaborate, especially if we are to provide culturally-relevant mental health care in traditional South African settings.

Western herbal medicine consultations for common menstrual problems; practitioner experiences and perceptions of treatment.

To explore the prevalence with which Australian Western herbalists treat menstrual problems and their related treatment, experiences, perceptions, and interreferral practices with other health practitioners. Members of the Practitioner Research and Collaboration Initiative practice-based research network identifying as Western Herbalists (WHs) completed a specifically developed, online questionnaire. Western Herbalists regularly treat menstrual problems, perceiving high, though differential, levels of effectiveness. For menstrual problems, WHs predominantly prescribe individualised formulas including core herbs, such as Vitex agnus-castus, and problem-specific herbs. Estimated clients' weekly cost (median=$25.00) and treatment duration (median=4-6months) covering this Western herbal medicine treatment appears relatively low. Urban-based women are more likely than those rurally based to have used conventional treatment for their menstrual problems before consulting WHs (p=.001). Only 19% of WHs indicated direct contact by conventional medical practitioners regarding treatment of clients' menstrual problems despite 42% indicating clients' conventional practitioners recommended consultation with WH. Western herbal medicine may be a substantially prevalent, cost-effective treatment option amongst women with menstrual problems. A detailed examination of the behaviour of women with menstrual problems who seek and use Western herbal medicine warrants attention to ensure this healthcare option is safe, effective, and appropriately co-ordinated within women's wider healthcare use.

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.

Process of care in outpatient Integrative healthcare facilities: a systematic review of clinical trials.

BackgroundPatients currently integrate complementary medicine (CM) and allopathic, choosing a combination of therapies rather than a single therapy in isolation. Understanding integrative healthcare (IHC) extends beyond evaluation of specific therapies to encompass evaluations of multidisciplinary complex interventions. IHC is defined as a therapeutic strategy integrating conventional and complementary medical practices and practitioners in a shared care setting to administer an individualized treatment plan. We sought to review the outcomes of recent clinical trials, explore the design of the interventions and to discuss the methodological approaches and issues that arise when investigating a complex mix of interventions in order to guide future research.MethodFive databases were searched from inception to 30 March 2013. We included randomized and quasi-experimental clinical trials of IHC. Data elements covering process of care (initial assessment, treatment planning and review, means for integration) were extracted.ResultsSix thousand two hundred fifty six papers were screened, 5772 were excluded and 484 full text articles retrieved. Five studies met the inclusion criteria. There are few experimental studies of IHC. Of the five studies conducted, four were in people with lower back pain. The positive findings of these studies indicate that it is feasible to conduct a rigorous clinical trial of an integrative intervention involving allopathic and CM treatment. Further, such interventions may improve patient outcomes.ConclusionsThe trials in our review provide a small yet critical base from which to refine and develop larger studies. Future studies need to be adequately powered to address efficacy, safety and include data on cost effectiveness.

Public reaction to direct-to-consumer online genetic tests: Comparing attitudes, trust and intentions across commercial and conventional providers

The success of personalised medicine depends upon the public's embracing genetic tests. Tests that claim to predict an individual's future health can now be accessed via online companies outside of conventional health regulations. This research assessed the extent to which the public embrace direct-to-consumer (DTC) genetic tests relative to those obtained by a conventional medical practitioner (MP). It also examined the reasons for differences across providers using a randomised experimental telephone survey of 1000 Australians. Results suggest that people were significantly less likely to approve of, and order a DTC genetic test administered by a company compared to a MP because they were less trusting of companies' being able to protect their privacy and provide them with access to genetic expertise and counselling. Markets for DTC genetic tests provided by companies would therefore significantly increase if trust in privacy protection and access to expertise are enhanced through regulation.

Exploring clients’ experiences of craniosacral therapy: A qualitative study (2012)

Introduction: Current social and political factors are influencing the need for research within the field of Complementary and Alternative Medicine (CAM) and more specifically Craniosacral Therapy (CST). CST is one of a number of ‘body based’ or energy medicine practices which aim to support the body's natural healing mechanisms. The mindset of practitioners and their beliefs about health, illness and bodily functions are different from those of conventional medical practitioners. It was essential to identify what outcomes and changes are important to clients having CST. There is limited published literature and gaps remain in understanding and knowledge surrounding CST. Aims – Research Questions: What changes do clients experience whilst engaging in the CST process? What outcome measure would be suitable for a body based therapy such as CST? Methods: Qualitative study based on constant comparative methods informed by grounded theory. Semi-structured interviews explored clients’ experiences. Inductive thematic analysis resulted in themes, concepts and vignettes. Participants: Purposive sample of 29 (over 16 years old; had received six sessions or more of CST within a 12 month period). Results: Four thematic areas were identified. Expectations of CST: Participants reported seeking a solution for pain relief, emotional and psychological issues, rehabilitation and stress relief. Changes and outcomes: Participants all described positive changes in health related quality of life. These changes were categorised into three domains body, mind and spirit. Most described positive change in more than one domain. Participants described how health status could change in three ways, reduction of symptoms (either sustained or temporary), recovery or complete resolution of symptoms and reassessment of the problem. No serious adverse affects were described. The CST Process: Participants reported their experiences, including altered states of consciousness, increased awareness, other specific sensations and emotions; and the value of the therapeutic relationship. The implementation of CST: Participants reported barriers to accessing CST, resolving scepticism, how CST was implemented. Overarching theme identified; increased awareness was underlying the themes in two of the four thematic areas and proved an important mechanism in the process of change. Outcome measures: measures commonly used in CAM were appraised against the outcomes reported: Warwick-Measure Your Medical Outcome Profile 2 (MYMOP2), Short Form-36v2 (SF-36) and Harry Edwards Healing Impact Questionnaire (HEHIQ). None of the measures cover all outcomes identified; each has advantages and disadvantages. Discussion: Awareness seems to be the medium that links the themes changes and outcomes and CST processes. Participants’ perspectives changed in regard to their health status and interrelatedness of body, mind and spirit; utilising new skills of awareness allowed participants to notice processes in body, mind and spirit and in their interactions with self and others. Changes were identified in six domains including self-concept; mind-body-spirit links; psycho/emotional aspects; adoption of coping strategies; undertaking self-care and improved interpersonal relationships. The emerging theory was that the process of CST can bring about change experienced as recovery, relief and reduction of symptoms by fostering new levels of understanding and awareness of body mind and/or spirit and their interrelationships.

Are the CAM professions engaging in high-level health and medical research? Trends in publicly funded complementary medicine research grants in Australia

Developing research capacity is an essential part of professional development in the health professions, as well as essential to improving health care delivery. CAM is one area in which the importance of research capacity has been previously highlighted. To determine whether academic and research CAM practitioners were actively engaged in high-level CAM research in Australia successful National Health and Medical Research Council grants data for projects starting between 2000 to present (2013) were collated and analyzed. CAM practitioners are not involved in most NHMRC-funded research, with non-clinical academics leading nearly half of all NHMRC-funded CAM grants. Conventional medical practitioners led the majority of CAM grants headed by clinicians. Only Chinese medicine and naturopathy practitioners appear to be building capacity, with NHMRC-funded CAM grants led by these practitioner groups increasing. University CAM faculties are for the most part not engaging in high level research, with most NHMRC-funded CAM projects being led by groups outside these faculties. Even the majority NHMRC-funded research led by CAM clinicians is administered outside university CAM faculties. The CAM professions have a low level of engagement with high-level health and medical research in Australia. Current levels of engagement appear to be dependent more on individual clinician involvement rather than professional strategy. Failure to engage with high-level health and medical research may pose challenges for the CAM professions, unless research engagement is improved. This requires an active and concerted effort from within CAM ranks to build research capacity in the CAM professions.

Attitudes and Practices of Massage Therapists as Related to Conventional Medicine

Research into opinions about complementary and alternative medicine (CAM) has focused on conventional medical practitioners with little exploration of CAM practitioners' views. To survey attitudes and practices of massage therapists toward conventional medicine. An anonymous online survey consisting of Likert-type scales, fill-in answers, and multiple-choice questions was used. Members of the Associated Bodywork & Massage Professionals (ABMP), the largest massage therapy association in the US with over 77,000 members. Participants were asked about their years of practice and training, choice of health care practitioners, sources for information about CAM and Western/allopathic medicine, client referral patterns, optimal treatment approaches for various medical conditions, and overall impressions of CAM and Western/ allopathic medicine. Analysis of n = 3,148 responses indicated that while 66.9% of respondents had a neutral or worse impression of Western/allopathic medicine, 64.3% use a conventional medicine practitioner as their primary health care provider, 61.9% have referred clients to a conventional medicine practitioner in the past six months, and 90.5% seek out information on Western/allopathic medicine. The mode response of the best treatment approach to various medical problems was a mix of Western/allopathic medicine and CAM. This study suggests that despite the ambivalence of many massage therapists towards conventional medicine, many use it, encourage clients to do so, and see involvement of both as crucial to health.

The Use of Intuition in Homeopathic Clinical Decision Making: An Interpretative Phenomenological Study

While intuition plays a role in clinical decision making within conventional medicine, little is understood about its use in complementary and alternative medicine (CAM). The aim of this qualitative study was to investigate intuition from the perspective of homeopathic practitioners; its' manifestation, how it was recognized, its origins and when it was used within daily clinical practice. Semi-structured interviews were carried out with clinically experienced non-National Health Service (NHS) UK homeopathic practitioners. Interpretative phenomenological analysis was used to analyze the data. Homeopaths reported many similarities with conventional medical practitioner regarding the nature, perceived origin and manifestation of their intuitions in clinical practice. Intuition was used in two key aspects of the consultation: (i) to enhance the practitioner-patient relationship, these were generally trusted; and (ii) intuitions relating to the prescribing decision. Homeopaths were cautious about these latter intuitions, testing any intuitive thoughts through deductive reasoning before accepting them. Their reluctance is not surprising given the consequences for patient care, but we propose this also reflects homeopaths' sensitivity to the academic and medical mistrust of both homeopathy and intuition. This study is the first to explore the use of intuition in decision making in any form of complementary medicine. The similarities with conventional practitioners may provide confidence in validating intuition as a legitimate part of the decision making process for these specific practitioners. Further work is needed to elucidate if these findings reflect intuitive use in clinical practice of other CAM practitioners in both private and NHS (i.e., time limited) settings.

Perceived Benefit of Complementary and Alternative Medicine (CAM) for Back Pain: A National Survey

Complementary and alternative medicine (CAM) is commonly used to treat back pain, but little is known about factors associated with improvement. We used data from the 2002 National Health Interview Survey to examine the associations between the perceived helpfulness of various CAM therapies for back pain. Approximately 6% of the US population used CAM to treat their back pain in 2002. Sixty percent of respondents who used CAM for back pain perceived a "great deal" of benefit. Using multivariable logistic regression, the factor associated with perceived benefit from CAM modalities was reporting that a reason for using CAM was that "conventional medical treatment would not help" (odds ratio [OR], 1.46; 95% CI, 1.14-1.86). The 2 factors associated with less perceived benefit from CAM modalities were fair to poor self-reported health status (OR, 0.58; 95% CI, 0.41-0.82) and referral by a conventional medical practitioner for CAM (OR, 0.7; 95% CI, 0.54-0.92). Using chiropractic as a reference, massage (OR, 0.62; 95% CI, 0.46-0.83), relaxation techniques (OR, 0.25; 95% CI, 0.14-0.45), and herbal therapy (OR, 0.3; 95% CI, 0.19-0.46) were all associated with less perceived benefit whereas those with similar perceived benefit included yoga/tai chi/qi gong (OR, 0.71; 95% CI, 0.41-1.22) and acupuncture (OR, 0.71; 95% CI, 0.37-1.38). The majority of respondents who used CAM for back pain perceived benefit. Specific factors and therapies associated with perceived benefit warrant further investigation.