Role Of Complementary And Alternative Medicine Research Articles

Complementary and alternative medicine use during the COVID-19 pandemic: Community pharmacists' knowledge, attitudes, and practices.

The challenges in COVID-19 treatment have driven patients to seek Complementary and Alternative Medicine (CAM) for the prevention and/or treatment of the disease. Pharmacists are uniquely positioned to promote the effective and safe use of CAM. Assess the beliefs, practices, and knowledge of community pharmacists in Lebanon about existing evidence for the use of CAM for the prevention and/or treatment of COVID-19. A national cross-sectional survey was conducted among community pharmacists during the COVID-19 pandemic in Lebanon (n=310 respondents). Participants completed an online questionnaire addressing, in addition to the socio-demographic characteristics; the beliefs, practices, and knowledge of pharmacists regarding the existing evidence of CAM use for COVID-19 prevention and/or treatment. Pharmacists (70%) received frequent inquiries about CAM for COVID-19 prevention or treatment. Only 25.5% of the pharmacists reported having enough time to get information about CAM and COVID-19. Almost all participants believed that pharmacists have a major role in the fight against COVID-19 (98%) and that they have enough information to counsel patients in that regard (75%). For practices, the majority of pharmacists reported counseling their patients on proper use (98%) and possible adverse reactions (93%) of CAM, but only 51% reported toxic or undesirable effects. Regarding knowledge, although most pharmacists answered correctly the questions on the role of CAM in preventing COVID-19, few knew about its role in treating the infection. Pharmacists who trust the WHO website as a credible source had a higher knowledge score (β=0.52, 95%CI: 0.05-0.986). The positive beliefs and practices of pharmacists towards CAM during the pandemic were coupled with a few gaps, especially in their knowledge about existing evidence for CAM use. Concerted efforts ought to be dedicated to supporting pharmacists in playing a more prominent role during health crises such as the COVID-19 pandemic.

Opinions and experiences of physicians regarding complementary and alternative medicine (CAM). A research report from Poland

Background: The term CAM denotes complementary and alternative medicine. However, CAM is practiced by individuals without academic medical education and formal eligibility for treating people. The extent of interest in CAM is considerable. The WHO global report on traditional and complementary medicine has demonstrated that 87% of all WHO Member States legally recognise individual forms of CAM, and 100 Member States have national policies regarding such practices. In Poland, performing medical activities without appropriate qualifications is prohibited.
 Material and Methods: Diagnostic survey distributed as Google Forms was used as the basic research method with the research technique of a questionnaire. The questionnaire starting with a metrics part consisted of several questions regarding popularity and tendency of CAM, causes of CAM popularity, approach to those types of practices and patients as well as role of CAM during the pandemic. Sixty-one responses were obtained from physicians of different age, experience and speciality.
 Results: Ninety-five percent (95%) of doctors believe that alternative medicine can be dangerous; 67.2% think that the phenomenon of alternative medicine should be combated; almost half of the physicians surveyed believe that there is a fundamental contradiction between evidence-based medicine (EBM) and alternative medicine. Furthermore, according to 48% of respondents, physicians in Poland should be able to recommend and combine methods of traditional and alternative medicine.
 Conclusion: Doctors point to the increasing popularity of CAM among patients in Poland, the consequences of which cannot be determined because there is still a lack of research on the safety of alternative methods. The most frequently cited reasons for interest in CAM suggest that there is a need for a better tailored biomedical approach to individual patient needs.

Complementary and Alternative Medicine Usage and Yoga Practice in Patients with Metastatic Breast Cancer

Metastatic breast cancer has a poor prognosis, and many patients practice yoga or use other complementary and alternative medicine (CAM) in their healthcare. CAM has risks and benefits, and it will be useful to understand the role of CAM integrated with conventional treatments such as chemotherapy and radiation. Patients with metastatic cancer may respond differently to CAM than those without metastases, and less literature has addressed disease progression in this regard. This short review will attempt to address CAM usage in patients with breast cancer, focused on metastatic disease. The review will address some geographical and cultural differences in CAM usage, benefits of yoga for this patient population to improve quality of life, and highlight study limitations and implementation.

On the edges of medicine \u2013 a qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations

BackgroundIn routine practice, general practitioners (GPs) see many patients for whom treatment might not be necessary, or evidence-based treatments are not available, yet often a treatment is prescribed. We denote such situations as therapeutically indeterminate. We aimed to investigate 1) whether therapeutically indeterminate situations play a role in the accounts of GPs in their practical work; 2) the role of complementary and alternative medicine (CAM) modalities or non-specific therapies, and of other strategies used in handling therapeutically indeterminate situations; and 3) factors associated with preferences for specific strategies.MethodsWe performed semi-structured, individual face-to-face interviews with 20 purposively sampled, experienced GPs from Bavaria, Germany. A grounded theory approach was used for data analysis.ResultsParticipants reported that therapeutically indeterminate situations recur often in their daily practice. Professionally legitimate strategies such as empathetic consultations without providing a treatment intervention did not seem to suffice for coping with all of these situations. CAM treatments were used frequently, but motives varied. While some participants were convinced that these treatments were active and effective, others were uncertain or had doubts and used them as a relational tool, as a non-specific treatment or as a beneficial placebo. Conventional drugs were also used in a non-specific manner or despite doubts regarding the risk-benefit ratio. The extent to which GPs felt responsible for offering solutions in therapeutically indeterminate situations seemed to influence their preference for specific strategies.ConclusionOur results demonstrate the important role of CAM and the somewhat smaller role of non-specific therapies for German general practitioners in dealing with therapeutically indeterminate situations. The concept of therapeutically indeterminate situations may be helpful in better understanding why many general practitioners treat patients in situations where treatment does not appear to be clearly indicated.

Use of Complementary and Alternative Medicine in Women With Heart Disease, Hypertension and Diabetes (from the Australian Longitudinal Study on Women's Health)

The uptake of complementary and alternative medicine (CAM) is common, especially among patients with chronic illness. However, the use of CAM by women with cardiovascular disease and how this influences the interface with conventional medicine is poorly understood. To examine the relation between heart disease, hypertension, and diabetes and the use of CAM and conventional medicine in a cohort of women, data were taken from the 2010 survey (n=9,748) of the 1946 to 1951 cohort of the Australian Longitudinal Study on Women's Health (ALSWH). Analyses focused on women who had been diagnosed or treated for heart disease, diabetes, and/or hypertension. The outcome measures were the use of conventional or CAM treatments in the previous year. Most women had hypertension only (n= 2,335), and few (n= 78) reported having heart disease, hypertension, and diabetes. Women with hypertension were less likely (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74 to 0.91) to consult with a CAM practitioner and less likely (OR 0.86, 95% CI 0.77 to 0.97) to use self-prescribed CAM, while women with diabetes were also less likely (OR 0.66, 95% CI 0.54 to 0.81) to consult with a CAM practitioner and less likely (OR 0.68, 95% CI 0.55 to 0.83) to use self-prescribed CAM. In conclusion, compared with studies conducted on CAM use and other chronic illness groups, the use of CAM by women with heart disease, hypertension, and/or diabetes in this study was lower, and future research is needed to explore patients' perceptions of cardiovascular risk and the role of CAM in their self-management in the community, among other issues.

The Role of CAM in Public Health, Disease Prevention, and Health Promotion.

As the worldwide burden of chronic disease continues to rise, disease prevention and health promotion become increasingly important components of public health. Although many complementary and alternative medicine (CAM) practices have emphasized health promotion and the area of CAM health care holds much opportunity and challenge for issues of public health, CAM research to date has been dominated by more clinically restrictive issues [1, 2]. However, CAM practitioners can constitute a public health resource to increase the population's access to certain clinical preventive services if integrated into mainstream public health practice. As part of this integration of CAM practices, it is important to investigate methods of effective interprofessional collaboration involving both CAM and mainstream professions. It is also essential to identify issues that might be challenging to integration from the perspective of both mainstream and CAM providers such as professional biases on both sides, differences in perception of health and disease, common language, and adherence to evidence-based principles. This special issue includes original research papers and systematic reviews investigating the issues related to CAM practices in the public health arena as well as outcomes of CAM treatment for chronic disease prevention and/or management (tertiary prevention). There are 14 articles in this issue, from six countries and on a wide variety of topics. The topics addressed are almost equally divided between treatment of specific conditions of public health importance and disease prevention through risk factor reduction. A smaller number of articles address issues related to traditional medicine use among the general public. Articles on treatment of conditions include a large clinical study by J.-F. Tang et al. on safety and evaluation of Danhong injection; a basic science study on Brucea javanica oil by Y. Liu et al.; a systematic review and meta-analysis of the efficacy of compound kushen on cancer pain by X. Ma et al.; an analysis of Qigong's effect on chronic fatigue syndrome by L. P. Yuen et al.; a systematic review of acupuncture for allergic rhinitis and asthma by L. Zhou et al.; and an analysis of the effects of guided imagery on patients on mechanical ventilation by B. Brakovich et al. Articles on prevention and risk factor reduction were a randomized controlled trial of Tai Chi on weight loss, metabolic syndrome, and bone mineral density by T. C.-Y. Kwok et al.; an analysis of body constitution through Traditional Chinese Medicine by C.-H. Lee et al.; a survey of apitherapy use for disease prevention by S. Trumbeckaite et al.; an exploration of the possible effect of CAM on antibiotic resistance by W. B. V. Leeuwen et al.; and a survey of the effect of Traditional Chinese Medicine on decreasing stroke risk among users of corticosteroids for dermatitis by J.-L. Shen et al. Finally, F. Xu et al. described the validation of a questionnaire based on Traditional Chinese Medicine to assess health status; S. H. Ng et al. described use of the Theory of Planned Behaviour related to Traditional Chinese Medicine use; and G. D. Hughes et al. characterized the use of herbal medicines for noncommunicable disease. These articles tended to focus more on single herbal or other traditional preparations or procedures for both treatment and prevention, with very little emphasis on health behaviour, which is typically a cornerstone of public health programs. Behaviours related to diet, physical activity, and stress reduction are known to be increasingly important factors in determining the health of the public and are also areas of importance and emphasis for many CAM practitioners. It is necessary for CAM professions to become visible in this arena and for CAM research to extend into this direction rather than focusing narrowly on specific therapies if these efforts are to be recognized and utilized for the benefit of populations. Cheryl Hawk Jon Adams Jan Hartvigsen

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers

BackgroundComplementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care.MethodsHealth service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women’s health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage.ResultsFindings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach.ConclusionsFrom the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services.

A Short Review: Complementary and Alternative Medicine in Lung Cancer

Complementary and alternative medicine (CAM) is a growing field that has started to integrate itself into the management of many diseases and disorders, including cancer. As more patients continue to incorporate the use of CAM into their treatment plans, it is important to understand the mechanism and clinical effectiveness of CAM. This review focuses on the role of CAM in lung cancer, including the available research trials that have focused on evaluating symptom control, quality of life, and survival rates in lung cancer patients. We have also reviewed the potential risks and benefits of several CAM medications as well as the future direction of this field.

Use of Complementary and Alternative Medicine Among Children, Adolescent, and Young Adult Cancer Survivors

The main objective of this study was to investigate the prevalence of complementary and alternative medicine (CAM) use, types and reasons for use, and determinants of use among survivors of childhood cancer. An interviewer-based survey of CAM use was administered to 197 survivors or their guardians. Demographic data, CAM therapies used, purpose and referral for use, and communication about use was collected. A total of 115 (58%) survivors reported using CAM in survivorship, 72% of which used biologically based therapies. The majority of therapies were used for relaxation and stress management (15%), referred for use by the parent (25%), reported as very effective (62%), and initiated 0 to 4 years after completion of cancer treatment (41%). Among CAM users, young adults used manipulative and body-based therapies [odds ratio (OR)=3.3; 95% confidence interval (CI), 1.4-7.8] and mind-body therapies (OR=2.8, 95% CI: 1.2-6.4) more than children. Use of mind-body therapies was associated with not attending religious services regularly (OR=2.4; P<0.01). Half (51%) of all CAM therapies were disclosed to the physician. Survivors of childhood cancer frequently use CAM for health promotion and mitigation of physical and psychological conditions. Clinicians should consider the role of CAM in the adoption of healthy lifestyles among this population.

Role of Complementary and Alternative Medicine in Cardiovascular Diseases

Role of Complementary and Alternative Medicine in Cardiovascular Diseases

27 The Role of CAM (Complementary and Alternative Medicine) in the Cancer Setting – The Different Perspectives of Patients, Oncology Professionals and CAM Practitioners

27 The Role of CAM (Complementary and Alternative Medicine) in the Cancer Setting – The Different Perspectives of Patients, Oncology Professionals and CAM Practitioners

Patterns and Determinants of Complementary and Alternative Medicine Practitioner Use among Adults with Diabetes in Queensland, Australia.

There is evidence that complementary and alternative medicine (CAM) use is common among people with diabetes. The role of CAM in the treatment or management of diabetes is an emerging health issue given the potential side effects and benefits associated with the use of this kind of medicine. This paper examined patterns and determinants of CAM practitioner use in Queensland, Australia, using a large population-based sample of people with type 1 and type 2 diabetes. The study found that within a 12-month period, 7.7% of people with diabetes used the services of CAM practitioners alongside or as a complement to conventional health care service. Younger age, female gender, a higher education, having private health insurance, and engagement in preventive health behaviours are significant predictors of individuals who are more likely to visit a CAM practitioner. There was no significant difference in CAM practitioner use between people with type 1, type 2 insulin requiring, or type 2 noninsulin requiring diabetes. The findings highlight the need for further research on the role of CAM in the prevention and management of diabetes.

What does integrative medicine mean to the physician and the ministry of health and welfare?

Our aging society, rapid growth of diseases resulting from unhealty habits, frequent occurrences of sickness, and variations in the awareness of health by patients, the worldwide need for integrative medicine, which means the incorporation and integration of complementary and alternative medicine (CAM) into conventional medical systems, is growing rapidly. The most widely available forms of CAM in the treatment of diseases in the U.S. and Europe are acupuncture, chiropractic, phytomedicine (western herbal medicine), mind-body therapies, and nutrition therapy. The well-known hospitals in the U.S. and in Europe (e.g., Harvard, Memorial SloanKettering Cancer Center, Duke, Maryland, Essen, and Humboldt) are offering integrative medicine. The clinical practices as well as the education on CAM of medical schools is becoming more widespread in Korea. It is critical for us as physicians to be aware that the role of CAM is to support and complement conventional medicine, not to substitute for it. To manage chronic diseases effectively, it is imperative for physicians to incorporate and integrate Korean oriental medicine as well as CAM into the conventional medical systems. It is the duty of the medical universities and hospitals to integrate care delivery proven by CAM therapies into the conventional medicine and to develop the standard curriculum for integrative medicine at the undergraduate and graduate levels. To globalize Korean oriental medicine and to scientifically prove the efficiency of CAM, the role of integrative medicine is critical. One of the most important roles of the Ministry of Health and Welfare is to support the hospitals in which integrative medicine is systematically practiced and financially supported. In order to successfully accomplish integrative medicine in Korea, it is important to not only establish an integrative medicine center, but to also develop the contents and clinical pathway along with legal systems regarding integrative medicine with the support of the specialists in the field of integrative medicine.

Patients' views of CAM as spiritual practice

Objectives This paper explores Danish cancer patients’ narratives on spiritual beliefs, practices and the relationship these practices may have to complementary and alternative medicine (CAM). Design Narrative inquiry was used to understand how spiritual beliefs and practices might be related to CAM. Thirty-two cancer patients, family, friends and alternative practitioners were followed up over a two year period by face to face interview, telephone and focus groups. Results Although religious and spiritual issues were not manifestly expressed by many of the subjects, these issues were significantly elaborated upon in narratives by four female participants to warrant more detailed consideration and analysis. Conclusion It is suggested that for some cancer patients CAM may function, not just as a treatment for cancer related symptoms and side effects, but also as a form of spiritual practice. For some individuals a belief in the ‘spiritual’ role of CAM per se may be analogous to religious belief.

CAM-education in the medical curriculum: Attitude towards and knowledge of CAM among Dutch medical students

Aim of the study The purpose of the study was to investigate the attitudes and knowledge of medical students towards complementary and alternative medicine (CAM) at Dutch medical schools. The increased use of CAM and the changing perspectives of the Royal Dutch Medical Association (RDMA) on medical education and CAM raised the question what medical students think about CAM and its place in the medical curriculum. Materials and methods In total 10,532 RDMA student members from all Dutch medical schools were invited to complete a questionnaire by email. Participants were asked to state their attitude and knowledge about CAM, and the role of CAM in the medical curriculum. Results The response rate was 19% ( N = 2004). Students of all medical schools responded equally. Student's average age was 22.0 years (SD: 3.0) and 72.4% was female. Further, 74.2% indicated that their knowledge about CAM is limited and two-thirds (62%) emphasized the importance of CAM education in the medical curriculum. One-third (35.7%) of the students would like CAM to be part of the core medical curriculum. More than three-quarters of the students (76.9%) indicated that doctors should have knowledge about CAM. The majority of respondents (83.0%) answered that doctors should be able to give patients objective information about CAM. Seventy percent (69.9%) stated that more research should be performed on the effectiveness and safety of CAM. Conclusions The results show that medical students in the Netherlands have a positive attitude towards CAM as well as its place in the medical curriculum.

Complementary and alternative medicine (CAM) use among cancer patients in community oncology settings.

e19544 Background: Previous surveys of CAM use in oncology have primarily been conducted at comprehensive cancer centers and other major medical centers. The prevalence and attitudes towards CAM in community oncology settings is unknown. Methods: We are conducting an educational intervention within the M. D. Anderson CCOP network to encourage oncology nurses to discuss CAM use with their patients. Here we provide baseline data on the frequency of and reasons for CAM use and how often CAM was discussed with oncology health care practitioners. Participants included 566 cancer patients from 36 CCOP component sites. Questionnaires were completed immediately following the patient's oncology visit. Results: Patients were 65% female, 86% non-Hispanic white, average age of 59 (range 23-88), and 30% had a college degree or higher. The most common cancers were breast cancer (31%), lung cancer (12%), and colorectal cancer (10%). Time since initial cancer diagnosis was 1.96 years and 28% had a cancer recurrence. Thirty-nine percent indicated that they have used one or more CAM therapies following their cancer diagnosis. Reasons for using CAM included: believes CAM beneficial (27%), to address the emotional and spiritual aspects of the disease (23%), and to boost immune system (21%). The most common categories of CAM used by patients were massage therapy (19%), relaxation techniques (19%), special diet (18%) and megavitamins (15%). Patients indicated that 9% of their physicians and 12% of nurses had asked them about their use of CAM at that oncology visit. Twenty-one percent of patients reported that they initiated a discussion with their providers about their use of CAM and the most common responses were: encouraged me to continue (13%) and was neutral (7%). Reasons for not telling health care practitioners about CAM use included: my health care provider never asked (27%) and unsure if CAM beneficial (18%). Conclusions: More than one-third of patients indicated that they used some type of CAM therapy and the majority of their providers did not ask them about their CAM use. There remains considerable uncertainty among patients about the role of CAM in the context of cancer care. No significant financial relationships to disclose.

The role of complementary and alternative medicine (CAM) in Germany – A focus group study of GPs

BackgroundThere has been a marked increase in the use of complementary and alternative medicine (CAM) in recent years worldwide. In Germany, apart from 'Heilpraktiker' (= state-licensed, non-medical CAM practitioners), some general practitioners (GPs) provide CAM in their practices. This paper aims to explore the attitudes of GPs about the role of CAM in Germany, in relation to the healthcare system, quality of care, medical education and research. Furthermore, experiences of GPs integrating CAM in their daily practice were explored.MethodsUsing a qualitative methodological approach 3 focus groups with a convenience sample of 17 GPs were conducted. The discussions were transcribed verbatim and analysed using qualitative content analysis.ResultsThe majority of the participating GPs had integrated one or more CAM therapies into their every-day practice. Four key themes were identified based on the topics covered in the focus groups: the role of CAM within the German healthcare system, quality of care, education and research. Within the theme 'role of CAM within the healthcare system' there were five categories: integration of CAM, CAM in the Statutory Health Insurance, modernisation of the Statutory Health Insurance Act, individual healthcare services and 'Heilpraktiker'. Regarding quality of care there were two broad groups of GPs: those who thought patients would benefit from standardizing CAM and those who feared that quality control would interfere with the individual approach of CAM. The main issues identified relating to research and education were the need for the development of alternative research strategies and the low quality of existing CAM education respectively.ConclusionThe majority of the participating GPs considered CAM as a reasonable complementary approach within primary care. The study increased our understanding of GPs attitudes about the role of CAM within the German healthcare system and the use of 'Heilpraktiker' as a competing CAM-provider. It seems to be a need for increased funding for research, better education and remuneration by the Statutory Health Insurance in order to improve access to 'Integrative medicine' in Germany.

Capturing the value of complementary and alternative medicine: Including patient preferences in economic evaluation

Complementary and alternative medicine (CAM) is growing in popularity among patients, for an increasing range of conditions. However, current provision of CAM in the National Health Service in the UK is limited, patchy and disparate, which results in considerable inequity and patient unease. This has led to an escalation in the debate about the role of CAM within the NHS. Lack of evidence about the cost effectiveness of CAM therapies compared with other forms of care is often cited as the main reason for the reluctance of funders to integrate CAM into mainstream service provision. Cost-effectiveness relies on evidence about costs and benefits. Cost data are relatively straightforward to collect but it has proved difficult to value the complete package of benefits offered by CAM, likely to be both process and outcome based, in a way that can be compared with alternatives. Stated preference discrete choice modelling (SPDCM), a method of healthcare evaluation growing in popularity, uses information about patient preferences to identify the important characteristics of an intervention or method of delivering care and how patients value these. SPDCM is a method that could be used to evaluate the 'added value' provided by CAM and thus supply evidence on cost-effectiveness that policy makers could use in configuring service provision.

Academic doctors' views of complementary and alternative medicine (CAM) and its role within the NHS: an exploratory qualitative study.

BackgroundThere has been a marked increase in the use of complementary and alternative medicine (CAM) in the UK population in recent years. Surveys of doctors' perspectives on CAM have identified a variety of views and potential information needs. While these are useful for describing the proportions of doctors who hold particular attitudes towards CAM, they are less helpful for understanding why. In addition, while the views of non-academic doctors have begun to be studied, the perspective and rationales of academic doctors remains under-researched. It seems important to investigate the views of those with a research-orientation, given the emphasis on the need for more scientific evidence in recent debates on CAM.MethodsThis exploratory study used qualitative methods to explore academic doctors' views of CAM and the rationales they provided for their views. A purposeful sampling strategy was used to identify doctors with a dual clinical and academic role in the Bristol area, with an anticipated variety of views on CAM. Semi-structured interviews were conducted with nine doctors. The data were analysed thematically, drawing on the Framework Approach.ResultsThe doctors expressed a spectrum of views on CAM, falling into three broad groups: the 'enthusiasts', the 'sceptics' and the 'undecided'. Scepticism or uncertainty about the value of CAM was prominent, except among those practising a form of CAM. A variety of rationales underpinned their perspectives on CAM, a key recurring rationale being their perspective on the scientific evidence base. The main themes arising included: the role of doctors' professional experiences of conventional medicine and CAM in shaping their attitudes towards CAM, doctor-patient communication about CAM and patient disclosure, whether there is a need for training and education in CAM for doctors, a hierarchy of acceptability of CAM and the nature of evidence; and the role of CAM within the NHS.ConclusionDespite the caution or scepticism towards CAM expressed by doctors in this study, more open doctor-patient communication about CAM may enable doctors' potential concerns about CAM to be addressed, or at least enhance their knowledge of what treatments or therapies their patients are using. Offering CAM to patients may serve to enhance patients' treatment choices and even increase doctors' fulfilment in their practice. However, given the recurring concerns about lack of scientific evidence expressed by the doctors in this study, perceptions of the evidence base may remain a significant barrier to greater integration of CAM within the NHS.

Use of complementary and alternative medicine in children: too important to ignore.

There is evidence that complementary and alternative medicine (CAM) is commonly being used for Australian children, however, at the same time, many doctors have little interest or understanding of the topic. Just as with mainstream treatments, CAM therapies have significant potential for adverse effects and drug interactions. Some of these are potentially serious. The use of CAM therapies in children is not an occasional fringe activity, and evidence suggests its usage will increase further. Whatever one's own views on the role of CAM in childrens health care, the topic is important and it should not be ignored.