From Rivalry to Rapproachement: Biomedicine, Complementary Alternative Medicine (CAM) at Ethical Crossroads

Against the backdrop of the political intrigue in biomedicine’s ascendancy to orthodoxy, this article examines its contemporary rapprochement with Complementary Alternative Medicine (CAM), in the move toward an integrated medical regime. It also identifies and explores factors underlying the rapprochement, as well as different ethical challenges that face integrated medicine. It argues that a major approach to tackling these challenges hinges on devising just and equitable criteria for evaluating the efficacy of plural therapeutic paradigms inherent in CAM models. This is attainable through a policy that encourages creating public health policy and medical personnel deliberately exposed as part of their curriculum to the philosophical and theoretical features of diverse therapeutic traditions.     

Discriminators of Complementary and Alternative Medicine provider use among men with HIV/AIDS

OBJECTIVE: To examine comprehensively the potential correlates of Complementary and Alternative Medicine (CAM) practitioner use among men with HIV/AIDS. METHODS: Men (n=122) recruited from HIV/AIDS service organizations completed extensive written surveys. Questions comprised several domains that have been thought or demonstrated to influence individuals to use CAM, and also addressed respondents' social networks. RESULTS: Discriminant analyses revealed 2 social network variables and 2 attitudinal variables proved statistically significant when controlling for relationships among variables. CONCLUSION: The significant contribution of social influence/social networks in choosing CAM modalities demonstrated has not heretofore been examined in CAM user studies; implications for future research are discussed.     

Use of and Attitudes Toward Complementary and Alternative Medicine Among Family Practice Patients in Small Rural Illinois Communities

CONTEXT: Complementary and alternative medicine (CAM) use continues to increase in the United States. Data on rural patients' use and extent of integration of CAM with conventional medicine are lacking, although this is a population often associated with use of "folk remedies" and self-care strategies. PURPOSE: To examine rural primary care patients' attitudes toward and use of CAM. METHODS: A total of 176 surveys (70% response rate) were returned by patients at 5 geographically dispersed, rural Illinois family practice clinics to examine rural patients' use of, attitudes toward, and experiences with alternative medicine and providers. FINDINGS: Nearly two thirds of patients reported use of alternative medicine. Therapies most often used were vitamins/megavitamins, chiropractic, relaxation, and prayer/faith healing. Rural patients with more medical problems and a higher level of education were more likely to use alternative techniques. Three fifths of the patients felt that their doctor should discuss alternative medicine and therapies with them. CONCLUSIONS: Physician understanding and communication regarding CAM may be especially important in rural areas, where access to care is more limited and where there is greater reliance on the primary care physician as a "gatekeeper" for patient health.     

Complementary and alternative medicine (CAM) in the undergraduate medical curriculum: the Southampton experience

OBJECTIVE: We describe the planning, development and evaluation of a special study module (SSM) on Complementary and Alternative Medicine (CAM) as part of the Southampton Medical School undergraduate curriculum. AIM: To address how the module was received by students, the themes that emerged, the effect on student attitudes to CAM and how the teaching aims developed into learning objectives. METHOD: Student feedback questionnaires and regular teaching staff meetings over a period of 3 years. RESULTS: The course resulted in a significant change in student attitudes to CAM and was well received by the students. It offered a reflective insight into conventional medicine. We have developed and validated core teaching objectives. CONCLUSIONS: We hope that our well validated and well received core teaching objectives will provide a broadly applicable base for those who wish to run similar courses.     

Exploring Predictors of Health Sciences Students’ Attitudes Towards Complementary-Alternative Medicine

This study demonstrated that a less scientific worldview predicted health science (HS) students’ positive attitude towards complementary-alternative medicine (CAM), independently of important background characteristics as gender, pre-college science immersion, age, and type of HS education of the students. A total of 473 students in their final 3rd year of education in the health sciences (nursing, physiotherapy, social educator, and radiography) participated in the study, which was based on a questionnaire consisting of items mapping student background characteristics and their attitudes towards worldview reflecting statements in constructs. The results showed that large fractions of the HS students were positive towards the use of CAM treatments. Multiple regression analysis demonstrated that 24% of the total variance in HS students’ attitudes towards the use of CAM could be accounted for by the indicators of a worldview opposing a scientific one. These indicators were more important predictors of the HS students’ positive attitude towards the use of CAM than the HS students’ background characteristics alone, which accounted for only 2 % of the total variance. HS students’ Paranormal beliefs, and their Willingness to include CAM in HS education were the most important predictors. The study results suggest stronger emphasis on teaching about epistemologies in HS educations.     

Complementary and alternative medicine in Brazil: one concept, different meanings

This article discusses the various meanings ascribed to the concept of Complementary and Alternative Medicine (CAM) in Brazil, where research on this theme has a limited tradition in terms of influences from anthropology, sociology of knowledge and epistemology, and sociology of CAM and clinical medicine. By means of the concepts identified in the literature, we elaborated a table with types of meanings. The terms Alternative Medicine and Complementary Medicine were found in more than one of the types in the table. Alternative Medicine identifies a model of medical practice influenced by the social, political, and economic context and by the logic of scientific production based on opposing pairs. Beginning in the 1980s, the important volume of reflections on official medical practice and the search for other forms of knowledge production led to the creation of the concept of Complementary Medicine. Its meaning is that of a new epistemological form of knowledge production between the official and alternative poles, a set of therapeutic practices, and confusion with the nomenclature for ancillary medical diagnostic tests, referred to in Portuguese as "complementary exams".     

The use of complementary and alternative medicine by women experiencing menopausal symptoms in Bologna

Background  

The present study describes Complementary and Alternative Medicine (CAM) use amongst Italian women transitioning through menopause. Popularity and perceived effectiveness of CAM treatments, use of pharmaceutical medications, characteristics of CAM users, the extent of communication between medical practitioners and women about their use of CAM, and variables associated with CAM use were also investigated.     

How Does Acculturation Affect the Use of Complementary and Alternative Medicine Providers Among Mexican- and Asian- Americans?

Researchers have found that immigrants in the United States gradually relinquish cultural practices and adopt health behaviors similar to native born individuals as they acculturate. Few studies have looked at acculturation and Complementary and Alternative Medicine (CAM) use, particularly ethnic forms of CAM. This study uses data from the 2001 California Health Interview Survey—Complementary and Alternative Medicine (CHIS-CAM) supplement to estimate the prevalence of CAM provider use among Mexican- and Asian- Americans and examine the relationship of acculturation on use. Multinomial logistic regression models were used to predict the probability of provider use based on socio-demographic variables, health status and acculturation. Mexican- and Asian- Americans who have spent more time in the US were more likely to use chiropractors or massage therapists compared to no CAM provider. Both groups were less likely to use ethnic-specific CAM providers with more time in the US compared to chiropractors or massage therapists.     

Health Literacy Considerations for Users of Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) users may present a unique challenge for health literacy. Though the average CAM user is not considered at high risk for limited health literacy, CAM use is multi-faceted and cannot be generalized to a single population. There may be different reasons for use of CAM in place of, or alongside, conventional medicine. Health literacy must be assessed, not only in terms of functional skills, but in the context of personal belief systems. Health literacy can be considered a holistic construct composed of functional, critical, and communicative skills, with the goal of understanding how belief systems and personal philosophy affect medical decision-making.     

Values in complementary and alternative medicine

In recent years so-called Complementary and Alternative Medicine (CAM) practices have made significant political and professional advances particularly in the United Kingdom (UK): osteopathy and chiropractic were granted statutory self-regulation in the 1990s effectively giving them more professional autonomy and independence than health care professions supplementary to medicine; the practice of acupuncture is widespread within the National Health Service (NHS) for pain control; and homoeopathy is offered to patients by a few General Practitioners alongside conventional treatments. These developments have had a number of consequences: one is that both CAM and Conventional and Orthodox Medical (COM) professions have had to reappraise their professional identity. In manual therapy for example, questions have been asked about the differences between physiotherapy, osteopathy and chiropractic, and what the justification is for having separate professions. A wider question concerns the relationship between CAM and COM; are CAM distinct professions or should they, as has happened to a limited extent in the UK, be absorbed into the broader field of ‘Medicine’ or ‘Health Care’ as adjunctive therapies. CAM professions have also had to develop, implement and enforce codes of practice for practitioners and clarify the scope of practice within a profession. At the heart of these issues lies the need to identify and clarify professional values. A key claim of CAM professions is that their practice is distinct and the outcome of treatment at least as effective and in many cases more effective than with conventional therapies. In addition, what counts as effective outcome is often different from conventional medical understanding, involving more subtle humanitarian considerations, for example. Three values are identified as being commonly held across CAM professions. These are: offering ‘natural’ treatment; being patient rather than disease focussed; and being holistic. However, these may not be as distinctive of CAM as is claimed either because the meaning is unclear or because COM professions claim similar values. The paper argues that the values that inform ‘good practice’ and ‘effective outcome’ should be seen as distinct components of professional competence. This has implications for establishing professional identity and codes of practice.     

Delays in Seeking Conventional Medical Care and Complementary and Alternative Medicine Utilization

Objective

To test the association between delays in utilization of conventional medical care and complementary and alternative medicine (CAM) utilization.

Data Source

The 2007 National Health Interview Survey, a cross-sectional nationally representative study of adults aged 18 years and older.

Study Design

Using zero-inflated regression models, delays in utilizing conventional care due to organizational inaccessibility are examined to determine whether delays are associated with both the decision to try CAM and the number of CAM types used.

Principal Findings

Individuals have significantly higher odds using provider-based CAM types if they delayed seeking conventional care due to organizational inaccessibility (OR = 1.63). Individuals use significantly more types of both provider-based (IRR = 1.35) and non-provider-based (IRR = 1.49) CAM if they delayed seeking conventional care due to organizational inaccessibility.

Conclusion

Individuals who delay seeking conventional medical care are more likely to use CAM and use more types of CAM. The current structure of the conventional health care system may have created barriers that can make conventional health care inaccessible. Individuals who face these barriers appear to be pushed not only into trying CAM but using a greater number of CAM types, a finding not in previous research.     

A Cross-Sectional Evaluation of Complementary and Alternative Medicine Use in a Non-urban Malaysian Population

Journal of Community Health - Complementary and alternative medicine (CAM) therapies have been an integral part of Malaysia culture for many centuries. In recent years influences from other parts...     

Assessing medical students’ self-regulation as aptitude in computer-based learning

We developed a Self-Regulation Measure for Computer-based learning (SRMC) tailored toward medical students, by modifying Zimmerman’s Self-Regulated Learning Interview Schedule (SRLIS) for K-12 learners. The SRMC’s reliability and validity were examined in 2 studies. In Study 1, 109 first-year medical students were asked to complete the SRMC. Bivariate correlation analysis results indicated that the SRMC scores had a moderate degree of correlation with student achievement in a teacher-developed test. In Study 2, 58 third-year clerkship students completed the SRMC. Regression analysis results indicated that the frequency of medical students’ usage of self-regulation strategies was associated with their general clinical knowledge measured by a nationally standardized licensing exam. These two studies provided evidence for the reliability and concurrent validity of the SRMC to assess medical students’ self-regulation as aptitude. Future work should provide evidence to guide and improve instructional design as well as inform educational policy.     

Complementary Medicine Practices in a Community-Based Sample of Lesbian and Heterosexual Women

While researchers have examined the established the foundation for understanding the correlates of complementary and alternative medicine (CAM) use among some medical populations, less is known about the correlates of CAM use in nonclinical samples of women, and particularly according to sexual orientation. Information on CAM modalities was collected as part of a survey of lesbian and heterosexual women's health. Eighty-two percent of the sample reported CAM use. Predictors of CAM use included a lesbian sexual orientation, less health-related worry, and perceived discrimination in health care settings. Additional research is warranted to better understand how sexual orientation relates to use of CAM. Future studies should also examine the relationships between and experiences with discrimination in traditional medical settings and increased use of complementary and alternative medicine.     

Medical students’ attitudes towards peer physical examination: findings from an international cross-sectional and longitudinal study

Although studies have begun to shed light on medical students’ attitudes towards peer physical examination (PPE), they have been conducted at single sites, and have generally not examined changes in medical students’ attitudes over time. Employing both cross-sectional and longitudinal designs, the current study examines medical students’ attitudes towards PPE at schools from different geographical and cultural regions and assess changes in their attitudes over their first year of medical study. Students at six schools (Peninsula, UK; Durham, UK; Auckland, New Zealand; Flinders, Australia; Sapporo, Japan and Li Ka Shing, Hong Kong) completed the Examining Fellow Students (EFS) questionnaire near the start of their academic year (T1), and students at four schools (Peninsula, Durham, Auckland and Flinders) completed the EFS for a second time, around the end of their academic year (T2). Univariate and multivariate analyses revealed a high level of acceptance for PPE of non-intimate body regions amongst medical students from all schools (greater than 83%, hips, at T1 and 94.5%, hips and upper body, at T2). At T1 and T2, students’ willingness to engage in PPE was associated with their gender, ethnicity, religiosity and school. Typically, students least comfortable with PPE at T1 and T2 were female, non-white, religious and studying at Auckland. Although students’ attitudes towards PPE were reasonably stable over their first year of study, and after exposure to PPE, we did find some statistically significant differences in attitudes between T1 and T2. Interestingly, attitude changes were consistently predicted by gender, even when controlling for school. While male students’ attitudes towards PPE were relatively stable over time, females’ attitudes were changeable. In this paper, we discuss our findings in light of existing research and theory, and discuss their implications for educational practice and further research.

Complementary Alternative Medicine Practices Used by Religious Professionals

Religious professionals completed an online survey of their use of health related practices currently known as complementary and alternative medicine (CAM). They indicated how often they engaged in these practices and how often they had used these practices when helping other people. The majority of religious professionals used at least one of the practices when alone and when helping other people. The most frequently used practices were meditation and deep breathing exercises used both when alone and when helping others. Female respondents were more likely to use these practices on their own and when helping others than were males, and older respondents were more likely to use multiple CAM practices than their younger counterparts. Other Faith/Humanists used the most CAM practices when alone and Jewish respondents used the fewest. In general, religious professionals used fewer practices when helping others than they used for themselves. Limitations of this study and suggestions for future studies for examining CAM practices among religious professionals are discussed.     

Use of Complementary and Alternative Medicine for Work Related Musculoskeletal Disorders Associated With Job Contentment in Dental Professionals: Indian Outlook

Background

High prevalence rates of work-related musculoskeletal disorders (WRMSD) among dentists have been reported. Complementary and alternative medicine (CAM) therapies can be helpful in managing and preventing work-related musculoskeletal disorders. The purpose of this study was to determine if dental professionals are using CAM for work-related musculoskeletal disorders. Who have greater job satisfaction: dentist who uses Complementary and alternative medicine (CAM) or conventional therapy (CT) as a treatment modality for WRMSD

Method

Dentists who registered in Uttar Pradesh state, India under Indian Dental Council, Uttar Pradesh branch (n=1134) were surveyed. Data were analyzed using univariate and bivariate analyses and logistic regression.

Result

A response rate of 53% (n=601) was obtained, revealing that 82% (n=487) of the respondents suffered from work-related musculoskeletal disorders. The use of complementary and alternative medicine or conventional therapy was reported among 80% (n=390) of the dentists with work-related musculoskeletal disorders. Complementary and alternative medicine users reported greater overall health compared to conventional therapy users (P<0.001). Of those with work-related musculoskeletal disorders, 35.5% (n=172) considered a career change for once, and 4.0% (n=19) reported having left dentistry.

Conclusion

Complementary and alternative medicine therapies may improve quality of life, reduce work disruptions and enhance job satisfaction for dentists who suffer from work-related musculoskeletal disorders. It is important that dentists incorporate complementary and alternative medicine strategies into practice to facilitate musculoskeletal health that will enable longer and healthier careers, increase productivity, provide safer workplace and prevent musculoskeletal disorders.