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Summary This short paper looks at the doctor's role in meeting the increasing demand for complementary and alternative medicine (CAM). As CAM develops a growing presence within the National Health Service (NHS), doctors' and complementary practitioners' (CP) knowledge of and their attitudes toward one another's work will need to adapt. The probability is considered that non-conventional therapies (NCT) techniques adopted from CAM will eventually be widely used by doctors and a brief account of the challenges of collaboration between CPs and GPs given. The author, a doctor and complementary practitioner with experience as a GP trainer, researcher and postgraduate teacher, considers educational approaches that would familiarise doctors with CAM, preparing them for cooperation with CPs, and outlines a model postgraduate curriculum introducing CAM to mainstream health care workers.

Background: \ud \ud To date, our programme of systematic reviews has assessed randomised controlled trials (RCTs) of individualised homeopathy separately for risk of bias (RoB) and for model validity of homeopathic treatment (MVHT).\ud \ud Objectives: \ud \ud The purpose of the present paper was to bring together our published RoB and MVHT findings and, using an approach based on GRADE methods, to merge the quality appraisals of these same RCTs, examining the impact on meta-analysis results.\ud \ud Design: \ud \ud Systematic review with meta-analysis.\ud \ud Methods: \ud \ud As previously, 31 papers (reporting a total of 32 RCTs) were eligible for systematic review and were the subject of study.\ud \ud Main outcome measures: \ud \ud For each trial, the separate ratings for RoB and MVHT were merged to obtain a single overall quality designation (‘high’, ‘moderate, “low”, ‘very low’), based on the GRADE principle of ‘downgrading’.\ud \ud Results: \ud \ud Merging the assessment of MVHT and RoB identified three trials of ‘high quality’, eight of ‘moderate quality’, 18 of ‘low quality’ and three of ‘very low quality’. There was no association between a trial’s MVHT and its RoB or its direction of treatment effect (P > 0.05). The three ‘high quality’ trials were those already labelled ‘reliable evidence’ based on RoB, and so no change was found in meta-analysis based on best-quality evidence: a small, statistically significant, effect favouring homeopathy.\ud \ud Conclusion: \ud \ud Accommodating MVHT in overall quality designation of RCTs has not modified our pre-existing conclusion that the medicines prescribed in individualised homeopathy may have small, specific, treatment effects.

This research study explored the anti-cancer effects of natural materials in South Korea. Although South Korea has a long history of traditional medicine, many natural materials of South Korea have not yet been introduced to the rest of the world because of language barriers and inconsistent study conditions. In the past 3 years, 56 papers introducing 56 natural materials, which have anti-cancer effects, have been published by scientists in South Korea. Further, these studies have introduced five kinds of natural materials presented in research papers that were written in Korean and are therefore virtually unknown overseas. The anti-cancer effects were confirmed by 2-3 cancer markers in the majority of the studies, with the most common targets being breast cancer cells and gastric cancer cells. These cancers have the greatest incidence in South Korea. The natural materials studied not only exhibit anti-cancer activity but also display anti-inflammatory, anti-oxidative stress, and anti-diabetic activities. They have not yet been used for the direct treatment of disease but have potential as medicinal materials for alternative and complementary medicine for the treatment of many modern diseases. Many natural materials of South Korea are already known all over the world, and with this study, we hope to further future research to learn more about these natural medicines.

Highlights • It is a comprehensive comparison between two traditional medicines. • The spread of modern medicine do impacted the rise and fall of traditional medicines. • Deepening exchanges and cooperation between China and Thailand are beneficial. • Traditional medicines can serve for upgrading healthcare tourism., The work presented in this paper compares traditional Chinese medicine and traditional Thai medicine, expounding on origins, academic thinking, theoretical system, diagnostic method and modern development. Based on a secondary analysis of available literature, the paper concentrates on two crucial historical developments: (1) the response to, and consequences of, the impact of the Western medicine; and (2) the revival of traditional medicine in these two countries and its prospects. From a comparative perspective, the analysis has led to the conclusion that the rise and fall of traditional medicine is an issue closely related with social and political issues; and the development of traditional medicines requires national policy and financial support from governments, human resource development, the improvement of service quality, and the dissemination of traditional medicine knowledge to the public. In addition, this paper also suggests deepening exchanges and cooperation between China and Thailand, strengthening cooperation between traditional medicine and medical tourism.

This paper describes the annual conference, this year held in York on 24 April 2008, which brings together researchers from around the UK and beyond who have an interest in the development of strategies for research in complementary and alternative medicine. This year’s event was held in York, and was attended by sixty academics, students and practitioners in the field. As in the preceding events in Northampton and Southampton, the plan for the day was that it be developmental for both the presenters and the audience. Therefore the papers presented were all at a stage where there was scope for audience input, for rethinking the future direction of projects and for developing creative solutions to some unresolved issues. Overall this created a supportive environment where speculation, innovation and creativity could flourish. The keynote presentation was given by Professor Kate Thomas, and she set out her twenty years of experience conducting research into complementary and alternative medicine (CAM). She has been at the forefront in documenting the levels of utilisation of CAM since her early study of CAM utilisation in the late 1980s. She has built on this with several other studies which together provide evidence of substantial use of CAM, which has largely been paid for out-of-pocket, rather than provided for within the National Health Service. Her research interest has extended to conducting pragmatic randomised controlled trials and exploring the policy implications of CAM being more widely available within the NHS, where the evidence for use justifies it. What followed at the conference was a series of seven oral presentations, each one tackling a different challenge. The therapies covered included acupuncture, Chinese herbal medicine, chiropractic, osteopathy and homeopathy. Two presentations involved studies with multiple presenting conditions, while others had a focus on specific conditions, including secondary lymphoedema, infantile colic, endometriosis, and menopausal hot flushes. Methodologies discussed were wide-ranging, including randomised controlled studies, cohort studies, and cost-effectiveness studies, as well as the last paper which opened up discussion of the broader dimensions of the research culture within which we conduct our research.

In this paper I critically address what is becoming the wholesale adoption of the concept of complementary medicine in researchers’ analyses of lay participation in alternative therapies. This paper emerged out of a qualitative study of 21 Canadians who use and/or practice alternative therapies. I found that only seven informants used the term ‘complementary’ in describing their use of alternative therapies. Of those seven who did, five were alternative practitioners. I discuss the variability of meaning of the concept of ‘complementary’ and I argue that alternative practitioners have a professional interest in using the concept to avoid seeming in competition with medical professionals and to reduce the likelihood of being labelled ‘quacks’. I conclude with a plea for researchers to define their terms in analyses of individuals’ use of alternative and/or their dual use of alternative and allopathic health care.

Amidst the substantial change currently gripping primary health care are two developments central to contemporary debate regarding the very nature, territory and identity of general practice - the integration of complementary and alternative medicine (CAM) and the rise of evidence-based medicine (EBM). This paper reports findings from a study based upon 25 in-depth interviews with general practitioners (GPs) personally practising complementary therapies alongside more conventional medicine to treat their NHS patients. The paper outlines the GPs' perceptions of EBM, its relationship to their personal development of CAM, and their notions of good clinical practice more generally. Analysis of the GPs' accounts demonstrates how CAM can be seen as a useful resource with which some GPs defend their clinical autonomy from what they perceive to be the threat of EBM. © 2000 Harcourt Publishers Ltd.

Summary The aim of the present paper is to describe what kind of adverse effects of acupuncture Norwegian doctors and acupuncturists have encountered, and to indicate how often these adverse effects occur. The questionnaire was sent to an unweighted, stratified, random sample of 1466 working Norwegian doctors under the age of 71. A similar questionnaire was sent to all 311 acupuncturists found in the Yellow Pages of the telephone directory. A total of 1135 (77%) and 197 acupuncturists (68%) responded. The myth of acupuncture as a therapy without adverse effects has not been substantiated. Pneumothorax, the most common serious adverse effect of acupuncture was reported in 33 patients. Local skin infections (n = 66), perichondritis on the auricle (n = 6), arthritis and osteomyelitis (n = 4), are reported from doctors, but not from the acupuncturists. Fainting during treatment is relatively common among acupuncturists (n = 140), while the doctors report more cases of psychiatric problems (n = 20) and increased pain after acupuncture treatment (n = 56). The study indicates that the acupuncture adverse effects rate is at least 0.21 per year of practice as an acupuncturist. This paper presents a broad panorama of adverse effects of acupuncture. The study should imply more focus on who should practise acupuncture, and when to use the method. Despite the reported adverse effects, acupuncture can still be presented as a relatively safe therapeutic measure.

The need for health care reform in the USA is abundantly clear to consumers, providers, third parties and policy makers alike. This paper present a rationale for the evaluation and integration of complementary approaches into the mainstream of modern medicine as a way of both decreasing costs and increasing the quality of care. A project aimed at building the necessary scientific basis for this is described. The ultimate goal of the project and this paper is to stimulate new thinking about health and illness, toward encouraging models of health care which attend as much to the person and their experience of ‘illness’ as to their symptoms and ‘disease’.

This paper gives a short outline on the acupuncture research carried out and reported in the UK literature to date. It examines the reasons for the slow uptake of acupuncture research in the UK with particular reference to the community of practitioners who have trained in traditional acupuncture and practise on a full-time basis. The problems facing researchers investigating acupuncture, and in particular traditional acupuncture, are summarised. Doubts are raised as to the usefulness of conventional methodology for acupuncture research. This is followed by a short appraisal of acupuncture research envisaged by the Council for Acupuncture (CFA), UK, to be of use in promoting the interests of the profession as a whole. The paper concludes with an outline of strategies and discusses a number of concrete steps that are being put in motion by the CFA, UK, to promote research on all levels of the acupuncture community in the UK.

Summary Context The N-of-1 trial design (randomized and blinded single-patient trials) has been popular abroad for 25 years or more. Many papers using the N-of-1 trials have been published in international medical journals. However, little is known about this methodology in China. Our purpose is to describe the current status of N-of-1 trials in China, to explain why they have not been more widely used, and to suggest a roadmap for the development of N-of-1 trials, especially for the study of Traditional Chinese Medicine (TCM). Methods An electronic search was conducted using the Chinese Biological Medicine Database (CBM) and China National Knowledge Infrastructure (CNKI) with the keywords “N-of-1 trial, single case OR individual patient AND randomized”. We also searched PubMed. The Chinese Science Citation Database (CSCD) as a citation was searched at last. Results 23 studies were retrieved from CBM and 34 from CNKI. There were 13 papers about N-of-1 trials in CBM and 17 in CNKI. Only 3 studies were rigorously designed (i.e., using randomization, control periods and blinding). The other 8 papers were descriptive and review articles, most of which were in TCM. One review was published in SCI-E and one in MEDLINE. Three papers were found in CSCD as citations. Only one of the retrieved studies was funded. Conclusions While N-of-1 trials may offer a good tool to individualize clinical care and enrich TCM clinical research, they have not been widely used to date. To spur the development of this method, we would like to suggest three points. First, the Chinese government should endorse and sponsor N-of-1 studies. Second, researchers and physicians should be systematically trained in the method. Third, thorough considerations on trials allow better research and focus on the patients’ needs.

Summary Objectives: To describe Pilates exercise according to peer-reviewed literature, and compare definitions used in papers with healthy participants and those with low back pain. Design: A systematic review of literature was conducted. A search for ‘‘pilates’’ within the maximal date ranges of the Cochrane Library, Medline, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, ProQuest: Nursing and Allied Health Source, Proquest: Medical and Health Complete, Scopus, Sport Discus, and Web of Science, was undertaken. To be included, papers needed to describe Pilates exercise, and be published in English within an academic, peer-reviewed journal. There were no restrictions on the methodological design or quality of papers. Content analysis was used to record qualitative definitions of Pilates. Frequencies were calculated for mention of content categories, equipment, and traditional Pilates principles. Frequencies were then compared statistically in papers with healthy participants and those with low back pain. Results: 119 papers fulfilled inclusion criteria. Findings suggest that Pilates is a mind—body exercise that focuses on strength, core stability, flexibility, muscle control, posture and breathing. Exercises can be mat-based or involve use of specialised equipment. Posture was discussed statistically significantly more often in papers with participants with low back pain compared to papers with healthy participants. Traditional Pilates principles of centering, concentration, control, precision, flow, and breathing were discussed on average in 23% of papers. Apart from breathing, these principles were not mentioned in papers with low back pain participants. Conclusions: There is a general consensus in the literature of the definition of Pilates exercise. A greater emphasis may be placed on posture in people with low back pain, whilst traditional principles, apart from breathing, may be less relevant. © 2012 Elsevier Ltd. All rights reserved.

Many health care professionals in the UK, especially nurses, have shown increasing interest in the concept and applications of Therapeutic Touch (TT). This paper explores the background to TT, including relevant working models, defines its actions and reviews the main research findings which support its use. A growing body of research now offers a rationale for the application of the practice of TT and the paper discusses some of the implications for practitioners.

Summary In November 1994, a conference was held on competence and complementary medicine, and the papers were published in the January 1995 issue of this journal. Time did not permit a full exploration of all the areas of concern to the participants, and this paper attempts to remedy the omission.

Summary Nurses, midwives and health visitors collectively represent the largest grouping in the NHS (DHS 1993). 1 In 1992 the United Kingdom Central Council (UKCC), the central registering body for nurses revised an advisory paper, Administration of medicines (issued in 1986). The Standards for the Administration of Medicines 2 recognised the growing use of complementary therapies within nursing practice, with paragraphs 38 and 39 referring explicitly to the administration of herbal, homoeopathic and complementary and alternative therapies. Increasing utilisation of complementary therapies within nursing raises issues associated with competence and efficacy. Additionally, discussion centres upon whether complementary therapies represent the expanding role of nursing practice, or a conceptually distinct emergence of specialised nursing roles based upon collaborative, multidisciplinary approaches to health care. This paper describes some of the key issues at the forefront of the debate concerning the utilisation of complementary therapies within mainstream nursing practice, and makes some suggestions concerning the way forward for the provision of academic and practical competence in complementary medicine.

In this paper we identify the need for further research exploring the relationship between complementary and alternative medicine (CAM) use and women's health. We offer our personal thoughts on the direction such future research might take outlining a number of research domains (type of CAM consumption, longitudinal analysis of women's use of CAM, cross-cultural analysis of women's CAM consumption, reasons for women's CAM consumption). We hope that this brief paper helps inspire greater research attention upon what we believe to be a well deserving sub-field of study within the social science of CAM.

This paper charts the developing historical relationship between orthodox and alternative medicine in Britain, focusing on the work of health practitioners. It begins by defining the concepts of orthodox and alternative medicine, noting that this was not really a meaningful distinction until the mid-nineteenth century with the rise of the medical profession. Before this time there was a relatively undifferentiated playing field. Thereafter doctors gained state-underwritten professional standing, with alternative therapists becoming increasingly marginalised by the mid-twentieth century. However, in the wake of the medical counterculture of the 1960s and 1970s there has been growing public interest in alternative medicine coupled with an associated increase in the numbers of its practitioners, particularly in the private sector. Despite initial resistance, alternative medicine has now gained greater acceptance by medical orthodoxy. The paper concludes by considering how orthodox and alternative health care can be brought together in more integrated fashion in the future—for the benefit of the wider public.

Despite the depth of interest in complementary and alternative medicines (CAM) within the nursing community, the intersection between nurses, nursing and CAM has largely avoided sociological analysis. This paper presents findings from one part of an ongoing exploratory study of how nurses present and interpret the apparent affinity of their profession with CAM. A text analysis of papers published from within the nursing community on CAM was conducted. Within the broad area of professional identity, differentiation and development, two dominant themes emerged from the analysis. Firstly, the use of professional distancing to underpin the legitimacy of the nursing/CAM axis; and second, the potential offered by the relationship for a reconstruction of lines of professional authority. As one dimension of the way in which nursing’s intersection with CAM is being constructed and perpetuated, the relationship with medicine appears to be of significance and requires further attention. © 2001 Harcourt Publishers Ltd.

Objectives Little is known about women’s use of health services affected by headache or migraine during pregnancy. This paper directly addresses the research gap reporting on the healthcare utilization among Australian pregnant women experiencing headache or migraine. Design and setting In this retrospective observational study, data on 1,835 Australian pregnant women were obtained from the nationally-representative Australian Longitudinal Study on Women’s Health. Information on quality of life and health seeking behaviors regarding conventional medicine and complementary and alternative medicine providers was identified among these participants. Factors associated with healthcare use were analyzed using regression analyses. Results A total of 16% of the pregnant women surveyed experienced headache or migraine, and over 20% sought help from more than two types of healthcare practitioners for their headache or migraine. General practitioners (37.8%) were the most commonly consulted providers of pregnant women for their headache or migraine. Women with headache or migraine during pregnancy had worse health-related quality of life than those without. Education level and private health insurance status of pregnant women are the predictors of the use of healthcare practitioners for their management of headache or migraine (both p Conclusions Headache or migraine during pregnancy significantly impacts upon pregnant women’s quality of life. The use of multiple healthcare practitioners, including conventional medicine and complementary and alternative medicine practitioners, highlights the need for further research investigating health services utilization of pregnant women with headache or migraine in different severity and frequency to help inform effective and safe treatment.

The objective of the study described in this paper was to define Chinese medicine formula patterns for the treatment of menopausal women in London. These formula patterns are intended to become best practice guidelines for a future pragmatic randomised controlled trial with the ultimate goal of evaluating the possibility of integrating Chinese medicine treatment strategies for menopausal symptoms into the UK National Health Service. Data from a clinical study that had demonstrated the effectiveness and safety of Chinese medicine in treating 117 perimenopausal women at the Westminster University Polyclinic in London was analysed for symptom occurrence and herb use. The frequency of occurrence of different presenting symptoms and the frequency of use of individual herbs is described, and the patterns of combined herb use and the correlations between these patterns and the presenting symptoms is analysed by means of factor analysis. Treating these use patterns as Chinese herbal medicine formulas, five distinctive formula patterns emerged in the course of this study. While there is some overlap between these formulas and their associated symptom patterns and those described in Chinese medicine textbooks, some formula patterns appear to be unique to London women. This indicates that best practice guidelines for the Chinese medicine treatment of menopausal symptoms, which have been shown to vary cross-culturally, need to be derived from local clinical practice. We discuss the advantages and limitations of the methods – action based clinical study plus factor analysis – we employed to this end.

Background Patients, and especially oncology patients, increasingly demand information and application of complementary therapies to supplement their conventional medical treatment and follow-up care. Due to the widespread interest in holistic treatment opportunities in oncology populations, healthcare professionals need to be prepared in differentiating evidence-based methods of the complementary and alternative medicine (CAM) spectrum and how to consult with patients about it. Objective This paper reports on the implementation and evaluation of a newly designed module “Complementary and Alternative Medicine in oncological healthcare” in the bachelor degree program Interprofessional Health Care (B.Sc.). Design The study applied a developed evaluation questionnaire to capture students’ perspectives on the CAM contents. This assessment instrument was administered pre and post the CAM teaching unit. Setting Interprofessional medical education, University Hospital Heidelberg, Germany. Results The integration of the CAM elective module was possible and was met by positive response. Students’ interest was reflected in an increase of their self-reported knowledge gain and positive CAM attitude. Comparison of pre and post evaluation data demonstrate that, particularly, students’ expectations on developing their own opinion about CAM, and getting an overview of the evidence-base of different CAM methods have been met. Conclusions Evaluation results indicate that the module content was in line with the students’ expectations and may have positively impacted on their general CAM attitude. The results support us in continuing to offer this CAM course within the elective module to prepare today’s healthcare professionals for patient-oriented healthcare delivery.

Objectives This descriptive study investigated how cancer patient characteristics and utilization of CAM resources, services, and activities at a regional cancer center were associated with patients’ understanding of their health needs, emotional health, and their ability to self-manage their condition. Design Cross-sectional questionnaire. Sixty-one patients completed a mailed 17-item paper and pencil survey about their sociodemographics, use of CAM offerings, barriers, and perceived benefits. Setting Mail-based survey completed by cancer patients in a southern state. Main outcome measures As a result of participating in the center’s cancer support services, patients indicated if: (1) they had a better understanding of their health needs; (2) their emotional health has improved; and (3) they take better care of themselves when they are at home and in the community. Results Participants reported using 0.93 (±1.20) CAM activities (e.g., yoga), 0.62 (±0.71) resources (e.g., the library), and 1.62 (±1.34) services (e.g., monthly support groups), although also reported experiencing 0.74 (±0.81) barriers (e.g., transportation) to accessing these offerings. Perceived benefits were interrelated, where those perceiving CAM offerings to improve their understanding of their health needs also perceived improved emotional health (χ 2 = 27.93, P Conclusions Greater utilization of CAM offerings was also associated with greater perceived benefits. These results highlight the benefits of CAM therapies for cancer patients’ well-being. Integration of CAM therapies in standard cancer care should be encouraged to complement cancer treatment.

Summary Objective Across the Western world, including Australia, growing popularity of complementary medicines (CMs) mandates their implementation into medical education (ME). Medical students in international contexts have expressed a need to learn about CMs. In Australia, little is known about the student-specific need for CM education. The objective of this paper was to assess the self-reported need for CM education among Australian medical students. Design Thirty second-year to final-year medical students participated in semi-structured interviews. A constructivist grounded theory methodological approach was used to generate, construct and analyse data. Setting Medical school education faculties in Australian universities. Results Medical students generally held favourable attitudes toward CMs but had knowledge deficits and did not feel adept at counselling patients about CMs. All students were supportive of CM education in ME, noting its importance in relation to the doctor–patient encounter, specifically with regard to interactions with medical management. As future practitioners, students recognised the need to be able to effectively communicate about CMs and advise patients regarding safe and effective CM use. Conclusions Australian medical students expressed interest in, and the need for, CM education in ME regardless of their opinion of it, and were supportive of evidence-based CMs being part of their armamentarium. However, current levels of CM education in medical schools do not adequately enable this. This level of receptivity suggests the need for CM education with firm recommendations and competencies to assist CM education development required. Identifying this need may help medical educators to respond more effectively.

Summary Objectives To determine the effects of Tai Chi practice on health related quality of life in patients with various chronic medical conditions. Background One of the characters of chronic illness is life-long condition with the deterioration in health related quality of life. Tai Chi has become a popular mind-body exercise and self-management strategy for patients with chronic conditions regarding its various physical and psychological effects. Methods Eight databases (the Cochrane Library, PubMed, Medline, EBSCO, Web of science and three Chinese databases: CNKI, Wanfang data and VIP) were searched (up to December 2013) for relevant studies. Studies including participants with chronic conditions were selected. All studies were randomized controlled trials reporting the effects of Tai Chi on health related quality of life. Two independent reviewers extracted trial data and assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Results Of the 2021 papers which were screened, 21 studies including 1200 patients met the eligibility criteria. Most studies (18 of 21 studies) found significant improvements on health related quality of life for participants with chronic conditions in Tai Chi group. No evidence was observed to suggest that Tai Chi was more effective than other types of exercise. And objective measures were not always consistent with self-reported quality of life measures. Conclusions Tai Chi appears to be safe and has positive effects on health related quality of life in patients with chronic conditions, especially for patients with disorders in Cardio-cerebrovascular and respiratory systems, and musculoskeletal system. However, as the delivery mood of Tai Chi provides multiply benefits, which part of the group provides the most benefit in improving quality of life is unclear. Due to the design limitations of previous studies, more larger and well-designed RCTs are needed to confirm the effects. And qualitative researches are warranted to explore how Tai Chi may work exactly from patients’ own perspectives.

This paper explores why qualitative research in the field of complementary and alternative medicine (CAM) is underused and, when used, done so defensively. It argues that qualitative research methods can encompass the complexity of CAM and identify richer veins for research exploration. The rigorous application of holistic research methods, used non-defensively, can only benefit CAM and the knowledge base of science.

Objectives: The existing knowledge base on the use of complementary and alternative medicine among patients with allergies is built upon findings of cross-sectional surveys and there is a lack of longitudinal data. There is also a lack of studies that examine both the use of conventional medicine and complementary and alternative medicine among allergy patients. Design and setting: : This paper reports the findings of the first ever longitudinal study of the use of conventional providers, practitioners of complementary and alternative medicine, and self-prescribed modalities amongst women with allergies, hayfever and sinusitis from a large nationally representative sample. Main outcome measures: : Analysis focused upon data from 7538 women from the younger cohort of the Australian Longitudinal Study on Women's Health collected between 1996 and 2006. Chi-square tests were employed to compare the groups across consultations and self-prescribed treatments and one-way analysis of variance was used to compare the groups across health status. A modified Bonferroni test was used to correct for multiple comparisons. Results: The study identified that women who sought help for their allergic disorder were more likely to consult a range of practitioners and self-prescribed complementary and alternative medicine than women who either did not seek help or did not have allergic disorders. The analysis shows that many women with allergic disorders use complementary and alternative medicine alongside or as a complement to conventional healthcare services. Conclusions: The frequent use of a range of conventional providers and practitioner-based and self-prescribed complementary and alternative medicine amongst women with allergic disorders warrants further investigation. © 2012 Elsevier Ltd.

Health related absenteeism costs an estimated $153 billion annually in the United States (Witters and Agrawal, 2011). 1 Chronic conditions (major contributors to absenteeism) are often successfully managed by Complementary and Alternative Medicine (CAM). As CAM becomes an increasingly visible component of healthcare, firms may wish to consider whether CAM therapies can help reduce illness-related absenteeism. This paper aims to extend the literature on healthcare utilization and absenteeism by exploring whether CAM treatment is associated with fewer workdays missed due to illness. Methods Using the 2007 National Health Interview Survey (NHIS) and propensity score matching (PSM), this study estimates the relationship between visits to CAM practitioners, health, and illness-related absenteeism. Results In a sample of 8820 workers, the average annual number of workdays lost due to illness is 3.69. Visiting an acupuncturist correlates with lower absenteeism among men (1.182 fewer workdays missed, p Conclusions Estimates suggest that some CAM modalities correlate with lower absenteeism, and many correlate with improved health. Two limitations of this study are worth noting. First, a small proportion of the sample uses CAM, limiting the generalizability of results. Second, if health conscious individuals are more likely to use CAM, then health attitudes may be contributing to lower absenteeism among the treated. Further research is needed to identify a causal relationship between CAM treatment, health, and absenteeism.

Complementary and alternative medicine (CAM) is frequently used in patients in industrialised countries. Despite this popularity, there remains a considerable deficit of discourse and cooperation between physicians practicing CAM and conventional medicine. The aim is to present the methodology and results of the first international case conference on integrative medicine (IM) dealing with a patient with low back pain. In this paper the methodological tool "case conference on IM" is also described.The interactive case conference took place on November 20th, 2009 as part of the "2nd European Congress of IM" in Berlin, Germany. An experienced expert panel from both conventional medicine and CAM developed integrative medical diagnoses and therapeutic strategies using as their starting point an individual patient case on chronic low back pain (LBP). The case was selected because LBP is a common diagnosis with considerable economic impact and a problem which is often treated with CAM.In this case conference, the expert panel agreed on a diagnosis of "chronic non-specific LBP with somatic and psychological factors" and proposed multi-modal short- and long-term treatment including of CAM. The importance of the patient-physician-relationship and the consultation process with appropriate consultation time for treatment success was highlighted. There was consensus that the diagnostic process and resulting treatment plan should be individualised and focussed on the patient as a complete person, identifying the significance the disease has for the patient and not just on the disease for itself. Considerable differences were found amongst the experts regarding the first steps of treatment and each expert saw possibilities of "effective and adequate treatment" being met by their own individual treatment method.The case conference on integrative medicine stimulated an intensive exchange between the approaches used by conventional medicine and CAM clarifying different treatment possibilities for low back pain. Therefore, case conferences on integrative medicine could serve as a model for evaluating similar activities in academic hospitals and establishing such approaches in routine medical care. This strategy has the potential to improve patient centred care.

Summary Objective The aim of this paper is to describe the treatment and physician characteristics in a randomised trial of acupuncture for osteoarthritis of the knee. Design Three-armed, randomised, controlled multicentre trial with 1-year follow-up. Setting Twenty-eight outpatient centres in Germany. Interventions A total of 294 patients with osteoarthritis of the knee were randomised to 12 sessions of semi-standardised acupuncture (at least 6 local and 2 distant points needled per affected knee from a selection of predefined points, but individual choice of additional body or ear acupuncture points possible), 12 sessions of minimal acupuncture (superficial needling of at least 8 of 10 predefined, bilateral, distant non-acupuncture points) or a waiting list control (2 months no acupuncture). Outcome Participating trial physicians and interventions. Results Forty-seven physicians specialised in acupuncture (mean age 43 ± 8 years, 26 females) provided study interventions in 28 outpatient centres in Germany. The median duration of acupuncture training completed by participating physicians was 350 h (range 140–2508). The total number of needles used was 17.4 ± 4.8 in the acupuncture group compared to 12.9 ± 3.3 in the minimal acupuncture group. In total, 39 physicians (83%) stated that they would have treated patients in either a similar or in exactly the same way outside of the trial, whereas 7 (15%) stated that they would have treated patients differently (1 missing). Conclusions Our documentation of the trial interventions shows that semi-standardised acupuncture strategy represents an acceptable compromise for efficacy studies. However, a substantial minority of participating trial physicians stated that they would have treated patients differently outside of the trial.

Background The aim of this article is to summarize and critically evaluate the evidence from systematic reviews (SRs) of complementary and alternative medicine (CAM) for lowering blood lipid levels (BLL). Methods Eight electronic databases were searched until March 2016. Additionally, all the retrieved references were inspected manually for further relevant papers. Systematic reviews were considered eligible, if they included patients of any age and/or gender with elevated blood lipid levels using any type of CAM. We used the Oxman and AMSTAR criteria to critically appraise the methodological quality of the included SRs. Results Twenty-seven SRs were included in the analyses. The majority of the SRs were of high methodological quality (mean Oxman score = 4.81, SD = 4.88; and the mean AMSTAR score = 7.22, SD = 3.38). The majority of SRs (56%) arrived at equivocal conclusions (of these 8 were of high quality); 7 SRs (37%) arrived at positive conclusions (of these 6 were of high quality), and 2 (7%) arrived at negative conclusions (both were of high quality). There was conflicting evidence regarding the effectiveness of garlic; and promising evidence for yoga. Conclusions To conclude, the evidence from SRs evaluating the effectiveness of CAM in lowering BLL is predominantly equivocal and confusing. Several limitations exist, such as variety of doses and preparations, confounding effects of diets and lifestyle factors, or heterogeneity of the primary trials among others.

Traditional Chinese herbal Medicine (TCHM) has been gaining interest and acceptance world wide. TCHM provides on the one side promising perspective of scientific interest and on the other side possible health risks if TCHM drugs are not controlled with respect to quality standards or if practitioners for TCHM are not well trained. This paper outlines an introduction to the scientific aspects and potential risks of TCHM therapy followed by a brief, exploratory overview of the current status of TCHM regulations in certain Western countries like the USA, United Kingdom, Germany, Australia and in China as the Eastern origin country of TCHM. Legal foundations to establish quality and safety standards for TCHM crude drugs and ready-made formulas exist in some countries on a local basis but in practice are poorly enforced, where this products have no drug status. In addition practitioners treating patients with TCHM should be well versed in the pharmacology, side effects, and interactions of these substances with Western medicines and should be certified on a regular basis.

Objectives: For people with dyspepsia who are receiving orthodox general practice care, what is the effect on outcome and on NHS costs of adding treatment by a choice of acupuncture or homeopathy? This paper describes and reflects upon a pilot study with user involvement. Design: A randomised pilot study. Patients chose between acupuncture and homeopathy and were then randomised to this preference or to the control group of normal GP care. Setting and participants: Sixty people with dyspepsia (≥2 weeks) presenting in one UK general practice were recruited in consultations and by letter to those on repeat prescriptions. There were few exclusion criteria. The homeopath and the acupuncturist treated the patient individually according to their normal practice for up to 6 months. After the trial there was a focus group for participants. Outcome measures: SF-36 health survey, Measure Yourself Medical Outcome Profile (MYMOP), and General Well-being Index (GWBI). Counts of prescriptions, consultations and referrals from practice computer records. Results: No trend or significant difference between the groups for clinical outcome or NHS costs. Major costs for the 6 months, mean (S.D.) cost per patient, were general practitioner consultations £8 (18), prescriptions £64 (73), acupuncture £175 (52), homeopathy £105 (33). Participants gave insights and suggestions which will inform the full trial design. Conclusions: Reflection on the pilot study data and experience by participants, treating practitioners and researchers led to modifications in the design and a sample size calculation. How to demonstrate individual responses to treatment remains a problem.

Traditional Chinese medicine (TCM) has been increasingly practised in many countries of the world. Some recent textbooks of TCM still recommend formulas containing various animal tissues such as tiger bones, antelope, buffalo or rhino horns, deer antlers, testicles and os penis of the dog, bear or snake bile. Usually, animal tissues are combined with medical herbs. In most of the cases, the medical use of the preparations is justified in terms of the rules of TCM. So far, little research has been done to prove the claimed clinical efficacy of TCM animal products. This paper discusses some related ecological, ethico-legal and health concerns such as hunting, breeding and trade with endangered species, risks of transmission of zoonoses, quality of the products, and alternatives to preparations from endangered species.

Summary Many case studies and several controlled clinical trials have indicated the effectiveness of hypnotherapy for some medical conditions. However, because of methodological inadequacies hypnotherapy is still criticized for not having strong scientific evidence to support its claims. While randomized placebo-controlled clinical trial is generally accepted as the gold standard study design, creating a credible placebo control for hypnotherapy is a major challenge. This paper recommends "neutral hypnosis" as a credible placebo control for hypnotherapy trials.

Summary Background and purpose: There has been a gradual change in the management of cancer patients, with a more holistic approach being adopted. There has also been an increase in the use of complementary therapies within oncology departments in England and Wales. This paper identifies the number of departments offering individual therapies in the management of cancer patients and the types of therapies being offered. It also identifies whether these therapies are practised by in-house therapists or by external complementary practitioners. Material and methods: Therapeutic radiography managers of the 55 oncology departments in England and Wales were sent a simple, postal questionnaire. The questionnaire was used to identify the complementary therapies being provided by the departments and the different types of practitioners. A pilot study was used to test for ambiguity of questions and the validity of responses. Results: A 100% return rate of the questionnaire identified that 38 oncology departments were offering at least one complementary therapy in the management of cancer patients. Of the 20 therapies identified, six were most commonly used, namely aromatherapy, relaxation therapy, massage, reflexology, visualization and acupuncture. The vast majority of therapies were practised by employees of the hospitals in which they were practised, although some therapies were provided by external complementary practitioners. Conclusions: Complementary therapies have an increasing role in the management of cancer patients, with several therapies being offered. These therapies may raise ethical concerns within the field of oncology, especially with regard to control over their safety and practice.

Summary Pain is a common presenting symptom in many alternative, complementary and heterodox medical practices. One method of pain control involves utilizing naturally occurring opioids such as Beta-endorphin. This paper examines the available scientific evidence from human and animal studies for the effectiveness of some of the complementary and alternative therapies (acupuncture, chiropractic, hypnosis, and osteopathy) and exercise upon inducing endogenous opiate analgesia. It concludes that there is insufficient evidence to support the idea that any of the forms of complementary medicine studied can claim to induce endogenous opiate analgesia. Suggestions are proposed for further improvements in the research methodology for studying the effect of complementary medicines upon Beta-endorphin levels, particularly with respect to manual medicine approaches.

Summary Objectives: To provide information necessary for the strategic planning of research on the effectiveness of complementary therapies in asthma. Design: A qualitative study of the views of patient representatives, researchers, doctors and complementary practitioners followed by a systematic review of randomized trials of complementary therapy interventions in asthma. Main outcome measures: Qualitative study: views on research priorities in complementary medicine and asthma; Systematic review: intervention, number of treatments, number of patients, control group, blinding, length of follow-up, patients and outcome measures. Results: Qualitative study: randomized trials were seen as essential; there was disagreement about the role of placebos with some respondents wanting to know whether particular therapies had specific effects whilst others sought information about the overall effects of a treatment; there was support for trials where interventions are examined as they are practised; it was thought that outcome assessment needed to be long-term. Systematic review: Thirty-five papers were included in the review, 29 of which examined either acupuncture of self-regulation techniques such as yoga or relaxation. With the exception of the latter, most studies were small, short-term, placebo-controlled, assessed lung function rather than patient-assessed symptoms and investigated a treatment not widely found in clinical practice. Trials on self-regulation techniques tended to be larger, involved longer-term follow-up and investigated the techniques normally used by practitioners. Conclusions: There are numerous points of disparity between what is sought from research on complementary medicine in asthma and what has been published. Future research should be problem-led.

Summary This paper describes the work of the Acupuncture Research Resource Centre (ARRC). Since 1994, the organization has responded to the needs of the acupuncture profession and has promoted awareness about the potential uses of acupuncture in health care in the UK. Its activities include an information service and bibliographic database, support for practitioner researchers and the staging of research study days and symposia.

Summary The classical randomized controlled trial (RCT) is still held up by many researchers as the gold standard design for evaluating the effectiveness of a clinical intervention, despite its limitations. This has the consequence of polarizing the complementary medicine research community into those who wish to force research into this model, and those who reject the RCT as impractical. In this, the second of two papers which assess the usefulness of specific research designs for evaluating the provision of complementary therapies in the National Health Service (NHS), we describe two alternative RCT designs: the partial randomization (randomized block) design; and a pragmatic design with prior randomization. The strengths and weaknesses of each design are discussed. We conclude that they should be considered as serious alternatives to the ‘old favourite’ in the ‘race’ to evaluate the potential contribution of complementary therapies to the NHS.

More than one-third of U.S. adults over the age of 20 years are classified as obese and nearly two-thirds are overweight or obese. The prevalence of obesity among U.S. children and adolescents has almost tripled since 1980, with 17% of all youth and children now considered obese. Nine million children aged 6-19 years are overweight, making obesity the largest health care threat facing today's children. Historically, the arsenal against obesity has been primarily focused on interventions that increase physical activity and decrease caloric intake. American weight loss strategies that incorporate dietary modifications and exercise have proven effective in achieving weight loss, but most of the weight is regained over time. Mindfulness based interventions, combined with other traditional weight loss strategies, have the potential to offer a long-term, holistic approach to wellness. However, research reports examining the complementary addition of mindfulness based approaches in the treatment obesity and eating disorders are relatively scarce in the empirical literature. This paper describes what is currently known about the role of mindfulness based interventions when used alone, or in combination with, other traditional approaches in the treatment of obesity and eating disorders.

Summary There is an increasing demand for complementary medicine. This paper reviews some of the audits that have been used within this area of medicine and suggests a strategic approach to the development of complementary medical audit within the National Health Service. It is hoped that this will allow purchasers and practitioners of complementary medicine to determine the effectiveness and cost-benefits of these therapies, at the same time as improving standards of practice.

Summary Complementary medicine, within the UK, has undergone enormous change in terms of educational standards and internal organization. These alterations are partly in response to external pressures from the Government, the European Union, the medical profession in the UK and the consumers, and partly come from an internal desire to enhance the status and legitimacy of complementary medical practice. Consequently, the many professional associations representing complementary medicine have engaged in a process of professionalization. This paper briefly reviews some of the changes that have resulted.

Summary In 1993, Grampian Health Board identified complementary therapies as an area for potential investment and decided to use a consensus development conference to inform their decision-making. Following the conference and consultation, Grampian Health Board agreed a number of policy actions to encourage the local development of complementary therapies within the National Health Service. This paper describes the rationale for and conduct of the consensus conference and subsequent policy processes. Part 1: Is there a real demand? was published in Vol 4, number 1.

Summary One of the most disabling neurological diseases experienced by 80 000 adults in the UK is multiple sclerosis. The many forms of treatment available have not always been successful in helping these patients or preventing relapses. The holistic approach of acupuncture has been considered by trained therapists to be suitable for the management of multiple sclerosis. This paper, through assessment, classification, and treatment, studies the effect of acupuncture, based on traditional Chinese medicine, in patients whose predominant symptom was spasticity. Whilst the results of this research could not be regarded as conclusive, they were encouraging enough to invite further investigation.

Summary There are many treatments within complementary medicine that have been shown to have some effect on both prevention of migraine and the acute attack. This paper presents an overview of the evidence available within homoeopathy, herbal medicine, dietary exclusion, acupuncture, and a variety of psychological techniques.

Summary Interest in complementary therapies is growing rapidly and the number of people using them is rising. This paper outlines what is currently being taught within undergraduate medical curricula and suggests that, if and when complementary therapies gain a wider inclusion and accepted place, this should embrace the holistic philosophies on which many are founded. Without this, a full sense of both the therapy and its usefulness cannot be achieved. It also outlines some of the changes currently taking place within medical education which may allow for this area to be explored further.

Summary This paper reviews hypnosis and acupuncture as treatments for smoking cessation. It contrasts and compares these two complementary medical techniques with the major conventional smoking cessation therapies available, and concludes that complementary medicine is probably slightly more effective than conventional anti-smoking treatments.

Summary This paper describes the most effective ways of handling rheumatoid arthritis using complementary medicine. Acupuncture, food sensitivities, and homoeopathy are each described in detail in relation to the condition.

Summary One view of nursing sees it as a series of manual/technical tasks, related to a medical diagnosis and carried out under the instructions of doctors. Many developments in nursing and health care have fundamentally challenged and changed this reductionist view. Part of that process has been the incorporation of complementary therapies into nursing. This paper explores some of the underlying trends and concepts. The use of complementary therapies in nursing is examined, expecially in relation to the competence to practise of the nurse. It is suggested that there is a qualitative difference in the competence required when using complementary therapies as an aid to caring and comforting, from their use as treatments for a particular disease.