What is complementary medicine?

Which disciplines are complementary?

Our list is not exhaustive, and new branches of established disciplines are continually being developed. Also, what is thought to be conventional varies between countries and changes over time. The boundary between complementary and conventional medicine is therefore blurred and constantly shifting. For example, although osteopathy and chiropractic are still generally considered complementary therapies in Britain, they are included as part of standard care in guidelines from conventional bodies such as the Royal College of General Practitioners.

The wide range of disciplines classified as complementary medicine makes it difficult to find defining criteria that are common to all. Many of the assumptions made about complementary medicine are oversimplistic generalisations.

Historical development

Since the inception of the NHS, the public sector has supported training, regulation, research, and practice in conventional health care. The recent development of complementary medicine has taken place largely in the private sector Until recently, most complementary practitioners trained in small, privately funded colleges and then worked independently in relative isolation from other practitioners.

Research

More complementary medical research exists than is commonly recognised—the Cochrane Library lists over 4000 randomised trials—but the field is still poorly researched compared with conventional medicine. There are several reasons for this, some of which also apply to conventional disciplines like occupational and speech therapy. However, complementary practitioners are increasingly aware of the value of research, and many complementary training courses now include research skills Conventional sources of funding, such as the NHS research and development programme and major cancer charities, have become more open to complementary researchers.

Training

Although complementary practitioners (other than osteopaths and chiropractors) can legally practise without any training whatsoever, most have completed some further education in their chosen discipline.

Numbers of medical schools offering or planning to offer courses on complementary medicine as part of the curriculum

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There is great variation in the many training institutions. For the major therapies—osteopathy, chiropractic, acupuncture, herbal medicine, and homoeopathy—these tend to be highly developed, some with university affiliation, degree level exams, and external assessment. Others, particularly those teaching less invasive therapies such as reflexology and aromatherapy, tend to be small and isolated, determine curricula internally, and have idiosyncratic assessment procedures. In some courses direct clinical contact is limited. Some are not recognised by the main registering bodies in the relevant discipline. Most complementary practitioners finance their training without state support, and many train part time over several years.

Conventional healthcare practitioners such as nurses and doctors often have their own separate training courses in complementary medicine.

Regulation

Apart from osteopaths and chiropractors, complementary practitioners are not obliged to join any official register before setting up in practice. However, many practitioners are now members of appropriate registering or accrediting bodies There are between 150 and 300 such organisations, with varying membership size and professional standards. Some complementary disciplines have as many as 50 registering organisations, all with different criteria and standards.

The General Osteopathic Council and General Chiropractic Council have been establishedby acts of parliament to regulate their respective disciplines

Recognising that this situation is unsatisfactory, many disciplines are taking steps to become unified under one regulatory body per discipline. Such bodies should, as a minimum, have published criteria for entry, established codes of conduct, complaints procedures, and disciplinary sanctions and should require members to be fully insured.

The General Osteopathic Council and General Chiropractic Council have been established by acts of parliament and have statutory self regulatory status and similar powers and functions to those of the General Medical Council. A small number of other disciplines—such as acupuncture, herbal medicine, and homoeopathy—have a single main regulatory body and are working towards statutory self regulation.

Efficient regulation of the “less invasive” complementary therapies such as massage orrelaxation therapies is equally important. However, statutory regulation, with its requirements for parliamentary legislation and expensive bureaucratic procedures, may not be feasible. Legal and ethics experts argue that unified and efficient voluntary self regulatory bodies that fulfil the minimum standards listed above should be sufficient to safeguard patients. It will be some years before even this is achieved across the board.

There are multiple levels of disease and, therefore, multiple levels at which therapeutic interventions can be made

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The holistic approach

Many, but not all, complementary practitioners have a multifactorial and multilevel view of human illness. Disease is thought to result from disturbances at a combination of physical, psychological, social, and spiritual levels The body's capacity for self repair, given appropriate conditions, is emphasised.

According to most complementary practitioners, the purpose of therapeutic interventionis to restore balance and facilitate the body's own healing responses rather than to target individual disease processes or stop troublesome symptoms. They may therefore prescribe a package of care, which could include modification of lifestyle, dietary change, and exercise as well as a specific treatment. Thus, a medical herbalist may give counselling, an exercise regimen, guidance on breathing and relaxation, dietary advice, and a herbal prescription.

In reflexology areas of the foot are believed to correspond to the organs or structures of the body

It should be stressed that this holistic approach is not unique to complementary practice. Good conventional general practice, for example, follows similar principles.

Use of unfamiliar terms and ideas

Complementary practitioners often use terms and ideas that are not easily translated into Western scientific language. For example, neither the reflex zones manipulated in reflexology nor the “Qi energy” fundamental to traditional Chinese medicine have any known anatomical or physiological correlates.

Acupuncturists may “take a patient's pulse,” but they assess characteristics such as “wiriness” or “slipperiness”

Sometimes familiar terms are used but with a different meaning: acupuncturists may talk of “taking the pulse,” but they will be assessing characteristics such as “wiriness” or “slipperiness,” which have no Western equivalent. It is important not to interpret terms used in complementary medicine too literally and to understand that they are sometimes used metaphorically or as a shorthand for signs, symptoms, and syndromes that are not recognised in conventional medicine.

Different categorisation of illness

Complementary and conventional practitioners often have very different methods of assessing and diagnosing patients. Thus, a patient's condition may be described as “deficient liver Qi” by a traditional acupuncturist, a “pulsatilla constitution” by a homoeopath, and “a peptic ulcer” by a conventional doctor. In each case the way the problem is diagnosed determines the treatment given.

Confusingly, there is little correlation between the different diagnostic systems: some patients with deficient liver Qi do not have ulcers, and some ulcer patients do not have deficient liver Qi but another traditional Chinese diagnosis This causes problems when comparing complementary and conventional treatments in defined patient groups.

It should be stressed that the lack of a shared world view is not necessarily a barrier to effective cooperation. For example, doctors work closely alongside hospital chaplains and social workers, each regarding the others as valued members of the healthcare team.

Approaches to learning and teaching

Complementary practitioners are not generally concerned with understanding the basic scientific mechanism of their particular therapy. Their knowledge base is often derived from a tradition of clinical observation and treatment decisions are usually empirical. Sometimes traditional teachings are handed down in a way that discourages questioning and evolution of practice, or encourages reliance on their own and others' individual anecdotal clinical and intuitive experience.