Changing the conversation about health

Complementary Medicine Roundup – May 2019

PRINT AND ONLINE MEDIA: RECOGNISING THE VALUE OF CAM

Reflecting the interest of their readers in the healing processes and in CAM modalities, print and online media reports are increasingly adopting an open-minded, non-sceptical and diverse approach.

Examples include:

 

 

 

 

For more information about Yoga see the research abstracts cited below and refer to my March 2018 blog (USING YOGA FOR CHRONIC LOW BACK PAIN AND SCIATICA: NICE GUIDELINES LINES…);

 

 

 

 

 

 

 

 

 

 

Following an apparent decline in the recognition of CAM within the UK public health and social care sectors after about 2003, when, according to “guidance on integrating complementary therapies into clinical care” issued (in July 2003) by The Royal College of Nursing to its members, it appeared to be establishing its services within the NHS (especially in primary and palliative care), there has, in recent years, been evidence of a resurgence of support for CAM to be an effective contributor to those sectors. This acknowledgement of a “New Horizon” for CAM was the subject of my February 2019 blog.

INTEGRATIVE HEALTHCARE POLICY: CAM & CONVENTIONAL MEDICINE CONTRASTED 

How is integrative healthcare defined from a UK NHS perspective and to what extent, if at all, does this definition include reference to CAM modalities?

A University of Southampton research theme relating to “integrative health care” includes the following statement: 

‘…Many people turn to traditional and alternative therapies to help them cope with illness when western medicine does not seem to supply the whole answer. We believe that some traditional therapies can ‘complement’ Western medicine and should be accepted and integrated into a person-centred approach…An integrative approach aims to utilize the strengths of both conventional and complementary systems of medicine to optimize the effectiveness and cost-effectiveness of treatments, to reduce adverse effects, and to address both the symptoms and the root causes of disease…’

A perspective from the US may be found in the publication “Integrative Health and Medicine: Today’s Answer to Affordable Healthcare” (March 2015; authors: Patricia Herman, ND, PhD; Erica Oberg, ND, MPH; Mimi Guarneri, MD, FACC) published by The Integrative Health Policy Consortium (IHPC) This publication is described on the IHPC website as a reference booklet:

‘…designed for decision makers who develop care programs, for public policy and regulatory decisions, practitioners at all levels and consumers…’

It includes the following paragraph:

‘…CAM creates better outcomes, especially in those who are chronically ill. Contrary to the common critique that there is a lack of evidence, thousands of studies, including randomized controlled trials published in top medical journals demonstrate superior outcomes compared with usual or conventional care. For example, on page 6, we highlight research demonstrating the ways naturopathic medicine prevents cardiovascular disease and metabolic syndrome at a cost less than prescribing a pill! Colon cancer patients receiving a treatment protocol consisting of acupuncture, traditional Asian medicine and vitamins had a 60%-82% survival rate at five years compared with a 7%-8% survival rate among patients receiving conventional care alone [cited research: 4]. European countries, in which general practitioners are co-trained in integrative approaches, have incorporated CAM into national health care systems based on studies showing better outcomes and lower costs. See page 12…’ 

Other Policy Documents and Actionsby the IHPC may be found here.

Contrast the above with a NHS reference to integrated care in the context of emergency and acute medical care. Paragraph 38.1 (page 5) of the National Institute for Health and Care Excellence (NICE) Guideline 94 (March 2018) titled Emergency and acute medical care in over 16s: service delivery and organisationmakes no mention of “Complementary Systems of Medicine” but acknowledges that [extract]:

‘…Increasingly, patients treated by the NHS are complex with multiple morbidities and with needs that cross service boundaries – needs that are met with both physical and psychological healthcare, by several specialty departments at one or more hospitals, by health and social care provision and for the majority by both primary and secondary care…There is currently no standard description of integrated care and so this is interpreted in a particular clinical context or for a particular patient group…’

[Note: bolding of text added by me]

Another attempt to define Integrated Care from an NHS perspective, again without express reference to Complementary Medicine, may be viewed in the Nuffield Trust publication (June 2011) What is Integrated Care: An overview of integrated care in the NHS and also here.

Notwithstanding the absence of any reference to CAM in either the NHS or the Nuffield Trust documents mentioned above, a NHS England document relating to personalised care includes the following statement:

‘…Personalised Care will benefit up to 2.5 million people by 2024, giving them the same choice and control over their mental and physical health that they have come to expect in every other aspect of their life. A one-size-fits-all health and care system simply cannot meet the increasing complexity of people’s needs and expectations. Personalised care is based on ‘what matters’ to people and their individual strengths and needs. The NHS Long Term Plan advises that personalised care will become business as usual across the health and care system and Universal Personalised Care confirms how we will do it…’

[Note: bolding of text added by me]

INTEGRATED HEALTHCARE: AN INTEGRATIVE PAIN MANAGEMENT PROGRAM FOR PATIENTS ON PRESCRIPTION OPIOIDS

A non-randomised US study published in February 2019 and titled Patient-Reported Outcomes of an Integrative Pain Management Program Implemented in a Primary Care Safety Net Clinic: a Quasi-experimental Study (authored by Maria Teresa Chao, Dr PH, MPA, Emily Hurstak, MD, MPH, MAS, Kristina Leonoudakis-Watts, BA, Frank Sidders, MPH, Joseph Pace, MD, Hali Hammer, MD, and Barbara Wismer, MD, MPH)

(also reported here and hereresearched, among other things, how the application of acupuncture, massage, mindfulness, exercise and group support brought relief to patients receiving prescription opioids. The study provided:

‘… practice-based data suggesting that increased access to non-pharmacologic approaches in primary care safety-net settings may be a strategy to improve pain management for vulnerable patients with chronic pain…’

Readers will be aware of newspaper reports investigating a UK opioid “epidemic” including those in The Sunday Times on the 24.02.19 respectively captioned Britain’s opioid epidemic kills five every day and We are sleepwalking towards carnage in our communities. Sunday Times analysis of NHS data concluded that, in 2017, 41.1 million opioids were prescribed by GPs. The equivalent of 79 packs of pills a minute, something a former Health Minister is reported to have described as “a state-sponsored public health crisis”. Prescribing rules for GPs from the National Institute for Health and Care Excellence (NICE) is reportedly expected soon. It is to be hoped that this guidance will constitute “guidelines not tramways” and that the professional judgement of GPs will be respected, especially when prescribing pain relief for patients with cancer and end of life care.

Encouraged by the above quotes (respectively) from the publications of the University of Southampton, the Integrative Health Policy Consortium (IHPC), by research abstracts referred to in this roundup and by the Pain Management Program (opioid) cited above, it is, I suggest, reasonable to argue that UK public health and social care policy initiatives should embrace CAM services which clearly have much to contribute, particularly when integrated with orthodox/conventional medicine to combat chronic pain.