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Edzard Ernst, MD, FRCP, is professor
of complementary medicine
at Peninsula Medical School, Universities
of Exeter and Plymouth, and editor-in-chief of the journal Focus
on Alternative and Complementary Therapies
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Ephedra (Ma Huang) has been used to treat asthma |
Many pharmacists are puzzled by the popularity and commercial success
of alternative medicines. If conventional drugs are more effective than
ever before, why do people turn to alternatives?
The first point to make is that alternative medicines, such as herbal
remedies, homoeopathy, flower remedies and aromatherapy, are not normally
used as alternatives. Usually, they are used as an adjunct to conventional
health care. In most cases the term “alternative medicine” is,
therefore, wrong.
A second point is that there is no single reason or set of reasons why
consumers use alternative medicines. It all depends on what the remedies
are being used for. Imagine a person suffering from a life-threatening
condition (eg, cancer) and someone with chronic arthritis. Their reasons
for trying complementary medicines will be dramatically different.
Notwithstanding these caveats, research has identified numerous reasons
or motivations for trying such products. These can be divided into negative
(“push”) and positive (“pull”) factors (see Panels
1 and 2, respectively).1 Depending on the circumstances, the relative
importance of these factors will vary considerably.
Panel 1: Push factors
· Dissatisfaction with aspects of conventional medicine
· Total rejection of conventional medicine due to an anti-science
or anti-establishment attitude
· Desperation |
Push factors
Much of the presently high popularity of complementary medicine amounts
to a criticism of conventional health care. In a way, this is a backlash
from the spirit of the mid-20th century when we expected science to
achieve everything. Reality turned out to be different. Consumers now
feel disappointed that so many medical conditions cannot be cured or
adequately alleviated. And they are discouraged by the often serious
adverse effects that drugs can cause. Complementary medicines, on the
other hand, are “free” of such problems — at least,
this is what their proponents incessantly claim and many consumers
believe.
In addition, the delivery process of conventional health care is, far
too often, inadequate. This includes allegations that people have poor
relationships with conventional health care providers. It has been shown,
for instance, that arthritis sufferers in the UK who use both complementary
and GPs for their condition are more satisfied with their therapeutic
relationship with the former compared with the latter group of professionals.2 Inadequate health care delivery also
includes long waiting lists and hurried consultations. Go to your GP
and he or she will (eventually) see you for five to 10 minutes, but go
to a homoeopath and he or she might give you one hour of his or her time.
Desperation can, perhaps, be the most
powerful push factor. It is understandable that a patient who has been
given a life-threatening diagnosis might look everywhere for help. And
there are plenty of promises of a cure in complementary medicine.3 The
fact that these are often false promises is usually not appreciated by
those driven by desperation.
Panel 2: Pull factors
· Hope for increased well-being and other positive outcomes
· Philosophical congruence (eg, with the “spiritual dimension” of
alternative medicine, its emphasis on holism or the more active
role patients play)
· Personal control over treatment
· Good relationship with therapist (eg, interaction on equal terms,
time for discussion, emotional factors allowed for)
· Accessibility |
Pull factors
Users of complementary medicine usually learn from friends or the media
about the
latest alternative. The undue influence of the media has already been
discussed in this series (PJ, 1/8 January, p21 PDF (70K)). At
present, the UK media seem to have jumped on the bandwagon of uncritical
reporting
and the
often misleading promotion of unproven treatments. Who can blame the
consumer or politician for being influenced by this incessant flow of
misinformation? A recent Government-sponsored patient guide is a good
example. It perpetuates the myths promoted by the self-interested alternatives
industry and is, irresponsibly, devoid of information on risk and benefit.4 Consumers are seduced by promises of better health and fewer side effects.
Sadly, the reality that there may be no evidence for such claims is easily
forgotten. The fact that the Government has sponsored such a guide could
be seen as overtly negligent. On the other hand, it shows just how much
the pull of promotional claims and wishful thinking has infiltrated our
current thinking.
Philosophical congruence with aspects of complementary medicine is another
important pull factor. Philosophical congruence
essentially means that many messages of complementary medicine ring intuitively
true — many people want to be treated as whole human beings, take
active roles in their health care or believe that natural means benign.
Again, there is much criticism here of conventional health care delivery.
For instance, all good medicine has always been (and should always be)
holistic.5 Complementary medicine, therefore, has by no means a monopoly
on holism. But consumers may well have a good reason to prefer alternative
therapies when they experience a conventional health care interaction
that is suboptimal. Through the human approach of complementary therapists,
patients experience all the sympathy, understanding and empathy they
crave. However, I argue that we should not have to consult complementary
practitioners to benefit from this. Conventional health care should provide
it as well.
Conclusion
The reasons for using complementary medicines are diverse and can differ
from person to person. Many studies have investigated this area1
and have come up with reasons that vary in relative importance depending
on the exact circumstances. Many of the reasons amount to a direct
or indirect criticism of conventional health care delivery. I think
it is high time to listen to this criticism.
References
1. Ernst E, Pittler MH, Stevinson C, White AR. The desktop guide to
complementary and alternative medicine. Edinburgh: Mosby ; 2001.
2. Resch K, Hill S, Ernst E. Use of complementary therapies by individuals
with arthritis. Clinical Rheumatology 1997;16:391–5.
3. Schmidt K, Ernst E. Assessing websites on complementary and alternative
medicine for cancer. Annals of Oncology 2004;15:733–42.
4. The Prince of Wales's Foundation for Integrated Health. : Complementary
healthcare: a guide for patients. Available at: www.fihealth.org.uk
5. Calman K. The profession of medicine. BMJ 1994;309:1140–3. |
The
Pharmaceutical Journal