Perspectives on Complementary and Alternative Medicine This book forms part of the core text for the Open University course K221 Perspectives on Complementary and Alternative Medicine and is related to other materials available to students, including two more texts also published by Routledge, Taylor & Francis: ■ Complementary and Alternative Medicine: Structures and Safeguards (Book 2) ■ Perspectives on Complementary and Alternative Medicine (Course Reader) If you are interested in studying this course, or related courses, please write to the Information Officer, School of Health and Social Welfare, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK Details are also given on the web page at http://www.open.ac.uk/ Perspectives on Complementary and Alternative Medicine Edited by Tom Heller, Geraldine Lee-Treweek, Jeanne Katz, Julie Stone and Sue Spurr (The Open University) Routledge Taylor & Francis Group in association with This book forms part of an Open University course K221 Perspectives on Complementary and Alternative Medicine Details of this and other Open University courses can be obtained from the Course Information and Advice Centre, PO Box 724, The Open University, Milton Keynes MK7 6ZS, United Kingdom: tel +44 (0)1908 653231; e-mail ces-gen@open.ac.uk Alternatively, you may visit the Open University website at http://www.open.ac.uk/ where you can learn more about the wide range of courses and packs offered at all levels by The Open University To purchase this publication or other components of Open University courses, contact Open University Worldwide Ltd, The Open University, Walton Hall, Milton Keynes MK7 6AA, United Kingdom: tel +44 (0)1908 858785; fax +44 (0)1908 858787; e-mail ouwenq@open.ac.uk; website http://www.ouw.co.uk/ First published 2005 by Routledge, Taylor & Francis Park Square, Milton Park, Abingdon OX 14 4RN, United Kingdom This edition published in the Taylor & Francis e-Library, 2006 To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to http://www.ebookstore.tandf.co.uk/ Copyright © 2005 The Open University All rights reserved No part of this publication may be reproduced, stored in a retrieval system, transmitted or utilised in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher or a licence from the Copyright Licensing Agency Ltd Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd of 90 Tottenham Court Road, London W1T 4LP ISBN 0-203-02329-3 Master e-book ISBN ISBN 0-415-351-60X (hbk) ISBN 0-415-351-618 (pbk) 1.1 258590B/k221b1prelimsi1.1 Contents Contributors Acknowledgements Introduction Part Complementary and Alternative Medicine in Context Chapter Changing perspectives Geraldine Lee-Treweek Chapter Can complementary and alternative medicine be classified? Julie Stone and Jeanne Katz Chapter Political and historical perspectives Mike Saks Chapter Ethics in complementary and alternative medicine Julie Stone Chapter Complementary and alternative medicine and mental health Tom Heller Part People and Complementary and Alternative Medicine Chapter Understanding health and healing Julie Stone and Jeanne Katz Chapter Understanding why people use complementary and alternative medicine Sarah Cant Chapter The therapeutic relationship and complementary and alternative medicine Julie Stone and Jeanne Katz Chapter Critical issues in the therapeutic relationship Geraldine Lee-Treweek and Julie Stone Chapter CAM in supportive and palliative cancer care 10 Jeanne Katz vi viii x 29 53 74 99 126 128 155 183 206 230 Part Complementary and Alternative Medicine in Different Settings 259 Chapter Traditional, folk and cultural perspectives of CAM 11 Andrew Vickers and Tom Heller 261 Chapter Investigating patterns of provision and use of CAM 12 Andrew Vickers, Tom Heller and Julie Stone 289 Chapter Cash and CAM: the private sector and CAM practice 13 Julie Stone and Tom Heller 313 Chapter Integration of CAM with mainstream services 14 Tom Heller 336 Chapter Information sources and complementary and alternative medicine 15 Tom Heller and Julie Stone 364 Index 384 Contributors Tom Heller is a general practitioner in a deprived area of Sheffield His practice is associated with the integration of complementary and alternative forms of practice alongside orthodox medical approaches For the last 20 years he has also been a Senior Lecturer at The Open University School of Health and Social Welfare and involved in the production of a series of health-related courses Geraldine Lee-Treweek is a sociologist of health and illness and was a Lecturer in Health Studies at The Open University until autumn 2004 Her main field of specialism is complementary and unorthodox healing, in particular CAM therapeutic relationships, the experience of long-term users of CAM and the professionalisation of modalities She also has long-standing interests in chronic illness and disability, trust and belief in contemporary society, social gerontology and the sociology of unexplained phenomena Jeanne Samson Katz is Director of Postgraduate Studies and a Senior Lecturer in the School of Health and Social Welfare at The Open University She is a medical sociologist and has contributed to many courses in the health curriculum in the School since 1990 Much of her research has focused on the care of people dying in different settings, most recently in residential and nursing homes Julie Stone is Deputy Director of the Council for Healthcare Regulatory Excellence She was previously a lecturer in health care ethics and law, teaching pre- and postregistration health care practitioners across a wide range of conventional and CAM professions A lawyer by training, Julie has advised many CAM bodies on ethical and legal responsibilities and has contributed to policy initiatives in the CAM arena both nationally and internationally Julie has written and lectured extensively on legal, ethical and regulatory aspects of complementary and alternative medicine Her books include: Complementary Medicine and the Law (1996, Oxford University Press) with Joan Matthews; An Ethical Framework for Complementary and Alternative Therapists (2002, Routledge); and Psychotherapy and the Law (2004, Whurr) with Peter Jenkins and Vincent Keter Sue Spurr is a Course Manager at The Open University School of Health and Social Welfare, working on health-related courses She is a qualified teacher of science and biology and is currently training to become a shiatsu practitioner Professor Mike Saks is Pro Vice Chancellor at the University of Lincoln He was formerly Dean of the Faculty of Health and Community Studies at De Montfort University He has published extensively on professionalisation, health care and complementary and alternative medicine and given many presentations at national and international conferences His latest books include Regulating the Health Professions, Complementary Medicine: Challenge and Change and Orthodox and Alternative Medicine: Professionalization, Politics and Health Care He has been a member and chair of numerous NHS committees and has served on a range of national groups on complementary and alternative medicine, including the NHS research and development capacity building committee for this area He is a member of the Executive of the International Sociological Association Research Committee on Professional Groups and the editorial team for the new international journal Knowledge, Work and Society, as well as the current Chair of the Research Council for Complementary Medicine Sarah Cant is Senior Lecturer in Applied Social Sciences at Canterbury Christ Church University College She has written extensively on the sociology of complementary medicine and is currently researching the use of and access to complementary medicine on the internet as well as continuing her interest in professionalisation Andrew Vickers is a research methodologist and statistician who has focused on complementary and alternative medicine for much of his career He received his Bachelor’s degree in the History and Philosophy of Science from the University of Cambridge and his doctorate in Clinical Medicine from the University of Oxford He has been an investigator on numerous clinical trials and systematic reviews of complementary therapies, including a study of acupuncture for headache that is among the largest randomised trials of acupuncture ever conducted He has also conducted considerable statistical and methodological research, with a particular emphasis on randomised trials with quality-of-life outcomes Dr Vickers now works at Memorial Sloan-Kettering Cancer Center in New York where he has appointments in the Departments of Medicine, Biostatistics, Urology and Public Health (Weill Cornell Medical College) Dr Vickers’ most recent methodological research has centred on medical prediction Acknowledgements Grateful acknowledgement is made to the following sources for permission to reproduce material in this book Chapter Figure Figure 1.1: Reproduced by permission of CPPIH Photographs p 12: Nigel Stead, LSE; p 16, left: The Wellcome Trust; p 16, right: unknown source Chapter Photographs p 40: The Wellcome Trust; p 50: Anthea Sieveking/The Wellcome Trust Chapter Photographs pp 61, 67 and 70: The Wellcome Trust; p 73: Rex Features Chapter Photographs p 112: Photographer Terry Di Paolo; p 113: Hulton Archive; p 120: Susan Tyler Hitchcock, www.mdx.ac.uk/www/study/ylamb.htm; p 128: Bernhard/Fotex/Rex Features; p 131: The Wellcome Trust Chapter Photographs p 153: Sally and Richard Greenhill; p 161: Science Photo Library Chapter Photographs p 174: Wellcome Library, London; p 191: Maximilian Stock Ltd/Science Photo Library Tables Table 7.1: Thomas, K.J., Nicholl, J.P and Coleman, P (2001) ‘Use and expenditure on complementary medicine in England: population based survey’, Complementary Therapies in Medicine, Vol 9, Harcourt Publishers Ltd; Table 7.2: Ernst, E and White, A (2000) The BBC survey of complementary medicine use in the UK’, Complementary Therapies in Medicine, Vol 8, Harcourt Publishers Ltd Chapter Photograph p 210: BSIP Keene/Science Photo Library Chapter Photographs p 243: Courtesy of Hay House, Inc.; p 250: The Wellcome Trust Chapter 10 Photographs p 272: St Christopher’s Hospice; p 276: Photograph courtesy of Marie Curie Cancer Centre; p 281: From Love, Medicine and Miracles by Bernie S.Siegel, MD, Arrow Books; p 282: Reprinted by permission of SLL/Sterling Lord Literistic, Inc A/A/F Bernard Siegel Figures Figure 10.1: Payne, S., Seymour, J and Ingleton, C (eds) (2004) Palliative Care Nursing, Open University Press; Figure 10.2: Barraclough, J (ed.) (2001) Integrated Cancer Care Copyright © Oxford University Press Chapter 11 Photographs p 295: Courtesy of Center for Adventist Research, James White Library, Andrews University; p 298: Courtesy of Matt Utting; p 301: Courtesy of J.D.Lasica; pp 303 and 304: Science Photo Library Text Box 11.11: R.Carroll (2003) ‘It’s green, prickly and sour, but this plant could cure obesity and save an ancient way of life’, The Guardian, January Chapter 12 Photographs p 336: Banana Stock/Alamy; p 342: Courtesy of South Hams Tourism; p 345: Copyright © The Guardian Chapter 13 Photographs p 356: Science Photo Library; p 369: Material reproduced with kind permission of the Publisher, How To Books Ltd; p 371: Today’s Therapist, Issue 25, http://www.todaytherapist.com/, http://www.chexpo.com/ Chapter 14 Photographs p 382: Sally and Richard Greenhill; p 386: Wellcome Library London; p 391: Alamy; p 394: Dr Amita Raja, Homoeopathic Physician at the Royal London Homoeopathic Hospital (Complementary Medicine on the NHS); p 397: Science Photo Library; p 402: Photo courtesy of Mid Somerset Newspapers Figures Figure 14.1: House of Lords Science and Technology Committee Sixth Report © Crown copyright material is reproduced under Class Licence Number C01W0000065 with the permission of the Controller of HMSO and the Queen’s Printer for Scotland Chapter 15 Photograph p 411: Science Photo Library Front cover Photograph Copyright © Getty Images Index 393 understandings of 145–7 WHO definition 144–5 health and beauty treatments 190, 370 Health Belief Model (HBM) 150, 164 health beliefs see beliefs health care delivery, models of 151–60 health care pluralism see pluralism health care relationships see therapeutic relationships health geography 338–43 health gurus 18 health indicators 145 health and leisure sector 370 health needs 23–8 health networks 149–50 health seekers 413–14 Hebden Bridge 339 Helman, C 148, 149, 155, 195, 268 herbalism 8, 20, 50, 60, 417 alternative medicine 41 expectations of therapeutic relationship 213–14 herbal products 278–9, 366–7, 370 philosophies underpinning 162–3 relationship aspects of treatment 226–7 Herbalists’ Council 69 heroic medicine 65 Herzlich, C 146, 147 hierarchy of knowledge 11 hierarchy of need 24–5, 335–6 Higginson, I 263 high-fibre diet 294 Hills, D 401–2 Hippocratic/Arabic medicine 311–12 historical perspectives 59–82 development of medical orthodoxy and marginality 68–72 early forms of health care 62–4 18th century 65–6 first half of 19th century 66–7 medical incorporation of CAM 75–7 pluralism in pre-industrial era 62–7 resurgence of CAM 72–5 HIV/AIDS 316 Holford, P 424 holism 60, 125–6, 402 attractions of CAM 193–5 CAM as holistic and CAM therapeutic relationship 219–20 holistic models of health care delivery 158–60 and ideas about the body 240–3 palliative care and 275 holistic healing 219 holistic medicine 219 Holland, J 122 Index 394 Hollis-Triantafillou, J 297 homoeopathy 8, 50, 60, 173, 174, 344, 366 conditions it is used for 181 expectations of therapeutic relationship 212, 213 individualistic approach 373 origin and folk medicine 304 remedies for eczema 193–5 symptomatic relief and quality of life 281 users 164, 165, 187–8 hoodia cactus 313, 314–16 ho’oponopono 335 Hospice Information Service 273–4 hospice services 272–3 hospital medicine 69 House of Lords Select Committee report 42, 174, 395–6 categorisation of CAM 48–9, 76–7 factors affecting PCO decision-making on CAM provision 398, 399 recommendations 394, 395 Hurwitz, B 155 hydrogen peroxide therapy 422–3 hydropaths 71 Hypericum see St John’s Wort hypnotherapy 7, 282 ideas about the body 240–3 changes in 13–14 ill person, dealing with 226–8 Illich, I 73, 334 illness 145 CAM and conceptualising 241–2 dealing with in therapeutic relationship 224–6 influences on health and illness behaviour 149–51 responsibility for causes of ill health 236–7 see also disease; sickness immigrant communities 318–19 imperialism 310–12 income access to internet 414 and use of CAM 180 see also prosperity India 370 indigenous communities naming 310 see also folk medicine; traditional medicine individualised approach to health 373, 402–3 Indonesia 369 informal healing 358–63 information 89, 409–32 Index 395 CAM and celebrity 425–7 CAM as news 425 consent requirements 105 internet see internet printed media 418–25 information technology 12 informed consent see consent ingestive techniques 223 integrated cancer care 283–4 integrated (integrative) medicine 35, 43–6, 53, 391–4 integration 9, 21–2, 310, 379–407 advantages and disadvantages 382–6 case study 400–3 degrees of 393–4 versus domination 386–90 future of therapeutic relationship 254 government support for 365 and the NHS 381–2, 394–400 interaction failure in 247 social 335 internet 410–18 CAM and 416–18 finding reliable health information on 417–18 health information and 410–14 health product sales on 371 quality of health information on 414–16 using for health information 413–14 invasive techniques 52, 223 Israel 311–12 Jacobsen, B.K 278 Japan 369 Jewson, N 68–9 Johnson, J.E 422–3 Johnston, S 307, 319 Johnstone, P.A S 280 Jonas, W.B 386 Jones, L.J 153–4 Jordan, N 264–5 Jorm, A 130 Josselin family 63–4 justice, respect for 85, 96, 100 Kalahari desert 314–16 Kaptchuk, T.J 159 kava 192, 316, 317 Kellogg, J.H 294, 295 Kelner, M 213, 214–18 Kennedy, S.S 123 Kessler, R 124 Index Kimby, C.K 278 Kite, S.M 283 Kleinman, A 152 knowledge hierarchy of 11 modernity and post-rnodernity 11–12, 13 professional 154 rise of new knowledge systems 17–18 Köhler, C 413–14 Kohn, M 263, 264 Kwekkeboom, K.L 280, 282 labelling health products 190–1 people with mental distress 119 laboratory medicine 69 laetrile 278–9 law 208 more stringent requirements than ethics 92 lay health beliefs 145–7, 154 lay health care see folk medicine Layzell, S 122 Lee, T.Berners 411 Lee-Treweek, G 237 Leibovici, L 385 Leiner, B.M 410, 411 leisure sector 370 lengthening life 264 Levin, J.S 386 Lewith, G 260, 337 ley lines 343 lifestyle 10, 15–16 lifestyle journalism 424–5 litigation 254–5 Lloyd, P 182, 184, 195 local policy initiatives/developments 395–6 locality purchasing 397–8 location of CAM 338–43 Loman, D 180 Luff, D 386–7, 396 Lupton, D 192 Ma Huang (ephedra) 308 MacLennan, A 178 Macmillan Cancer Relief 273, 274 Maizes, V 392 manipulative and body-based methods 48 manufactured risk 185–6, 280 marginality 61, 68–72 Martin-Facklam, M 417 Maslow, A, 24, 336 396 Index 397 massage 251, 283 Matthews, J 42–3, 220–1, 235–6 McTaggart, L 380 medical diagnosis see diagnosis medical-ministry alliance 68, 69 medical model 120 Medical Registration Act 1858 62, 66, 68 medicine see biomedicine; orthodox medicine medicine men/women 62 see also traditional medicine meditation 281–2 Memorial Sloan Kettering Hospital, New York 277 mental health 111–39 biomedicine and its challengers 117–21 conceptualising mental health issues 112–17 effectiveness of CAM and 129–34 how CAM therapies fit into mental health recovery 122–3 how people with mental distress use CAM 123–9 major and minor types of mental distress 116–17 users and survivors of mental health services 119, 121–3 mental techniques 224 meridians 162, 163, 241, 302 mesmerism 67 meta-analysis 327 metastatic cancer 265 Metz, J.M 278, 279, 280, 282, 284–5 Mezereum 194 midwifery 309 Miller, J.J 129 Mills, S 367 mind-body therapies 47, 116, 281–3 minimum intervention 250 Mintel survey 366–7 Mitchell, A 116, 122, 130, 207, 208, 216, 218, 219–20, 223, 227, 239, 244, 252 Mitchell, E 423 modality, choosing 186–7 models of health care delivery 151–60 modernity 11, 73 monopolistic system 53 musculo-skeletal integrated medicine service 400–1 musculoskeletal pain 19 mutual trust and mutual responsibility 102 narrative-based medicine 234 National Association of Complementary Therapists in Hospice and Palliative Care 274 National Center for Complementary and Alternative Medicine (NCCAM) (USA) 37–8, 42, 44, 277 classification of CAM 47–8 National Council for Hospice and Specialist Palliative Care Services 274, 276 National Guidelines for the Use of Complementary Therapies in Supportive and Palliative Care 283–4 National Health Service (NHS) 76, 173 Index 398 case study of integration 400–3 choice 177 integration and 381–2, 394–400 NHS cancer plan 275 The NHS Plan 381 palliative care 272 and provision of CAM treatments 356, 362 role and provision of CAM 363–5 structural and organisational changes 254 National Health Service Act 1946 68 National Health Service Act 1977 364 National Institute for Clinical Excellence (NICE) 276, 364 National Insurance Act 1911 68 National Research Council (USA) 46 National Service Frameworks for Mental Health 118 Native American healers 307 natural, CAM as 5–6 needs hierarchy of 24–5, 335–6 of people with cancer 268–71 pluralism and changing health needs 23–8 negotiation of contracts with users 104–5 Netherlands 54 networks health 149–50 submerged 388–9 ‘new experts’ see experts, ‘new’ New Zealand 309 ‘newly diagnosed’ internet users 413 non-maleficence 85, 93, 94, 100 non-whole systems 50–5 north-south divide 339 Nouwen, H 248 nurses 346–7 obesity 314–16 O’Callaghan, F.V 264–5 Oerton, S 251 ‘old wives’ tales’ 72 see also folk medicine Oncovin 317 Oneschuk, D 261, 278 Ong, C 8, 319 onset of symptoms, time and mode of 152, 224 orthodox medicine 18–20, 62, 363 attitudes of professionals to integration 382–5 backlash 126 CAM and changes in 337 counter-culture 72–4 definitions of CAM by exclusion 37, 38–9 development 65–6, 68–72 Index 399 ethics of practitioners compared with those of CAM practitioners 90–1 guidelines for clinicians with patients using CAM 133–4 and harm caused by CAM 54–5 as imperialism 310–12 incorporation of CAM 75–7 integration of CAM see integration limitations and cancer care 263, 264 mental health 117–21 professionals practising CAM 345–7 and religion 334 state of medicine in first half of 19th century 66–7 support from the state 61 using traditional medicine alongside 310 see also doctors/physicians; general practitioners osteopathy 8, 50, 60, 76, 344, 380 complementary therapy 41 conditions it is used for 181 cranial osteopathy 190 minimum intervention 250 origins and development 302–3 philosophies underpinning 161 regulation 69, 98, 253 users 188 outcome-based ethics 100–1 over-the-counter (OTC) remedies 9, 177–8, 367 ownership of the body 238–40 Pacific islanders 307 Pakistan 307 Palestinian areas 311–12 palliative care 272–7 similarities in status with CAM 274–5 supportive and palliative care 275–7 Palmer, D.D 302 Paltiel, O 261 Pan, C.X 280 Pandolfini, C 416 Panton, C 211 Papua New Guinea 307 parallel system 53, 310 Paramore, L 326 participation, patient/user 25, 193 paternalism 85–6, 90, 93–4 paternalistic model of therapeutic relationship 214–16 pathology 152, 224 patient-centredness 234, 235–6 patients see users of CAM Patterson, R.E 260–1 paying for health services 356–8 see also private sector Index 400 PC-SPES 279 Peeke, P.M 124 Pennell, I 236 Pescosolido, B 151 Peters, D 245, 394 philosophical factors 125–6 philosophies, underpinning 160–4 physicians see doctors/physicians; general practitioners physiological needs 24 Pierret, J 147 place, sense of 340 placebo, therapeutic relationship as 244–6 placebo effect 223, 245, 255 plants Ethnomedica project 299–300 traditional medicine as source of commercial medicines 312–17 pluralism 148, 363 and changing health needs 23–8 pre-industrial era 62–7 politics of CAM 59–61 see also historical perspectives Porter, R 123 post-modernity 11–12, 73 power mental health professionals 119, 121 in therapeutic relationship 212 practical aspects of treatment 226 practical ethics 92 practitioners of CAM 344–7 attitudes to integration 385–6, 387 autonomy 360 checking out 362 creating dependency to satisfy own emotional and financial needs 249–51 earnings 372 ethics compared with conventional doctors’ ethics 90–1 and finance 372–4 imposing own views on users 244 intuitive knowledge of how to act ethically 90 numbers of 344, 367 orthodox health professionals as 345–7 regulatory status and surveys 331–2 responsibilities and accountability 98–103 role and nature of CAM therapeutic relationship 216–18 wounded healers 248–9 pre-industrial era 62–7 press 418–25 celebrity health 425–7 lifestyle journalism 424–5 and public responsibility 419–23 Press Complaints Commission (PCC) 423 primary care Index 401 CAM within 396–400 Somerset Trust for Integrated Health Care 400–3 primary care organisations (PCOs) 397–8 Prince of Wales’s Foundation for Integrated Health 44, 391, 421, 426 printed media see press prioritisation 23 private sector 353–78 advantages of private CAM use 359 current patterns of private CAM provision 363–5 disadvantages of private CAM use 360–1 economic aspects of CAM provision and use 365–74 provision of CAM in 354–63 product-based therapies 52 see also CAM products professional bodies 97–8, 253 professional boundaries see boundaries professional ethics 84, 92, 97–8 professional etiquette 107 professional knowledge 154 professions, development of 68 prosperity 335–7 prostate cancer 261 Prostratin 316 Provincial Medical and Surgical Association 65, 66 provision of CAM 337–48 geography 337–44 location of CAM 338–43 practitioners 344–7 settings for CAM 343–4 psoriasis 316 psychiatry 113–14, 120–1 psychological intervention 52 psychoneuroimmunology (PNI) 240, 246, 255 psycho-social needs 24, 226 psychotherapy 235–6 public health, traditional medicine and 307–9 public responsibility 419–23 public service model of broadcasting 425 qi (vital energy) 162, 163 quackery, great age of 65 qualitative research 132–3 quality of health information 414–16 quality of life 264, 280–3 Rainie, L 412–13 Ramlow, J 183 randomised controlled trials (RCTs) 131–2, 245, 393 Read, N 392 reductionism 6, 117, 239 Reed, K 319 Index 402 Rees, L 43–4, 392 Rees, R.W 261 reflexivity, social 186 reflexology 54, 190, 344 regulation 360, 361 categorising CAM according to regulatory status or potential 51 professional bodies 97–8, 253 regulatory status of CAM practitioners and surveys 331–2 reiki 61, 163, 213, 221 Reilly, D 281, 331 relationship aspects of treatment 226–8 relationships changes in 13–14 therapeutic see therapeutic relationships religion 334 remote techniques 224 Report as to the Practice of Medicine and Surgery by Unqualified Persons in the United Kingdom 71 research 104, 245–6, 374 qualitative 132–3 RCTs 131–2, 245, 393 Research Council for Complementary Medicine (EU) 98–9 residence, changes in patterns 10 responsibility for causes of ill health 236–7 changing notions of the therapeutic relationship and 233–8 mutual trust and mutual responsibility 102 patients and therapeutic responsibility 221–2, 234–6, 359 press and public responsibility 419–23 retailing CAM 371 rights 84–5 Risberg, T 278 risk, manufactured 185–6, 280 Rogers, A 114 Rosenberg, M.W 339, 342, 343 Rosenheck, R.A 125 Royal Commission on the press 419 royal family 426 Russell, S 426 Russinova, Z 125 safety of CAM 191–2 safety needs 24 Sagaram, S 417 Saks, M 61, 68, 71, 75–6 Salmenpera, L 261 salutogenic model 157–8 San bushmen 314–16 Saunders, C 272, 274 Sawyer, C 183 Sceletium 316 Index 403 Scheff, T 119 Schneirov, M 387–9 Schulz, V 130 science 11 advances in 255 Scott, A 359, 373 Segrott, J 337, 424 self-actualisation needs 24 self-determination 86 self-healing 220–2 self-help 16, 64, 65, 226 self-help techniques 52 self-responsibility 221–2 self-treatment 17, 21 surveys and 327–30 sensationalism 419 sense of coherence model 157–8 sense-making 195 sense of place 340 serious mental illness 125 settings for CAM delivery 343–4 sexual abuse 251–2 shamans 62 see also traditional medicine shared decision-making model 214–16 shark products 279–80 Sharma, U 7, 91, 165, 166–7, 180, 181, 182, 183, 183–4, 190, 192, 195, 233, 235, 244, 336, 344, 345, 372 Shepperd, S 416 Shumway, C 419–20, 425 sickness dealing with 226 see also disease; illness Sirious, F.S 165, 188 smoking 316 social activism 236–7, 373 social change 10–22 social class 180 social interaction 335 social needs 24, 226 social reflexivity 186 Socio-Behavioural Model (SBM) 150 socioeconomic disadvantage 403 Somerset Trust for Integrated Health Care 400–3 Sparber, A 122 specialisation 74 cross-specialisation 330 spirituality 159–60 Spotlight Health 426 St Christopher’s Hospice 272 St George, D 389–90 Index 404 St John’s Wort (Hypericum) 130, 131, 192, 417 ‘stable users’ 182, 183 Stacey, M 146, 151–2, 254 state see government/state Stephan, J 53 Still, A.Taylor 161, 302–3 Stone, J 39, 42–3, 51–3, 96, 98, 102, 105, 211–12, 220–1, 235–6 Straus, S.E 45–6 stress 115–16, 316 Struthers, R 307 submerged networks 388–9 Sunday Times ‘What’s the Alternative?’ column 421 supportive care 275–7 see also palliative care surgeons 62, 65 surveys 326–33 analysing results 326–31 effect of regulatory status on 331–2 growth of CAM 332–3, 365–9 purposes 332 symptoms relief from 264, 280–3 time and mode of onset 152, 224 Tavares, M 274, 276 taxonomy 21 see also classification Taylor, C.R 193 technical aspects of treatment 223–4 theoretical aspects of treatment 224–6 Theory of Planned Behaviour (TPB) 151 Theory of Reasoned Action (TRA) 150 therapeutic intent 209–10 therapeutic landscapes 340, 341, 342 therapeutic relationships 163, 205–58 centrality of ethics in 88–96 changing notions of responsibility and 233–8 characteristics underpinning 218–22 effecting change within 222–8 ethics and 84–8 expectations of 212–18 failure of CAM therapeutic relationships 246–53 future of 253–5 inhibitory factors 211–12 meaning of 206–18 ownership, control and ideas about the body 238–44 as placebos 244–6 principles of good practice 210–11 reasons for choosing CAM 192–3, 266 users’ experiences 232–3 therapy culture 231, 237 Index 405 Thoits, P 117 Thomas, K 8–9, 114, 116, 178, 179, 326, 332–3, 367, 386–7, 396–7, 398–9 Thomas, P 118, 121, 131 Thompson, E.A 281 Thorlby, M 211 time spent in consultation 192 timescale for improvement 250 tobacco addiction 316 tolerant system 53 total pain 272, 273 Totnes 339, 340–2 touch 335 tradition CAM as traditional diversity in 20–2 traditional Chinese acupuncture (TCA) see acupuncture traditional Chinese medicine (TCM) 20, 40, 60, 304–6 traditional medicine (TM) 39, 294, 296, 299, 306–17, 327, 358 early societies 62 extinction 311–12 how folk medicine becomes traditional medicine 304–6 positive and negative aspects 307–10 as a source of commercial medicines 312–17 transference 251–2 treatment (universal theme) 152, 225 trust 87, 88 mutual trust and mutual responsibility 102 truthfulness 419 ‘tyranny of health’ 237–8 United States (USA) 368, 369 NCCAM 37–8, 42, 44, 47–8, 277 universal themes 152, 224–5 Unutzer, J 124 use of CAM 173–203, 325–37 conditions CAM is used for 181–2 considerations that may govern 334–7 demography 177–81 investigating with surveys 326–34 pathways to care 183–4 patterns of use 182–3, 325–37 people with cancer 260–2 reasons for 176, 188–95, 262–6 theorising the CAM renaissance 184–8 users of CAM beliefs 333–4 CAM therapists imposing own views on 244 disclosure of use of CAM to physicians 284–5 expectations 164–7 Index 406 experiences of the therapeutic relationship 232–3 explanations for using CAM 176, 188–95, 262–6 meeting expectations of people with cancer 277–83 negotiation of contracts with 104–5 satisfaction with CAM 192 surveys and defining 330–1 therapeutic responsibility 221–2, 234–6, 359 users and survivors of mental health services 119, 121–3 Velban 317 Verheij, R 343 Verhoef, M.J 132 Vickers, A 165, 240, 262, 279, 295, 344 victim blaming 243 Vincent, C 188 virtue ethics 100–1 visualisation 282–3 vital (life-force) energy 6–7, 162, 163, 241, 302 voluntary hospitals 66 Wakley, T 67 Waldram, J 306–7 Walker, L.G 282 Wallcraft, J 123, 131, 132, 133 Ward, A 53–4 Watkins, A 343 Watts, G 160, 166 Weiger, W.A 279, 284 Weihmayr, T 420 Weil, A 43–4, 392 Weisbord, S 416 ‘well’ internet users 413 wellbeing mental 119 people with cancer and improvement in 264, 280–3 whistleblowing 107 White, A 188, 189, 326–7, 368 whole systems 50–5 Wiles, J 339, 342, 343 Wilkinson, S 280, 283 Williams, R.G.A 147 witchcraft 64 see also traditional medicine women 64 use of CAM for mental health 124 see also gender Wootton, J 122 work trend 10 World Health Organization (WHO) 39, 53, 120 definition of health 144–5 report on traditional medicine 307, 308 Index World Wide Web 411 wounded healers 248–9 Wurtzel, E 119 Yager, J 133–4 Yates, P.M 265 Yu, M 188 Zollman, C 165, 240, 295, 344 zone rebalancing 20–1 407 ... De Montfort University He has published extensively on professionalisation, health care and complementary and alternative medicine and given many presentations at national and international conferences... Motivation and Personality, New York, Harper & Row Changing perspectives 27 Mintel (2003) Complementary and Alternative Medicine in the UK, London, Mintel Ong, C and Banks, B (2003) Complementary and. .. opposition to conventional health care The terms include ? ?alternative medicine? ??, ? ?complementary medicine? ?? and ‘nonconventional medicine? ?? Do you think it is helpful to think of CAM and orthodox medicine