Positive Health Online

Never before have complementary therapies found so much favour. Patients are choosing and using complementary therapies in greater numbers than ever before. Practitioners may feel confident that their therapies are finally receiving some of the recognition that they deserve. Perhaps. It is certainly true that complementary therapies are finding a place in all sort of health care settings. There are examples of aromatherapy being used in intensive care, acupuncture in cancer care – to alleviate the nausea of chemotherapy.

Massage, osteopathy, homoeopathy, nutritional therapy are amongst the therapies finding their way into general practice. Most hospices use complementary therapies extensively – probably because in this setting the emphasis is no longer on cure but on caring for the patient's comfort and well-being.

The popularity of complementary therapies is not just a '90s phenomenon. There have always been alternatives to established orthodoxy. The early Greeks had competing schools of medicine. In medieval times, orthodox doctors competed with herbalists, wise women and bone setters. It was really only the late 19th and 20th century that saw an almost complete dominance of orthodox scientific medicine. Not too surprising with the extraordinary advances – aseptic surgery, sulpha drugs and antibiotics. But the thalidomide disasters of the early 60s marked a sea change in public perceptions of science and medicine. There grew a distinctive movement away from high tech, high cost medicine towards more safe and natural approaches. Patients wanted a say in how they were treated and began to find the egalitarian style of complementary therapists who had time to listen and form therapeutic partnerships increasingly appealing. So, led by patients the popularity grew.

Some of the complementary therapy disciplines like osteopathy, chiropractic and acupuncture have grown organisational structures to meet the demands of a credible profession in the late 20th century. There are many challenges, not least keeping sight of the discipline's core values whilst remaining open to collaboration with the mainstream.

But medicine has not stood still whilst all this has been going on – after all the most convincing critiques of medicine have come from within medicine itself. Included amongst these developments are the extremely rigorous protocols for the development of new medicines, ethical committees with lay representation to review all research proposals that impact on patient care, and the development of screening programmes for breast and cervical cancer (however problematic these have been). In fact, it is fair to say that most of the research into new forms of therapy including complementary therapies has been conducted by doctors.

Another very significant new development in the UK has been the formation of Primary Care Groups (PCGs) where GPs and other health professionals come together to set priorities and take responsibility for patient populations of roughly 100,000. There has been a shift in priority for health care away from high tech, high cost hospital medicine towards primary care settings in the community.

This is a setting in which complementary therapies are increasingly finding themselves a place. But also one for which they will need to provide evidence that they are safe, effective, and cost beneficial.

Patients have not watched all this passively. As health care consumers they make their choices (within financial constraints) and most of the evidence suggests that people are not abandoning medicine in favour of alternatives. They do want the high tech solutions medicine can provide but in addition to having their disease treated they also want to be managed in a way that respects their individuality and gives due concern to their well-being as well as their illness. If they cannot get all that in one consultation they will consult with more than one practitioner. Patients create their own forms of integrated medicine – they pick and mix their therapies in quite sophisticated ways.

So what are the challenges for complementary therapists in the 21st century?

1 To provide evidence that their therapies are safe, useful treatments. This evidence needs to be in terms that are meaningful for other health professionals, patients, as well as those who control the budgets. Complementary therapists have been critical of some scientific research claiming that it is incongruous with the philosophy of complementary therapies. It is now up to practitioners to learn how to conduct research that does respect their unique ways of working. It is unlikely that any one piece of research will speak to all of the above audiences, but rather than launch into randomised controlled trials (the gold standard in medicine) which are expensive, time consuming and useful for answering very precise questions, there is plenty of scope for more exploratory research that rigorously describes how complementary therapists practice.

2 To learn how to work effectively with other healthcare professionals. Collaboration with others can bring to the surface difficulties with professional boundaries. The inequality of power relations that exists when a complementary therapist begins to work with established professionals and the absence of shared common language to describe what is going on with patients can lead to conflicting opinions and confusion. For those wanting to work within the NHS it may also mean learning how to negotiate contracts with their local Primary Care Group. Again, finding ways to communicate effectively with other professionals as well as patients is crucial.

3 To engage in ongoing education. Of course there are no shortage of courses in complementary therapy techniques at a basic and advanced level, and these will continue to be popular. But along with the acquisition of new techniques, practitioners need to learn how to critically reflect upon their own work, how to research into their practice and how to work inter- professionally. I passionately believe that complementary therapies have a great future and successful practitioners will be those who have learned how to manage in these crucial areas.