Positive Health Online

This is an urgent call to all practitioners to state the case for complementary and alternative medicine (CAM).

It seems that practitioners may be failing to promote the efficacy of their practice of CAM. This failure detracts from the professionalism of their practice and perpetuates the misinformation and misunderstandings surrounding CAM, to the ultimate detriment of those who need it.

Practitioners will no doubt have lost count of the times when they have been left frustrated by the outcome of media coverage of CAM issues. Generally, what should be an informative and valuable investigation into the merits of the CAM treatment of a health condition, is reduced to the often repeated arguments that CAM lacks the evidence base of a double-blind, placebo-controlled trial and that, at best, it leads to no more than a placebo effect.

These arguments were raised on 13th September 2010 in the BBC radio 4 programme You and Yours which addressed the issue of whether or not homeopathic treatment should be given either complementary to or as an alternative to the MMR vaccine, to those who had opted not to receive the vaccine. The broadcast referred to the recommendation on 22nd February 2010 of the House of Commons Science and Technology Select Committee that the NHS "should stop funding homeopathy". No mention was made, however, of the rejection of this recommendation by the Department of Health, which issued the following statement on 28th July 2010:[1]

"We believe in patients being able to make informed choices about their treatments, and in a clinician being able to make informed choices about their treatments. The local NHS and clinicians, rather than Whitehall, are best placed to make decisions on what treatment is appropriate for their patients - including complementary or alternative treatments such as homeopathy - and provide accordingly for those treatments.'"

This omission resulted in those listening to the programme not being given full, fair and balanced information about the position of the British government with regard to CAM and homeopathy. 

Practitioners will have been encouraged by the recommendation on 27th May 2010 of The National Institute for Clinical Excellence (NICE) that people with lower back pain should be prescribed a course of acupuncture, exercise classes or some form of manual therapy or massage if their symptoms persisted for six weeks or more. This was the first time that NICE had officially recommended complementary therapies for use on the NHS in England and Wales. How many practitioners of these therapies took the opportunity to inform their clients about this endorsement of CAM?

With regard to aromatherapy, how many Aromatherapists promote their therapy by mentioning in their marketing information the results of the double-blind, placebo-controlled trial using Melissa which found a 35% improvement in the management of agitation in severe dementia?[2]

Furthermore, how many practitioners of Meditation therapy make use of the guidance on meditation issued by NICE in 2004 after studies suggesting that it might bring benefits, or of the subsequent findings of the Mental Health Foundation report Be Mindful?[3]

I invite practitioners to identify other examples of where they think opportunities may have been missed to promote the efficacy of CAM.

It would also be interesting to know how many CAM practitioners actively encourage their clients (or themselves?) to subscribe to the free monthly newsletters issued, for example, by The Complementary and Alternative Medicine Library and Information Service (CAMLIS), or the NHS Evidence - complementary and alternative medicine specialist collection or by Positive Health PH Online UK, including its Research Updates [ www.positivehealth.com/research-subject-list.php ] (see below).

Similarly, how many CAM practitioners also refer, in their marketing material, to the availability of relevant CAM Cochrane Reviews and to the Complementary and Alternative Therapies web page published by Bandolier (see below)?

When stating the case for CAM, practitioners could quote from the Foundation for Integrated Health website[4] (percentages in brackets have been added by the author), to the effect that:

"Supporters of complementary medicine often assert that there are many orthodox medicines and practices that have not been subjected to evidence-based assessment, and indeed the publication British Medical Journal (BMJ): Clinical Evidence (http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp ) agrees that 46% (now updated to 51%) of commonly used orthodox treatments have no data as to their effectiveness with another 10% (now updated to 5%) unlikely to be beneficial - or even likely to be harmful."

In this regard, practitioners are referred to the report in Scientific American[5] asserting that preventable medical mistakes and infections are responsible for about two hundred thousand deaths in the United States each year.[6]

They could then give information about the recent review published by The Institute for Quality and Efficiency in Health Care[7] titled Reporting bias in medical research - a narrative review, which states:

"In conclusion, reporting bias is a widespread phenomenon in medical literature. Mandatory prospective registration of trials and public access to study data via results databases need to be introduced on a worldwide scale....".

Practitioners might make the point that, arguably, it is because of these anomalies that an increasing number of those practising in the medical professions are now seeking to train in homeopathy, acupuncture and other CAM therapies. This is presumably with a view to increasing the range and the safety of available treatment options.

It is, of course, recognized by practitioners that Randomised Controlled Trials (RCTs) are not appropriate for all types of CAM but, again as asserted by the Foundation for Integrated Health:[4]

"although the individualized treatments typical of complementary therapy make traditional RCTs more complex to design, there are still ways to create studies that will give credible results. Qualitative studies which look at the effect on the whole person are also an important part of the picture."

Appropriate here would be reference to the recent report published in the Journal of the Faculty of Homeopathy[8] on the largest study of homeopathy ever undertaken, based on data taken from over eleven million people (involving the population of Cuba) which has, it is said, "startled opponents calling for an end to NHS homeopathic treatment."[9] 

I propose that practitioners must urgently take every initiative to publicize and promote evidence-based and other proper research information which is available about their practice speciality. Furthermore, practitioners should be prepared to take an active role in promoting CAM as a whole. Many practitioners practise more than one therapy so they should feel comfortable about taking this broad approach to supporting the CAM professions. The media often presents CAM as a single abstract category of treatment rather than as a number of separate professional disciplines, so practitioners should brief themselves to respond to this.

In October 2003, the editor of Positive Health Magazine was kind enough to publish in Issue 93: www.positivehealth.com/article-view.php?articleid=2734  my article titled Complementary Medicine - Prepare for the Future. In this, I argued for the concept of integrated healthcare and for more pro-active marketing strategies. Amongst other things, I also suggested that practitioners "should compile a dossier of evidence-based research information as resource material and for inspection by clients and the public."

Seven years on, I again suggest that practitioners should compile such a dossier and actively promote its content.
 
Now, more than ever, the voices of practitioners must be heard so that the public is properly and effectively informed about the value of CAM. In an increasingly bureaucratic and regulatory environment, failure by the CAM professions and its professionals to take up this challenge will jeopardise the development of CAM and ultimately deny the public its many and various benefits.

An example of such jeopardy is the challenge facing the European Herbal sector from April 2011, as a result of the EU Traditional Herbal Medicine Products Directive. Practitioners and their clients should take action now to support the campaign and fundraising appeal launched by The Alliance for Natural Health (www.anh-europe.org/campaigns/freedom-health-choice ) and The European Benefyt Foundation. Challenges are also presented by the EU Food Supplements Directive and the EU's Nutrition and Health Claims Regulation.

Practitioners should also be aware of the implications presented by the government's so-called 'Big Society' initiative and its objective of encouraging an increased social role for the voluntary sector. The observations I made in my article Complementary Medicine and the Voluntary Sector (www.positivehealth.com/article-view.php?articleid=2735  ) continue to apply.

Most practitioners now have a website and those who do not may be thinking of setting one up (see: www.freeparking.co.uk ). I suggest that a practitioner's website should include a 'General CAM Research' page and also a second 'Research page' dedicated to the practitioner's therapy speciality / specialities.

For the purposes of this article and by way of example, I have identified below some general research website addresses and also some specific research information about Reiki. Practitioners should, of course, substitute the Reiki information with research information about their therapy speciality / specialities.

Please be aware that, as in the case of this article, research addresses and other information should always be given 'without liability'. Practitioners should aim to avoid responsibility for the content or reliability of any linked websites or publications referred to and they should make it clear that they do not endorse the views these express. For instance, a practitioner cannot guarantee that such links will work at all times or that such links and publications will be available or up to date.

Example Page for General CAM Research

CAMLIS  - the Complementary and Alternative Medicine Library and Information Service of the The Royal London Hospital for Integrated Medicine: www.cam.nhs.uk/ 
The Cochrane CAM Review: www.compmed.umm.edu 
The Research Council for Complementary Medicine: www.rccm.org.uk/
Bandolier: www.medicine.ox.ac.uk/bandolier/booth/booths/altmed.html
The British Medical Journal: www.bmj.com   (advance search for: 'Complementary and Alternative Medicine')
Positive Health PH Online : www.positivehealth.com  and www.positivehealth.com/research-subject-list.php
The University of Southampton - Complementary and Integrated Medicine Research Unit: www.cam-research-group.co.uk/
Camcomm:  www.camcomm.dk  
Prince's Foundation for Integrated Health: www.fih.org.uk/integrated_health/research_and_evidence/
NHS Evidence - complementary and alternative medicine : www.library.nhs.uk/results.aspx?SearchTitleType=searchTitleFieldOnly&search_term_row1=Complementary+and+alternative+Medicine&sc=evi&sc=gui&sc=spl
NHS Conditions and Treatments  (complementary medicine): www.nhs.uk/Search/Pages/Results.aspx?___JSSniffer=true&q=Complementary+and+Alternative+medicine
International Society for Complementary Medicine Research : www.iscmr.org
Informed Health Online :  www.informedhealthonline.org     
US National Library of Medicine :  http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?query=complementary+and+alternative+medicine&imageField.x=18&imageField.y=8&v%3Aproject=nlm-main-website
National Center for Complementary and Alternative Medicine : www.nccam.nih.gov/  
Samueli Institute :  www.siib.org/research   
University of Westminster - CAM Degree Courses : www.wmin.ac.uk
EICCAM - The European Information Centre on Complementary and Alternative Medicine : www.eiccam.eu
Thames Valley University Faculty of Health & Human Sciences: www.health.tvu.ac.uk/chi/cam/research.asp

Example Page for Reiki Research

     
The following Reiki Research information is taken from various research databases including the Cochrane CAM Reviews of Integrative Medicine and links to it: www.cochrane.org/search/reviews/Reiki

A phase II trial of Reiki for the management of pain in advanced cancer patients.
Olson K and Hanson J and Michaud M.
Faculty of Nursing and International Institute for Qualitative Methodology, University of Alberta, Edmonton, Alberta, Canada.
Participants experienced improved pain control following Reiki treatment

Using Reiki to manage pain: a preliminary report.
Olson K and Hanson J.
Cross Cancer Institute, Edmonton, Alta. karino@cancerboard.ab.ca
Research showed a highly significant reduction in pain following Reiki treatment.

Long-term effects of energetic healing on symptoms of psychological depression and self-perceived stress.
Shore AG.
Upon completion of Reiki treatment there was a significant reduction in symptoms of psychological distress
Reiki Treatment for Psychological Symptoms - an Intervention Protocol
J.Joyce, Complementary Health Clinic, Dunedin, New Zealand and G.P. Herbison, Dept. Of Preventive and Social Medicne, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Has as its objective the examination of the effectiveness of Reiki when compared with no intervention/sham Reiki/treatment as usual/waiting list, pharmacological treatments or psychological therapies for anxiety and depression.

Pilot crossover trial of Reiki versus rest for treating cancer-related fatigue.
Tsang KL and Carlson LE and Olson K.
Department of Psychology, University of Calgary, Alberta, Canada.
Participants experienced a decrease in cancer related fatigue and a significant improvement in quality of life.

The empowering nature of Reiki as a complementary therapy.
Nield-Anderson L and Ameling A.
Yale University School of Nursing, New Haven, Connecticut, USA.
The reasons for the increased success of Reiki as an alternative and complementary healing method in the Western world are addressed as well as the practice of Reiki as a healing method for self and others.

Reiki therapy: the benefits to a nurse/Reiki practitioner.
Whelan KM and Wishnia GS.
Graduate Family Nurse Practitioner Program, Spalding University, Louisville, KY, USA. kwhelan931@aol.com
This study evaluates how nurses who gave Reiki therapy perceived the benefit of this therapy on their clients and themselves.

Autonomic nervous system changes during Reiki treatment: a preliminary study.
Mackay N and Hansen S and McFarlane O.
Institute of Neurological Sciences, South Glasgow University Hospital NHS Trust, 1345 Govan Road, Glasgow G51 4TF, Scotland, UK.
This study indicates that Reiki has some effect on the autonomic nervous system.

Reiki can reduce bleeding caused by excessive noise exposure.
Baldwin and Schwartz.
Department of Physiology, College of Medicine, University of Arizona Tucson USA
The aim of this study was to determine whether Reiki can significantly reduce micro-vascular leakage caused by exposure to excessive noise using an animal model. In all 3 experiments Reiki significantly reduced the outcome measures compared to the other noise groups.

The increasing use of Reiki as a complementary therapy in specialist palliative care.
Burden B and Herron-Marx S and Clifford C.
Compton Hospice, Wolverhampton, West Midlands, UK. Barbaracompt@aol.com
An article considering the position of Reiki as an emerging Complementary therapy within the field of specialist palliative care and, within this context, the rise in popularity of Reiki and its potential benefits.

Reiki as a clinical intervention in oncology nursing practice.
Bossi LM and Ott MJ and De Cristofaro S.
Children's Hospital Boston, MA, USA. larraine.bossi@childrens.harvard.edu
This article describes the process of Reiki, reviews current literature, presents vignettes of patient responses to the intervention and makes recommendations for future study.

Biological Correlates of Reiki Touch Healing
Wardell DW et al.
Journal of Advanced Nursing Vol.33 Issue 4, Pages 439-445
Findings suggest both biochemical and physiological changes in the direction of relaxation.

Touch therapies for pain relief in adults
So PS and Jiang Y and Qin Y.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright (c) 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.
Main results
Twenty-four studies involving 1153 participants met the inclusion criteria. There were five, sixteen and three studies on HT, TT and Reiki respectively. Participants exposed to touch had on average of 0.83 units (on a 0 to ten scale) lower pain intensity than unexposed participants (95% Confidence Interval: -1.16 to -0.50). Results of trials conducted by more experienced practitioners appeared to yield greater effects in pain reduction.

It is also apparent that these trials yielding greater effects were from the Reiki studies.
Whether more experienced practitioners or certain types of touch therapy brought better pain reduction should be further investigated. Two of the five studies evaluating analgesic usage supported the claim that touch therapies minimized analgesic usage. The placebo effect was also explored. No statistically significant (P = 0.29) placebo effect was identified.

Preliminary report on the use of Reiki HIV-related pain and anxiety
Miles P.
Alternative Therapy Health Med. 9(2). 36.Mar-Apr. 2003.

Effect of Reiki Treatments on Functional Recovery in Patients in Post Stroke Rehabilitation: a Pilot Study
Shiflett SC et al.
J Altern Complement Med. 8(6); 755-63. December 2002.

Research: Rubric et al.
Reiki improved growth of heat-shocked bacteria in a healing context
www.positivehealth.com/research

Reiki Review of a Biofield Therapy history, theory, practice and research
Miles P and True G
Altern. Ther. Health Med. 2003 9(2): 62-72.Mar - Apr. 2003.

Palliative Care Service at NIH includes Reiki and other mind-body modalities
Miles P.
Adv. Mind Body Med. 20(2). Summer 2004

If there is any significant experience with using Reiki in the hospital or ER Setting and if there is any literature to support this use?
Miles P.
Explore (NY). 1(5): 414. September 2005.

Science and the Human Energy Field
Oschman J.L.
Reiki News Magazine 1: Issue 3.  Winter 2002.  www.reiki.org

An example of where a website has been prepared to include research information may be found at www.marioneaton.com  [10]

Practitioners who do not provide a website should, it is suggested, prepare and keep updated a hard copy dossier of research. This should be kept at their practice address and be open for inspection by existing and potential clients.

In conclusion, it is hoped that this article will assist practitioners to amend their professional marketing material and strategies to incorporate a CAM research element. It is also hoped that, if they are not already doing so, it will encourage them to take a pro-active role in promoting CAM. To delay is no longer an option.

References

1. CAMLISS News. CAMSTRAND 201. 28 Jul 2010 at 04:40 AM PDT.  The Magazine for complementary and alternative medicine professionals (CAM Magazine) 11: Issue 3 at p4. October 2010.
2. www.medicine.ox.ac.uk/bandolier/booth/neurol/aromadement.html
3. The Times Newspaper. Back pain sufferers should be offered acupuncture on NHS, says watchdog. 27 May 2009.
4. www.fih.org.uk/integrated_health/research_and_evidence/index.html
5. Dead by Mistake: www.chron.com/deadbymistake
6. The Magazine for complementary and alternative medicine professionals (CAM Magazine) 10: Issue 2 at p24. September 2009.
7. www.trialsjournal.com/content/11/1/37  .13 April 2010.
8. Bracho G et al. Large-scale application of highly diluted bacteria for Leptospirosis epidemic control. Homeopathy 99: 156-66. 2010.
9. The Magazine for complementary and alternative medicine professionals (CAM Magazine) 11: Issue 2 at p6. September 2010.
10. My thanks to Mrs Marion Eaton, Reiki Master Teacher, for her permission to share the information posted on her website: www.marioneaton.com  (as at 14 September 2010).