The motivation to use complementary medicine healing methods. Study of a general internal medicine and orthopedic patient sample

436 patients from two different clinics of internal medicine and one orthopaedic unit were asked to fill a questionnaire on their attitude towards and use of alternative medicine. Of the 272 questionnaires returned, 235 could be used for analysis. 42.6% of all analysed persons confirmed use of alternative medicine. About half of them were motivated to do so by their nursing staff. Homeopathy was by far the most frequently used method. Persons who used alternative medicine were characterised by a distinct environmental awareness and regular sports activity. They had also often had positive experience of alternative methods in childhood. On the other hand, age, sex, education, duration of the treated disease and success of conventional therapy did not correlate significantly with the use of alternative medicine. An essential motive for the need to seek help by alternative therapists was the opinion that conventional forms of treatment would concentrate too much on the purely physical side of a health problem. All in all, users of alternative medicine did not seek confrontation with conventional medicine but rather sought a real complement to conventional forms of treatment.     

Folk medicine and health culture in contemporary society

Folk medicine comprises "unofficial health beliefs and practices" which rely heavily (but not exclusively) on oral transmission. It is one form of alternative medicine, and a major source for many other forms such as phytotherapy and mind/body medicine. While many folk medicine ideas and practices are associated with particular ethnic groups, many others are widely distributed throughout American society. Folk medicine is not dying out in the modern world. Because it has both medical benefits and risks, effective medical care with folk medicine requires awareness and discussion of its influence.     

Children''s willingness to share activities with a physically handicapped peer: am I more willing than my classmates?

OBJECTIVE: To explore the views of Primary Care and homeopathic doctors in the same geographical and population catchment area towards Homeopathy as a discipline and the motives that bring patients to use its services. DESIGN: A qualitative study, using in-depth interviews and a focus group. SETTING: A community of 18,000 inhabitants with a Health Centre and four homeopathic physicians. PARTICIPANTS: The four homeopathic physicians and nine of the ten doctors from the Health Centre. METHOD: After face-to-face and later telephone interviews, each of the four homeopathic physicians was interviewed in depth and the author led a focus group with the 9 Health Centre doctors. MAIN RESULTS: a) From the homeopaths: they emphasised an integrated patient-centred approach. They insisted on their status as doctors and that their treatment was not iatrogenic, etc. b) From PC doctors: They were ignorant of Homeopathy. They identified it with a type of remedy of which they knew nothing, but for which they demanded scientific evidence, etc. CONCLUSIONS: PC doctors' ignorance of Homeopathy put them at risk of not understanding patients' expectations. It seems that the patient-centred, as against disease-centred, care model is, in practice, outside the scope of PC health delivery.     

Consultations with practitioners of alternative medicine

More than 2,000 Jewish adults, aged 45-75, in urban areas of Israel were interviewed regarding consultations with practitioners of alternative medicine. 6% (122) of the respondents reported visiting such practitioners in the year prior to the interview. Homeopathy was the most frequent therapy, followed by reflexology, naturopathy, and acupuncture. The most common medical complaint was pain, particularly back pain. The most frequent reason for consulting the practitioner was disappointment with the outcome of conventional treatment. 39% of respondents who visited a practitioner were being treated by a conventional physician at the same time, for the same problem. The medical problems of a large majority had been relieved, but 22% said they were not helped by the practitioner. Women were more likely than men to consult a practitioner. Respondents with secondary or higher education were more likely to visit than those with less education. There were no age or socio-economic differences between users and nonusers. The mean payment for the whole series of treatments was NIS 770 (about $250). Respondents who visited practitioners reported worse health and more pain than nonusers, and were also more likely to have visited their conventional primary care physician in the past month. The findings suggest that nonconventional medicine should be seen as complementary to, rather than in competition with conventional medicine.     

Bridge between scientific medicine and complementary medicine--utopia?

In this keynote presentation on a complex and controversial subject, I attempt to answer the following questions: 1. What is scientific medicine, what is alternative medicine? 2. Why is there in our days an increasing trend in the population towards concepts and methods of alternative (complementary) medicine? 3. Why are many scientific physicians defensive, sceptical and opposed to alternative medicine? 4. Are traditional and alternative medicine fundamentally irreconcilable worlds? The author believes that complementary medicine is beneficial and justified especially in private practice, above all in the many patients suffering from psychosomatic, psychovegetative, neurotic, depressive, functional disorders, with feelings of ill-health and often with marked subjective symptoms but in which no severe organic disease is present. In these types of patients alternative methods are often 'more gentle' and cost-effective. The doctor's personality, his empathy, his willingness to communicate are decisive factors for their effectiveness. Certain methods of complementary medicine should be increasingly integrated into our hospitals and be learnt and critically assessed locally by the scientific physicians. Scientific medicine is and remains the indispensable solid foundation for correctly indicating the use of alternative therapeutic methods.     

Tactical note on the relation between scientific and statistical hypotheses.

Grant, Binder, and others have debated what should be the appropriate relationship between the scientific hypotheses that a scientist is interested in and the customary procedures of classical statistical inference. Classical significance tests are violently biased against the null hypothesis. A conservative theorist will therefore associate his theory with the null hypothesis, while an enthusiast will not—and they may often reach conflicting conclusions, whether or not the theory is correct. No procedure can satisfactorily test the goodness of fit of a single model to data. The remedy is to compare the fit of several models to the same data. Such procedures do not compare null with alternative hypotheses, and so are in this respect unbiased. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A radical rupture in the paradigm of modern medicine: conflicts of interest, fiduciary obligations, and the scientific ideal

Conflicts of interest serve as a cipher for a radical rupture in the Flexnerian paradigm of medicine, and they can only be addressed if we recognize that health care is now practiced by institutions, not just individual physicians. By showing how "appropriate utilization of services" or "that which is medically indicated" is a function of socioeconomic factors related to institutional responsibilities, I point toward an administrative and organizational ethic as a needed component for addressing conflicts of interest. The argument is developed by reviewing three important books. First, I consider Mark Rodwin's attempt to configure the economic structures of medicine so that classical fiduciary and scientific ideals can be fostered. Second, I consider E. Haavi Morreim's attempt to modify the classical ideals in order to account for new economic realities. Finally, by considering essays in a recent volume on conflicts of interest edited by Spece, Shimm, and Buchanan, I argue for a constructive dialectic between the approaches of Rodwin and Morreim. In order to properly address conflicts of interest, there must be a radical reassessment of medicine that accounts for the interrelation between scientific, ethical, and economic concerns. Until institutions come into view and professional ethics is developed to account for their role, legitimate interests and obligations of diverse parties cannot be harmonized.     

Is homeopathy more than a placebo?

Homeopathy can be characterized by three axioms "treating like with like" (law of similars), "increasing effects with increasing potency" (potentization) and "effects on the basis of ultra-high dilutions" (beyond-molecular effects), where it is unlikely that the dilutions contain a single molecule of the original substance. On the basis of these tenets and the clinical evidence further research priorities are developed. Current reviews indicate small homeopathic verum effects, even after adjustment for internal validity and publication-bias. However, the results remain disputable, because reproducibility isn't assured by independent examiners. For further validation, independent replication of studies with high quality, including specially treatment with high-potencies according to law of similars, seem to be important. The prerequisites for a homeopathy-specific study methodology (inclusion of populations according to their homeopathic diagnosis) still are not fulfilled today. There is neither convincing evidence for specific drug pictures by placebo-controlled drug provings, nor is the reliability of homeopathic diagnosis proven. By reason of extensive, individual interviews, preceeding every classical homeopathic remedy finding, placebo-effects could play an important therapeutical role. The relevance of homeopathic placebo-effects should be explored against other sham treatments and an untreated group.     

How Relational are Construction Contracts?

For many years, the construction industry has relied on formal contracts to define and enforce the obligations and rights of contracting parties. Legal scholars have suggested that, based on their transaction characteristics, there are three different forms of contracts: classical, neoclassical, and relational. Of these, which form is more appropriate for use in construction projects? With increasing awareness of the importance of teamwork in construction, there is clear evidence of a rising trend in adopting a partnering approach to construction project delivery. For projects that seek to achieve a partnering relationship, relational contracts that value relationships, trust, and communication appear to be the appropriate form of contract. This paper discusses the application of relational contracts in construction by examining the fundamental question “How relational are construction contracts?” The degree of relationalism is assessed using a relational index comprising eight factors: cooperation, organizational culture, risk, trust, good faith, flexibility, the use of alternative dispute resolution, and contract duration. It was found that in the traditional design–bid–build form of delivery, the main contract and domestic subcontract forms are more relational than those of the nominated subcontract and the direct labor contract. The study was conducted in Hong Kong.     

Potential contribution of therapy to cancer mortality reduction

Reductions in cancer mortality may come about for a number of reasons, including improvements in treatment. The impact will vary from cancer to cancer. For some, expert curative surgery is crucial, whereas for others, the use of appropriate chemotherapy is a key factor. Examples of the latter, in which there are already discernible reductions in national cancer mortality data resulting from chemotherapy, include testicular cancer and Hodgkin's disease. For more common diseases, such as ovarian cancer, reductions also are being seen. For others, such as breast and colorectal cancer, the current more widespread use of adjuvant chemotherapy may lead to overall mortality reduction in the future. It should be recognized that chemotherapy should be given only by those experienced in its use, and that this facility should form part of a larger provision for health care in relation to cancer, ranging from public education to population screening and from better oncology training for clinicians to greater encouragement to participation in clinical trials. New drug development is clearly a priority, but further advances can be made in many countries already using available forms of chemotherapy if treatment facilities are organized appropriately.     

Aristophanes' Wealth: ancient alternative medicine and its modern survival

The miraculous cure of the blind god Plutos ("Wealth') in Aristophanes' play illuminates some of the reasons why people have sought help in alternative medicine over the ages. Apart from limitations of conventional medicine these factors can be social, political, religious, psychological, and scientific. Alternative medicine may function in a complementary way to the conventional. Nevertheless, an overestimation of its therapeutic potentials by the public can lead to the domination of irrationalism, all in the name of liberation from the shackles of a mechanistic rationalism.     

External fetal version from breech presentation to cephalic presentation: modifying factors, reliability and risks]

BACKGROUND: This article describes a survey of new clients entering care with nine practicing classical homeopaths in the Los Angeles metropolitan area between January 1994 and July 1995. METHODS: Participants completed a self-administered questionnaire before undergoing diagnosis by the homeopath. Follow-up interviews were conducted by phone 1 month after diagnosis and face to face 4 months after diagnosis, along with a self-administered questionnaire before the final interview. A total of 104 participants entered the study; 77 completed all data collection. RESULTS: Clients sought homeopathic care for a wide array of largely chronic conditions. Respiratory, gastrointestinal, and female reproductive problems were the most common primary complaints. Most clients were highly educated, but had limited knowledge about homeopathy before entering treatment. Approximately 80% reported earlier, unsuccessful attempts to get relief from mainstream care. Four months after treatment, general measures of health status showed improvement, and only 29% of participants reported no improvement for the primary complaint leading to treatment. Satisfaction with homeopathic treatment was high regardless of outcome. Three outcome measures of perceived change--overall health status, primary condition for which treatment was sought, and outlook on life--were predicted by different combinations of study variables. CONCLUSIONS: Homeopathy does not divert people from seeking mainstream care. The use of alternative modes of care such as homeopathy can be understood as attractive and satisfying to educated individuals with chronic problems.     

Alternative pathway of complement in ruminants: role in infection

Besides being initiated by antigen-antibody complexes, the classical pathway also can be activated by two innate mechanisms: (1) A family of proteins called collectins, which resemble C1q, bypass the activation of C1q. (2) Acute phase proteins, belonging to the family of pentraxins, activate the classical pathway by binding to C1q. The term 'alternative' complement pathway is a misnomer. This system is a primary primitive immune mechanism. It is phylogenetically older than the classical pathway. Contrary to the classical pathway, it does not require development of a specific immune response before getting into action. It acts within minutes after the microorganism has entered the body. The alternative pathway is continually activated at a low controlled rate but amplified by the surface of intruding microorganisms. It has the capacity to distinguish between self and non-self. Many nonpathogenic microorganisms are killed by the alternative pathway of complement. Pathogens have developed evasion mechanisms to escape the killing effect of this pathway. The kinetics of the activation of the alternative pathway of ruminants differs from that of mouse and man. The difference might be mediated by conglutinin.     

Complementary medicine--health policy and health care costs

Complementary medical methods are increasingly offered by physicians as well as other members of the health services and numerous therapists and they are sought and used by a majority of the population. From the point of view of health care authorities the question of acceptance or admission of methods and offering persons is raised. Unfortunately Switzerland lacks an uniform federal curriculum for practitioners of natural cures of other therapists in complementary medicine. Therefore, in order to control the steadily increasing wild growth of complementary medical offerings, several states (Kantone) have introduced examinations for the registration of such paramedical practitioners. Whether complementary (paramedical) medicine will really reduce costs of health care remains unproven so far. According to several surveys most alternative methods are used in addition to "school medicine" (academic medicine). Health insurance companies should subject reimbursement of costs to the fulfillment of standards regarding efficacy, appropriateness and economy equal to all other medications and therapies.     

Preoperative radiotherapy and surgery for endometrial carcinoma: prognostic significance of the sterilization of the specimen

We have recently demonstrated that two different forms of IL-4R exist; classical or alternative. The classical IL-4R is predominantly expressed in hematopoietic cells and consist of IL-4R and IL-2Rgammac (gammac) chains. On the other hand, alternative form of IL-4R is predominantly expressed in non-hematopoietic cells and consists of IL-4R and IL-13Ralpha' chains. Moreover, the alternative form of IL-4R is also utilized as a functional component IL-13R complex. It has been shown that the phosphorylation and activation of JAK3 tyrosine kinase is crucial for IL-4 activation of STAT6 in hematopoietic cells. However, we have recently demonstrated that non-hematopoietic cells lack JAK3 expression. We also demonstrated that in these cells, STAT6 activation is mediated through JAK1 and JAK2 tyrosine kinases instead. Furthermore, our results show that IL-4 and IL-13 signals are transmitted through the alternative form of IL-4R in these cells. Thus, major differences exist between hematopoietic and non-hematopoietic cells with regard to structure and signal transduction through IL-4R and IL-13R systems.     

The case study as a scientific method for researching alternative therapies

This article argues that the case study design is a research method capable of providing valuable data and insight into alternative therapies. The background and roots of the case study in medicine and clinical practice are covered, and the status of the case study as a scientific method is examined. The highly regarded randomized controlled clinical trial--though often powerful and useful--is neither feasible nor ideal for understanding the effects of many unconventional treatment approaches. Given the complexity of the factors involved in unconventional therapeutic applications--health beliefs, changing health paradigms, patient/practitioner interactions, multiple treatment modalities, multiple symptom profiles--the case study approach offers an alternative methodological route for investigating and generating findings in this arena. Reliability and validity of data collection, data reduction, and interpretation can be enhanced through steps discussed in this article. As it continues to work with evidence that is currently unorganized, the field of alternative medicine can benefit both in clinical prowess and scientific stature from additional, carefully conducted case studies.     

Alternative medicine in private personal insurance

In Germany there is a trend to so-called "natural" or "alternative" medical methods especially among young people of good education and higher income. Those persons are also the typical target group of the private person insurance so that it seems necessary to deal with such methods. While the original "classical" methods of naturopathy have been acknowledged in the scientific medicine for many years and are mainly used in the medical rehabilitation, the so-called "alternative" methods are further on controversial. In the first place, the risks of such unconventional methods are to be monitored, especially the danger of a wrong diagnosis in using unproved diagnostical methods and the danger of side-effects in therapy. Another problematical fact is that during an unconventional treatment the diagnosis of an intoxication by outdoor or indoor pollution or by amalgam of toothfillings is often made without standing a critical proof. Usually, an expensive therapy will follow with no end in sight. Furthermore, the diagnosis of a so-called intoxication of psychical disordered patients, especially those with a masked depression, can prevent a necessary medical or psychotherapeutic treatment. Disorders will be felt more and more as somatic and get a chronical course so that they are finally resistant to therapy.     

Some structural changes that might facilitate the development of behavioral medicine.

Three types of organizational change are considered that may facilitate the development of behavioral medicine teaching, practice, and research over the next decade. The first and most critical of these changes is a consideration of the role of a department of behavioral medicine within the medical school. The second is support for the development of research collaborations across centers, with the advantage of bringing a broader array of expertise and facilities to the solution of health problems. Finally, some changes in the role and organization of scientific societies that support behavioral medicine are considered. It is argued that, without such changes, behavioral medicine will become overly narrow in its focus and will not have the impact on the medical arena that it might otherwise have. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

For an updated acupuncture

The author proposes an acupuncture which is characterized by its complete break with the ancient chinese physiopathology and its concepts of "acupuncture points" (in the old sense of the term) of "meridians", "energies", "ying-yang" etc.. This process of renewal of the practice and the theory has been coined "contemporary acupuncture". Its originality stands out in comparison with most teachings of acupuncture which have remained faithful to traditional acupuncture. Contemporary acupuncture creates bridges between acupunture and classical medicine. It offers simple therapeutic gestures to general practitioners. Acupuncture acts, from a clinical point of view, particularly through the following forms of action: a) a relaxing action on striated muscle; b) an anti-inflammatory action on the ligaments; c) an antidepressant and anxiolytic action.