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Whose opinion counts, anyway?

by Mark Kane(more info)

listed in clinical practice, originally published in issue 37 - February 1999

Everyone has their own opinion about the effectiveness of complementary therapies. As a practitioner of complementary therapies I have to make choices and evaluate the therapies that I use day by day. The importance of this evaluation is most clear to me when I chose one therapy over another for a particular patient. As a multi-skilled practitioner I have a range of options that I can call on to treat specific problems. For instance I have used acupuncture, osteopathy and naturopathy successfully in the treatment of arthritis but the important question when I see each patient is - which therapy or in what combination will be the most beneficial in this particular case?

Clearly some kind of evaluation of the therapies has to be made. Should they all be used? Should they be used together at the same time, in succession or alternately? Whilst in some cases it may be valid to use all approaches it is probably prohibitive in terms of time and money for most people.

Patients want to know which will be the most effective and efficient way of dealing with their problem and if more than one therapy is needed how can their use be co-ordinated. Evaluating the options is clearly important but patients are not the only ones forced to make such judgements. General practitioners, purchasers for NHS trusts as well as practitioners skilled in more than one discipline all have to choose which therapies to offer their patients. But on what basis should they make those choices? Effectiveness is central but how can you judge it?

For patients in pain, relief from that pain certainly comes as a high priority but that is not their only concern. From my own research into back pain I know that patients want sensible explanations as to what caused their problem. They want effective strategies for dealing with the problem and they want to know how to prevent the problem from recurring. Symptom removal is not the only way patients judge whether the therapy they are using is beneficial.

Users of complementary therapies commonly describe an improved sense of well being, better sleep, improved vitality - physically and sexually or just a return of their joie de vivre. These outcomes whilst important to patients and practitioners are often overlooked by hard nosed medical researchers when evaluating the effectiveness of a therapy. The methods of science favour standardised pain and disability scales or objective changes such as those detectable in the blood chemistry or on scans. These may well be important measures but equally they are unable to detect some of the more qualitative changes noticed by patients and their practitioners. As a clinician I make judgements about how effective my work is by paying attention to all the above outcomes as well as more objective examination findings.

One of the strongest indicators that I use to evaluate success in treatment, is how empowered the patient is in managing their own health - how they deal with the symptoms, what they do in a crisis, how able they are to put in place preventative strategies. Now if these are the kind of outcomes that practitioners and patients believe are important then it is in these terms that complementary therapies need to be evaluated.

This is all part of the difficulty in integrating complementary therapies with mainstream medicine. Whilst complementary therapies have been concerned with 'well being' much of the attention in orthodox medicine has been on 'disease'. In many respects we have had a National Disease Service rather than a National Health Service. So introducing therapies and therapists with a different orientation is a culture shock, to say the least. Add to this the politics of health care where the controllers of budgets want to see convincing, objective evidence of effectiveness, that will lead to tangible cost benefits and it's surprising that things have moved as far forward as they currently are.

We certainly do need the right kind of evidence to show how complementary therapies can promote health and make an impact on disease. This challenge is starting to be met by complementary therapists who are researching their own practice in the context of post graduate studies. They are learning to investigate and gather evidence that will help answer some of the questions important to them as practitioners and to their patients.

The principal reason that complementary therapies have been pushed into prominence is because those who use them have the strong sense that they are of benefit, that they do have a role to play in the nations health care. Now we need to evaluate the therapies in terms that are congruent with patient's and practitioner's experience but can also speak to the hard nosed scientists as well as the money managers. My own experience as a practitioner in an integrated NHS practice tells me this is something worth struggling for.

Working together collaboratively with other professionals and the patient can produce some extraordinary results. The complementary and mainstream health professionals have much to learn from each other about how to work with patients in sickness and in health.

They both have much to learn from patients, particularly when it comes to how health care should be evaluated.


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About Mark Kane

Mark Kane is an osteopath, naturopath and acupuncturist working within the NHS at the Marylebone Health Centre and in private practice. He is a senior lecturer at the Centre for Community Care and Primary Health University of Westminster and the course leader for the MSc in Complementary Therapy Studies. He is also a Researcher at the British School of Osteopathy.

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