Research Database -
International Updates

Alternative Medicine/
Complementary Therapies

Issue 69

MAZUR and colleagues, Department of Pediatrics, The University of Texas-Houston Medical School, 6431 Fannin, Ste 3.138, Houston, TX 77030, USA, identified and compared alternative and complementary treatments used for asthma, and examined potentially effective and harmful effects.
Methods: A survey of 48 multicultural parents of children with asthma.
Results: 39 of the parents (81%) used at least one form of alternative or complementary therapy to treat their child’s asthma. Therapies included: prayer, over-the-counter (OTC) medicines, herbal teas, vitamins and massage. African-Americans were more likely to rely on prayer; Hispanics on herbal and massage therapies. Use of OTC medicines and vitamins was similar among groups. Three herbal remedies were potentially toxic: lobelia, possible pennyroyal mint, and tea tree oil.
Conclusion: Medical histories of all patients should include inquiries into the use of alternative therapies.
Mazur LJ et al. Use of alternative and complementary therapies for pediatric asthma. Texas Medicine 97 (6): 64-8. Jun 2001.

KEEFER and BLANCHARD, The University of Albany, State University of New York, Center for Stress and Anxiety Disorders, 12203, USA, tested the relaxation response meditation program (H. Benson, 1975) as a possible treatment for irritable bowel syndrome (IBS).
Methods: 16 adults with IBS were matched into pairs based on presence of Axis I disorder, primary IBS symptoms and demographic features and randomized to either a 6-week meditation condition or a 6-week wait list symptom monitoring condition. Patients assigned to the meditation condition were taught the meditation technique and asked to practise it for 15 minutes twice a day. Composite Primary IBS Symptom Reduction (CPSR) scores were calculated for each subject from end of baseline to 2 weeks post-treatment or post-wait list. All subjects assigned to the wait list were subsequently treated.
Results: 13 subjects completed the initial study treatment/wait list
symptom monitoring and follow-up. Meditation was found to be significantly superior to control (p=0.04; one-tailed independent-sample t-tests). In the meditation group, there were significant within-subject improvements for flatulence (p=0.03) and belching (p=0.02) post-treatment. At 3 months’ follow-up, symptoms diaries of subjects revealed significant improvements in flatulence (p=0.01), belching (p=0.02), bloating (p=0.05) and diarrhoea (p=0.03) in the meditation group; constipation also showed a trend towards improvement (p=0.07).
Conclusion: Benson’s relaxation response meditation appears to be a viable treatment for IBS.
Keefer L, Blanchard EB. The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study. Behaviour Research and Therapy 39 (7): 801-11. Jul 2001.

KIM and colleagues, Department of Ophthalmology, Kangnam St. Mary’s Hospital, Medical College, The Catholic University of Korea, Seoul, South Korea, investigated the effectiveness of hand massage to reduce anxiety in patients undergoing cataract surgery under local anaesthesia.
Methods: 59 patients having cataract surgery between December 1996 and February 1997 were assigned either to receive a hand massage 5 minutes before surgery (n=29) or not to receive a hand massage (n=30). Anxiety levels were assessed before and after the hand massage (if the subjects had one) and 5 minutes before the end of surgery using a visual analogue scale (VAS) and by measuring systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse rate. Epinephrine, norepinephrine, cortisol and blood sugar levels, and neutrophil and lymphocyte percentages in white blood cells (WBCs) were also measured.
Results: Hand massage significantly decreased psychological anxiety levels, SBP, DBP, pulse rate, and epinephrine and norepinephrine levels in the massage group. Epinephrine, norepinephrine and cortisol levels increased in the control (no massage) group, and the differences between the two groups were [statistically] significant. Blood sugar levels or neutrophil or lymphocyte percentages in WBCs did not differ significantly between groups.
Conclusion: Hand massage appears to decrease psychological and physiological anxiety levels in patients having cataract surgery under local anaesthesia.
Kim MS et al. Effects of hand massage on anxiety in cataract surgery using local anesthesia. Journal of Cataract and Refractive Surgery 27 (6): 884-90. Jun 2001.

WRIGHT and SLUKA, School of Medical Rehabilitation, University of Manitoba, Winnipeg, reviewed (156 references) evidence for the usefulness of physical therapies in the management of musculoskeletal pain.
Background: Several types of physical therapy are used in the management of painful musculoskeletal disorders, and can be broadly categorized as: electrotherapy modalities; acupuncture; thermal modalities; manual therapies; and exercise. Treatment parameters can vary significantly within each of these categories.
Objective and Methods: The authors aimed to consider the available evidence related to clinical effectiveness for these main categories of therapy in the management of musculoskeletal pain, and to review evidence from basic science studies evaluating potentially therapeutic effects of the various therapies.
Results and Conclusions: Results of basic science research suggest that many of the therapies could have therapeutic effects. However, there is only a limited amount of high-quality evidence from randomized clinical trials supporting the therapeutic effectiveness of several of the therapies. Thus, some preliminary evidence supports the use of manual therapies, exercise and acupuncture in the management of some categories of musculoskeletal pain. The authors discuss limitations of the existing research base and give recommendations for areas of future research.
Wright A, Sluka KA. Nonpharmacological treatments for musculoskeletal pain. The Clinical Journal of Pain 17 (1): 33-46. Mar 2001.

Comment: It is encouraging that research is underway to assess the efficacy of a whole range of complementary therapies in the treatment of many conditions, from asthma to IBS, to musculoskeletal pain.

Issue 68

RAMSEY and colleagues, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA, examined how frequently older adults with osteoarthritis used alternative therapies and how much they spent on them.
Methods: Adults in the general community with osteoarthritis were recruited to take part in a randomized clinical trial. Participants recorded their use of alternative and traditional healthcare on postcard diaries over 20 weeks. Questionnaires were used to assess general and arthritis-specific quality of life.
Results: More than 47% of participants reported using a least one type of alternative care during the study period. The most commonly used treatments were massage therapy (57%), chiropractic services (20.7%) and non-prescribed alternative medications (17.2%). 4% of subjects reported using only alternative health care during the study period. An average of US$1,127 per year was spent on alternative therapy, compared with US$1,148 on traditional therapies.
Discussion: Use of and expenditure on alternative health care were high in this cohort of older adults with osteoarthritis. Clinicians may want to ask their patients about their use of such therapies before recommending treatments.
Ramsey SD et al. Use of alternative therapies by older adults with osteoarthritis. Arthritis and Rheumatism 45 (3): 222-7. Jun 2001.

Issue 67

LAVY and colleagues, Israel Ministry of Health, Pharmaceutical Policy and Economics Unit, reviewed the regulation and supervision of natural health products in Israel and other developed countries.
Background: Growing public interest in natural health products leads to concern over the efficacy and safety of such products, and the question arises whether they should be classified as pharmaceuticals or as dietary supplements. At present they are classified as dietary supplements in Israel, which means that manufacturers are prevented from claiming medicinal/healing properties for their products.
Methods: This was a comparative study, analyzing the regulation and supervision of natural health products in different countries including Israel, the USA, Germany and Switzerland.
Results: Some natural health products do possess pharmacological activity according to accepted medical criteria.
Conclusions: It is recommended that manufacturers should be allowed to make limited claims for specified therapeutic properties. The registration regulations should be stricter than those applicable for dietary supplements to ensure safety, but should still be more lenient than those for pharmaceutical products.
Lavy T, Haran B, Shemer J, Shani s. Regulation of natural medicines in Israel and abroad. Harefuah 139(9- 10):339-44, 408, 407. Nov. 2000.

MILLS, Department of Library Learning, University of Exeter, Exeter, UK, S.Y.Mills@ex.ac.uk, summarized the House of Lords report on complementary medicine.
The House of Lords report concludes that public satisfaction with complementary and alternative medicine is high, and its use is increasing. Evidence is required that it has an effect ‘above and beyond placebo’. Appropriate regulation is necessary by and for each therapy. Acupuncture and herbal medicine, and possibly non-medical homeopathy, should be subject to statutory regulation. The regulatory status of herbal medicines is unsatisfactory and needs to be clarified. Training needs to be standardized and include basic biomedical science. Conversely, conventional health professionals should become more familiar with complementary medicine. The provision of information to the public and to health professionals is inadequate and needs to be improved. Health professionals should work towards integration between conventional and complementary health care.
Mills SY. The House of Lords report on complementary medicine: a summary. Complementary Therapies in Medicine 9 (1):34-9. Mar 2001.

THOMAS and colleagues, Medical Centre Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK, k.j.thomas@sheffield.ac.uk, have attempted to estimate the use of complementary medicine in the UK based on the population.
Background: Claims are made for the increasing popularity of complementary health care, and some population based data are available for the USA and Australia to substantiate these claims, but to date no estimate has been made in the UK.
Methods: A previously piloted questionnaire was posted to a random sample of 5010 adults in England in 1998. Questions were asked about contacts with practitioners of acupuncture, chiropractic, homeopathy, hypnotherapy, medical herbalism, osteopathy, and also reflexology and aromatherapy. Additional information was requested on the use of homeopathic and herbal remedies purchased over-the-counter.
Results: A response rate of about 60% was achieved. Respondents were older and more likely to be female than non-responders. After adjustment for this distribution, it was estimated that 10.6% of the adult population of England had visited at least one practitioner of the six most popular therapies in the past months. If all eight therapies, and also the use of over-the-counter remedies were included, the rate rises to 28.3% for the past 12 months, and 46.6% for lifetime use. An estimated 22 million visits were made to practitioners of the six more common therapies in 1998, and the annual out-of-pocket expenditure was estimated to be around £450 million in 1998.
Conclusions: Complementary medicine makes a measurable contribution to first-contact primary care. As 90% of this is purchased privately, further research is urgently necessary into the cost-effectiveness of different therapies to facilitate equal and appropriate access via the NHS.
Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complementary Therapies in Medicine 9 (1):2-11. Mar 2001.

WARDELL and ENGEBRETSON, School of Nursing, University of Texas Houston Health Science Center, Houston, Texas, USA, dwardell@sonl.nur.uth.tmc.edu, have investigated the relaxing effects of Reiki in order to establish a mechanism for the healing effect of various touch therapies.
Background: Touch therapies are popular but poorly understood, and their biological outcomes are not well investigated. This study aimed to reveal if relaxation could be the main effect of those therapies.
Methods: 23 healthy subjects were treated with a 30-minute session of Reiki, and a number of biological parameters, including salivary IgA, cortisol, galvanic skin response, anxiety, blood pressure, and muscle tension, were measured before, during and after treatment.
Results: Anxiety was significantly reduced after the Reiki treatment, and IgA levels were significantly raised. Blood pressure dropped significantly. Skin temperature increased and muscle tension decreased but not to a significant degree. No significant changes were recorded in the other parameters measured.
Conclusions: Biochemical and physiological changes towards greater relaxation are suggested by these findings, and the changes in IgA levels warrant further investigation of the effect of touch therapies on immune function.
Wardell DW, Engebretson J. Biological correlates of Reiki Touch (sm) healing. Journal of Advanced Nursing 33 (4): 439-45. Feb 2001.
Comments: The above research indicates the widespread use of complementary therapies by a wide sector of the population, as well as certain political and regulatory issues arising from the non-integrated (from the medical profession’s point of view) nature of these therapies. As the use and clinical research of the many complementary disciplines grows, it behoves the medical profession to get its act together and become more knowledgeable, less hostile and more co-operative, particularly in its willingness to fund research to discover the reasons for such efficacy.

Issue 66

BERK and colleagues, Center for Neuroimmunology, School of Medicine, School of Public Health, Loma Linda University, Loma Linda, California, USA investigated the efficacy of mirthful laughter to modulate human
neuroimmune parameters.
Background: Humour therapy and the related mirthful laughter have been suggested to have preventative and healing effects. The effects may be mediated by neuroendocrine/neuroimmune modulation; however, specific neuroimmune parameters have not been fully investigated.
Methods: The investigators conducted a series of 5 separate studies based on a multivariate repeated measures design, with post-hoc simple contrast analysis. 52 healthy men viewed a humour video for 1 hour. Blood samples were taken 10 minutes before, 30 minutes into, and 30 minutes and 12 hours after the video viewing, and analyzed for natural killer (NK) cell activity; plasma immunoglobulins (Igs); functional phenotypic markers for leukocytes including activated T cells, nonactivated T cells, B cells, NK cells, T cells with helper and suppressor markers, and assessment of plasma volume and compartmental shifts; the plasma cytokine interferon-gamma; and total leukocytes with subpopulations of lymphocytes, granulocytes and monocytes.
Results: Increases were found in NK cell activity (p<0.01); IgG (p<0.02), IgA (p<0.01) and IgM (p<0.09), with several such effects lasting 12 hours; functional phenotypic markers for leukocyte subsets (activated T cells, p<0.01; active cytotoxic T cells, p<0.01; NK cells, p=0.09; B cells, p<0.01; helper T cells, p<0.02; uncommitted T cells with helper and suppressor markers, p<0.02; helper/suppressor ratio, p=0.10), with several leukocyte subset increase effects lasting 12 hours; the cytokine interferon-gamma (p=0.02), with increases lasting 12 hours; total leukocytes, with specific subpopulation lymphocytes during the intervention (p<0.01) and 90 minutes into recovery (p<0.05); and granulocytes during the
intervention (p<0.05) and 90 minutes following the intervention (p<0.01).
Conclusions: Modulation of neuroimmune parameters during and
following the humour-associated eustress of laughter may benefit
wellness and provide a complementary adjunct to whole-person integrative medicine therapies.
Berk LS et al. Modulation of neuroimmune parameters during eustress of humor-associated mirthful laughter. Alternative Therapies in Health and Medicine 7 (2): 62-72. Mar 2001.
Comment: The immune indices above, enhanced significantly, add to the growing body of ‘hard’ evidence regarding how mood and emotional expression may dramatically influence our health.

ADAMS and colleagues, Department of Psychiatry, Division of Clinical Psychology, University of Texas Southwestern Medical Center at Dallas, USA reviewed (63 references) recent compelling research on complementary and alternative medicine (CAM) interventions targeted at cognitive deficits in the elderly.
Background: Aged populations in the USA are increasing and are likely to be affected most by the changing shape of healthcare delivery. Within these elderly populations, decreased cognitive function due to dementing disorders is rising.
Methods: Publications on original clinical research studies, review articles, chapters and books on treating cognitive deficits in the elderly were obtained. Additional information concerning developments in this field was obtained by contacting complementary and alternative medicine researchers. The review included research studies that were methodologically sound. More purely clinical studies were also included to provide a thorough overview of the limited amount of accumulated knowledge in this field. The data were synthesized qualitatively to comprehensively present all the information accumulated to date.
Results and conclusions: Clinical research in this area is still in the preliminary stages of development. However, existing data from research on the benefits of CAM therapies on cognitive deficits in the elderly show a significant level of promise that warrants a further investment of resources.
Adams LL et al. Complementary and alternative medicine: applications and implications for cognitive functioning in elderly populations. Alternative Therapies in Health and Medicine 7 (2): 52-61. Mar 2001.

MISHRA and colleagues, Southern California University of Health Sciences (SCUHS), SCUHS Whittier Health Center, Whittier, California, USA reviewed (28 references) the Ayurvedic approach to healthcare and disease management.
Background: In Ayurveda, disharmony of mental doshas (satogun,
rajogun and tamogun) and body doshas (vata, pitta and kapha) are the major cause of illness. The goal of illness management in Ayurveda is therefore to restore harmony among the doshas.
Discussion: Management of illness includes clinical examination, diagnosis, and dietary and lifestyle interventions and treatment. The clinical examination consists of 8-point diagnosis (pulse diagnosis, urine, stool, tongue, voice and body sound, eye, skin and total body appearance examinations) and examination of the digestive system and the patient’s physical strength. The treatment consists of cleansing (Panchkarma), palliation (improving digestion, removing toxic waste, fasting, observing thirst, exercising, sunbathing and meditating), mental nurturing, and spiritual healing, depending on the disturbed doshas and the patient’s constitution. The authors also discuss the preferred use of bhasma [complex purification processes whereby metals, gems, plants and animal products are made non-toxic] and herbal formulae over the respective metallic salts or the single herbs.
Conclusions: According to the authors, this review suggests a great potential for integration of Ayurvedic therapies into the US healthcare system.
Mishra L et al. Healthcare and disease management in Ayurveda. Alternative Therapies in Health and Medicine 7 (2): 44-50. Mar 2001.

GOOD and colleagues, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, mpg@po.cwru.edu
investigated the effects of relaxation, music and a combination of the two on postoperative pain.
Background: Opioid analgesics do not always provide sufficient pain relief for postoperative patients and they may have undesirable side effects. Recently, more complete pain relief (10-30%) was found with adjuvant interventions of relaxation, music and their combination. Studies to compare effects between days and treatments have not yet been conducted. This secondary analysis of a randomized, controlled trial was carried out between 1995 and 1997 and aimed to compare effects between 2 days and 2 activities (ambulation and rest) and across ambulation each day.
Methods: The study used a repeated measures design. 468 abdominal surgery patients in 5 US hospitals were assigned randomly to receive: 1) relaxation; 2) music; 3) relaxation and music; or 4) neither relaxation nor music (controls). Subjects were interviewed and taught the interventions preoperatively. Postoperative testing during ambulation and at rest was
carried out on Days 1 and 2 using visual analogue scales (VAS) for sensation and distress of pain. Multivariate analysis was applied to the data obtained.
Results: Pain decreased by Day 2. Interventions were not different between days and activities. The interventions were effective for pain across ambulation on each day, across ambulation and across rest over both days (all p<0.001), and had similar effects by day and by activity.
Conclusions: The investigators concluded that nurses can safely recommend any of these interventions for pain on both postoperative days and during both ambulation and rest.
Good M et al. Relaxation and music to reduce postsurgical pain. Journal of Advanced Nursing 33 (2): 208-15. Jan 2001.
Comment: For further evidence, readers may wish to re-read Simon Heather’s article The Healing Power of Sound from Issue 64.

Issue 65

VEERAMAH and HOLMES, Department of Continuing Care Nursing, Canterbury Christ Church University College, Canterbury, Kent, UK explore the increasing use of complementary therapies worldwide.
Background: There is a view that medicine has lost its holistic perspective, and people are now seeking the help of ‘alternative’ practitioners who can devote more time to them and treat the ‘whole person’ rather than just their symptoms. 
Discussion: The authors question whether the increasing use of complementary therapies reflects dissatisfaction with traditional (allopathic) medicine or rather an increased satisfaction with alternative therapies. The authors also look into the use of and attitudes towards such therapies in mainstream medicine, and ask whether they should be seen as a threat to or an enhancement of modern medicine.
Veeramah EK and Holmes S. Complementary therapy: complement or threat to modern medicine? Journal of the Royal Society of Health 120 (1): 42-6. Mar 2000.

ERNST and WHITE, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, UK aimed to provide data on the use of complementary and alternative medicine (CAM) by the general population in the UK.
Background: Recent data about the use of CAM by the general population exist for Australia and the USA but not the UK.
Methods: 1,204 British adults were interviewed in a nationally representative random telephone survey.
Results: 20% had used CAM in the previous year. The most popular
therapies were herbalism, aromatherapy, homeopathy, acupuncture/acupressure, massage and reflexology. The main reasons for trying CAM were: its perceived effectiveness, a positive inclination towards it, and its relaxing effects. Users spent an average of £13.62 per month on CAM, which extrapolates to an annual expenditure of £1.6 billion for the whole nation.
Conclusion: Complementary and Alternative Medicine is prevalent in the UK. Its scientific validation has therefore become an ethical imperative.
Ernst E, White A. The BBC survey of complementary medicine use in the UK. Complementary Therapies in Medicine 8 (1): 32-6. Mar 2000.

Comment: The amount mentioned above regarding the amount spent per month by users of CAM – £13.62 – is tiny when you consider that this is less than the price of a meal, about the cost of a CDROM, less than the cost of a massage or most other treatments, which often average out at about £25. However, I think that it is always difficult to extrapolate expenditure to the entire nation from such a small sample.

ANDERSSON and LYTTKENS, Department of Psychology, Uppsala University, Sweden, Gerhard.Andersson@psyk.uu.se reviewed the psychological treatment of tinnitus using meta-analysis.
Background: Meta-analysis combines results from different studies to obtain estimates of effects across studies. To date, meta-analysis has rarely been used in audiological research.
Methods: The outcomes of 18 studies, including 24 samples and up to 700 patients, were included and coded. Studies included those on cognitive/cognitive-behavioural treatment, relaxation, hypnosis, biofeedback, educational sessions and problem solving. Effect sizes for perceived tinnitus loudness, annoyance, negative affect (e.g. depression) and sleep problems were calculated for randomized controlled studies, pre-/post-treatment design studies and follow-up results.
Results: There were strong to moderate effects on tinnitus annoyance for controlled studies, pre-/post designs and follow-ups. Effects on tinnitus loudness were weaker and these disappeared at follow-up. Effects on tinnitus loudness were also obtained for measures of negative affect and sleep problems. Exploratory analyses revealed that cognitive-behavioural treatments were more effective on ratings of annoyance in controlled studies.
Conclusion: Psychological treatment for tinnitus is effective, but aspects such as depression and sleep problems may need targeting in future studies.
Andersson G, Lyttkens L. A meta-analytic review of psychological treatments of tinnitus. British Journal of Audiology 33 (4): 201-10. Aug 1999.

SUNG, Mount Sinai School of Medicine, New York, NY, USA examines the sources of shortcomings in the treatment of Asian American patients.
Background: Asian [Americans] frequently receive suboptimal medical care.
Discussion: The author argues that the cause of suboptimal treatment is mainly a failure to interpret patient behaviour correctly. Such failure stems not from prejudice, but from a lack of understanding of, much less respect for, the systems of thought about health and illness that form the basis of the traditional or tradition-influenced Asian American patient’s approach to illness. ‘Noncompliant’ patient behaviour is misunderstood if the physician does not grasp the roots of such behaviour in a system of beliefs that are not his own. Misunderstanding begets further ‘noncompliance’, initiating a downward spiral.
Conclusion: The author suggests that the way out of such spirals lies in seeking a more adequate understanding of the patient’s beliefs and their behavioural consequences.
Sung CL. Asian patients’ distrust of western medical care: one perspective. The Mount Sinai Journal of Medicine, New York 66 (4): 259-61. Sep 1999.

Issue 64

OMLOR and colleagues, Klinik fur Allgemeine, Viszeral- und Gefasschirurgie, Katholische Kliniken Essen-Nord gGmbH, Essen, Germany evaluated the effects of preoperative relaxation (visualization) therapy on postoperative outcome of patients who underwent surgery for primary inguinal hernia or goitre.
Methods: This randomised controlled trial included 208 patients, over 18 years of age, who had primary inguinal hernia or goitre. Those with ASA status IV-V, recurrent inguinal hernia, recurrent goitre, or malignant neoplasms were excluded. 103 patients received visualization therapy prior to surgery and 105 patients underwent surgery without a preoperative therapy.
Results: There were no preoperative differences in age, sex, duration of surgery, training of the surgeon or blood parameters between the two patient groups. Postoperatively, patients who received preoperative visualization therapy had significantly fewer haematomas (30.3%) than those who received no preoperative therapy (44.4%) and significantly less pain (4.2 versus 5.2), and consumed significantly less analgesic medication (59.7 mg versus 72.5 mg Tramadol HCl) (p<0.05). There were no significant differences postoperatively in infections, nausea, hypocalcaemia, tetania, recurrent nerve palsy or fever.
Conclusion: Preoperative visualization therapy significantly reduced the number of postoperative haematomas and analgesic requirements.
Omlor G et al. (Effect of preoperative visualization therapy on postoperative outcome after inguinal hernia surgery and thyroid resection.) Zentralblatt fuer Chirurgie 125 (4): 380-5. 2000.

HEUSSER, University of Bern, Kollegiale Instanz fur Komplementarmedizin KIKOM, Inselspital, Switzerland commented on a study by Sommer et al, recently reported in Complementary Therapies in Medicine, that looked into the costs and effectiveness of complementary medicine made available within Switzerland’s mandatory basic health insurance provisions.
Discussion: Following its publication, the report by Sommer et al has been heavily criticized in Switzerland. The study inadequately reflected real practice, the study design was inadequate relative to the central research objective, the applied instrument and procedure for health assessment were of questionable value, and the authors failed to consider published literature relevant to the topic. The study therefore was unable to answer its central questions regarding costs and effectiveness of complementary medicine within Switzerland’s basic health insurance provisions.
Conclusion: Heusser proposes more practice-related, non-experimental study designs to realistically answer these questions.
Heusser P. Commentary on Sommer et al. ‘A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance’. Complementary Therapies in Medicine 8 (1): 50-3. Mar 2000.

GREENFIELD and colleagues, Department of Primary Care and General Practice, Medical School, University of Birmingham, Edgbaston, UK aimed to describe the motivation, experience and attitude change of undergraduate medical students who chose a special study module in complementary therapy (CT).
Methods: Second-year medical students completed a self-administered questionnaire before and after taking a special study module in CT concentrating on homeopathy at the University of Birmingham Medical School.
Results: 20 questionnaires were completed at each time point, resulting in 19 sets of paired data. Prior to taking the module, 11 students had had personal experience of CT, and students’ attitudes varied widely from ‘scepticism’ to ‘acceptance’. Students saw the module as offering a rare opportunity to examine and evaluate non-orthodox therapies. They tended to rate CT as a whole and homeopathy in isolation similarly (p=0.005). After taking the module, the trend was less marked (p=0.077). CT as a whole was rated higher than homeopathy in isolation, both before and after the module. Individual students’ ratings moved in both directions. After taking the CT module, 12 students considered learning and practising a CT, most commonly acupuncture.
Conclusion: UK undergraduate medical curricula have begun to incorporate non-core components through special study modules. The Birmingham CT module was popular and attracted students with a range of initial attitudes. The module allowed discernment about the value and role of CT within the established medical system while maintaining heterogeneity of opinion.
Greenfield SM et al. Considering the alternatives: a special study module in complementary therapy. Complementary Therapies in Medicine 8 (1): 15-20. Mar 2000.
Comments: The above studies illustrate how far the study of a variety of complementary therapies has pervaded the medical profession, with universities, such as the University of Birmingham, incorporating special study modules to accommodate such learning.

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