When It Comes To Integrative Medicine, Does The UK Lag Behind The US?
In spite of recent cuts to publicly funded advertising campaigns, the UK has led the charge in effective public health campaigns aimed at promoting preventative measures, including healthy eating and smoking cessation.
Last week, for example, researchers from the London School of Hygiene & Tropical published the results from the so-called "txt2stop" campaign. Some 5,800 smokers were sent text messages encouraging them to quit; those who did were twice as likely to stop after six months than their counterparts who received no messages. The campaign has been hailed as a simple but cutting-edge intervention that could serve as a powerful tool in promoting behavioral change.
But when it comes to complementary and alternative medicine (also referred to as CAM) aimed at prevention, many experts agree that the UK lags behind the US in access to -- and acceptance of -- integrative therapies. Many of those therapies -- acupuncture, aromatherapy, chiropractic, homeopathy, massage and osteopathy -- aim to promote prevention of chronic and serious disease.
"Generally, CAM has not been a part of the infrastructure within health care in the UK," explained Giles Tomsett, managing International director of Healthways, a company that specializes in disease management. He added that complementary medicine had not yet fully infiltrated the mainstream.
Indeed, a recent US survey found that nearly 40 percent of American adults use some form of alternative medicine. A House of Lords report from year 2000 cites two estimates of CAM use: One found that only 20 percent of British adults had used CAM in the last year. Another, focusing on England specifically, put that estimate closer to 28 percent.
"Because of the tight central government controls on the use of modalities in the NHS, alternative or complementary medicine used by medics tends to be attacked rather than embraced," said Michael E. Ash, an osteopath and naturopath, who is a vocal proponent of alternative medicine. Ash is coordinating a new course in functional medicine through the US-based Institute of Functional Medicine, which is set to begin in October.
In the UK, most people pay for CAM privately; currently only two CAM professions -- osteopathy and chiropracty -- are regulated by statute. Of those, the NHS does provide some funding for osteopathic treatment, though it is subject to location and at the discretion of one's general practitioner. (In the US, osteopathic physicians are licensed as Doctors of Osteopathic medicine; they can practice medicine and surgery. In the UK, osteopaths must be registered with the General Osteopathic Council, but do not prescribe drugs.)
A 2001 report cites estimates suggesting that somewhere between 35 and 50 percent of general practices had some access to alternative therapies, whether delivered by a primary care physician, a CAM practitioner working within a practice or NHS referrals to outside providers.
"I don't think the scene is huge in the UK," said Jasmine Johnson, a Fulham-based osteopath, adding that it was growing, albeit slowly. "You used ot be a bit of a freak if you were a vegetarian; these days, it's not unusual to go into a healthfood shop and buy raw food chocolate."
One person who does seem intrigued by the potential preventative benefits of CAM is the Prince of Wales, who has hailed alternative medicines as a "potentially powerful resource." According to Ash, the Prince also commissioned a report that found three-quarters of the British public would like to see alternative therapies covered by NHS.
For his part, Tomsett believes the Prince's interest in CAM might give it a slow but steady push into the mainstream.
"Because Prince Charles is very engaged in this, it does carry a weight of interest," he said. "There is this whole range of alternative medicines that are being accepted as an alternative way for people to improve their well being."
In other parts of Europe, CAM also enjoys relative popularity. A 2005 survey conducted by Denmark's National Institute of Public Health found that 45.2 percent of Danes age 16 or older had used alternative medicine at some point in their lives, while a small, 2003 review suggested that in Germany, almost 95 percent of gynecology and obstetrics clinics surveyed had incorporated acupuncture in their practices. In January, Switzerland's Health Minister announced a trial inclusion of six CAM methods in its basic health insurance beginning in 2012. In total, the European Federation for Complementary and Alternative Medicine (EFCAM) claims that more than 100 million EU citizens currently use some form of CAM.
In spite of this relative popularity, it can be difficult to determine how effective these CAM methods actually are, given there is no pill or physical treatment to clearly test in a scientific trial.
"For skeptics, randomized, control clinical trials are the only approved method for demonstrating efficacy, often assumed to be the same as real-world effectiveness," Ash wrote in a recent opinion piece arguing for the efficacy of CAM.
Indeed, though studies supporting the efficacy of many complementary and alternative therapies do exist and are growing, groups like the US' National Institutes of Health's National Center for Complementary and Alternative Medicine caution that well-designed clinical trials are often lacking, meaning the "safety and effectiveness of many CAM therapies are uncertain."
Earlier this year, Gallup Healthways released its first-ever well being index for the UK, which showed that physical health in was slightly higher than in the U.S., and that the prevalence of chronic conditions was substantially lower. There are myriad factors that inform health and well being at the population level, but such findings raise the question of whether or not greater acceptance of CAM in the US has actually paid off.
For now, the best support of that might be anecdotal.
Dr. Susan Blum, a New York-based medical doctor who practices functional and mind body medicine, says that she has treated scores of people who have found no comfort in traditional medicine. Blum calls these people the "walking wounded" -- patients who have been hampered by a constant headache or bowel issue that they cannot shake, in spite of being told by doctor after doctor that they are fine. In her experience, Blum said, complementary medicine can help get to the root of the problem.
“In the world of allopathic medicine, prevention is all about early detection," she said. "It’s about a mammogram and a pap smear and about catching something before it’s too late. But what I am really interested in is, ‘how do we prevent these things before they even start?’ And that’s real primary prevention. It’s all about changing your health behaviors.”
RELATED: Meanwhile in the U.K., financial problems in the publicly funded National Health Service are threatening to increase wait times for patients seeking health services ranging from hip surgery to fertility treatments, BBC News reported.
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First Posted: 07/05/2011 11:40 pm EDT Updated: 09/04/2011 6:12 am EDT