Producing Standards for
Integrated Complementary Medical Practice "If all effective types
of unconventional medical treatments induce healing in human beings, Keywords: Alternative,
Complementary, Medicine, Abstract
In a world where conventional medical practice proves not to be enough to improve the quality of well being many people have increasingly turned to methods of recovery that are complementary to or independent of orthodox medical services. With more of the public becoming private practitioners of unconventional medicine there is an urgent need to standardise the curriculum content at establishments offering complementary medical education. In addition the production standards of some complementary medical products lack appropriate scientific measures of quality. Research to support an understanding of the process of physiological or psychological change supposedly initiated by such products is also lacking. Although there has been a proliferation of
organisations representing the interests of complementary medical practitioners the issue
of a national or international body to protect the interests of consumers of complementary
medical services, equivalent to the General Medical Council, has yet to be addressed in a
practical way. In 1989, despite over a quarter of the UK population reporting use of complementary medicine1, the UK. government neglected to mount an adequate public awareness campaign as to the efficacy of any unconventional methods of practising medicine. It took the British Medical Association until 1993 to produce a guide to such unconventional treatments, Complementary medicine: new approaches to good practice. Although this was available publicly it was not a document that could be acquired free of cost from local GPs or clinics by any person wishing to do so. Practitioners of complementary medicine can find it difficult keeping up with changes in governmental regulations regarding complementary medicine practice. In the event of changes in regulations, especially ones originating from within the European Parliament, the effect on the public is only communicated through complementary medical organisations and is unlikely to lead to the dissemination of information amongst the patients of an average GP's surgery. Clearly there is a need for a public awareness campaign which ensures that information regarding the efficacy of available complementary medical practices and associated products is freely and widely available. The kind of information that should be disseminated can be determined if a wide ranging survey is carried out of both purchasers and providers of complementary medical services and products. The people interviewed should include members of the public using complementary medicine products or services, non-medically and medically qualified complementary medical practitioners, manufacturers of medical products and associated research scientists, nurses, representatives of Family Health Service Associations, administrators of public and private hospitals, Assessors of medical insurance companies, MPs and town councillors as well as members of the public practising complementary medicine privately but without any nationally recognised license to practice. The entire survey should be preceded by a public awareness campaign and the results collated to extract statistics that can be interpreted, summarised and published for the public and those involved in complementary medical practice. The kind of questions that could be asked include: Do you know what complementary medicine is? Which of the following practices have you heard of? Have you been treated with any? Which one? Do you know what the treatment involves? If you have any specific doubts about any particular treatment what are they? Does your local doctor have any literature on the variety of complementary treatments available including those that can be obtained via the NHS? Manufacturers could be asked questions like, On what basis do you set quantitative and qualitative standards? The answers obtained from the survey could be used to produce literature to inform the public on all essential points as well as those that most often seem to lead to misinterpretation or confusion. The resultant literature should be made available, free of charge, at all establishments that provide medical information to the public, such as libraries, hospitals, clinics and surgeries as well as commercial outlets, schools, colleges and offices of government. Once more people become aware of complementary medical services and products there is likely to be a redistribution of public expenditure in this area. Over time the allocation of resources for such services by local health authorities or non fund-holding GP's can be more accurately reserved leading to possible economic benefits. Information will also be gleaned as to what topics need to be included in the education of complementary medical practitioners. If integrated with current courses these topics will ensure that the public can obtain a clear understanding from practitioners of what is involved in any prospective complementary medical treatment and the contraindications and benefits that may be obtained. In addition, manufacturers can provide more relevant product descriptions. Protecting Consumers of Complementary Medicine. With conventional medical practice statutory laws enforced by the General Medical Council protect the patient. The GMC holds a register of all medically qualified individuals that have a license to practice conventional medicine. It is alarming to think that such doctors can practice other forms of medicine, considered to be unconventional under this license even though no additional training or qualifications would be required. This problem is equally serious for complementary practitioners that practice treatments that are outside of the range of treatments that they have been trained for. The case of either type of practitioner prescribing treatment that is outside of their field of training is a common occurrence. A misunderstanding that often occurs is that the use of some therapies should be avoided while other treatment regimes are in effect. In practically all cases of homeopathic treatment, practitioners suggest that a parallel application of Aromatherapy would interfere and possibly antidote the remedies prescribed, especially in the use of substances such as Camphor or Peppermint. If these therapies share a common mechanism of action that leads to such effects, then in principle it would not only be possible, through appropriate research, to demonstrate evidence of these contraindications but also show possible complementary benefits. Some patients are known to be on more than one complementary therapy treatment programme at any one time. Individuals that take on multiple treatments simultaneously, or polytherapy, are those that are most likely to suffer from contraindications, but occasionally, when the mix is appropriate, cures that appear to be miraculous can be induced. So there is an imperative to not just understand how complementary medical treatments can enhance or negate conventional medical treatment, but also each other. This method of polytherapeutic treatment should not simply be a random mixing of treatments. Consideration of a common mechanism of action should be taken into account. Those treatments sharing common processes that initiate recovery would be the best to start feasibility studies with. Practitioners that understand the relationship between
different treatment modalities will be better able to decide when a patient needs to be
referred to another type of practitioner. This may lead to a reduction in income but the
priority is that the practitioner is protecting the interests of the consumer. However an
appropriate referral system could include compensation for such referrals. The system
could be established by a nationally recognised body that represents the interests of the
consumer. An equivalent body to the GMC could be set up that maintains standards of
practice and keeps a record of all licensed practitioners. So the need for protecting consumer interests against commercial bias could be addressed better if a Complementary Medical Council (CMC) was set up. Unlike the variety of complementary medical organisations that currently exist, this body would represent the interests of the public alone. Its role would be to set standards of practice and ensure strict adherence to them from all complementary medical practitioners. Those that agree to operate under a charter for patients would be allowed to register as members. Members would be expected to take examinations and undergo psychological evaluation in order to receive full membership. They would have to agree to attend regular training courses that ensure that their medical knowledge is up to date as possible. If any members should abuse their positions and associated privileges then the right to practice should be legally denied and further practice be subject to criminal prosecution. Those persons applying for membership that have a record of malpractice should be seriously investigated before considering acceptance of any application for membership. In the setting up of the CMC, consumer associations that have in the past monitored complaints from the public regarding complementary medical practice or products should be consulted. The CMC should also be responsible for monitoring and implementing changes in UK and European legislation of complementary medical practice. The CMC would also act as a watchdog on associated products and quality assurance standards during manufacture and delivery to the consumer. In this end it could act in liaison with manufacturers representatives in the Natural Medicines Society. Breaches of complementary medical practice or quality assurance standards relating to product manufacture would lead to the CMC to encourage those affected to take legal action that would result in the implementation of disciplinary procedures. It will be the role of the CMC to ensure that its members are kept up to date with the latest developments both in legal matters and their commitments to the maintenance of public awareness regarding complementary medicine matters. One of the responsibilities of the CMC should be to monitor new treatments and the latest, relevant scientific research. This will be necessary so that it can inform the public of any transformations that may be required in the practice of complementary medicine. The Need for More Acceptable Research The reductionist approach that many scientific endeavours endorse has been feverishly concentrating on the components of systems under investigation. This is nothing more than a game of taxonomy. It is a mistake to adopt the perception that once something is labelled that it is understood. It is important to know what the constituents of physical structures are but it is equally important, if not more so, to understand the relationships between these components. With the development of 'Chaos' theories it is becoming apparent that we need to view physiological and psychological structures not just as systems of components that stick together but systems of relationships that are transformed by other relationships changing their nature. Although components can be easy to measure and quantify, the relationships between them are not. Relationships do not necessarily follow quantitatively measurable linear laws and as such cannot be considered to be able to be understood via detection and analysis with conventional material science alone. However, the field of statistics provides the tool of meta-analysis which can be used as a starting point in measuring qualitative properties of systems under investigation. The problem with adopting the scientific method in complementary medical research is that it would focus analysis on strictly material or quantitatively measurable properties. Many physiological processes are initiated by changes in the psychology of individuals which cannot be quantified. The key point to remember about complementary medicine is that in most cases it is said to offer transformation both in psychology and physiology of the individual who is taking it. In some cases there is no physical contact between the individual and the source of the treatment yet change is still seen to be directly related to that source. These situations often involve a change in the relationship between the patient and their environment. The most difficult cases to analyse are of this type. In these cases there can be no physical substance taken internally or applied that could induce pharmacological change. An internal change in the perception of the external environment is responsible for a later alteration in physiological functions. This shift in awareness is the first stage of recovery from such a treatment. It is clear that if there is a change in the relationship that a person has with their environment then anything in that environment will also be affected in some way. So practitioners should also observe a change in their world view when giving treatment. If this does not occur then it is unlikely that any true psychological or even physiological benefit has been imparted. It is the mutual transformation that takes place during the evolution of the relationship between practitioner and patient that makes integrated medical practice distinct from conventional practice. Again this is fundamentally a change in the relationships rather than the components of the practitioner-patient system. Physiological changes within the practitioner and patient can result from changes in this relationship between them. In such scenarios the laws of Chaos or complexity can come into play and the final effect on the practitioner-patient relationship is seen to be sensitively dependent on initial set-up conditions. In these cases small changes in the relationship between practitioner and patient on initial meeting can lead to widely varying final results. Also in a similar way, a small transformation of the patients relationship with themselves can initiate dramatic shifts in awareness which are accompanied by a host of physiologically correlating processes that result either in a movement of symptoms towards cure or further degeneration of health. Either way, small shifts in awareness or energetic processes within human beings can lead to major transformations of psychology and physiology. Human beings utilise the laws of complexity to ensure efficiency in the transformation of psychological states into changes in physiology. Small increases in hormone levels or small shifts in the way we perceive the world, like when we get a joke and laugh, are equally as effective in altering biochemical processes. These changes are such that only the minimum change in energetic processes at molecular levels is needed to bring maximum transformation at both cell, tissue, organ, system and body levels. The architecture of the body consists of basic structures that repeat their form at different scales, otherwise known as fractals. These structures allow the efficient translation of changes in psychology into changes in physiology. Also, fractal processes of the type just described ensure optimum biochemical functioning and processing of cellular products. Complementary medical practices such as Homeopathy and Acupuncture and other 'subtle energy' medical disciplines can bring about major transformations of psychology and physiology by inducing practically infinitesimal changes which affect the highly sensitive fractal biological architectures and processes found within living systems. The small changes induced by the treatment are efficiently magnified into very specific alterations in health. If quantitative research is to be done into the mechanism of action of complementary medical practices then it should seriously look at Fractal structures and processes and their role in translating the subtle influences of complementary medical treatments into major changes in the overall level of health. What needs to be measured is one of the criteria in designing a trial to validate the efficacy of a particular mode of treatment. In trials it is the state of fractal processes and structures that needs to be monitored. Two other considerations that need to be taken into account will be (1) How are the measurements to be made? and (2) Which method shall be used to interpret the results? What is measured or seen to change in research
within clinical trials is also what needs to be at the core of complementary medicine
education Complementary Medicine Education Complementary medicine on the most part deals with human beings. All human beings essentially share the same physical structure and usually can be seen to follow characteristic psychological traits. If all effective types of unconventional medical treatments induce healing in human beings then there must be biophysical and psychological processes that are common to them all which are utilised to initiate evolution of well being. Knowledge and experience of these processes that are common to all treatments must be at the centre of a core curriculum of education for all alternative and complementary and medical practitioners.[See The Science of Unified Medicine] Orthodox medical education gives student doctors a training which outlines key biological functions and their biochemistry and that are common to all major forms medical specialisation. Later when diagnosing patients this allows doctors to ensure that the most appropriate specialist is handling their case. In addition the common language based on the biochemical approach facilitates efficient and appropriate communication between specialists of all types for the purposes of research and development. Common training, practice models and communication languages are the hallmark of a body that can be considered to be a profession be it medicine, accountancy, law or any other discipline. Complementary medicine also needs a unified model of human functioning which serves to explain all effects observed in all therapies. Treatments should be based on the implications of change that the model proposes. The model could then be used to investigate how integration of treatments from different therapies can enhance healing as well as protect patients from possible contraindications, such as the case of individuals who receive both Aromatherapy and Homeopathy. Such a model would be at the centre of complementary medical education. It would demonstrate how different treatments act by utilising the same mechanisms of action. It would not simply be inclusion of subjects such as Anatomy and Physiology. Conventional interpretations of those subjects are simply too incomplete and inappropriate for some treatments. A new expanded form of the subjects would be required which coherently depicted how other models, such as the Chinese meridian system, related to the conventional one. It is probable that unification may only be possible by building a model starting with the fundamental physics of the processes involved and then expanded to include higher level processes central to changes in health. With a common education based on a common process of healing, orthodox doctors prescribing complementary medicine can choose the most appropriate therapy for a given patient's case, even if that happens to be conventional drug treatment. In addition, complementary practitioners would know when they had reached the limits of the treatment they are giving and pass on the patient to a more appropriate therapy. Examples of possible implementation of this practice include Homoeopaths referring patients to Bach Flower Remedies, Aromatherapists recommending Reflexology or conventional doctors recommending spiritual healing. The perception of biological processes and functions that form the basis of complementary and orthodox treatments should be independent of which discipline a practitioner has trained in. However the methods with which practitioners diagnose is biassed because what practitioners recognise is dependent on what they have learned to recognise. Metaphorically speaking, human beings are structured like a one-roomed house. The processes that are responsible for healing are equivalent to the contents of the room. No matter what way someone came in they will end up always seeing the same things in the room albeit from different angles. The variety of complementary medical treatments correspond to the ways that people can get into the house, some being more effective at their method of access than others depending on the entry channel chosen. No matter what way people try to access the healing processes of an individual it will seen by practitioners trained in truly integrated medicine that there are always a fundamental set of functions or structures that will have to be transformed in order for health to be transformed. The structures and functions that are altered are linked to a persons awareness and what they have learnt through experience, just as people would only recognise things in the house providing they had prior experience of them. This awareness is structured according to sensory information received by the person. This means that healing is essentially dependent on the way that information from the five senses and higher associated faculties is interpreted by the brain and its associated nervous system. In a nutshell, the act of our perceptions transforming our mind is responsible for altering our health. The implications of these concepts for research
methodology are significant. The methodology is clearly going to have to find ways of
assessing the non-material aspects of complementary medicine, especially relationships
between practitioners and patients. It is the nature of these that will decide what the
future structure of complementary medicine will be. 1 MORI poll. The Times 1989.Nov13. Ijaz Rasool was born in 1966 in
Pakistan. He has been resident in London since 1970. (c) 1993-1999,Ijaz Rasool, All Rights Reserved. For Further information please email : webmaster@bodymind.co.uk |
