Unconventional medicine teaching at the Universities of the European Union

Health care professionals' personal and professional views of herbal medicines in the United Kingdom

Health care professionals (HCPs) have a pivotal role in optimizing patient care and should be familiar with complementary and alternative medicines. The aim of the study was to explore UK-based HCP personal and professional opinions and experiences of herbal medicines (HMs). An online questionnaire was distributed via social media to recruit (n = 112) a range of HCPs from across the United Kingdom. HCPs from primary and secondary care, the private sector, and academia took part. A large proportion of participants (62%) said they did not personally use any HMs, and 38% did use HMs. HCPs who had personally used HMs had a positive impression of HMs and were more likely to recommend HMs to patients than those who had not used HMs themselves. Participants were given the opportunity to share their perceptions on the safety and efficacy of HMs and their experiences with patients reporting adverse drug reactions to HMs and herb-drug interactions. HCPs identified their lack of knowledge on HMs and insufficient training, which made them unable to advise patients on the safe use of HMs. More education on HMs would help improve HCP knowledge of HMs and help them make better informed decisions when considering patient pharmaceutical care plans.

Effects of Homeopathic Preparations on Human Prostate Cancer Growth in Cellular and Animal Models

The use of dietary supplements for various ailments enjoys unprecedented popularity. As part of this trend, Sabal serrulata (saw palmetto) constitutes the complementary treatment of choice with regard to prostate health. In homeopathy, Sabal serrulata is commonly prescribed for prostate problems ranging from benign prostatic hyperplasia to prostate cancer. The authors' work assessed the antiproliferative effects of homeopathic preparations of Sabal serrulata, Thuja occidentalis, and Conium maculatum, in vivo, on nude mouse xenografts, and in vitro, on PC-3 and DU-145 human prostate cancer as well as MDA-MB-231 human breast cancer cell lines. Treatment with Sabal serrulata in vitro resulted in a 33% decrease of PC-3 cell proliferation at 72 hours and a 23% reduction of DU-145 cell proliferation at 24 hours (P<.01). The difference in reduction is likely due to the specific doubling time of each cell line. No effect was observed on MDA-MB-231 human breast cancer cells. Thuja occidentalis and Conium maculatum did not have any effect on human prostate cancer cell proliferation. In vivo, prostate tumor xenograft size was significantly reduced in Sabal serrulata–treated mice compared to untreated controls (P=.012). No effect was observed on breast tumor growth. Our study clearly demonstrates a biologic response to homeopathic treatment as manifested by cell proliferation and tumor growth. This biologic effect was (i)significantly stronger to Sabal serrulata than to controls and (ii)specific to human prostate cancer. Sabal serrulata should thus be further investigated as a specific homeopathic remedy for prostate pathology.

Teaching Acupuncture to Medical Students: The Experience of Rio Preto Medical School (Famerp), Brazil

Complementary and alternative medicine, and in particular acupuncture, has been practised and taught in recent years in many universities in the Western world. Here, we relate our experiences since 1997 in teaching acupuncture to medical students at Rio Preto Medical School (Faculty of Medicine of São José do Rio Preto (FAMERP)), Brazil. Classes are given in the third and fifth years. The main goals of understanding the mechanisms of action and being able to recognise patients who may benefit from treatment and referring them have been well achieved, scoring 3.6 and 4.1, respectively, on a scale of 1–5. Also using that scale, medical students believe that acupuncture is important in the curriculum (4.6), course time is not sufficient (2.7) and they would like more information (4.6). To overcome these concerns, many students join an undergraduate study group (Acupuncture League) where they have more time to learn. We also describe the presence of foreign medical students who, since 2000, have enrolled in a course of 150 h in an exchange programme.

Integration of complementary and alternative medicine into medical schools in Austria, Germany and Switzerland--results of a cross-sectional study

BACKGROUND

The results of a survey of decision makers (directors of clinical departments, along with research and education institutes) at German medical schools in 1997 demonstrated that although most respondents were in favour of integrating complementary and alternative medicine (CAM) into medical school curricula, only a minority had implemented these into their medical schools. The aims of this study were to evaluate the current opinions on CAM from decision makers at medical schools in three German-speaking countries and the present extent to which it has been integrated.

METHODS

In 2004 we sent a standardised questionnaire to 1,017 department directors at medical schools in Austria (A, n = 75), Germany (G, n = 873) and Switzerland (CH, n = 69).

RESULTS

487 questionnaires (overall response rate: 48%, country-specific response rate: A 39%; G 49%; S 42%) were returned. 40% of respondents had a positive opinion on CAM, whereas 28% had a neutral and 29% a negative opinion and 3% were unsure with a significant difference between Germany (44% positive opinion) in favour for CAM vs. Switzerland (22%; p = 0,021). The CAM therapies rated most positively were acupuncture (53%), osteopathy (52%) and naturopathy (38%) with no statistical differences between the countries. Naturopathy (39%) and herbal medicine (34%) were viewed more positively in Germany compared to Austria (4%, p = 0.001 and 8%, p = 0.01), but not to Switzerland (27%, p = 0.289 and 24%, p = 0.353). The majority of respondents favoured the integration of CAM into the medical system (research 85%, teaching 84% and treatment 60%). However, only 162 respondents (34%) indicated that CAM therapies had already been integrated into the curriculum at their medical schools (treatment 26%, research 19% and education 18%) with no significant differences between the countries. Respondents of Switzerland indicated lower activity of CAM integration (treatment 10% and research 10%) compared to Austria (28%, p = 0.016 and 28%, p = 0.016) and Germany (27%, p = 0.01 and 20%, p = 0.174).

CONCLUSIONS

The majority of respondents favoured the integration of CAM into the medical system. However, this integration remains limited and does not reflect the high usage of CAM in the population.

How should complementary and alternative medicine be taught to medical students in Switzerland? A survey of medical experts and students

BACKGROUND

In Switzerland and in the whole western world, the growing popularity of CAM is calling for its implementation in the undergraduate medical curriculum.

AIMS

To determine whether medical experts and medical students are favorable to complementary and alternative medicine (CAM) education at Swiss medical schools and to investigate their opinion about its form, content and goals.

METHODS

Experts in the fields of conventional medicine (COM, n = 106), CAM experts (n = 29) and senior medical students (n = 640) were surveyed by an online questionnaire.

RESULTS

48.7% of the COM experts, 100% of the CAM experts, and 72.6% of the students are favorable to CAM education at Swiss medical schools. The most requested disciplines are acupuncture, phytotherapy, and homeopathy; the most recommended characteristics of CAM education are elective courses, during the clinical years, in the format of seminars and lectures. For the CAM experts, the priority is to improve the students' knowledge of CAM, whereas for the COM experts and the students, the priority is to analyze efficiency, security, interactions, and secondary effects of CAM.

CONCLUSIONS

CAM courses should be informative, giving the students sufficient knowledge to provide a critical analysis of efficiency and security of different CAM modalities.

Medical students' attitudes to complementary and alternative medicine: further validation of the IMAQ and findings from an international longitudinal study

BACKGROUND

Current research mainly employs cross-sectional designs to examine changes in medical students' attitudes towards complementary and alternative medicine (CAM).

AIMS

This paper reports the findings of a longitudinal study to further validate the Integrative Medicine Attitude Questionnaire (IMAQ) and examine changes in medical students' attitudes over 3 years.

METHODS

A total of 154 medical students from four schools in three countries completed a modified version of the IMAQ during their first (T1) and fourth year (T2).

RESULTS

We established the validity of a three-factor model for the IMAQ: (1) attitudes towards holism; (2) attitudes towards the effectiveness of CAM therapies, and (3) attitudes towards introspection and the doctor-patient relationship. We found that IMAQ factor scores did not differ significantly from T1 to T2, emphasizing the relative stability in attitudes across time. Various student characteristics were significantly associated with IMAQ factor scores at T2: age, gender, CAM use, CAM education and school; and two variables (gender and CAM use) predicted changes in medical students' attitudes between T1 and T2.

CONCLUSIONS

We urge medical educators to continue exploring medical students' attitude changes towards CAM and we provide examples of what further research is needed.

Anomalous therapies and public health: a utilitarian bioethical response

A utilitarian approach is used to evaluate the ethics of incorporating unscientific anomalous therapies within health care and related settings. This paper argues that incorporation of anomalous therapy methods into health care systems is highly problematic, and should be avoided on ethical grounds. The ethical responses open to various bodies and individuals are discussed, including legislative bodies, public health care providers, the medical research community, medical providers, individual agents, and international bodies. It is argued that a moral imperative exists to act against the inclusion of anomalous therapy methods in health care systems.

Comparison of attitudes, beliefs, and resource-seeking behavior for CAM among first- and third-year Czech pharmacy students

OBJECTIVES

To assess and compare first- and third-year Czech pharmacy students' attitudes toward CAM, CAM use, CAM evidence, recommending CAM to patients, and including CAM in the pharmacy curricula.

METHODS

The CAM Health Belief Questionnaire (CHBQ) was translated from English to Czech and administered to 250 first-year and 187 third-year students.

RESULTS

The students' mean CHBQ score was 48.5, affirming positive attitudes toward CAM. Vitamins, herbs, massage, and relaxation were the most commonly used therapies among students. Czech students reported significantly low use of evidence-based resources on CAM. Ninety percent of the pharmacy students surveyed would recommend CAM and 89% believed pharmacists should be knowledgeable of CAM. Ninety-one percent of first-year vs 78% of third-year students supported CAM education (p = 0.01).

CONCLUSIONS

Czech students have positive attitudes about CAM, but are less likely to access evidence-based information. They agree pharmacists should be educated about CAM.

Towards a model for integrative medicine in Swedish primary care

Background

Collaboration between providers of conventional care and complementary therapies (CTs) has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM). The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care.

Methods

Investigative procedures involved research group and key informant meetings with multiple stakeholders including general practitioners, CT providers, medical specialists, primary care administrators and county council representatives. Data collection included meeting notes which were fed back within the research group and used as ongoing working documents. Data analysis was made by immersion/crystallisation and research group consensus. Results were categorised within a public health systems framework of structures, processes and outcomes.

Results

The outcome was an IM model that aimed for a patient-centered, interdisciplinary, non-hierarchical mix of conventional and complementary medical solutions to individual case management of patients with pain in the lower back and/or neck. The IM model case management adhered to standard clinical practice including active partnership between a gate-keeping general practitioner, collaborating with a team of CT providers in a consensus case conference model of care. CTs with an emerging evidence base included Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong.

Conclusion

Despite identified barriers such as no formal recognition of CT professions in Sweden, it was possible to develop a model for IM adapted to Swedish primary care. The IM model calls for testing and refinement in a pragmatic randomised controlled trial to explore its clinical effectiveness.

Status of complementary and alternative medicine in European medical schools

BACKGROUND

The aim of this study was to investigate whether Complementary and Alternative Medicine (CAM) education is part of the regular medical curriculum in European universities and whether it correlates with the public demand for CAM methods.

MATERIALS AND METHODS

Using the World Directory of Medical Schools, 265 medical faculties in EU countries were contacted via e-mail or regular post and asked to fill out a questionnaire of 7 questions concerning CAM education in their establishments.

RESULTS

Only 40% of the responding universities were offering some form of CAM training. We could not show any correlation between the public demand for CAM methods and the availability of CAM training in medical universities.

CONCLUSIONS

The growing popularity of CAM makes it very important for physicians to gain information on these methods and techniques, thus better incorporation of CAM education into the regular medical curriculum is needed in all European medical faculties.

Alternative, complementary, energy-based medicine for spinal cord injury

This paper provides an overview on various alternative, complementary, or energy-based therapies that expand the healing spectrum of individuals with spinal cord injury (SCI). Not only do they have the capability to help a variety of secondary conditions, they have the ability in some people, for certain injuries, to restore function, sometimes dramatically. After providing an overall contextual rationale for the use of alternative medicine, this paper briefly summarizes various Eastern-medicine healing modalities, laser-based therapies, nutritional and homeopathic approaches, and pulsed electromagnetic therapies.

Integration of complementary and alternative medicine into German medical school curricula -- contradictions between the opinions of decision makers and the status quo

INTRODUCTION

There is a growing demand for complementary and alternative medicine (CAM) in Western societies. This trend has lead to the gradual integration of CAM courses into medical school curricula. The aim of this study was to survey key decision makers at German medical schools with regard to their views on CAM and to examine the extent to which CAM has already been integrated in the German medical school system.

MATERIALS AND METHODS

A questionnaire was sent to 753 clinic and institute directors at German medical schools.

RESULTS

A total of 500 questionnaires (66%) were returned. 39% of respondents had a positive opinion of CAM, 27% had a neutral opinion and 31% had a negative opinion. 3% of respondents were unsure. The CAM therapies viewed most positively were osteopathy (52%), acupuncture (48%), and naturopathy (41%). Most respondents were in favor of integrating CAM into the medical system. However, a larger percentage favored its use in research (61%) and teaching (59%) rather than in the treatment of patients (58%). Only 191 respondents (38%) indicated that CAM treatment methods had been integrated into the curriculum of their respective medical schools. In these schools, CAM was mainly used in patient treatment (35%), followed by research (22%) and education (21%).

CONCLUSIONS

Our data show that the majority of respondents were in favor of integrating CAM into medical school curricula. However, at the time of our survey, only a small percentage of medical schools had actually put this into practice. The reasons for this discrepancy are unclear and should be further investigated.

Homeopathy and acupuncture teaching at Faculdade de Medicina da Universidade de São Paulo: the undergraduates' attitudes

CONTEXT AND OBJECTIVE

Homeopathy and acupuncture, although recognized as medical specializations in Brazil, are not taught in most medical schools. The objective was to evaluate undergraduate attitudes towards them following their inclusion as optional disciplines at Faculdade de Medicina da Universidade de São Paulo (FMUSP) in 2002.

DESIGN AND SETTING

Questionnaire, at FMUSP.

METHODS

484 students answered a self-administered questionnaire on these therapies, regarding their interest in learning, the teaching methods, their knowledge/experience (or that of someone close to them) and how it was acquired, the main indicators and general effectiveness of these therapies, and the possibilities for offering and integrating them within public healthcare units.

RESULTS

Over 85% of the students considered that homeopathy and acupuncture should be included in curricula, as options (72%) or compulsorily (19%); 56% showed great interest in learning about them. Although 76% had little or no knowledge, 67% believed that these therapies had some effectiveness, and that chronic diseases (37%) or even chronic and acute diseases (29%) would be the main indicators for their use. Around 35% were receptive towards offering public primary care using both therapies, while 34% thought these treatments should also be available in hospitals and 60% believed they could be integrated with conventional medical practices.

CONCLUSION

The medical students were interested in learning the principles of homeopathy and acupuncture, were able to observe and report on the effectiveness of these treatments and defended the use of these medical specializations within public healthcare.