I was working next to a world renowned psychic and spiritual healer in the healing sanctuary of a music festival. This made me nervous: my own training in complementary medicine before medical school gave me no such special powers. Many of the people I treated had the customary battle wounds of a sedentary office bound existence. Others came in just to feel better. These people were clearly treating themselves. Who else uses complementary and alternative medicine (CAM) and why?
Many users of CAM have medically unexplained symptoms. This non-diagnosis is a big burden for primary care, accounting for a quarter of consultations in England. It’s also a big burden for the patient, implying that it’s all in the head. Much of the literature and nomenclature surrounding medically unexplained symptoms is from psychiatry, which serves to reinforce this implication. If a profession largely dedicated to the scientific exploration of phenomena cannot articulate the problem it is unsurprising that patients look for other explanations.
Several approaches in CAM employ language and metaphors redolent of Eastern concepts of balance and energy flow. These are strikingly at odds with the reductionist technical lexicon of allopathic orthodoxy. This perhaps appeals to patients interested more in the “why” as opposed to the “what.” If stripped of its more esoteric overtures, this is of course no different to the best practice offered by general practitioners. A crucial difference, however, is the luxury of time.
Another commodity sparingly used in modern medicine is touch. Whereas the doctor-patient relationship is ever more impersonal, with the growing battery of diagnostic technology, many CAM therapies thrive on a greater intimacy. Perhaps part of CAM’s appeal is that touch offers patients something magical and mysterious. It is also for many, the purveyor of the natural, free from the market hungry wolf of big bad pharma and the side effects of its drugs.
Working at the festival brought home to me how the tensions that exist between CAM and allopathic medicine can illuminate each other’s blind spots. Where primary care’s 10 minute consultation, spot of reassurance, and some tablets fail to hit the spot, I suspect that in some cases the holistic principles underpinning some CAM approaches are as instrumental in making the patient feel better as the intervention itself. In such instances the therapy is unlikely to perform too well in randomised controlled trials, focusing as they do on an illusory magic bullet.
A willingness to develop an understanding of the appeal of CAM, despite its shortcomings, might be more likely among doctors if they had a better understanding of the fallible foundations on which their own pedestal of evidence based medicine is built. At the very least, it might make for a bit more humility and less flippant mockery when confronted with the popularity of the clairvoyant shop next door.
Jonny Martell is a third year medical student at Kings College London