CHAPTER 14 The complementary and alternative health care system in Australia

Julia Twohig

When you finish this chapter you should be able to:

• describe Complementary and Alternative Medicines (CAMs), their evidence-base and their place in the Australian health system

• explain the holistic nature of CAM and the commonly used modalities

• discuss the increasing growth and demand for CAM

• outline the current regulatory requirements and questions about statutory registration.

The Complementary and Alternative Medicine system

In Australia, Complementary and Alternative Medicine (CAM) is a wide range of popular but diverse health care practices which exist parallel with, but are not regarded as part of, the mainstream biomedical system (McCabe 2005). Even this definition is rather wanting because it is defines what they are not, rather than what they are (Coulter & Willis 2004). Yet a succinct definition covering all of CAM remains elusive as the great range of different health practices vary greatly in their philosophy and therapeutic approach (British Medical Association 1993).

Although many differences exist in the approach to treatment, the modalities that comprise CAM do share some common features:

• CAM takes a holistic view of the individual and a belief in the interconnectedness of mind, body and spirit. Giving attention to emotional, psychological and behavioural presentations is actually essential to a successful prescription in many of the therapies.

• CAM places emphasis on individualising the treatment. For example, individuals with asthma would each require a different treatment. One individual’s asthma may have different causes and different aggravating and ameliorating factors, necessitating different treatment.

• Most CAM approaches encourage a partnership approach to the consultation and management of the case. This can be empowering for individuals and can relieve the practitioner of some of the onerous sense of responsibility that rests with the treatment decisions made.

• Many of the CAM clinical approaches have an underlying belief that people heal themselves, given the right support and stimulus. The consultation and the treatment are the catalyst to initiate rebalance and harmony to the life force (Weir 2005).

Each of the modalities or areas of health practice that comprise CAM in Australia have operated quite separately from the mainstream and have existed and prospered in a system of self regulation.

Education and regulation

Towards the close of the 20th century many CAM practitioner associations chose to develop education and training programs within the Vocational Education and Training (VET) sector. The participation in the development of a Health Training Package (HTP) (Commonwealth Department of Education, Science and Training 2007a) ensured government endorsement and three nationally recognised components for CAM:

1. national competency standards

2. a national system of assessment

3. national qualifications.

Government-endorsed qualifications now exist for a variety of CAM and range from Certificate IV to Advanced Diploma and include the following modalities:

• aromatherapy

• aromatic medicine

• ayurvedic lifestyle consultation

• ayurvedic medicine

• homoeopathy

• kinesiology

• naturopathy

• nutritional medicine

• remedial massage

• reflexology

• shiatsu and oriental therapies

• traditional Chinese medicine/acupuncture

• traditional Chinese medicine remedial massage (an mo tui na)

• Western herbal medicine.

This chapter is confined to those CAMs which are primary contact practices: practices which accept patients directly without referral from another practitioner. These CAMs require a minimum entry level of education for practice of either an Advanced Diploma or a higher education qualification from a university. Below is a brief description taken from a range of sources of primary contact practices.

Aromatherapy (aromatic medicine)

Aromatic medicine uses essential plant oils and aromatic extracts to treat illness. The oils can be inhaled, applied to the skin, inserted into the body or taken orally. Aromatic essential oils and extracts are commonly used in conjunction with tactile therapies, such as massage, and can be used to treat a wide variety of conditions.

Ayurvedic medicine

The Sanskrit literal translation for Ayurvedic medicine is the science of life.

Ayurveda is a system of natural medicine developed in India. Ancient texts attribute the early sages who developed yoga and meditation with the development of this system of healing. The Ayurvedic approach aims at restoring balance and harmony to the mind, body and spirit. Treatments include diet, meditation, exercise, herbs, massage and controlled breathing (National Centre for Complementary and Alternative Medicine [NCCAM] 2007).

Homoeopathy

The word homoeopathy is derived from the Greek homoios — like + pathos, disease, suffering.

Homoeopathy was first developed as a medical art and science by the 19th century physician, biologist, chemist, linguist and visionary, Samuel Hahnemann (Twohig 2007). Homoeopathy is a therapeutic approach based on the concept of a holistic and indivisible disease state which becomes observable through signs and symptoms expressed by the sick individual. Disease is regarded as an expression of the vital force that is inseparable from the patient (Kurz 2005). Guided by this law of ‘similars’, the selection and prescription of a medication, which through prior testing on healthy people and from clinical experience and observation, is known to produce a similar symptom picture to that of the patient. The ‘potentised’ medication is prepared by serial dilution and by succussion which involves vigorously striking the vial of medicine at each stage of its preparation. The medicine is prescribed in the minimum dose required to stimulate healing.

Naturopathy

The word is derived from Greek and Latin — literal translation, nature disease.

Naturopathy has evolved over time and reflects an amalgam of various natural health movements from many different cultural influences. Naturopathy has six commonly espoused key principles at its core:

1. promote the healing power of nature

2. first do no harm

3. treat the whole person

4. identify and treat the cause of disease

5. prevention is the best cure

6. the physician as teacher.

Naturopathy places as much emphasis on prevention and treatment as it does on restoration of the bodys’ natural balance and takes a holistic approach which encourages maintenance of positive thinking, a balanced diet of whole, organic foods, elimination of toxic wastes, clean air, clean water, exercise and healthy lifestyle habits. It can encompass a plethora of treatment and diagnostic options including nutritional advice, herbs, limited use of homoeopathic medicines, iridology, reflexology, kinesiology, vitamin and mineral supplementation and tactile therapies.

Nutritional medicine

Nutritional medicine is a relatively new qualification in the Health Training Package and this health practice is centred on the principle that nutrition plays an essential part in achieving and maintaining good health. Nutritional medicine practitioners have expertise in all aspects of biochemical nutrition. They can assist with nutritional advice to support a healthy lifestyle, and to correct the nutritional deficiencies which contribute to the development of pathology. They can also tailor dietary approaches for specific conditions.

Traditional Chinese medicine/acupuncture

Traditional Chinese medicine (TCM) comprises a range of traditional medical practices that have developed over many thousands of years. These practices can now incorporate influences from other East Asian countries, such as Korea, Japan and Vietnam.

TCM regards the patient as a holistic entity and illness as a sign of a fundamental imbalance between Yin and Yang (Weir 2005). The philosophy that underpins TCM is a concept of chi, or an energy, that is said to flow through the body in channels or meridians. The five phases of chi are often classified as the five elements: wood; fire; earth; metal and water. The TCM practitioner aims to bring these elements into harmony and therefore to bring balance to chi. Practitioners can specialise in one particular type of treatment or combine a number of treatments from a wide range, including: herbal medicine, acupuncture, Chinese massage, dietary advice, moxibustion, breathing exercises, movement, meditation and manipulation (Komesaroff 1997).

Western herbal medicine (WHM)

Western herbal medicine (WHM) is an amalgam of herbal lore and practice that borrows from thousands of years of clinical use. Herbalists prepare medicines from a range of plant materials and provide individual treatments based on thorough consultations about an individual’s lifestyle, nutrition and presenting symptoms.

Chiropractic and osteopathic medicine

Chiropractic and osteopathic medicine are both statutory registered professions and, although their treatments are not included in the Medicare schedule, they generally enjoy a broader acceptance in the medical fraternity and the community generally, and GPs can now refer their patients to chiropractors and osteopaths for a limited number of treatments under the enhanced primary care scheme. For this reason they are not included in this description of complementary or alternative medicine, although in some situations and for some conventional practitioners and some patients they may still be regarded as complementary or alternative health practices.

Indigenous medicine

Although no formal system of recognition exists for the practice of Indigenous medicine, within the ambit of CAM some CAM practitioners may also incorporate aspects of Indigenous medical practices into their repertoire of treatments. An example of this can be seen in the successful commercialisation of a range of medicines known as Bush Flower Essences (Balinski 1998; Ralph-Flint 2001). It is interesting to note that the Western Australian Government Chemical Laboratories have for many years produced an extract made from Scaevola spinescens, an indigenous plant attributed with benefits in the treatment of oral cancer.

History of CAM in Australia

Many of the more established CAM practices have existed in Australia, in some form, since European settlement. TCM arrived with the early Chinese immigrants and homoeopathy with early European migration. These practices were often carried out by lay practitioners or by medical doctors who were also homoeopaths. Homoeopathic hospitals were established in Melbourne in 1882 and Sydney in 1901 (Homoeopathic Industry Reference Group 1999).

The introduction of antibiotics and the rapid expansion of pharmaceutical treatments and greatly improved public health programs are widely credited with contributing to the decline of CAM, especially after World War Two (Gray 2005). Since European settlement, CAM practitioners have often been marginalised by the dominant mainstream medical system, but despite this many practices have survived and even prospered due in large part to the dedication and commitment of its practitioners and the demand of its followers.

Those who seek CAM

Since the 1960s there has been a considerable resurgence in the popularity of CAM. This revival has taken place among the wealthier, more prosperous, well-educated sections of economically developed societies (Gray 2005). The increasing use of CAM by Australians mirrors the pattern of use in other Western, industrialised countries.

In a 2004 South Australian study, CAM was used by 52.2% of the study population, across a range of ages, with the highest use in well-educated, reasonably affluent women between the ages of 25–34 years, with the majority using CAM for maintenance of general health (MacLennan, Myers & Taylor 2006). In similar previous research 57% of CAM users revealed that they did not tell their doctor they were receiving CAM (MacLennan, Wilson & Taylor 2002).

One group of patients who use CAM are those diagnosed with cancer. Individuals seek CAM treatments to not only treat the disease but also to treat the side effects of some conventional treatment, including chemotherapy and radiation therapy, but people also tend to seek out CAM when mainstream medicine has no treatments left to offer. This is a difficult situation for both patient and practitioner as the disease is usually very advanced and the patient is also struggling with the debilitating side effects of the medical treatment they have received. An Australian study which researched the use of CAM in children with cancer found that 46% had used various treatments as a complement to conventional treatment and less than half of their parents had told their doctors (Sawyer et al 1994). A study on the supportive care needs of men with prostate cancer found that younger, better-educated men were more likely to combine the use of CAM with their mainstream treatment (Steginga et al 2001).

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