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Complementary Therapies in Clinical Practice 18 (2012) 2–3

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Complementary Therapies in Clinical Practice

journal homepage: www.elsevier .com/locate/ctcp

Editorial

Age, sex, disease, ethnicity et al – Are complementary therapies reachingthe parts?

A common criticism of private complementary therapy (CT)practice in developed countries is that the majority of its clientsare the worried well who are predominantly middle class, middleaged, white and female. While wealth, high social class anda good education may reduce your risk of illness and increaseyour access to treatment and care; it does not protect you fromcancer, old age or long-term conditions such as multiple sclerosis.Poverty, war, abuse and individual behaviours, for examplesmoking, add to the burdening costs and causation of illness.Working in clinical practice should expose practitioners to a widerpatient experience and demand greater skill and knowledge to takeus beyond the worried well.

When the journal celebrated its first decade in 2005; the Edito-rial Board identified common areas of practice; cancer care, infantand childcare settings and midwifery. It is important as servicesgrowwe look closely and critically at what areas of clinical practicewhere we fail to be inclusive and equitable, for example mentalhealth, the elderly and drug addiction. In the best of integrativehealthcare we need to offer evidence based choices to diverseand not exclusive populations. In this editorial Peter Mackerethand Gavin Andrews explore key ‘inclusive’ issues related to CTservice delivery and future research in the UK and Canada.

1. UK services and studies

Over the years CTCP has published a number of CT studies forpeople accessing cancer and hospice based care. In some waysthis is not surprising as surveys suggest that in excess of 90% ofhospices these settings offer a range of CT interventions.1 If wetake complementary therapies, putting in the words ‘breast cancer’into a search engine will reveal many well conducted studies. Incontrast, a search for ‘lung cancer’ produces a small number of pub-lished CT papers. Longer-term illnesses, such as multiple sclerosis,Parkinson’s disease, musculo-skeletal problems are also repre-sented in the UK CT literature, with this work largely funded fromcharitable sources. Pregnancy, infant and childcare studies alsofigure in the literature; commonly it is midwives and children’snurses who have carried out these studies.

People living with dementia, the homeless and prisoners arevirtually non-existent in the literature as CT recipients or partici-pants in studies. Over the last two decades complementary andalternative medicine (CAM) courses appeared to have gaineda small foothold in UK Universities, however recently there havebeen more losses than gains. The economic downturn and sus-tained attack from the anti-CAM lobby have played a part in this.

1744-3881/$ – see front matter � 2011 Elsevier Ltd. All rights reserved.doi:10.1016/j.ctcp.2011.10.002

With less students studying and investigating CAM there are risksto building and maintaining quality CAM research and education;this in turn undermines the available evidence to support clinicalprovision of CAM.

At the Christie Hospital (Acute Cancer Care Centre) in the UK,our CT service user database spanning the last 10 years has revealeda trend of increasing access by men, but no recorded data onethnicity. Recently we undertook a prospective audit of serviceuser demographics, as well as focus group work exploring ‘access’issues with CT therapists and data from both these projects willbe included in papers for submission for publication later thisyear. It is important to ask if CT practitioners are willing to workand learn in challenging areas of practice where bodies are frail,not toned, well fed, nipped or even tucked, but may be scarred bydisease, worn and wrinkled by age or owned by individuals livingwith dementia, disabilities and mental illness.

In the UK we have an ageing population with reduced health-care resources limiting CT development and evaluation. Is it thatelderly care offers complementary therapists less potential forcareer development and job satisfaction? Our recent study investi-gating motivation for working in cancer care suggests that whilesome CT therapists are prepared to volunteer, many see this asbuilding towards a paid CT career.2,3 The danger of limitedresources is the risk of the ‘deserving’ and ‘non-deserving’ rhetoricbecoming louder. Those who are the most articulate and usuallybetter off will get the most out of private, public and voluntaryservices. Those less able to articulate and be heard will lose out,e.g. people living with dementia. UK complementary therapyservices are not accessible or free at the point of delivery to all;too often they rely on short-term funding from charitable sources,are provided by volunteers and do not reach all the parts. Althoughmuch appreciated, volunteers can withdraw their labour at anytime and may not be the most sustainable workforce for providinginterventions in complex healthcare settings. Volunteers are alsounlikely to be able to take the lead with research or training others.However, they can and often will provide services in areas of need.To build a sustainable and inclusive CT service requires leadership,education, cooperation between researchers and clinicians andbest use of the available resources, both here in the UK andinternationally.

2. Canadian services and studies

In Canada whilst there is limited research evidence, there isconsiderable empirical evidence, suggesting increasing and

Editorial / Complementary Therapies in Clinical Practice 18 (2012) 2–3 3

widespread use of CAM amongst groups previously thought to beoccasional or light users.5 Part of this has to do with demographicchanges including the country’s’ rapidly ageing population andextensive immigration, particularly from South and East Asia tourban centres like Toronto. However, there have also been a numberof assumptions rather than evidence regarding the diversity of CAMusers in Canada. Although broader, diverse social groups such as theold, young, ethnic minorities and men might be using CAM more,there continues to be a disparity between the types of serviceprovision and therapies generically available. The development ofCAM in the health system as a whole, has so far been rather passiveand ad-hoc with no clearly defined health goals. In the community-based private sector, CAM businesses have tended to be located inareas where CAM markets already exist and so they have tailoredtheir services accordingly. For example, in Ontario, this can beseen by the prevalence of Chinese medicine in Toronto’s Chinatown; in the small retirement town of Port Perry there is an abun-dance of massage, osteopathy and chiropractic clinics. Even thenhowever, provision is orientated towards those who can afford topay for CAM treatments and the market does not solve the problemof restricted CAM access for poorer people, even in areas of concen-trated provision. Institutional-based integrated medicine is alsobecoming increasingly focused on particular demographic groupsand is influenced by the prevailing policies and attitudes of specificinstitutions. It is more common for example, to see CAM available inlong-term care environments for older people or cancer care ratherthan for disaffected minority groups such as the poor, disabled orthose with acute problems.

In Canada, inequalities of accessibility to CAM require cleardecisions by the Canadian Provinces on what forms of CAM shouldbe paid for publicly and what should be available privately and forwhom should they be made available. In terms of Canadianresearch, few initiatives deal specifically with the demographicsof CAM use. One of particular note however, is the Canadian Paedi-atric Complementary and Alternative Medicine Network (Ped-CAM) which serves to link researchers, educators, conventionaland non-conventional practitioners across the country with theaim of developing a competent knowledge base regarding CAMuse in Paediatric care. Other research initiatives that are beingseeded include the IN-CAM network for which provides informa-tion on research methods and tools integral to exploring the needsof population sub-groups. The Holistic Health Research Founda-tion of Canada (HRFC) provides grants for small scale CAM pilotprojects.

For complementary therapists and academics that are able toundertake and disseminate research, there is an urgent need to

promote equitable access and evaluation. The challenges aheadare to:

� Identify populations that are under provided for in CT practiceand research.

� Secure research funds for workwith the groups currently under-represented.

� Recruit skilled and motivated researchers to develop researchstudies.

� Ensure information technology is maximised, in order topromote inter-collegiate collaboration and research develop-ments both nationally and internationally.

CT practice and research desperately needs champions to illumi-nate and develop our knowledge and awareness in diverse andmarginal areas of clinical practice. As we move towards tocompleting our second decade of this journal, it is essential wecontinue to critique and disseminate the literature in relation toage, sex, disease, sexuality, ethnicity, the financially impoverishedand specific minority health care groups needing our attentionand care.4,5 The journal welcome submissions in these areas – wehope to present the best of this work in year leading to 2015.

References

1. Macmillan Cancer Relief. Directory of complementary therapy service in UK cancercare. Public and voluntary sectors. London: Macmillan Cancer Relief and Cam-bridge Publishers; 2002.

2. Mackereth PA, Parkin S, Donald G, Antcliffe N. Clinical supervision and comple-mentary therapists: an exploration of the rewards and challenges of cancer care.Complementary Therapies in Clinical Practice 2010;16:143–8.

3. Mackereth P, Carter A, Parkin S, Stringer J, Roberts D, Long A, et al. Complementarytherapists’ motivation to work in cancer/supportive and palliative care: a multi-centre case study. Complementary Therapies in Clinical Practice. 2009;15:161–5.

4. Andrews GJ. Private complementary medicine and older people: service use anduser empowerment, 22. Ageing and Society; 2002. 343–368.

5. Willison K, Andrews GJ. Complementary medicine and older people: pastresearch and future directions. Complementary Therapies in Nursing andMidwifery 2004;10(2):80–91.

Gavin Andrews*McMaster University, Main Street, Hamilton, Ontario, Canada L8S 4L9

Peter MackerethThe Christie NHS Foundation Trust, Wilmslow Rd,

Manchester M20 4BX, UK

* Corresponding author.E-mail address: andrews@mcmaster.ca (G. Andrews)