Traditional, Complementary and Alternative Medicine and Cancer Care pptx

Traditional, Complementary

and Alternative Medicine

and Cancer Care

Over the last decade, traditional, complementary and alternative medicine has

achieved an ever-higher profile amongst academics, healthcare professionals, policy

makers and service users, particularly in cancer care. Despite anecdotal evidence of the

importance of patient groups and grassroots networks to the way people access thera￾pies, research has tended to focus on the individual.

Traditional, Complementary and Alternative Medicine and Cancer Care provides

the first in-depth exploration of the role patient support groups play in the provision

of CAM in the UK and Australia. It also looks at the utilisation of non-biomedical

treatments in Pakistan focusing on the role of informal social networks.

Drawing on fieldwork in each country, the book explores:

● the empirical, theoretical and policy context for the study of CAM/TM and

cancer

● the nature, structure and evolution of patient support groups

● how groups function on a day-to-day basis

● the extent to which what is being offered in these CAM-oriented groups is in

any way innovative and challenging to the therapeutic and organisational

mainstream

● the ways in which processes of negotiating therapeutic options play out in

Pakistan.

Traditional, Complementary and Alternative Medicine and Cancer Care will be of

wide interest to those studying complementary and alternative medicine sociologi￾cally, to those involved in the provision of cancer care on a day-to-day basis and to

those looking to establish a more informed, evidence-based policy.

Philip Tovey is a Reader in Health Sociology at the School of Healthcare, University

of Leeds, UK.

John Chatwin is a Research Fellow at the School of Healthcare, University of

Leeds, UK.

Alex Broom is a Postdoctoral Research Fellow in the School of Social Science at the

University of Queensland, Australia.

An international analysis of

grassroots integration

Philip Tovey, John Chatwin

and Alex Broom

Traditional,

Complementary and

Alternative Medicine

and Cancer Care

First published 2007

by Routledge

2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN

Simultaneously published in the USA and Canada

by Routledge

270 Madison Avenue, New York, NY 10016

Routledge is an imprint of the Taylor & Francis Group, an informa business

© 2007 Philip Tovey, John Chatwin and Alex Broom

All rights reserved. No part of this book may be reprinted or reproduced

or utilised in any form or by any electronic, mechanical, or other means,

now known or hereafter invented, including photocopying and recording,

or in any information storage or retrieval system, without permission in

writing from the publishers.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloging in Publication Data

Tovey, Philip, 1963-

Traditional, complementary, and alternative medicine and cancer care : an

international analysis of grassroots integration / Philip Tovey, John

Chatwin, and Alex Broom.

p. ; cm.

Includes bibliographical references and index.

1. Cancer--Alternative treatment--Cross-cultural studies.

I. Chatwin, John. II. Broom,Alex. III.Title. [DNLM: 1. Complementary

Therapies--Australia. 2. Complementary Therapies--Great Britain. 3.

Complementary Therapies--Pakistan. 4. Neoplasms--therapy--Australia.

5. Neoplasms--therapy--Great Britain. 6. Neoplasms--therapy--Pakistan. 7.

Cross-Cultural Comparison--Australia. 8. Cross-Cultural Comparison--

Great Britain. 9. Cross-Cultural Comparison--Pakistan. 10. Self-Help

Groups--Australia. 11. Self-Help Groups--Great Britain. 12. Self-Help

Groups--Pakistan. QZ 266 T736t 2007]

RC271.A62T7344 2007

362.196'994--dc22

2006029003

ISBN 10: 0-415-35993-7 (hbk) ISBN 13: 978-0-415-35993-1 (hbk)

ISBN 10: 0-415-35994-5 (pbk) ISBN 13: 978-0-415-35994-8 (pbk)

ISBN 10: 0-203-00794-8 (ebk) ISBN 13: 978-0-203-00794-5 (ebk)

This edition published in the Taylor & Francis e-Library, 2007.

“To purchase your own copy of this or any of Taylor & Francis or Routledge’s

collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”

ISBN 0–203–00794–8 Master e-book ISBN

For

W. Talist (as always); Betty and Charles

Brian and Alison

List of illustrations ix

Acknowledgements x

List of abbreviations xi

Introduction 1

PART I 9

1 The empirical, theoretical and policy context in

international perspective 11

2 Methodology: an overview of approach and

research sites in the UK, Australia and Pakistan 32

PART 2 47

3 The nature of CAM-focused cancer support groups 49

4 Group performance: enacting therapeutic alternatives

in the collective environment 65

5 Confined innovation: organisational challenge and

its limitations 81

6 An exploratory comparative case study from

Australia 100

Contents

PART 3 115

7 Consumption, and perceptions, of traditional,

complementary and biomedical cancer treatments

in Pakistan 117

8 Patients’ negotiation of therapeutic options 130

9 Interprofessional conflict and strategic alliance 144

Conclusion 158

Notes 168

Bibliography 170

Index 178

viii Contents

Figures

1.1 Use of traditional medicine for primary healthcare 27

4.1 Layout of the group area 69

6.1 The meditation room 107

8.1 Cancer patients’ negotiation of therapeutic options in

Pakistan 134

Tables

1.1 Categories of CAM: National Centre for

Complementary and Alternative Medicine (US) 12

7.1 CAM/TM use and level of education 123

7.2 Use of a Hakeem and level of education 123

7.3 Total CAM/TM use by hospital 124

7.4 Socio-economic status by hospital 124

7.5 Perceptions of the effectiveness of TM, CAM and

biomedical cancer treatments 125

7.6 Satisfaction with CAM/TM and biomedical

cancer treatments 126

Illustrations

The projects on which this book is based were unusually complex to con￾duct and a number of people provided invaluable input. Thanks are due to

Muhammad Hafeez, Salma Ahmad and Shahin Rashid for their contribu￾tion to the work in Pakistan, and to Jon Adams for his involvement in

Australia. Thanks are also given to the many people in the UK fieldwork

sites who supported the work but who need to remain anonymous; and, of

course, we are grateful to the significant number of individual participants

in each of the countries. The work was funded by two grants from the

Economic and Social Research Council/Medical Research Council under

their Innovative Health Technologies programme.

Finally, many thanks to Kathryn Dewison for reading the final manu￾script – bhgaft.

Acknowledgements

CAM Complementary and alternative medicine

CRUK Cancer Research United Kingdom

DoH Department of Health (UK)

ESRC Economic and Social Research Council (UK)

NHMRC National Health and Medical Research Council (AUS)

NHS National Health Service (UK)

RCCM Research Council for Complementary Medicine (UK)

TCM Traditional Chinese medicine

TM Traditional medicine

WHO World Health Organization

List of abbreviations

The use of non-biomedical therapeutics and the management of cancer are

high profile issues in health internationally. They both generate, in their

own right, considerable debate amongst academics, practitioners and the

wider public. Increasingly, as non-biomedical approaches have become

more and more a feature of the range of therapeutic options available to

cancer patients, the two have become inextricably linked. This book is con￾cerned with that increasingly evident combination. Specifically, it is a

socially located analysis of previously under-researched aspects of this com￾ing together in both richer and poorer countries – namely, the UK, Australia

and Pakistan.

The book is written at a time of considerable change. In richer countries

the entrenched oppositional positions of less than a decade ago are being

replaced by a (largely) rhetorical consensus on integration. For many in

policy-making arenas the virtues of this trend have achieved an almost

taken-for-granted quality in a short space of time. At a global level a seem￾ingly positive shift in attitudes towards the promotion of traditional

medicine (TM) as a means of satisfying unmet health need (WHO 2001),

and the theoretical possibility of the spread of non-indigenous practices to

poorer countries have also established a dynamic of change.

Given these significant and fast-moving shifts in the use of non-biomedical

medicines for cancer care it is not surprising that research in the area is at a

relatively early stage. While this paucity of research is beginning to be

addressed in richer countries (e.g. Bishop and Yardley 2004; Cassileth and

Vickers 2005; Ernst and Cassileth 1998; Lewith et al. 2002; McClean 2005;

Morris et al. 2000; Rees et al. 2000), beyond the West, research has been min￾imal. However, as the need for research has become increasingly recognised

(House of Lords 2000), two inter-related elements have informed that push:

first, the necessity of evidence on the effectiveness and efficacy (as well as

safety) of specific practices; and second, the need for ‘results’ that will

inevitably and immediately lead to policy development and practice change.

When researching and writing on any issue within the broad field of

‘health’ there is an understandable tendency to seek solutions: to fast-track

Introduction

the process of gathering information in order to argue a case for change at

whichever level. This is, of course, not specific to health. However, the

issues presented by people’s suffering, by the persistence of an unequal

access to resources which have an immediate and apparent consequence in

terms of day-to-day wellbeing, and indeed survival itself, make the pursuit

of policy as the logical outcome of each and every study all the more

understandable.

And when the health topic in question is cancer, with all its symbolic,

and indeed, physical and practical importance and impact, the need to work

towards better patient outcome becomes all the more pressing. In the West

the expansion of use of non-biomedical approaches has occurred largely in

the absence of a biomedical-type evidence base and in a socio-political con￾text of patchy and minimal regulation. In poorer countries, given the global

spread of biomedicine, other practices generally exist in a similar context.

There are certainly very real issues to address here, such as providing the

best available evidence about practices as a means of underpinning

informed choice by cancer patients.

However, having acknowledged this, it is crucial to appreciate that

there are dangers associated with the development of a narrow policy and

practice-driven research agenda. It is naïve to assume that the production

of evidence produces, in a simple, deterministic way, a given set of behav￾iours and decisions amongst practitioners or patients. This is something

that needs to be borne in mind across the board in an area as contentious

as non-biomedical practices. In the context of non-biomedical practices

for cancer, consideration of the multifaceted nature of evidence and legit￾imacy is absolutely imperative. Positions that have evolved in the absence

of an evidence base have been established on the basis of very powerful

influences: professional identity, differentiation and jurisdiction claims,

ideological affinities, divergent conceptualisations of the nature of disease

and so on.

Consequently, there is a need for a very different research agenda to be

pursued in tandem with the one rushing headlong towards evidence colla￾tion and yes/no policy judgements about the incorporation or isolation of

specific therapeutic practices. This is an agenda directed primarily at the

generation of an understanding of processes underpinning action. It is a

sociologically informed approach which takes its primary purpose to be

gaining insight into this social phenomenon as an end in itself. It is not that

such work may not, in time, inform health policy and practice; it is rather

that it need not be its primary and immediate goal. Indeed, the removal of

the ‘recommendations imperative’ will help to permit the production of

focused work which does not have to be spuriously stretched to reveal the

supposedly ‘generalisable’ on the basis of single pieces of work. It will allow

the gradual production of a more solid knowledge base which will make for

more effective policy making in the long term.

2 Introduction