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MEDICINE AND SOCIETY Table 3. Institution for licensing Institution n = 195 % Ministry of Health 117 60.0 Universities 69 35.3 Private institutions 4 2.0 Other 2 1.0 Combination 3 1.5 Table 4. CAM methods that will be suggested if licensed CAM Methods Number of doctors % Acupuncture 50 25.6 Herbal therapy 30 15.3 Ayurveda, 7 3.5 Diet supplementation 7 3.5 Massage 6 3.0 Aromatherapy 4 2.0 Electromagnetic fields 4 2.0 Reiki 2 1.0 Osteopathic, reflexology, apitherapy, hot spring water 1 0.5 Table 5. Comparison of attitudes and opinions of residents and Professors on CAM Residents Professors n % n % χ2 p-value Interested in CAM 22 17.7 15 21.4 0.191 > 0.05 Patients asked for information on CAM Have referred patients to CAM 54 43.5 28 41.8 0.007 > 0.05 25 20.2 10 14.7 0.549 > 0.05 CAM is useful 52 43.0 25 36.2 2.789 > 0.05 Used CAM for themselves Would suggest CAM for incurable diseases CAM methods should be licensed Would suggest CAM if licensed Medical students should be informed on CAM Medical students should be trained on CAM 20 16.4 14 20.0 0.188 > 0.05 65 54.2 34 49.3 0.247 > 0.05 76 65.5 39 59.1 0.496 > 0.05 47 46.1 29 48.3 0.013 > 0.05 99 82.5 51 72.9 1.927 > 0.05 64 54.2 28 41.8 2.174 > 0.05 methods must be licensed in Turkey. The most common preferred institution for licensing CAM methods was the Ministry of Health (Table 3). If CAM methods were licensed, 38.9% of doctors stated that they would suggest any one of them (Table 4). CAM Training There were 151 doctors (77%) who thought that information about CAM should be given, and 93 (48%) thought that CAM should be taught in medical schools. There were no statistically significant differences in the evaluation of the residents and the Professors’ attitudes and opinions on CAM (p>0.05) (Table V). DISCUSSION Statement of principal findings Acupuncture, herbal therapy and massage were the most frequently known CAM methods in our study group. Although only 18.9% of doctors were interested in CAM, 77.4% thought that information about CAM should be given, and 47.6% thought that CAM should be taught in medical schools. Strengths and limitations of the study The present investigation is the first study evaluating the opinions and attitudes of OWM academic doctors on CAM. This paper provides a basic evaluation of CAM by OWM academic doctors, and there is no previous data on this subject. In addition, the response rate of the study group was very high. On the other hand, this study has three limitations. First, although the study may represent our medical school, it might not be representative for all of the medical schools in Turkey. Second, the recent performance of an Oriental Medical Team could have a positive influence on the opinions as well. Finally, the questionnaire was not validated. CAM use in other countries There are a number of CAM methods, which are being traditionally used in Turkey (17). Yet, there are no lectures or courses on CAM in medical schools. It has been stated that the CAM is now taught in 60% of medical schools in the United States of America. Indeed, many hospitals have created or are in the process of creating programs that incorporate these disciplines. Whether physicians prescribe CAM or not, they need to have a basic understanding and knowledge regarding its possible benefits and limitations (18). In our study group, giving information and training on CAM was accepted with a high percentage. Strength and weakness in relation to other studies Witkowski and Parish have stated that referral of patients 21 MEJFM - Volume 3 Issue 5 - November 2005
MEDICINE AND SOCIETY to practitioners of CAM is often avoided because of fear that a poor outcome might result in legal action (19). Berman et al. have reported that at least 10% of the physicians receive one or more patient requests for referral for CAM therapies (20). In our study, 17.9% of doctors have suggested CAM therapies to their patients, upon the requests of the patients. The referrals are not directly made by the physicians. This is probably due to the hesitation of referring patients to some kind of practices that they have very limited information. Jump et al. have reported that 34.8% of the physicians had personally utilised at least one of the CAM therapies (21). In our study, there is less utilisation of CAM therapies by OWM doctors (17.4%). This low rate of utilisation could be an indicator of the prejudice against CAM therapies. Yamashita et al. stated that patients who have used CAM in the last year have evaluated the effectiveness as follows; ‘effective’ 58.4%, ‘not effective’ 10%, and ‘do not know’ 31.6% (3). In our study, less doctors (39%) stated that CAM was useful. Implications The kind of CAM therapies which are licensed vary from country to country. There is much researches being carried out on CAM, where CAM therapies are compared to orthodox western medicine methods. The use of CAM is very common especially when OWM is not very effective. Therefore, the Ministry of Health or any institution that is assigned could prepare guidelines containing the spectrum of use of CAM, and the scientific data that is available about CAM therapies. It might then be easier for OWM doctors to decide whether they could suggest CAM methods or not, and it would be possible to give the most convenient information about indications and contraindications of CAM. Because of the widespread use of CAM by patients and the growing scientific evidence that certain CAM therapies are more effective than orthodox alternatives, it has been stated that CAM education must be integrated into medical education in allopathic and osteopathic schools in the near future (22). There is an increase in the use of CAM methods in Turkey as well. CONCLUSION medical doctors should have a basic knowledge on the indications of CAM methods, and be able to consult their patients when they ask about them without prejudice. It seems that inserting lectures on CAM in the medical curriculum could be a necessity in the near future. ACKNOWLEDGEMENTS her comments on the manuscript, and Dr. Ali Zaimoglu from Family Medicine Department of Erciyes University Medical Faculty for his assistance in administering the questionnaire. REFERENCES 1. www.nih.gov, 25 October 2002. 2. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998; 280: 1569-75. 3. Yamashita H, Tsukayama H, Sugishita C. Popularity of complementary and alternative medicine in Japan: A telephone survey. Compl Ther in Med 2002; 10: 84-93 4. Steyer TE. Complementary and alternative medicine: a premier. Fam Pract Manag 2001; 8: 37-42. 5. NIH Consensus Development Panel on Acupuncture. JAMA 1998; 280: 1518-24. 6. Whitmarsh TE. Homeopathy in multiple sclerosis. Complement Ther in Nurs Midwifery 2003; 9: 5-9. 7. Zuckerman GB, Bielory L. Complementary and alternative medicine herbal therapies for atopic disorders. Am J Med 2002; 113: 47-51. 8. Kang HJ, Ansbacher R, Hammoud MM. Use of alternative and complementary medicine in menopause. Int J Gynaecol Obstet 2002; 79: 195-207. 9. Strader DB, Bacon BR, Karen L. Use of complementary and alternative medicine in patients with liver disease. Am J Gastroenterol 2002; 97(9): 2391-97. 10. Peebles CT, McAuley JW, Roach J, Moore JL, Reeves AL. Alternative medicine use by patients with epilepsy. Epilepsy Behav 2000; 1: 74-77. 11. Moyad MA. Complementary/alternative therapies for reducing hot flashes in prostate cancer patients: reevaluating the existing indirect data from studies of breast cancer and postmenopausal women. Urology 2002; 59(4): 20-33. 12. Richardson MA. Complementary and alternative therapy use in gynecologic oncology: implications for clinical practice. Gynecol Oncol 2002; 84: 360-62. 13. Vickers AJ, Cassileth BR. Unconventional therapies for cancer and cancer-related symptoms. The Lancet Oncol 2001; 2: 226- 32. 14. Metz JM, Devine A, DeNittis. Internet utilization by radiation oncology patients. Int J Radiat Oncol 2001; 51: 100-101. 15. Valli G, Giardina EV. Benefits, adverse effects and drug interactions of herbal therapies with cardiovascular effects. J Am Coll Cardiol 2002; 39: 1083-95. 16. Heuschkel R, Afzal N, Wuerth A, Zurakowski D, Leichtner A, Kemper K et al. Complementary medicine use in children and young adults with inflammatory bowel disease. Am J Gastroenterol 2002; 97: 382-88. 17. Ceylan S, Hamzaoglu O, Komurcu S, Beyan C, Yalcin A. Survey of the use of complementary and alternative medicine among Turkish cancer patients. Compl Ther in Med 2002; 10: 94-99. 18. Fontanarosa PB, Lundberg GD. Alternative medicine meets science. JAMA 1998; 280: 1618-19. 19. Witkowski JA, Parish LC. The Other Medicine: Complementary and Alternative-Why, Why Not Clin Dermat 2002; 20: 456- 460. 20. Berman BM, Bausel B, Hartnol SM, Beckner M, Bareta J. Compliance with requests for complementary-alternative medicine referrals: a survey of primary care physicians. Integr Med 1999; 2: 11-17. 21. Jump J, Yarbrough L, Kilpatrick S, Cable T. Physicians’ attitudes toward complementary and alternative medicine. Integr Med 1998; 4: 149-53. 22. www.amsa.org. 21 October 2004. The authors would like to thank Prof. Dr. Fevziye Cetinkaya from Public Health Department of Erciyes University Medical Faculty for MEJFM - Volume 3 Issue 5 - November 2005 22
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