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CAM therapies were used as treats and as alternative, complementary, and conventional treatments

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F L Bishop

Dr F L Bishop, University of Southampton, Southampton, UK; F.L.Bishop{at}


How do patients use, think about, and conceptualise complementary and alternative medicine (CAM) therapies?


Ethnographic study.


2 clinics in pharmacy stores in the UK.


Purposive sample of 46 people (91% women) who were attending clinics for osteopathy, reflexology, aromatherapy massage, homeopathy, and herbal medicine. 2 participants used 2 services and were interviewed twice.


Semistructured interviews were audiotaped and transcribed verbatim or recorded in notes. Data were analysed thematically.


Participants used CAM therapies as treats or treatment, although they sometimes talked about the same therapy in different ways. (1) Therapies as treats. Aromatherapy massage and reflexology were considered treats when viewed as enjoyable luxuries rather than for health needs: “I personally wouldn’t use aromatherapy as a health treatment; no, I use it for being pampered.” However, holistic outcomes such as relaxation may be considered important for health. One participant described her experience with reflexology: “I didn’t appreciate the treatment basis of it, not until I actually had it. I thought it would just be quite nice and relaxing. I was amazed at how much it helped my feet…” Participants were willing to pay for therapies considered as treats. (2) Therapies as treatment. Treatments were used to prevent, relieve, or cure specific health problems and were described in 3 subcategories. (a) Alternative treatments. All 5 CAM therapies were used as alternative treatments, generally for chronic conditions (eg, arthritis, headache) when conventional medicine was unsuccessful or unsuitable. They were viewed as personal and participatory, focusing on individuals rather than symptoms and with comparatively few side effects: “When you have general malaise, homeopathy is better, it is a general, holistic approach.” Most participants felt that alternative treatments should be publicly funded. (b) Complementary treatments. Aromatherapy massage, reflexology, and osteopathy were sometimes used to supplement other CAM therapies and conventional medicine for both physical and emotional problems. Complementary treatments were described as more individualised, enjoyable, holistic, and gentle than conventional treatments and were sometimes used for mild or poorly defined symptoms or for problems that other therapies could not address. One participant used aromatherapy massage when she “just noticed my shoulders getting all stiff” and chiropractic services “whenever I have problems that require my actual chiropractor.” Some participants felt that complementary treatments should be publicly funded; others did not. (c) Conventional treatments. Osteopathy was the only CAM therapy considered to be conventional and was viewed as a technical treatment consistent with conventional medicine: “I would see it actually as quite conventional in the way that physiotherapy is about concentrating on soft tissues and things like that: osteopathy is to do with the spine.” In contrast to other CAM therapies, osteopathy was expected to affect physical and functional outcomes more than general well-being. Some participants viewed osteopathy as appropriate for problems that did not need conventional medical treatment: “just needed to talk to someone about the pain in my back.” Most participants felt that osteopathy could be publicly funded, although some suggested that it was similar to paying for prescription glasses or drugs.


People used CAM therapies as treats and as alternative, complementary, and conventional treatments.


Bishop FL, Yardley L, Lewith GT. Treat or treatment: a qualitative study analyzing patients’ use of complementary and alternative medicine. Am J Public Health 2008;98:1700–5.


Individuals are increasingly using CAM, either for perceived health benefits or as supplements or alternatives to traditional treatments.1 The findings of Bishop et al add to evidence about clients’ selection and use of CAM. However, without rigorous research into the effectiveness of CAM, evidence to support its use is still limited.

The value of the study by Bishop et al is in showing that individuals use CAM to generally feel better or to improve health outcomes when traditional treatment does not achieve personal goals. Nurses are in a position to recommend the use of CAM to clients who might be frustrated with the lack of effect of traditional treatments or their side effects.2 However, nurses must be aware of the physiological status of clients and potential effects and interactions of CAM with other treatments, such as antidepressants. The easiest way to guard against these effects is to ask patients whether they are using CAM, either alone or in combination with conventional medical treatments. In addition, nurses should teach their clients about possible side effects and when it is appropriate to notify care providers about potential problems. For example, use of St John’s wort for depression can inhibit responses to chemotherapy in some cancer patients.3

Future research needs to address the behavioural and cognitive effects of CAM, whether clinical benefits exist, the influence of patient preference and cultural and ethnic context on choosing CAM, willingness to pay for treatment, and reasons for stopping CAM. Continued research will add to evidence that may support CAM interventions and perhaps bring these therapies into the mainstream for insurance reimbursement.

View Abstract


  • Source of funding: Economic and Social Research Council CASE Studentship in collaboration with Boots PLC.

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