There is an increasing use of complementary therapies and complementary and alternative medicine (CAM) nowadays, and its use has steadily increased over the last ten to fifteen years in United Kingdom (UK) (Ernst and White 2000; 35). A more specifically data obtained within the UK has shown that there is a rapid increase in the use of complementary therapies and CAM with an estimated 15 million users nationwide (Andrew 2003; 337; House of Lords Select Committee 2000). It is estimated that this sector in the UK is rapidly expanding 1.6 billion pounds per annum industry, with around 60,000 practitioners, over 170 professional associations and around 5 million patients (Budd and Mills, 2000). The use of complementary therapies and CAM widely based in specific disease entities such as cancer, cystic fibrosis and asthma, in clinical settings such as obstetrical care and paediatric oncology and by international geographic locations (Yeh et al. 2000; 56).
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The concept of holism, which is an appreciation of the inter-relationship between body, mind and spirit, and recognition of the socio-cultural factors are fundamental to complementary therapies and medicine (Tiran 2006; 341). A number of definitions for complementary therapies and medicine have been proposed by different researchers. One of the definitions given is a broad domain of healing resource that encompasses health systems, modalities and practices and their accompany theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period (Snyder and Lindquist 2001; 6). According to Uzun and Tan (2004; 239), complementary therapy is defined as therapy used in conjunction with conventional therapy. Existing studies on complementary therapies and medicine focus mainly on two things. One is the focus on the specific mechanisms of actions such as particular herbal remedies, homeopathic medicines and essential oils, often with regard to assessing their safety and efficacy; the other one is focusing on specific therapies and medicine modalities such as herbal medicine, homeopathy and aromatherapy, as if they are stable or not, uniform and constant forms of health care practice (Williams 2000; 163).
CURRENT ISSUES IN THE COMPLEMENTARY THERAPY AND CAM
There is a steady increase in the use of complementary therapies and CAM by the general public in the last two decades (Ernst and White 2000: 32). This is parallel to their increased used in health care settings, including the UK NHS (Richardson 2001). In 1998, only 10% from 22 million visits to complementary therapy practitioners in England were though NHS contacts, highlighting a clear need for the provision of equitable and appropriate access to these services (Thomas et al. 2001; 8).
Cancer patients are amongst the main users of complementary therapies in the UK, with up to a third of patients having received one or more complements therapies (Wilkinson 2002; 68). Due to the increase in demand, the UK government has commissioned a House of Lords Select Committee Report on complementary therapies (House of Lords Select Committee 2000). In order to have a clearer and better understanding of the complementary therapies, the report recognised the urgent need for the generation of high quality research evidence to support the complementary therapy and CAM use (House of Lords Select Committee 2000).
The Prince of Wales Foundation for Integrated Health (FIH) has also recognised the need to combine the best of complementary therapy with conventional health care (Robert et al. 2005; 116). In order to deliver a good quality of complementary therapy, FIH has produced national guidelines for their use within the field of supportive and palliate care (FIH 2003). For application by the managers and commissioners of complementary therapy services within the field, the guidelines is used to inform service development and management, and practice development (Roberts et al. 2005; 116).
REGULATIONS AND PROFESSIONAL BODIES OF COMPLEMENTARY THERAPY
The number of people using complementary therapies and CAM in the K continues to grow (Thomas et al. 2001; 2). Unfortunately, a high proportion of complementary therapies and CAM practitioners in the UK are unregulated and due to the increased in demand, there is a need of certain mechanisms to protect the public against skilled practitioners (Mills 2001; 158).
At present, a General Practitioner (GP) can only delegate treatment to complementary therapists, and the GP are responsible for the treatment provided and their effects (Walker and Budd 2002; 8). Two therapies which have achieved statutory self-regulation are osteopathy and chiropractors (Walker and Budd 2002: 8).
Regulations and Professional Bodies of Aromatherapy
Aromatherapy was introduced in the UK during 1960s and is one of the fastest growing complementary therapies with number of registered therapists increase from 2500 to 6000 between 1991 and 2000 (Walkman and Budd 2002: 13).
The Aromatherapy Organisation Council (AOC) is an umbrella body represented by members from 13 established professional associations and claims to be the governing body for the aromatherapy profession in UK (AOC 2000). The AOC (2000) have welcomed and supported the findings of the select committee report, even though there is no statement stressing on the need for statutory regulation for aromatherapy but AOC will continue with their process under the Health Act 1999 towards statutory self-regulation to ensure public safety.
Regulations and Professional Bodies of Osteopaths and Chiropractors
The osteopathic and chiropractic professions have struggled for many years to be recognised as part of mainstream medicine (Walker and Budd 2002; 12). In May 2000, the Osteopathic Act was set up and enforced, making it a criminal offence for those who are not on the General Osteopathic Council register to call them osteopathic (GOsC 1999).
On the other hand, Chiropractors Act was enforced in June 2001 and the conditions are the same as Osteopathic Act whereby those failing to join the General Chiropractic Council statutory register are considered as a criminal offense (Copland-Griffths 1999: 5).
Regulations and Professional Bodies of Herbalists
In 1993, the European Herbal Practitioners Association (EHPA) was formed and the Medicine Control Agency (MCA) and Department of Health have been working with EHPA on legislation aimed at protecting public safety and the rights of herbalists to prescribe herbs (Walker and Budd 2002: 12).
Regulations and Professional Bodies of Acupuncturists
The main regulatory body of acupuncturists in the UK is the British Acupuncture Council (BAcC) with 2200 members and was formed in 1995 (Walker and Budd 2002: 12). British Acupuncture Accreditation Board (BAAB) was also being set up and well-established for educational standard(Walker and Budd 2002: 12), and Regulation Action Group was set up too to carry out an extension consultation exercise which include regional group meetings and discussing options for regulations (BAcC 1999).
WHO USES COMPLEMENTARY THERAPY AND CAM?
According to the study carried out by Fox et al. (2010; 95), the prevalence rate for visits to complementary therapies practitioners in UK increased from 20% in 1998 to 27% in 2002. The practitioners most frequently visited in UK (reflexology, aromatherapy, acupuncture, chiropractic and so forth) are similar to other findings done by other researchers (MacLennan et al. 2002; 170). UK complementary therapies and CAM users are more likely to be well educated, affluent, middle-aged and employed especially those suffering from panic, anxiety and depression, and the findings are similar to international findings (Fox et al. 2010; 95). According to Risberg et al. (2004; 532), females showed more positive view towards complementary therapies and CAM than males.
Consistent with the above findings of the complementary therapy and CAM, studies have found that a range of non-life threatening but long-term chronic conditions to be the most (Willison and Andrews 2004; 83). Wellman et al. (2001; 18) found that older CAM users typically presented with chronic non-life threatening conditions such as musculoskeletal problems (50%) and emotional problems (10%). Andrews (2002; 360) found that 59% of complementary therapies and CAM users were encountering musculoskeletal problem (including 11.3% for arthritis and 20% for chronic back pain) and 11% for emotional and mental health problems. On the other hand, Fautrel et al. (2002; 2438) were more specific and found use of complementary therapy and CAM on thyroid disease and arthritis. In the research carried out by Williamson et al. (2003; 25), complementary therapy and CAM users were found to use the treatments for moderate pain relief (54.8%) and in terms of general well-being, health fitness improvement purpose (45.2%) and life quality improvement (40.5%).
FACTORS OF USING COMPLEMENTARY THERAPYAND CAM
In the study carried out by Wellman et al. (2001), he found out that consumerâ€™s pathway to use complementary therapy had consulted a physician or specialist but subsequently turned to complementary therapy and CAM because the physician or specialist failed to help them. Similarly, Andrews (2002; 361) found dissatisfaction with orthodox medicine lead them opt for complementary therapies and CAM. On the other study, both Wellman et al. (2001) and Andrews (2002; 361) concluded that advice from families members and friends influence both their choice to use CAM and which complementary therapy to select.
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A study conducted by Lewith et al. (2002; 104) has found that 32% of patients indicated they were currently receiving some form of complementary therapies, suggesting a trend is increasing in usage of complementary therapies over recent years. An earlier survey showed that 70% of National Health Service (NHS) Hospitals in England and Wales were offering one or more complementary therapies in the management of cancer care, with relaxation and aromatherapy being the most commonly available (Scott et al. 2005; 132).
Aromatherapy involves the therapeutic use of essential plant oils and has existed for 5000 years (Barclay et al. 2006; 141). It is increasing being used in the cancer care and dermatology settings (Fellowes et al. 2004).
Ways of Application
Essential oils are applied to the skin by various method, such as ingested or inhaled, and they bring no harm unless it is used incorrectly (Steflitsch and Steflitsch 2008; 76). Aromatherapy massage is the most widely used complementary therapy in nursing practice (Macmillan Cancer Relief 2002).
Who Uses It and Effects of Aromatherapy
According to Kimber (2002; 22), aromatherapy massage helps to improve self-image during pregnancy and may aid acceptance of physical changes in mother. The relaxation effects generated also extend to the foetus (Diego et al. 2002; 404). Besides that, massage is found to be able to stimulate production of endorphins and decrease blood pressure, through its effect on the parasympathetic nervous system (Casar 2001; 11). Aromatherapy massage facilitates the absorptions of essential oils via the skin (Buckley 2002; 277), and aromatherapy is one of the primary therapy used to treat anxiety (Long et al. 2001; 182).
In addition, essential oils are able to stimulate areas associated with smell in the limbic system of the brain and evidence that odours affect emotions and cognition (Alexander 2002; 54). Study conducted by (Steflitsch and Steflitsch 2008; 78) found that cancer patients receiving aromatherapy significantly improved quality of life and anxiety. According to Burns (2000; 84), an analysis of 8058 mothers who had received aromatherapy between 1989 and 1990 indicated that more than 50% of mothers found it helpful to release stress and relaxing.
Ballard et al. (2002; 556) conducted a double-blind study involving dementia patients with clinically significant agitation treated with Melissa oil from eight NHS nursing homes in UK and concluded that those treated with Melissa group showed a higher significant improvement in reducing aggression than the control group by the fourth week. Besides that, aromatherapy is believed to have beneficial effect in reducing back pain and periarticular pain and Dolara et al. (2000: 357) had proven that aromatherapy exerts a strong anaesthetic effect that able to block the sodium current and thus reduce pain. Besides that, Friedman et al. (2002; 1555) concluded that essential oils have specific antibiotics and antifungal properties, and have significant beneficial effect on the urinary tract infection.
BENEFITS AND OUTCOMES OF OTHER COMPLEMENTARY THERAPIES AND CAM
The role of complementary therapy and CAM is mainly focusing on imposing the patientâ€™s quality of life (Roberts et al. 2005; 119) which includes psychological, social, spiritual and practical (Kaasa 2000). In one cancer clinical survey of trial patients carried out by Sparbe et al. (2000; 627), respondents informed that complementary therapies helped to enhance patientsâ€™ quality of life by improving the capability of coping with stress and decreasing the discomfort of treatments. Boon et al. (2000; 2518) found that most of the breast cancer patients use complementary therapy to boost their immune systems. Some patients claimed that complementary therapy is playing an essential role in ameliorating and curing conditions including chronic problems (Luff and Thomas 2000; 256).
DRAWBACK IN THE COMPLEMENTARY THERAPIES AND CAM
Complementary therapies and CAM are progressively being integrated into conventional health care through their provision in the UK NHS and independent hospice movement (Macmillan Cancer Relief 2002). However, there has been little effective evidence to support these developments in UK and this suggests that most complementary therapies and CAM services development over the last 10 years were in creeping developments (Roberts et al. 2005; 117). In conjunction to this matter, there is a need for the initiation of more scientific research to investigate individual complementary therapy and CAM (Wilkinson 2002; 468). In addition, there is also a need to evaluate the effectiveness of the provision of complementary therapy and CAM as an integrated NHS service, across acute and primary care (Roberts et al. 2005; 117).
Many researches have been using randomised control trials in the study of the effectiveness of the individual complementary therapy and CAM interventions (House of Lords Select Committee 2000). However, such approach does not allow for a more complex multi-dimensional analysis of the effectiveness of service provision as a whole (Roberts et al. 2005; 118). Besides that, it is also difficult to determine the effect of short-term versus long-term use of complementary and CAM therapies (Jones et al. 2010; 151).
Currently there are still a limited numbers of real complementary therapy and CAM professionals (Furnhan 2002; 44). Health professionals such as doctors and nurses also highlighted their lack of knowledge on complementary therapy and CAM consumption (Salmenpera et al. 2003; 360). Physicians have been reported to be indifferent or opposed to complementary therapy and CAM uses (Risberg et al. 2004; 530). This may be due to lack of understanding by clinicians, through a lack of appropriate education and doubts about the benefits offered by complementary therapy (Corbin-Winslow and Shapiro 2002; 1178). The issue of physicianâ€™s emphasis on scientific evidence and their lack of understanding may contribute to the lack of effective explanation to the patients of the purpose of complementary therapy interventions (Tasaki et al. 2002; 217).
Aromatherapy has shown in various studies to overcome anxiety and panic, back pain, fungal and virus infection, dementia and pregnancy stress. In conjunction with this, the future clinical application of aromatherapy will probably have a place to be integrated in clinical medicine, especially in the hospitals, clinics and health care centres. However, more future research needs to be carried out in order to identify the beneficial aspect and it effects of different essential oils. This is because essential oils exhibit pharmacological, antimicrobial, physiological and psychological properties. It is a waste if there is no much research to explore the vast beneficial potentials hidden in the essential oils in order to determine its clinical potential in healing.
The finding indicating physicians expressed more negative attitude towards complementary therapy and CAM compared to other health professionals such as doctors and nurses in UK is essential. This is because from this moment a better training and attitude can be provided to the physicians and other health care professionals so that they can have a better understanding on the importance and potentials of these therapies and medicine. In fact, it might also improve the understanding and cooperation between the health care professionals and the practitioners so that the practitioners can get a better confident, service and treatment from the health care professionals and physicians in the future.
Besides that, quantitative and qualitative research on short-term and long-term effects of the therapies and CAM must be emphasised more in order to obtain more accurate and precise data proving the reliability, consistency and accuracy of the research. This is also to allow the public to have a wider choice in selecting the best treatment for their health.
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