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Rapid Responses: Rapid Responses published:
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Complementary and alternative medicine.
- Maurice Lessof (4 January 2001)
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Re: Complementary and alternative medicine.
- Christine Barry (12 January 2001)
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Ethnography and understanding heatlh care
- Catherine Pope (19 January 2001)
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DUH?
- NANCY K OCONNOR (8 December 2002)
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Maurice Lessof
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EDITOR - A House of Lords Committee suggests more research into complementary and alternative medicine. It is to be hoped that that research will devise controls for the personality of the operator and will assess what factors other than the actual therapeutic intervention are important in leading to patient satisfaction. It is clear that there are many factors other than medicines which can influence the effectiveness of therapeutic interventions (1). Homoeopathy provides a therapeutic process which lends itself to trials of this kind, provided that neither the patient nor the therapist - nor the pharmacist - can know which patients are receiving a definitive therapy and which are receiving a placebo. The use of multiple centres could also help to assess factors other than the prescription itself which determine patient satisfaction. One hypothesis which needs to be formally tested is that the time and personal attention given to a patient can influence the outcome significantly and that the particular disorders or complaints for which this is true can be subject to analysis. At a time when a general practitioner may have only a few minutes to listen, to examine, and to advise a patient, those who visit a homoeopathist or acupuncturist for the first time may be given an hour or more as a routine. A comparison between interview conditions and patient reactions in a range of general practice and alternative medicine establishments could be salutory. It is time to study the differences and, hopefully, to learn from that experience. Maurice Lessof
Reference 1. Savage, J. Ethnography and health care. Brit. med. J. 2000, 321, 1400-2. |
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Christine Barry, Research Fellow Brunel University
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I was interested to read Maurice Lessof's letter as I am currently engaged in research for my PhD thesis of exactly the nature he is calling for. I am doing an ethnographic study on 2 different therapies: homeopathy and Tai Chi. I am researching these therapies in various different settings including general practice and private practice. My aim is to gain an understanding of how therapies differ in different contexts. I am also interested in the changing experiences of patients over time with these therapies and the ways in which they move in and out of traditional and alternative healthcare. Even on the basis of early findings it seems clear that it is wrong to assume that by talking about homeopathy, for example, we are talking about one unified standard treatment. Therapies differ according to the therapists offering them and the institutional settings in which they are provided. This brings into question some of the assumptions surrounding the calls for evidence into the workings of such therapies, and in particular the priority given to the collecting of RCT data. (Assumptions for example that effectiveness can be measured over the short term; that alternatives can be seen as a standardised technique or technology that can be applied like a surgical procedure or drug; and that the location or context of treatment is immaterial.) I hope to be in a position to report the findings of this research at a future date but would be interested to hear from others engaged in similar research. |
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Catherine Pope, Lecturer in medical sociology Department of Social Medicine, University of Bristol
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Although some of our medically qualified colleagues have joked with us about the colonisation of the British Medical Journal by qualitative social science we were pleased to see further exposition of one of its principal methods - namely, ethnography - in your pages (1). Indeed, one of us was shown this article by a consultant anaesthetist colleague - currently one of the participants in an ethnographic study - evidence of the far reaching impact of the Education and Debate section of the journal! We are cited in the article as not having given ethnography sufficient emphasis in our writing on qualitative methods. We believe this is unfair. We devoted a whole paper to ethnography and observational methods in the series of papers on different qualitative methods which appeared in the BMJ in 1995 (2), and described the approach in the subsequent books based on that series (3,4). In discussing ethnography we stressed that it was more than the ad hoc mixing of methods, and attempted to indicate the principles and methodological perspectives behind the approach. We also alluded to the links between ethnography and anthropology. These connections are evident in the examples of anthropologically informed health research cited by Savage. Spradley suggests that ethnography is "a culture-studying-culture…It seeks to build a systematic understanding of all human cultures from the perspective of those who have learned them. Ethnography is based on the following assumption: knowledge of all cultures is valuable" (5). Understanding health care cultures seems to us to be particularly important given their impact on the ways that the rest of society makes sense of issues of 'health', 'illness', 'disease'. Such an understanding is also vital for managing and changing health systems. Catherine Pope,
Nicholas Mays,
1. Savage J. Ethnography and health care. BMJ 2000;321:1400-2. 2. Mays N, Pope C. Observational methods in health care settings. BMJ 1995;311:182-4 3. Mays N, Pope C. Qualitative research in health care. London: BMJ Books, 1996 4. Pope C, Mays N. Qualitative research in health care. (Second edition) London: BMJ Books, 1999 5. Spradley J. The ethnographic interview. New York: Holt, Rinehart and Winston, 1979:9 |
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NANCY K OCONNOR, PAWHUSKA INDIAN HEALTH CENTER PAWHUSKA OKLAHOMA USA 74056
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I have worked in cross cultural medicine all my life.I think that the point of the article is that one must consider the patient's ethnic background when one practices medicine. My main problem in this article is that it is written in academic jargon that is almost impossible for non academicians to understand. Competing interests: None declared |
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