The Evaluation of CAM in routine health practice

Heather Godfrey P.G.C.E., B.Sc. (Joint Hons), F.I.F.A., M.F.H.T.


This discussion is written from the perspective of my professional experience as a complementary therapy practitioner (more specifically, Aromatherapist and Professional Supervisor) and lecturer, and  generally describes my understanding of the issues involved.


Complementary Medicine is a broad term that umbrellas a spectrum of potential healing modalities, ranging from the ethereal realms of Reiki and distant ‘healing’ (Dossey, 1999; Angelo, 1998; Proto, 1998; Hay, 1987), to the physical manipulation of chiropractic and osteopathy and the practical intervention of diet control and naturopathy (MacWhirter et al, 1996: Stanway, 1995). Many of these therapies are practiced as integrated specialities that may be overlaid at one and the same time. For example, an acupuncturist, depending on their underpinning premise, may use oral herbal remedies as well as ‘needling’ specific meridian points as a collective measure to achieve the rebalance of chi (energy flow) (Murray & Pizzorno, 1999; Stanway, 1996; Mann, 1993). A client receiving allopathic treatment from their GP for, say, mild depression and/or anxiety, may be advised to also to receive aromatherapy and/or attend mindfulness or yoga classes to aid their relaxation, and/or counselling sessions (Sorensen, 2000; Wildwood, 1997). Or, an individual may elect to use, of their own volition, say, aromatherapy massage (Tisserand, 1997; Buchbauer et al 1993; Miyake et al dnf), to deal with their insomnia and/or headaches and/or eczema, synchronously with dietary intervention following an allergy/food intolerance test (Murray & Pizzorno, 1999; Stanway, 1997; McWhirter et al 1996). Bach Flower Remedies, like homeopathic remedies, apparently influence subtle mental and emotional energetic resonance within the body affecting mood and emotional attitude, and may safely be used by virtually anyone in isolation or concurrently with allopathic medication and/or other complementary therapies (Howard, 1997). And so on. Others may select one method according to their condition/personality, such as homeopathy, acupuncture or chiropractic to work on the fundamental precursor, as well as the symptoms, of their condition (Gerber, 2001; Lockie, 1998). The author also observes from her own practice that complementary therapies are frequently utilised as a preventative measure, to support and maintain wellness, and to ‘manage’ the effects of stress.

“Vibrational healing methods represent new ways of dealing with illness. Practitioners of subtle-energy medicine attempt to correct dysfunction in the human organism by manipulating invisible yet integral levels of human structure and function. Healing at the level of human subtle-energy anatomy is predicated upon New Physics understanding that all matter is, in fact, a manifestation of energy.”   Gerber (2001)

This acceptance of subtle (as well as obvious) energy existence and resonance is the underpinning premise of most complementary and alternative medicine modalities (CAM), or integrated therapies. Unfortunately, it is the apparent vagueness of this concept (and underpinning ‘energetic’ focus for some CAM modalities, e.g. acupuncture, homeopathy, healing) that allopathic practitioners appear to have difficulty accepting and which is, equally, conversely exploited by some who imply that they posses an (unprovable) esoteric connection to this ethereal element, purporting their experiential superiority.

In spite of this, CAM has become increasingly popular. Explanation for this phenomenon is levelled at public disenchantment with allopathic drugs, their side effects and toxicity, especially when used for long-term chronic conditions. However, this shift towards public interest might equally be explained as a spontaneous enlightened perception, that acting as a precursor, or catalyst, has naturally directed attraction towards modalities complementary to the remit of integrated holism, which embraces the spirituality of our ‘being’ with equal significance: that part of us that emanates (assuming the presence of a vibrational aura or energy field) beyond, and innately within, our physical body and mind is also an integral part of our wholeness (and seamless connectedness with our internal and external environment), therefore wellness. (Reports of near-death-experiences and inclination towards public acceptance of meditation and spirituality etc, might offer some supporting evidence, or explanation, of this shift of perspective and acceptance of an ‘integrated whole’).

Some sceptics argued that CAM panders to an individuals need for attention, therefore, self indulgence, attracts those of a sensitive nature, especially ‘hypochondriacs’, the gullible and those desperate to find a ‘miraculous cure’ where conventional medicine has reached its limit.  The word ‘placebo’ is often cited in this context (see also, for example, Mackareth / Wilkinson debate ‘Benefits of Reflexology -v- Placebo’, 5th Clinical Reflexology Conference 2002). Observing her own (CAM) practice, the author notes that the majority of her clients are middle-class, mostly mature females, some males, who generally have access to a ‘disposable income’, therefore, are able to exercise a certain amount of freedom of choice; in this case, of their health and wellbeing. This author also notes, from her own experience. that her clients are generally sensible, intelligent professionals; working, for example, in health, education, care and management (see appendix). As a private, independent practitioner (sole trader), in order to cover costs, a minimal charge has to be applied, which consequently limits clientele to those who can afford to buy their treatments. This phenomenon is true for the majority of complementary practitioners. Although some practitioners offer concessionary rates, potential clients on low wages or who are in receipt of state pensions or benefits, tend to have a negligible disposable income, therefore, even cutting the cost of a treatment by half, still renders the therapy an unaffordable luxury to many, inhibiting access.

Even so, while the above disparities and limitations exist, people (from a range of socio-economic backgrounds) appear increasingly inclined to take personal responsibility for their own health and well being (and are also proactively encouraged by the governments ‘Healthier Nation’ campaign: Government Green Paper, Our Healthier Nation 1998; 2.3, 3.29-31, 3.9), exploring possibilities such as lifestyle management, diet and relaxation techniques. Self-help courses available, for example, range from crystal healing to yoga and nutrition, meditation and Buddhist Mindfulness philosophy and practice. Set within this trend, where there are extremes from nutritional advice to spiritual healing, CAM modalities might be seen as a fad by some mainstream health professional’s, therefore, it is convenient to perpetuate the notion of ‘pampering’. Unfortunately, this attitude also detracts attention from the potential efficacy of CAM, which currently receives insufficient funding support for research and development, in preference for the scientifically proven evidence of ‘real medicine’ (TES, 2008). However, CAM modalities appear accepted, or ‘allowed’, within ‘end of the line’ scenarios, where the focus is on the support and management of comfort, quality of life and emotional acceptance rather than on retrieval, cure or direct intervention: e.g. within palliative care. Indeed, it is true that CAM has an invaluable role within this sector of Health Care whatever the perceived premise might be (Mackareth, 2002). However, returning to the issue of cost and funding, in this context, these treatments are often delivered ‘free of charge’ or for nominal, token, fees, on a voluntary basis.

While the debates ensue, there is another concern – that is, the danger incurred from exploited ignorance and/or misguided naivety; which is a critical argument often presented by the sceptics (TES, 2008). It is true that, embracing the ethereal, CAM modalities are entangled with in the romantic notions of New Ageism, which in itself has cynically become a media driven commercial opportunity to be exploited for all its material worth. Although there seems a genuine and sincere trend towards holism and the spiritual dynamics involved in sustaining wellness and healing (Gerber, 2001), this is often obscured by the shroud of hype and a leaning towards Mystic-Meg-type freakishness. Unfortunately, the consequential ironical trivialisation also serves to perpetuate dangerous misperceptions, which may seriously skew important decisions when choosing health care modalities (Vickers, 1998). Although books and weekend courses abound in relation to an ever-increasing array of therapies and advices, this does not necessarily lead to well-informed enlightenment. Some contend that emotive, romantic claims regarding the therapeutic value or processes of certain therapies are made without real substantiation, are often anecdotal accounts and may, therefore, be misleading (TES, 2008; Duerden, 2004; Watts, 2001; Vickers, 1998). The other concern is that, in exploiting the commercial viability of the surge in interest in CAM, appropriate professional training is compromised, with over emphasis for ‘on-line’ learning (in some instances without any contact teaching or training) and short courses that allow rapid cost effective turn-around for the provider but which do not support depth of study or sufficient experiential guided training and learning.


Reflection on the above indicates a number of reasons supporting of the need for high quality outcome measures and rigorous research to assess the value and viability of interventions and treatment packages in CAM (Long, 2002). Research might provide the evidence necessary to placate scepticism, eradicate naive ignorance and correctly uphold respected use and integration of CAM modalities, and philosophy, and appropriate training, within a universally accessible health care system.

Research might be aimed broadly at:

  1. Identification of limitations
  2. Identification of strengths
  3. Validation of efficacy measured against a holistic outcome
  4. Identification of the ‘right fit’: which condition best suits which modality?

However, reflecting on her own practice, the author appreciates that some compromise is necessary – it is not possible to completely overlay the principles and philosophy of one approach on top of the other as integral parts of a whole without acknowledgement of validity. Acceptance and integration of attitudes and methods as diverse as those represented by reductionism and holism will require a shift of boundaries and mutually, amicably agreed consensus in terms of the achievement and validity of ultimate goals and outcomes; a universal consensus must be health and wellness maintenance and a personal sense of wellbeing. Eliciting evidence embraced within the holistic philosophy of CAM, however, might prove challenging to a reductionist mind set, as much as a reductionist stance is often perceived as inadequate to a CAM mindset.

Equally, as pointed out previously, users of CAM often engage various methods of treatment concurrently, rendering the outcome of a single treatment modality an unreliable indication of singular efficacy. Quantifiable data may be retrieved from consultation details, but CAM tends to treat each client as an individual, with longer client/therapist interaction time scales. Even if clients present with similar symptoms, methods of treatment are tailored and vary according to individual needs. CAM also holds as valid client’s perceptions of their treatment, their personal sense of wellness, and their personal response to their dysfunction or illness, seeing such attitudes as integral aspects of the underlying cause and/or ability to manage their recovery or energetic rebalance. What may be accredited a successful outcome by one mode of thinking might be measured as a failure or a limited success by another.

For example, eliciting the quantifiable details from consultation records, the author is able to determine the gender, age and socio economic status of her clients, their common underlying presenting conditions, general wellness status and identification of their reasons for coming for treatment. However, subsequent to consultation, each client has a treatment plan specifically orientated to their individual requirement, and consequently, each client is given a different blend of essential oils, which they participate in selecting on an acceptance/rejection basis. In terms of measurement of outcomes, the variables are endless in this type of scenario; success or failure tends to be judged subjectively. But does this invalidate the outcome? Clients usually come of their own volition, knowing what they expect, and are informed of the limitations before treatments commence, therefore, the rate of success is highly increased (in aromatherapy) as their expectations are already geared up for it. But does this preconception bias the successfulness of treatment? Is it not merely positive collaboration between the therapist and client to achieve a desired outcome? Equally significant, clients choose this therapy as a preventative measure, for its potential emotional balancing and immune stimulating qualities (see appendix for example of client’s comments). Consequently, this author believes, there needs to be a system of measurement which embraces what some might regard as the placebo effect, but others regard as an inevitable mechanistic result triggered by energetic manipulation, sometimes produced at a very subtle level, whether manifesting on a mental/emotional level, or a physical level, but which ultimately leads to health improvement or an ability to positively manage the effects and consequences of a chronic condition, or offer complementary support (Mackareth, 2002; Gerber, 2001)


  • CAM treatments may be applied singularly or applied (if appropriate) concurrently with allopathic treatments or other CAM methods.
  • CAM treatments may be used as a preventative therapy.
  • CAM treatments may be used to support wellness and a sense of wellbeing.
  • The premise of most CAM practices is underpinned by the acceptance of the principle that energy is an intrinsic part of all matter, therefore may be influenced on subtle as well as gross levels.
  • Allopathic practitioners do not necessarily accept the ethereal element implicated in energetic medicine.
  • The term placebo is often ascribed to CAM outcomes.
  • Trivialising CAM as a fad distracts attention from its potential efficacy.
  • New Ageism is entangled with some romantic notions and misperceptions of CAM that may serve to dangerously misguide choice regarding health care.
  • Reliable and fair research may placate ignorant and misguided misperceptions and validate the role CAM modalities may play in health and wellbeing, identifying and verifying appropriateness.
  • The reductionist view of allopathic medicine and the holistic, energetic view of CAM may not completely fit into each other’s ideological framework.
  • CAM practice and philosophy presents many variables and unquantifiable results that do not necessarily negate the validity of an outcome.

Research Methods



  • Independent research
  • Interviewed by researcher
  • Client’s views of process and outcome
  • Practitioner’s views of process and outcomes

Process outcome/bias

  • Qualitative
  • Some quantitative
  • Single case studies
  • Time consuming

Practitioner based


  • Researcher elicits information from clients and therapist regarding outcomes and procedures

Process outcome/bias

  • Quantitative
  • Qualitative
  • Researchers interpretation
  • Inference of questioning
  • Time consuming

Practitioner as researcher

  • Practitioner from single discipline
  • Practitioners from various disciplines – Independent Researcher to collate collective outcomes

Process outcome/bias

  • Quantitative
  • Qualitative
  • Case Studies
  • Anecdotal
  • Risk of bias

Independent researcher

  • Both potential for non-bias and bias outcome depending on motivation of researcher(s) / funding body (Duerden, 2003; Jenkins et al, 1998; Clegg, 1997)


As a practicing CAM therapist, it is difficult for the author not to display bias. If legitimate integration of CAM modalities within a universal health care system is to be achieved then all possible views and angles must be explored and ultimately synthesised into a realistic, workable and universally accessible health care infrastructure, perhaps with equal emphasis on the validity of ‘wellness’ (and ‘feeling well’) and preventative measures of maintaining health and wellness as on ‘cure’ and intervention. Success of treatment should be measured within a broader context. All treatments should embrace and be measured against a holistic perspective.


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