question: which factors influence the use of complementary and alternative medicine?

alternative-medicine-300x200

In the latter part of the 20th century, the validity of social sciences became widely accepted. Some branches of social science researchers researched and documented the role of complementary and alternative medicine [CAM] in society. Their actions helped to address the issues of missing data and evidence to support medical claims, which contributed to a rise in their use. Dr. Ernst, the first professor of CAM credits peoples’ belief that CAM is a safer, natural alternative to traditional medicine and the notion that the constraints of regulations in the allopathic medical field prevent practitioners from treating the whole body and encouraging an overall sense of well-being to an increase in use.

Since that time, there have been a number of studies aimed at understanding why people reject or embrace CAM. At the most basic level, many are looking for a treatment that encompasses the whole body, allows them to feel and look good, and produces a complete idea of self to negotiate their identity in society. It has also been suggested that the conceptualization of health is changing, leading to a shift in preferred treatment methods. For example, patients are seeking out ways to become empowered participants in their health, rather than the passive devalued products of the scientific medical community. As people reject the traditional “sick role”, they feel they are establishing themselves as individuals and “voting with their feet” when they seek out alternative forms of treatment. The sick role is:

  • The medical view of illness as deviance from the biological norm of health
  • The diagnosis of disease results from a correlation of observable symptoms with knowledge about the physiological functioning of the human being
  • Involves a social judgment about what is right and proper behavior

Disposable income appears to be one of the most influential factors in the United States, mostly because alternative medicine is not generally covered by health insurance. Many also view CAM as a luxury, rather than a part of their actual healthcare. Individuals in higher socioeconomic brackets are also used to having more resources and therefore control over their lives, enabling them to be more selective in their approach their healthcare. Those with fewer economic resources have a limited number of choices for their healthcare and are not able to consume luxuries and therefore less likely to report CAM use.

cultural medicine

Conversely, there is some evidence showing that people who cannot access “normal” forms of healthcare must use CAM. Others may also opt to reject allopathic medicine because it does not align with their cultural beliefs or because they wish to maintain their cultural heritage. There is also evidence suggesting that members of the non-dominant culture receive subpar care from the biomedical community so they seek out care elsewhere. Those who cite racial discrimination as a reason for their CAM use report that they seek it out to reassert control and self-direction over their health.

An individual or group’s culture and ethnicity also influence the type of CAM used. For example, Blacks and Hispanics are most likely to engage in prayer, Asians are most likely to engage in the use of mind-body interventions and energy therapies, and Whites are most likely to engage in manipulative and body-based therapies. Again, consumption choices are tied to culture. However, individuals who have immigrated to the United States are less likely to consume CAM. There are a number of potential reasons for this, including a lack of exposure to various CAM treatments in their native countries, the cost associated with CAM use, a lack of ability to communicate with healthcare professionals, low utilization of healthcare in general [either because they are healthier than their American natives (which is generally the case) or because they do not have access to CAM]. Immigrants may also believe that medical treatment in America should be provided by the allopathic medical community, especially if they come from a country where allopathic medicine is also dominant.

gender

Gender also influences the consumption of CAM, with women being more likely to use CAM than men. Their reasons are varied and include personal beliefs [which are influenced by (or a lack of) education and disposable income], a lack of results or undesirable side effects from traditional medicine [patient dissatisfaction], doctor recommendations, social influences, and advertising. Hispanic women cite family recommendations their most influential factor; White women cite personal beliefs [often that CAM is more natural], and Black women cite advertising. The issue of advertising influencing the Black community raises public health issues about the reliability of promotional information. This is of particular concern, not only for the Black community but society as a whole, because advertising and fewer regulations from CAM have contributed to a dangerous rise in use:

 

“The relaxed rules for health claims allowed supplement marketers to target messages to the specific concerns of the 80 million Baby Boomers who, as they reached middle age, became even more interested in self-care, more distrustful of conventional medicine, and more resentful of the increasingly impersonal nature of the managed care health system”. 

– Marion Nestle

In the end, however, the factor most strongly influencing CAM use is when an individual suffers from a chronic disease or ailments like back pain, irritable bowel syndrome, a disability, or HIV. Members of this demographic tend to view CAM as a component of self-management of care, a pragmatic approach to living as well as possible, a means to take responsibility for their well-being, and because they recognize a value in the cognitive and attitudinal approach to wellness. However, those who suffer from chronic illness tend not to perceive CAM as an unrealistic means to a cure or as a rejection of allopathic medicine.

sources:

 

image credit:

  • themedicalportal.com
  • cavsconnect.com
  • mexicolore.com.uk

a history of the clash between conventional and alternative medicine in the united states

Throughout the nineteenth century, a variety of medical sects competed for professional supremacy in the United States. Allopaths used methods like bleeding, blistering or purging.  Homeopaths prescribed “infinitesimal” amounts of substances to provoke symptoms of illness and stimulate the body’s natural defenses. Naturopaths employed botanical remedies. Osteopaths favored bodily manipulation. Other schools of thought, e.g. mesmerism, hydrotherapy, and chiropractic, were established in the later part of the century.

Of the different sects, allopathic medicine claimed to be the most scientific of the group, although at the time each subgroup was equally scientific. As the self-proclaimed winner, allopathic practitioners leveraged their “scientific supremacy” to dominate the medical field in the United States by eliminating the competition and aligning themselves with government organizations which then enacted restrictive legislation to remove licensing opportunities and funding for “irregular” practices.

With the competition removed, allopathic medicine bolstered its forces and built medical schools and hospitals, and established The American Medical Association [AMA] with the financial support of the US government.  During this period, heavy promotion, legislative support, and industry alliances aiming to repurpose wartime technology into technology usable in civilian life provided allopaths with unparalleled influence that enabled them to practically eliminate their competition. They achieved this by either forcing the “alternatives” either join forces, as is the case with osteopaths and homeopaths or legislating them out of existence, as in the case of midwives and hydropaths.

However, complementary and alternative medicines [CAM] remained resilient, even in the most unfavorable of times. Chiropractic sought to offer patients an alternative to allopathic medicine and encouraged those dissatisfied with regular medicine to seek out its services. As their base grew, chiropractic sought licensing rights, a chance to set up its own educational programs and inclusion in government-funded health insurance programs. As chiropractic gained recognition and respect, other CAM groups, such as massage therapy, acupuncturists, naturopaths and homeopaths followed suit. However, allopathic medical groups remain reluctant to concede power and have only recently begun to acknowledge its usefulness.

The gradual acceptance of alternative medicine by the scientific medicinal community began in the 1970s after a period of introspection and the realization that several unaddressed were affecting the medical field. Such issues included poor patient satisfaction, limitations in conventional medicine, and a mounting crisis in health. Likewise, America’s economy shifted towards a more diverse, consumer-centered medical marketplace. These changes were eye-opening to medical professionals because patient satisfaction had previously been an afterthought to the industry which left those in the medical field with unchecked power and influence that often resulted in apathy and disinterest in the patient. Following this enlightenment, the medical community began incorporating journal articles about CAM into prestigious medical journals and began acknowledging the possibility that some alternative medical practices were valid treatment methods.

As CAM’s influence disseminated, demand rapidly accelerated, despite a lack of scientific evidence to support claims made by the practitioners. However, a lack of cohesion, regulation, and structure continues to limit its ability to gain credibility in the scientific medical community. To date, there are issues of credibility with the rise of unregulated supplement and quasi-medical procedures that cloud the more grounded aims of the classic alternatives. For example, after the illness of several people who took unregulated medical supplements, an editorial was posted in the New England Journal of Medicine:

“We have seen see a reversion to irrational approaches to medical practice, even while scientific medicine is making some of its most dramatic advances…Since these products have flooded the market, subject only to the scruples of their manufacturers. They may contain the substances listed on the label in the amounts claimed, but they need not…labeling has risen to an art form of double-speak…It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine-conventional and alternative. There is only one medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.”

Former FDA Commissioner David Kessler also commented on the lack of regulation for the supplement market:

“The marketplace is awash with unsubstantiated claims….[W]e are literally back at the turn of the century when snake-oil salesman made claims for their products that could not be substantiated.”

However, such broad-stroke statements undermine the strides that CAM medicines have made, especially in terms of treating patients holistically. At present, there are still stigmas surrounding the use of non-conventional medical practices, limiting patient options. Some reason for a lack of collaboration include:

  • Allopaths are not well disposed to co-operation with practitioners of CAM. Their approach has been the “Gold Standard” for decades and conceding power and control is an uninviting prospect.
  • Many CAM modalities have not gone through the same clinical and scientific testing to meet the rigorous standards of bio-medicine so they are implemented based more on patient demand than practitioner recommendation.
  • Many doctors do not believe in the efficacy of CAM on its own, rather they see it as a form of relief that can be used in conjunction with scientific medicine.

However, the varying sectors of the scientific medical community view CAM differently. Senior physicians are less likely to use, accept, or recommend CAM because their work tends to deal with the acute and bio-medical manifestations of a problem more than their community-based counterparts. Senior physicians also spend less time with patients, so they are not as in-tune with the psycho-social aspects of medical problems. This can be a problem because senior physicians are often involved in policy-making decisions.

Primary-care physicians, however, are more likely to treat patients on an ongoing basis.  Therefore, they are more in-tune with the psycho-social needs of their patients which makes them more likely/willing to refer their patients to CAM practitioners. This is often a result of their wish to offer their patients with long-term coping strategies.  This is especially true for sufferers of chronic ailments. Unfortunately, there has been limited research into the views of non-senior hospital physicians.

At present, the following approaches to CAM have established nationally accredited organizations accepted by the United States Department of Education:

Congress has also established the National Center for Complementary and Alternative Medicine [NCCAM] to conduct rigorous research into the efficacy of various CAM treatments to ultimately remove ineffective/unsafe treatment methods from the market and/or encourage the integration of effective CAM practices into the healthcare system. However, the NCCAM is not currently responsible for credentialing CAM practitioners and there are no federal policies in place to regulate CAM practitioners. Instead, regulation varies greatly from state to state.

sources:

header image credit: foodmatters.com

question: how do allopathic and complementary & alternative medicine (CAM) differ?

Allopathic medicine is defined as a system of medicine that aims to combat disease by using remedies which produce effects that are different from or incompatible with those of the disease being treated. The medical community practicing this form of medicine includes medical doctors and others types of health professionals, e.g. nurses, pharmacists, and therapists. Common treatments within the scope of allopathic medicine include the use of drugs, surgery, or radiation and tend to focus on specific areas of the body, rather than an assessment of an overall condition. Allopathic medicine is also referred to as biomedicine, orthodox medicine, Western medicine, or conventional medicine.

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Courtesy of lnpaccidentlawyers

Complementary and alternative medicines are, respectively, forms of treatment that are in addition to or a substitute for standard treatments. CAM medicines are typically outside the realm of allopathic medicine and therefore not subject to the testing procedures prescribed by the American Medical Association that are intended to prove the efficacy and safety of allopathic medicines and procedures. However,  many of these practices have been employed with success by other cultures throughout the world. There are five subcategories of CAM:

  1. Alternative Medicine Systems: embody complete theories of health and practice
  2. Mind-Body Therapies: use the power of the mind to influence bodily and somatic processes
  3. Biologically-Based Therapies: involve the use of substances found in nature for health purposes
  4. Manipulative and Body-Based: emphasize the physical manipulation or movement of the body to promote healing
  5. Energy Therapy: emphasize the use of energy fields to maintain or restore health.

The aforementioned modalities include, but are not limited to, chiropractics, naturopathy, homeopathy, crystal therapy, megadose vitamins, dietary supplements, meditation, aromatherapy, massage therapy, folk healing, acupuncture, dietary supplements/nutraceuticals, tinctures, biofeedback, Ayurveda, Shiatsu, probiotics and spirituality/prayer.

cam-page
Courtesy of HLWIKI

Accordingly, the most relevant difference between allopathic medicine and CAM can be understood as differing views about how the body works. Ergo each employs a different approach to treatment. Such differences often result in incompatibilities between the different practices – something that can cause frustrations for patients seeking holistic treatment. Likewise, CAM is often disregarded by the allopathic medical community making collaboration between different practitioners difficult.

sources:

https://www.cancer.gov/about-cancer/treatment/cam
http://www.hopkinsmedicine.org/healthlibrary/conditions/complementary_and_alternative_medicine/types_of_complementary_and_alternative_medicine_85,P00189/
http://www.medicinenet.com/script/main/art.asp?articlekey=33612
Grzywacz, Joseph G., et al. (2007) Age, Ethnicity, and Use of Complementary and Alternative Medicine in Health Self-management’ Journal of Health and Social Behavior. 48(1):84–98.

question: what is horticulture?

Defined by the American Society for Horticultural Science as, “the art and science of producing, improving, marking, and using fruits, vegetables, flowers, and ornamental plants,” horticulture is an important component of society that positively impacts citizen’s quality of life. Such improvements can take the form of, for example, increased nutrition, more attractive living environments, or a demonstration of cultural identity.

From an economic perspective, horticulture is a $17 billion [USD] industry that produces more than 2.4 billion tons of goods annually as well as provides employment and income to various participants of horticultural supply and value chains. It is also a growth market with enterprises that vary vastly in size.

the horticulture supply chain
Source: International Society for Horticultural Science, exerted from ‘Harvesting the Sun’, 2012

Each supply and value chain has a number of different stakeholders who are affected by the flow of goods. The actions taken by each link of the chain influences the other members. Therefore, cooperation plays a strong role in the effectiveness of a supply or value chain.

supply chain history
Source: International Society for Horticultural Science, exerted from ‘Harvesting the Sun’, 2012

With such a wide-range of stakeholders, the types of employment provided by horticulture are many. The end-products of these services provide aesthetic, sociological, and psychological benefits. Such benefits range from being able to enjoy fresh fruit on a daily basis to drinking a fine bottle of wine with friends to being able to send a sick family member flowers to sitting in a well-tended park on Sunday afternoon. Horticulture is able to provide these benefits because it differs from other plant sciences and botany as it it incorporates both art and science.

employment sectors in horticulture
Source: International Society for Horticultural Science, exerted from ‘Harvesting the Sun’, 2012

In response to massive consumer demand for horticultural products and a quickly growing population, it has been argued that large-scale production, which is generally vertically integrated, is the only production system capable of consistently meeting global demand. This capability is grounded in the shift from the use of manual labor towards the expansion of the use of machinery and robotics. It has also been asserted that large-scale production is more efficient. However, evidence contrary to the aforementioned assertions has been produced, indicating that small-scale production is as productive as large-scale production. However, due to widespread modernization in the horticultural field, it is often much more difficult for small-scale producers to compete in the market which in turn allows for a concentration of economic power.

Nonetheless, changes in consumer demand may work in favor of small-scale producers as consumers seek out more authentic food experiences, diversity, and are more interested in supporting their local communities. If small-scale producers can effectively exploit such demands as well as provide high-quality products at reasonable prices, they are likely to be able to capture a greater market share. Specific opportunities can be found in tropical fruit production and the diversification of vegetables – two areas where both demand and consumption has steadily increased.

Current issues being faced by the horticultural industry, regardless of size, include controversy associated with seed production, changing weather patterns and climate, soil and fertilizer management, disease and pest control, rising energy costs, and water scarcity.

sources:

https://articles.extension.org/pages/64847/what-is-horticulture
http://www.ashs.org/?page=horticulture
http://www.harvestingthesun.org/sites/default/files/ISHS-Harvesting-the-Sun-full-profile.pdf

an introduction to community supported agriculture (csa)

First introduced in Japan and Switzerland in the 1970s, community supported agriculture (CSA) is a form of partnership between farmer and consumer.  They enter into a contract which provides consumers with a certain number of ‘shares’ in the farm. Each share provides the consumer a box (or bag or bucket or …) of vegetables or other products at a regular interval. 

There are four basic components of a CSA:

  1. Partnership: a mutual agreement between the producer and the consumer is established for the growing season
  2. Local Production: the exchange is local, i.e. a part of the community, in order to facilitate the relocalizing of the human-food relationship
  3. Solidarity: a unifying relationship is developed that is beneficial to both producer and consumer
  4. A Producer/Consumer Tandem: the direct person-to-person relationship, i.e. no intermediaries or hierarchies, is established

The establishment and execution of a CSA have several benefits and challenges for producers and consumers that are summarized below.

Challenges

Opportunities

Producers

  • Potential for a bad worth of mouth
  • Increased management requirements
  • Time demands → customer relations
  • Packaging and distribution costs

Consumers

  • May feel like they are not getting their money’s worth
  • Lack of choice
  • May be expensive
  • ‘Long-term’ commitment
  • Short shelf life (no preservatives)
  • A significant amount of produce that requires cooking
Producers

  • Marketing before the growing season
  • Consistent cash flow
  • Development of customer relationships → loyalty
  • Shared risk
  • Cuts out the ‘middleman’
  • Little capital investment
  • Word of mouth advertising

Consumers

  • Access to super fresh produce
  • Development of relationship with producer
  • Contact with the farm

Society

  • Reduced environmental impact of food(?)

For the implementation of a successful CSA, the participants – both farmers and consumers – must have the ‘right’ type of personality, i.e. committed and patient. However, if such a relationship can be established, CSAs are a very viable marketing strategies that can be used by small farmers to remain competitive in an environment largely dominated by industrialized agriculture.

sources:

http://www1.agric.gov.ab.ca/$department/deptdocs.nsf/all/agdex3482?opendocument
http://edis.ifas.ufl.edu/fy597

Medical Model vs. Population Health Model

Medical Model

Population Health Model

Geared toward clinically oriented system

Studies the effects any given health ailment

Changes the way society and the individual interact

Individuals engage in guided self-managed care

Places the fault with the individual

Assumes that there is something wrong with people who consume too much sodium and does not account for societal influences

Emphasizes public education

Individuals are provided with the information needed to make informed decisions regarding their healthcare

Maintains social hierarchy

Medical professionals are assumed to always know what is right and best

Studies a range of influencing factors

The reason(s) why a given health ailment exists are examined

Standardized

Care is based on measurable and objective inputs. For example, how much sodium an individual is consuming and what the cure will be for hypertension which discourages “out of the box” thinking.

Prevention-based

Reduces the need for treatments by encouraging proactive health-oriented decision-making, as well as emphasizes long-term planning as a key to lasting success and cost reduction

“Mechanically” oriented

Humans are machines that can be fixed if a component is defective

Personalized

Social factors influencing health, such as poverty and education, are incorporated into healthcare

A sickness care system

Symptoms continue to be treated, but underlying causes are never addressed

Encourages community participation

Individuals are empowered to make positive health choices

Uses public policy to make changes

Encourages regulations for food labeling, distribution and content limits, especially for young children

sources:

http://www.phac-aspc.gc.ca/ph-sp/approach-approche/index-eng.php

http://www.longwoods.com/content/16763

http://www.marco-learningsystems.com/pages/david-zigmond/medical-model.htm

https://org2.democracyinaction.org/o/6739/images/history-model.pdf

question: what are the causes of air pollution in china? how serious is this problem, and how does it impact other countries?

There are a variety of reasons for air pollution in China. Demand for cheap goods throughout the world prompt huge manufacturing efforts that are poorly regulated. A lack of enforceable energy and environmental standards enable production systems to exploit resources with few or no repercussions. An expanding middle class is also contributing to the increases in demand for transportation and electricity. Both produce a significant amount of air pollution, especially since electricity supplies in China are primarily dependent on some of the dirtiest sources of energy like coal.

Such a problem is incredibly serious. Citizens are subjected to terrible environmental conditions that are likely to cause various health ailments. The pollution also travels to the United States which contributes to already poor environmental conditions. For example, in California residents are subjected to at least one additional day of air conditions that exceed the federal limits for air pollution because of the influx of nitrogen oxides and carbon monoxide emitted by China and on other days at least one-quarter of sulfate pollution on the west cause is a result of exported goods from China. China also produces black carbon which is a known cause of asthma, emphysema, heart and lung disease, and various cancers. This type of pollution is not removed from the environment with rain.