Values in complementary and alternative medicine.

In recent years so-called Complementary and Alternative Medicine (CAM) practices have made significant political and professional advances particularly in the United Kingdom (UK): osteopathy and chiropractic were granted statutory self-regulation in the 1990s effectively giving them more professional autonomy and independence than health care professions supplementary to medicine; the practice of acupuncture is widespread within the National Health Service (NHS) for pain control; and homoeopathy is offered to patients by a few General Practitioners alongside conventional treatments. These developments have had a number of consequences: one is that both CAM and Conventional and Orthodox Medical (COM) professions have had to reappraise their professional identity. In manual therapy for example, questions have been asked about the differences between physiotherapy, osteopathy and chiropractic, and what the justification is for having separate professions. A wider question concerns the relationship between CAM and COM; are CAM distinct professions or should they, as has happened to a limited extent in the UK, be absorbed into the broader field of 'Medicine' or 'Health Care' as adjunctive therapies. CAM professions have also had to develop, implement and enforce codes of practice for practitioners and clarify the scope of practice within a profession. At the heart of these issues lies the need to identify and clarify professional values. A key claim of CAM professions is that their practice is distinct and the outcome of treatment at least as effective and in many cases more effective than with conventional therapies. In addition, what counts as effective outcome is often different from conventional medical understanding, involving more subtle humanitarian considerations, for example. Three values are identified as being commonly held across CAM professions. These are: offering 'natural' treatment; being patient rather than disease focussed; and being holistic. However, these may not be as distinctive of CAM as is claimed either because the meaning is unclear or because COM professions claim similar values. The paper argues that the values that inform 'good practice' and 'effective outcome' should be seen as distinct components of professional competence. This has implications for establishing professional identity and codes of practice.