Ten years ago, announcing that you were off to the osteopath, the herbalist or the reflexologist would have marked you down as a dabbler in the esoteric. Now complementary medicine is no longer seen as a fringe therapy.
Just look at the figures: 60 per cent of Germans, over 50 per cent of Americans and 30 per cent of people in the UK use or have used some form of complementary therapy.
While there are no figures available for Ireland, the rise of interest in an increasingly diverse range of therapies is evident from the number of registered practitioners here. A rough count from the recent Alternative Agenda series in this newspaper gives a total of over 2,000.
Establishing why people have turned towards complementary therapies is difficult. But disillusionment with orthodox - or allopathic - medicine is a large factor. "I think that doctors are no longer seen as independent of big pharmaceutical companies and therefore no longer viewed as the benign guardians of public health. The public is increasingly suspicious of drug side-effects and no longer confident that drug prescriptions are made solely on the basis of best practice," says Simon Curtis, a practising osteopath.
Curtis cites the following figures: iatrogenic disease (illness as a direct result of medical intervention) is the fourth biggest killer in the US; more than two million Americans are hospitalised due to adverse reactions to prescribed drugs. Antibiotic-resistant bacteria (so-called "superbugs") and reports on the potential side-effects of childhood vaccination has further fuelled dissatisfaction with orthodox medicine.
Herbalist Helen McCormack believes that people are demanding a more natural, safer form of medicine. She cites a recent study (reported in the British Medical Journal) in which St John's Wort was found to be more effective and safer than standard anti-depressants in treating depression. Interestingly, scientific research studies into the effectiveness of herbal remedies for such conditions as asthma and Alzheimer's are also emerging.
Coupled with this growing sense of the medical profession's inextricable link with drug companies is the changing relationship of doctor and patient. In many ways doctors have become victims of their own success. Busy surgeries are preventing them from giving their patients more than five or 10 minutes per visit.
"There is an enormous increase in demand for medical intervention, which is part of an overall increased demand by people about their health," says Dr Michael Boland, director of the post-graduate centre at the Irish College of General Practitioners. However, Boland does concede that there is some dissatisfaction with the medical profession among the public.
"The disenchantment with conventional medicine and conventional practitioners has arisen partly because of an unrealistic presentation by the medical profession of what medicine could do for people. In other words, we made promises we couldn't keep," says Boland. "The purely scientific approach adopted by some doctors has also left people disenchanted."
The length of consultation with an alternative health practitioner is another factor that has drawn support towards disciplines such as homoeopathy and herbalism. Many homeopaths and herbalists recommend patients to put aside between one and a half and two hours for the initial consultation, which involves the patient giving a detailed account of his or her health and lifestyle history. Complementary therapists don't only give of their time, they also touch and engage with their patients. "Some doctors sneer that it is because complementary practitioners give patients time that they get better. But complementary practitioners often develop a more positive consultation with patients by looking them in the eye and, in the case of therapies such as osteopathy, by safe, non-threatening touch," says Simon Curtis.
SO there is a strong "feel-good factor" in complementary medicine. But how important is this in effecting a cure? Complementary practitioners say it is part of the service they offer, while many in the medical profession dismiss it as the placebo effect.
"Current technology is removing the placebo effect in medicine," writes Dr Robin Coker in Alternative Medicine - Helpful or Harmful (Monarch Press, 1995). Coker explains that the patient's trust in the practitioner affects the ability to heal and that the patient's confidence in the drug being prescribed also affects the response to the treatment.
The significance of this psychological factor in healing is further emphasised by studies which have shown that a third of all patients will report improvement in their symptoms when given a placebo. In her book, The Whole Truth: the Myth of Alternative Health (Faber & Faber, 1989), Rosalind Coward suggests that alternative therapies are based on a new philosophy of the body, health and nature which has somehow managed to capture or echo popular consciousness. She says many alternative health practitioners "peddle" a world view (emphasising the natural above the processed, the country above the city, walking above driving, etc) which many people will find difficult to achieve.
The changing pattern of disease is another factor in the growth of interest in alternative medicine. While many childhood and infectious diseases have been eradicated in the West, there is an increase in the amount of chronic (often stress-related) illnesses. While cancer and heart disease have become the major causes of death, asthma, migraine, back pain and numerous allergies have become commonplace chronic health problems. It is often for these types of problems that people are turning to alternative/complementary practitioners.
Nutritionist Patricia Quinn has witnessed the growth of interest in alternative therapies since 1985. She believes there are numerous factors at play. "People started looking at their health more holistically. The top risk factors I find I treat in my work are damage due to poor nutrition, smoking, drinking alcohol, overuse of antibiotics, environmental pollution, a sedentary lifestyle and stress," she says.
The author of Healing with Nutritional Therapy (Newleaf, 1998), Quinn says she has noted a huge increase in illnesses caused by a poorly functioning immune system. These include bacterial/viral infections, post-viral fatigue, M E and yeast infections. Stress, Quinn believes is also a major player in illness. "Our society is fractured today and stress is falling on one head where it used to fall on one in 10 in an extended family." The lack of emotional support is another factor which contributes to illness, according to Quinn. Dr Michael Boland doesn't believe that there is a changing illness profile. Instead, he says, what has changed is people's willingness to tolerate ailments such as back pain, migraine and other chronic health problems.
"In the beginning, doctors colluded with that false expectation for a solution. Now, I think many alternative therapists are doing the same thing. One of the most difficult things a doctor has to do is to tell a patient that they can't do anything for them," he says. One contentious area which complementary health therapists need to address more comprehensively is a harmonisation of professional qualifications. The foundation of the Federation of Irish Complementary Therapies Associations is a start, as is the forthcoming meeting with the Department of Health regarding statutory regulation of professional bodies.
So, the divisions continue. Perhaps, what will emerge will be a more mature relationship between allopathic medicine and the alternative healthcare sector. Orthodox medicine will never lose its eminence in areas of hightech essential surgery and the care of acute patients. Meanwhile, the alternative sector will grow as people's need for advice on lifestyle issues becomes more important as the stress of 21st century living increases.
Next Monday, Sylvia Thompson begins a new series of inter- views with doctors who have embraced complementary therapies in their practices.