Journal of Evidence-Based Integrative Medicine

Health care in the United States is undergoing a profound change as reflected by the increasing availability and use of alternative health care goods and services such as acupuncture, homeopathy, chiropractic, or herbalism. With this change comes a shift in consumers' mindsets about health. The article describes an exploratory study that identifies four theories of health that are held among consumers. The results demonstrate that consumers' mindsets about health are not watered-down versions of practitioners' viewpoints, nor do consumers' beliefs neatly correspond to any orthodox approach to health care. Instead, their personal theories are complex amalgams of tacit knowledge and new information, often combining ideas from belief systems that are incommensurate or contradictory. Implications for health care consumer research and health care practice are discussed.

The present study piloted an investigation of the effectiveness of relaxation training and massage therapy as adjunctive interventions in the management of chronic pain associated with sickle cell disease. Sixteen adults with sickle cell disease were randomly assigned to receive either relaxation training or massage therapy. Visual analogue scales of pain were obtained before and after each session. The McGill Pain Questionnaire and the Sickness Impact Profile were completed at the first and sixth session. Treatment by the interventions was associated with short-term reduction in both sensory (p = .001) and affective (p = .002) dimensions of pain, and longer-term reduction in both sensory (p = .01) and affective (p = .02) dimensions of pain. There were no time by type-of-intervention interaction effects, indicating that relaxation training and massage therapy were not significantly different in effectiveness. There were no significant main effects or interactions in the Sickness Impact Questionnaire and McGill Pain Questionnaire scores in either condition. Further investigation is needed to establish the reliability and generalizability of the current findings. Special considerations concerning use of these interventions with this patient population are discussed, as are limitations of the current study.

This article reports some of the findings from an upcoming book, The New Healers: Minds and Hands in Complementary Medicine, that looks at the lives and practices of nine women who provide some sort of complementary (alternative) health care to clients. They offer a wide diversity of services that aim to restore or improve some aspect of the client's body, mind, or spirit. For lack of a better word, these practitioners have been labeled "healers." The reader should understand that that term applies only to the nine healers interviewed. I suspect their views are typical, but only further research could validate that. The women interviewed were nine practitioners among the thousands who have emerged across this nation in recent years. The therapies they use were diverse, including: acupunc ture, moxibustion, herbalogy, sound therapy, aroma therapy and essential oils, massage, neuromuscular therapy, structural integration, Reiki, guided imagery, astrology, thought- field therapy, neurofeedback, polarity therapy, color therapy, hypnosis, past lives therapy, Feng Shui, rolfing, cranio-sacral therapy, various forms of psychotherapy (often Jungian or Gestalt), and shamanic soul retrieval and negative energy extraction, among others. The healers range from persons self-educated after highschool (including certificates in various therapies) to persons with doctoral degrees. With one exception, all of these women make their living as complementary health practitioners. The exception is a professor in a major university whose complementary therapy is primarily applied to clients in her funded research. This article is not an attempt to review complementary medicine techniques. It is simply an orientation to the viewpoints of a small group of practitioners. One obvious similarity among the healers is that they are all women. Most of the women in this survey have local, regional, or state, rather than national or international, distinction. Mostly, they make their living with real live clients, not doing the speakers' circuit or promoting their latest book. I wanted to listen in depth to a few voices from this alternative medicine world. The New Healers: Minds and Hands in Complementary Medicine provides a fuller picture of the individual practitioners in frank, in-depth interviews concerning their practices, values, and philosophies. This article does not reproduce these interviews because of constrictions of space, but one could say that these women share the fact that they have given their practice a lot of thought and have their own ideas concerning how their therapies work. One shared factor is that they are all very adept at human relationships. They are concerned that others give their clients their full attention. Some of the main categories emerging from the data will be discussed here.

Reviewing the recent literature of horticultural therapy is of considerable use to the alternative health care practitioner. In addition to giving a broad overview of this interdisciplinary field from 1979 to 1998, it is possible to gain a practical perspec tive on the contexts in which horticultural therapy programs have been most successfully implemented, as with the elderly. This insight can then be transferred to populations who have received relatively little attention such as incarcerated individuals or children. More examples of case studies in occupational settings are also needed. The environmental benefits, as a consequence of such efforts, may be important yet often go unreported. The purpose of this article is twofold: to examine dominant themes in the practice of horticultural therapy based on a substantive review of selected articles and to identify "weak spots" where additional informa tion is needed by health care practitioners, including issues related to methodology, documentation, and assessment.

Congress, in coordination with the public, has been the driving force behind improving research, regulation, and access to complementary and alternative therapies. While government agencies have remained reluctant to move forward in conducting research in some areas of complementary and alternative medicine (CAM), at times displaying a bias against them, many in Congress have been open- minded and active in asking for more research in these areas and in wanting to make CAM therapies more accessible. Numerous surveys indicate a steady increase in the use and acceptance of these therapies and the "grass roots" participation in CAM- related legislation is very strong. Congress mandated the creation of the Office of Alternative Medicine (OAM) in 1992 with an original budget of just $2 million. In 1998, in a desire to give the OAM more control of its research portfolio, Congress included in the Fiscal Year (FY) 1999 Omnibus Bill language to elevate the OAM to Center status (National Center for Complementary and Alternative Medicine) with a $50 million budget. Dr. Stephen E. Straus has recently been named as the new director of NCCAM. Several people on Capitol Hill have been very supportive of CAM issues. Most notable are Congressman Dan Burton, Senator Tom Harkin, Senator Orrin Hatch, and Congressman Peter Defazio. CAM issues are typically nonpartisan. In the last year, the Government Reform Committee has conducted a series of hearings looking at the role of CAM in the US health care system as well as issues in research, regulation, and access. One recent advance that comes as a result of this investigation is the announcement of the Health Care Financing Administration that the Dean Ornish Multisite Lifestyle Modification Program for Heart Disease will be accepted as a demonstration program with Medicare. The Department of Defense is also developing this program as a result of appropriations language in FY 1999. Several CAM-related bills have been introduced in the 106th Congress. Con gress remains a key component in ensuring increased research focus and funding, better regulation, and improved access to CAM treatment options for all Americans.