Shamans, charlatans and quacks?

Prince Charles popped up on the Today Programme this morning. He seemed in jovial mood and chortled his way through an interview on using the rain forests to protect us all against climate change. HRH has long been interested in alternative issues, and is as well known for talking to his plants as for his ill-fated marriage to Diana.

Last month the Prince was in the news as a professor from Exeter university criticised guides to alternative medicine produced by the Prince's Foundation for Integrated Health. At the time the Today programme ran an interview with someone speaking for the Prince, suggesting that the important thing was that people should have information to help them make up their own minds, and that the guides presented the facts for them to consider.

CAM can be an easy target. Ben Goldacre, debunker of health myths, is not keen on it and practitioners of all its various aspects are regularly criticised on his blog. The good folk at Quackwatch also list many "alternative" therapies on their pages. A possible antidote to DR Goldacre is the NHS Alternative Medicine blog.

CAM has no Royal College or regulatory body, as as such. The Institute of Complementary Medicine exists to provide people with information on "safe and best practice" They keep a British Register of Complementary Practitioners and publish a code of ethics for practitioners.

There is also the British Complementary Medicine Association. The ICM's website has pictures of people in white coats, the BCMA has graphics of doors opening onto bright lights, but they also have a list of registered therapists and a code of conduct.

Some individual therapies have their own organisations - reflexologists, acupuncturists, Alexander teachers. How are these bodies regulated? Can they stop people from setting themselves up as practitioners without training? What training can there be? How about a postgraduate diploma in crystal therapy, complete with bibliography, continuous assessment and learners' portfolio? There are 61 complementary medicine courses available from bona fide UK universities.

There is a NLH Specialist Library for CAM. This covers the more mainstream end of things - herbal medicine, massage and art therapy. There is no section for crystals, reiki or macrobiotic diets. The NLH also offers a database of papers on alternative medicine - AMED.

Bandolier has a page of evidence on CAM. Cancer Research UK has a page of resources as does the Department of Health. Dr Foster has a search facility for finding CAM practitioners, although this only covers acupuncture, chiropractice, herbalism, homeopathy and osteopathy. Natural Standard is an American website that aims to provide "high quality, evidence based information about complementary and alternative therapies." You need to register to read anything on this site, although their blog is freely available. There is also a NHS Directory of complementary and alternative practitioners. As well as information on therapies it will tell you where to find your nearest crystal therapist. The Open University, working with the BBC, has a web resource on alternative medicine.

The Student BMJ has a basic run down of CAM issues. Further reading on this topic available in the library - natch.

CAM continues to strike up debate and controversy. It seems to me that one of the main problems is the attempt to lump together everything that is not mainstream medicine. Perhaps we need to stop thinking about CAM and think instead about the individual therapies, taking each one on its merits. More research might help. And in the end if we believe it makes us feel better, and it's not doing us harm, then why should we knock it?

With thanks to Newham Knowledge for suggesting the topic for this posting.


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What do you think of it so far?

What do patients think of us? How do they rate the cleanliness of hospitals? Do they like the food they are served? Do they see good teamwork between doctors and nurses? How long do they wait in A & E? The Healthcare Commission regularly surveys patients and their latest findings are out today.

How did Colchester Hospital University NHS Foundation Trust do? Well - we were neither in the top ten...nor the bottom ten. Those of you with a competitive streak can compare the results by trust or against previous years.

NHS Surveys has information for patients on how to complete questionnaires. It also has information on the other surveys of patients that are carried out from time to time.

There's nothing like asking service users what they think to help you improve your service. It's easy to guess what we think other people would like - but do we always guess right? Does your great aunt Hilda always guess right what you'd like for your birthday?

It's also horribly easy to do things for our benefit, rather than our users. I do it too. Only today someone told me that the they couldn't find what they were looking for on the library web pages. I think they are nice and clear - but then I write them, and I look at them regularly, so of course I can find everything I need on them.

There is an NLH specialist library on patient and public involvement. There is a Commission for Patient and Public Involvement in Health. NICE encourages patient input into its work. Individual trusts also welcome input from patients and and the public.

Of course, one of the easiest ways to find out what people think is just to go ahead and ask them. Please feel free to let me know what you think about our service or the website or this blog. I'm all ears.

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Communications - part 2

We're still waiting for our voicemail issue to be resolved, but the good news is that we now have a proper email address which is library dot services @ colchesterhospital dot nhs dot uk. That's services plural and hospital singular - no dot or space between colchester and hospital.

Communications break down

We're having an upheaval of communication systems here, and are being plagued by gremlins.

If you are emailing us the "@essexrivers.nhs.uk" part of our addresses is now "@colchesterhospital.nhs.uk" Sadly this doesn't work for the general library email address and so far we've been unable to find out what our address is. So if you are emailing us internally we're on the global as Library Services RDE Colchester Hospital University NHS Foundation Trust. Externally...you can't email us at all. Every variation of our address that we've tried so far has bounced.

You could give us a ring instead...only we're unable to access our voice mail.

Fax and snail mail welcome!!

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Haben sie schmerzen?

I'm always bemused by leaflets that say on them "please ask if you require this leaflet in other formats" If you only read braille - or Gujarati - how are you going to read that sentence to enable you to know that there is a leaflet for you? How many hospitals really keep leaflets in the complete range of possible languages, just in case?

Sometimes things are more pressing than a leaflet. That's when the Red Cross Emergency Multilingual Phrasebook is useful. It works a little like the menu in a Chinese restaurant - every phrase has a number allotted to it. So a number 10 is "have you any pain?", a 20 is "do your ankles swell?" and 25 is "do you smoke?" You select the question from your English version and point to the same number on the foreign language version. All the questions require a yes, no or pointing at something answer. Really very ingenious.

There is a Link to the resource in the National Library for health specialist library on Ethnicity and Health. The library covers cultural issues and illnesses specific to some ethnic groups.

Another communication resource is Sign Translate, which translates from English to British Sign Language and 12 minority languages.

Language isn't the only difference in health. The BBC has a guide to religions, so if you want to know how Mormons feel about contraception, or the Muslim thinking on abortion it's the place to visit. Ethnicity Online from Norfolk, Suffolk and Cambridgeshire WDC is no longer being updated, but has a range of resources around ethnicity. The Equality and Human Rights Commission (which replaced the Commission for Racial Equality among others) has information on rights around race.

We've plenty of books in the library covering cultural issues and the different customs around health and especially death and dying.

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Cover to cover

I don't know about you, but I like to get my money's worth out of things. That might mean staying to the bitter end of a film I hate, just because I paid to get into the cinema. More usually it means that when I buy magazines I like to read from cover to cover and back again. If there are a couple of bits I can cut out and keep - a review of a book I want to order from the library, a recipe I want to try, a web address I might visit - so much the better. The thought of paying out for an annual subscription to a magazine where I might - if I get round to it - flick through some of the copies, and perhaps read bits of one or two articles, makes my toes curl.

How is this relevant to you? Well, as departments find their budgets being nibbled away I find more of them phoning me up to ask if I will take on their journal subscriptions for them. My standard response is that I wont.

That's partly because the library budget has had its fair share of cuts, the same as everywhere else. But it's also because I don't believe that having two, three or four journals in a department is useful any more. Most people in the department wont know they are there. Those who do wont always remember to look at every issue, and when they do they will probably just flick through it. The number of papers that are read from end to end is probably very small. And when you want an older copy...well, somehow it isn't on the shelf and no one has seen it.

The better way to go about keeping up to date is to have the table of contents of journals sent to you on a regular basis. You can do this using eTOCs, where the journal itself emails the contents to you, or you can try RSS feeds using a feed reader. Either way you can normally see abstracts. Then, when you find a paper you actually want to read you ask us to send you a copy. We will get it from one of our partner libraries or the British Library. Yes, it costs us, although we don't charge you. But I guarantee that your department will not request enough papers from any given journal for the total cost to match or exceed the cost of subscribing.

Better still, in addition to the eTOCs or feeds - as many as you like - do a regular search on Medline or Cinahl. The point is that you will find papers of interest published in your favourite journals, some in more general journals, and others in journals you hadn't even heard of. Yes, there are standard journals that like to think they cover everything, but why miss out on papers just because they haven't appeared in the two titles you hoard in your department? There's a whole world of evidence out there - why restrict your reading?

Now, if you'll excuse me, there are still some snippets in the latest IWR I haven't read yet...

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