chronic lower back pain, chronic tension headaches and migraines because evidence
of effectiveness is only available for these conditions. Yet other claims have been made.
For example, White (2000) and Bassman and Uellendahl (2003) present fairly positive
reviews citing evidence for the effectiveness of acupuncture in treating depression and
substance abuse. Murcott (2006) is more pessimistic even regarding the evidence on
pain relief, noting that there are few studies of longer-term effectiveness. He compares
the evidence available for the analgesic effects of aspirin and acupuncture and concludes
that evidence for the latter is clearly weaker. Overall, he concludes that evidence for
the effectiveness of complementary therapies generally is equivocal. However, here
too there is debate about appropriate outcome measures. What if an alternative
therapy was found to have no effects on clinical outcomes over and above placebo
but was found to have a noticeable effect on patients’ reported happiness or sense of
empowerment? Would this constitute effective health care?
MANAGING LONG-TERM ILLNESS
In England, 15.4 million people have a long-term physical illness (LTI) and this is likely
to rise to 18 million by 2025. About 60 per cent of those older than 65 have a LTI
compared to 17 per cent of people under the age of 40. People with LTIs are intensive
health care users accounting, in the UK, for more than half of general practice appoint -
ments and nearly three-quarters of inpatient days in hospital. LTIs include hypertension,
asthma, diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease
(COPD), cancer, heart failure, chronic pain and epilepsy (Department of Health, 2008).
LTIs affect people’s lives in many ways. Sufferers are less likely to be in employment,
more likely to be poor and more likely to need additional care and support from
family members and others. With no medical cure in sight it is unsurprising that people
with LTIs are also more likely to be CAM users. We have noted that people with
LTIs may benefit from self-management interventions (see Chapter 8) and that longer
consultations focusing on the patients’ beliefs and feelings and prompting patients to
take control of illness management may be especially important for these patients (see
above). Empowering patients with LTIs to actively shape the consultations with health
care professionals may optimize the health benefits of consultations (Michie, Mills and
Weinman, 2003). Moreover, patient-centredness may need to be extended to become
an ‘empowering partnering approach’ that acknowledges patients’ independence in self-
management of their illness (McWilliam, 2009).
The challenge for people with LTIs is to adapt to their illness, adopt the most
effective coping strategies including social support seeking (see Chapter 4) and to
maintain high self-efficacy (see Chapter 7) and the best possible quality of life (QoL).
The extent to which they are able to do this and to enjoy life may predict longevity.
For example, Moskowitz, Epel and Acree (2008) found that positive affect, including
measures of enjoying life was associated with mortality among people with diabetes
and people over 65 and especially among those reporting higher levels of stress. The
findings suggested that positive affect may buffer stress (see Chapter 3). Consequently,
psychological support is crucial to helping this group and some CAM practitioners may
be able to offer such support more effectively than health care professionals because
they employ longer consultations focusing on overall well-being. A UK Department
248 RELATING TO PATIENTS