Comparison of pharmacy practitioner and pharmacy student attitudes toward complementary and alternative therapies in a rural state

American Journal of Pharmaceutical Education, Spring 2002 by Hamilton, William R, Monaghan, Michael S, Turner, Paul D

The purpose of this project was to perform a needs assessment for pharmacy practitioners and measure the attitudes of both pharmacy practitioners and students regarding alternative therapies. A 15-item-fivepoint scale questionnaire designed to measure the educational needs and attitudes of pharmacists regarding complementary and alternative medicine (CAM) was developed and mailed to 200 randomly selected practitioners. After two mailings, 94 (47 percent) were returned. A modified version of the questionnaire was administered to 35 students pharmacy students. The returned questionnaires were tabulated and identical items were statistically compared using nonparametric analyses. Significant differences were the following: practitioners were less likely to favor pharmacists becoming practitioners of CAM; practitioners believed those alternative therapies offered by pharmacists would decrease the public's respect for the profession; students were more likely to believe that sufficient evidence exists supporting the use of some alternative therapies; students were more likely to believe that pharmacy as a profession should aggressively pursue opportunities in alternative medicine; students were more likely to refer a patient to a practitioner of CAM; and students were more likely to believe that alternative therapies will offer new means for the pharmacist to develop primary care services. We do not know if other rural and urban states have similar disparities between pharmacy practitioners and students, but we share this data in case a needs assessment should be done in other states.

INTRODUCTION

Western medicine, either through restriction of access or overregulation, may have lost its `caring for the whole patient' perspective, resulting in a patient-mandated interest in other `holistic' practices(l). In a health care environment replete with regulatory and safety issues(2), Complementary and Alternative Medicine (CAM) use by the general public has increased from about 33 percent in 1990 to more than 42 percent in 1997(3). CAM includes a variety of unconventional healing practices and practitioners. Examples include unconventional healing systems (acupuncture, homeopathy, naturopathy), popular health reform (mega-vitamins), new age healing (crystals and magnets), mind-body (Deepak Chopra), and non-normative (chelation)(4). Health care consumers are changing the medical market through their use of CAM. A recent essay by Kaptchuk and Eisenberg documents the historical shift CAM has undergone - from being previously viewed as marginal and fraudulent to acknowledgment as a component of postmodern medical pluralism(5). Some examples of CAM use relevant to pharmacy practice and education are illustrated in the following.

Patients undergoing cardiac surgery reported using CAM in 75 percent of respondents when prayer and vitamins were included as therapeutic options(6). Patients receive their information regarding a range of CAM therapeutic options from physicians, pharmacists, nurses, physical therapists, nutritionists, alternative medicine specialists, friends, and health food store employees. The quality and accuracy (ie., scientific validity) of the information used by the patient from these sources vary considerably. While posing as a relative, an investigator received product recommendations for breast cancer from health food store employees most frequently for shark cartilage(7). Although used for cancer treatment, scientific review of shark cartilage currently is considered "likely ineffective when used orally for treating cancer(8)." A survey of a low-income population revealed reported use of herbs or supplements (nutraceuticals) at 56 percent. Forty-one percent of users cited friends or relatives as their main source of information. In the same study, 69 percent of their health care providers admitted they had received no education about nutraceuticals(9).

Seventy-seven out of 117 U.S. medical schools included CAM topics in required courses or offered elective courses in CAM in 1998(10). To some observers, this change in patient use and the necessity of teaching CAM is a "reverse technology transfer(11)." Nursing is actively incorporating CAM therapies into their curricula(12). In responses to a survey of schools of pharmacy, 50 of the 77 schools reported that 72 percent offered course work in some area of CAM(13). In a comparison of final-year medical, physical therapy, occupational therapy, nursing, and pharmacy students in Canadian schools, medical students reported the least amount of education about CAM. Pharmacy and medical students also desired more traditional scientific forms of evidence as a prerequisite to accepting CAM therapies(14). In the "Annual Report to Our Stakeholders," the director of the National Center for Complementary and Alternative Medicine predicts that science will convert some CAM therapies into "integrative medicine" therapies and eventually several nutraceuticals will be standardized for routine use in western medicine(15).