Regulation of Complementary and Alternative Medicine (CAM) Using Osteopathy as an example, describe and critically evaluate the ways in which the organisation and regulation of Complementary and Alternative Medicine (CAM) in the UK provides safeguards for users. The provision of CAMs in the UK is historically both a component of healthcare services and viewed with suspicion by the dominant medical model of healthcare which has characterised the NHS since its inception in 1948. The kinds of CAMs which are included under the aegis of NHS provision have been restricted, to, for example, homeopathy and osteopathy (Nicholls, in Lee-Treweek et al, ). Such provision is typically regulated and monitored in ways that a wide range of other therapies which come under the same umbrella are not. This essay explores the ways in which this organisation and regulation can provide service users with the same kinds of safeguards that other NHS services have always provided. This kind of regulation, such as that provided by the professional bodies of Nursing (the Nursing and Midwifery Council) and Medicine (The General Medical Council, is a valuable means of ensuring the highest quality of care provision by ensuring only properly trained practitioners are allowed to practice, whilst at the same time holding practitioners accountable for their practice. Patient feedback and other studies has demonstrated that the provision of CAMs within NHS care provides valuable treatment and support for patients with complex medical conditions. This is a symptom what Heller et al (2005) describe as the ‘late modernity’ of healthcare in the preesent context, characterised by increasing diversification (which is often not recognised by the dominant medical authority of the NHS).Rigorous randomised controlled trials, the gold standard for the provision of evidence for medical care, have demonstrated that CAMs are effective, yet the Medical model of care still does not always allow for the value of such treatments, and they are treated as ‘fringe’ medicine. Because of this, and because of the general standards of regulation and surveillance of medical care, very few complementary therapies are provided as a matter of course within the NHS, despite some therapies, such as Homeopathy, having a history of regulation and care provision going back to 1844 (Nicholls in in Lee-Treweek et al). The training of CAM practitioners has also changed, with a more rigorous training process which reflects professional education processes and principles, and some standardisation (though not national standardisation) of education and standards. However, one therapy which is provided in this context is osteopathy. The changing face of medicine has both served the inclusion of CAMs within the NHS and served to bring about regulation by aligning the training and provision of such therapies with the principles which have governed medicine and medical practice in the UK (Heller et al, 2005). The concept of health has also evolved (Cant, in in Lee-Treweek et al; Heller et al, 2005). This has led to the emergence of integrative medicine, in which CAM practitioners work in conjunction with multi-disciplinary healthcare teams which manage patient care in an holistic and comprehensive manner (Cant, in Lee-Treweek et al). Obviously, this is the ideal from the point of view of the service user, because the hitherto unchallenged medical model of health has been replaced by a growing understanding of the complex nature of health and illness and the similarly complex responses required from those charged with promoting health and treating illness, disease and injury (Cant, in Lee-Treweek et al). However, this has had what some view as a negative effect on CAM provision. As Heller et al (2005) state, “the growth of ‘integrative medicine’ represents an undermining of counter-cultural values, as more holistic paradigms based on challenging orthodox biomedical or ‘scientific’ theories may become displaced proximity to the dominant biomedical systems†(P xiii). Another issue is that as CAMs become more prevalent within ‘normal’ medicine and health, medical and nursing staff who are asked to advise on these therapies may not have been able to maintain current knowledge of the evidence about these therapies (Heller et al, 2005). One of the potential benefits of this influence, however, is that of ensuring patient safety. Heller et al (2005) state clearly that patients must make informed choices about such therapies, and should be able to have the information to evaluate the safety of the practitioner and the therapy. This is evident in the ways in which most people access CAMs, through private practice, through seeking out treatment and evaluating which practitioners of which therapies to access (Heller et al, 2005). However, there is such a diversity amongst many practitioners of sources of training and regulation that for many therapists, having a certificate of membership of a ‘professional’ organisation is no guarantee of quality or of redress should the service user be dissatisfied with or harmed by the therapy provided. The author has anecdotal evidence of discussions with medical doctors who believe that CAMs practitioners are dangerous, poorly regulated, and represent a danger to the public by preventing sick people accessing or utilising medical healthcare services. This is a rather limited view, but one which signifies certain areas of public opinion, which in turn reflects the ways in which many therapies have not been regulated, evaluated through rigorous testing, or been subject to the same kinds of quality control and surveillance as conventional medicine. Osteopathy, however, is regulated by Acts of Parliament in a similar fashion to medicine, nursing and allied healthcare professionals, and is described as one of the ‘big five’ of the CAMs, which have a better reputation and standing within conventional medicine (Heller et al, 2005). It is this regulation which is supposed to protect patient safety and safeguard the interests of service users, but it also serves other purposes. Stone (1996) argues that regulation is not merited by the majority of therapies and would be inappropriate for therapies which are too different from medicine. Regulation ensures that the profession itself has a better professional status, that all its practitioners are trained in a similar manner, and provides support, guidance and legal support to practitioners. This suggests an increased level of responsibility and accountability, because professional bodies maintain agreed and defined standards. Therefore, in terms of informed choice, any service user can be assured that any practicing osteopath is subject to the same standard of training and the same regulation, and so should be ‘safe’ to access, much in the same way as medical care is accessed. Thus regulation may safeguard patient safety by being required to formally adhere to ethical principles. Heller et al (2005) describe the requirements of professional ethical practice as: “a duty to tell the truth; a duty to act honestly and fairly; a duty to respect people’s wishes, and not to treat people as a means to an end, but as individuals with rights; a duty not to harm people;…[and the right] not to be harmed [and] not to be lied to.†(p 85). While these may be considered general human rights they are augmented by principles which are generally agreed to underpin healthcare, including the principles of beneficence and non-maleficence (Heller et al, 2005). It could be argued that no therapy should be provided, therefore, which does not have proven benefits to the patient, and is proven to do no harm to the patient. Professional regulation may serve this purpose, because it professionalises the therapy and demands acceptable standards of evidence to demonstrate these features. But only therapies which can provide this standard of evidence would be regulated (Stone, 1996) which could have detrimental effects on the status and reputation of more esoteric therapies which cannot be subject to the kinds of evidence that underpins medicine. Voluntary regulation may be the answer: “Consumers will best be protected by a dynamic, ethics-led approach to voluntary self-regulation in which high standards of practice together with visible and effective disciplinary procedures are given higher prominence than the pursuit of professional status (Stone, 1996 p 1493). In conclusion, this author believes that regulation, either statutory or voluntary, holds practitioners accountable and serves the interest of consumers by demonstrating that those providing CAMs are at the least educated to some kind of agreed standard, and by offering consumers a means of redress should they be dissatisfied with their treatment. However, only statutory regulation would give proper redress, but in the current legal context, there is so much legislation protecting the interests and rights of consumers of goods and services that there is plenty of room for redress through other means. Only statutory regulation could offer assurances of safety, but this is not suitable for all therapies (Stone, 1996). References Heller, T., Lee-Treweek, G., Katz, J. et al (2005) (eds). Perspectives on complementary and alternative medicine. Milton Keynes: Open University Press/Routledge. Stone, J. (1996) Regulating complementary medicine: standards, not status. BMJ 312 1492-1493.
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12/12/2019 0 Comments All Quite on the Western FrontHIST 234 March 21 All Quiet on the Western Front All Quiet on the Western Front is narrated by Paul Baumer. Paul was only a nineteen year old fighting in the German army on the French front with some of his classmates: Albert Kropp, the clearest thinker among them; Muller, a physics-inclined academic; and Leer, who wears full beard and lusty nature for girls. Their friends include Tjaden, a skinny 19-year-old locksmith who love to eat; Haie Westhus a large peat-digger, also 19; Deterring, a married peasant; and Stannislaus Katczinsky their wise and crafty 40-year-old leader.Page 3 they all joined the army voluntarily after listening to the stirring patriotic speeches from their teacher, Kantorek. But after experiencing ten weeks of brutal training at the hands of the petty, cruel Corporal Himmelstoss and the unimaginable brutality of life on the front, Paul and his friends have realized that the ideals of nationalism and patriotism for which they enlisted are simply empty line. They no longer believe that war is glorious or honorable, because they live in constant physical terror.At the very beginning of the book Erich Maria Remarque says “This book is to be neither an accusation nor a confession, and least of all an adventure, for death is not an adventure to those who stand face to face with it. It will try simply to tell of a generation of men who, even though they may have escaped shells, were destroyed by the war. †Page 0 This novel does not focus on daring stories of bravery, but rather gives a view of the conditions in which the soldiers find themselves. According to the writer “no one has the vaguest idea what we are in for. The wisest were just poor and simple people.They knew the war to be a misfortune. †page 11 The monotony between battles, the constant threat of artillery fire and bombardments, the young soldiers struggle to find food and the lack of training of young recruits meaning lower chances of survival. In the novel the author writes “our early life is cut off from the moment we came here and that without our lifting a hand†page 19. The young soldiers would often look back and try to find explanation but never quite succeed, since they consider themselves young and extraordinary vague because they were in the 20’s they only had their parents and maybe a girl, hich was not consider too much influences. Whereas older men have a strong background that cannot be destroy, they linked to various life for example they had a family, wife, children, occupations, interest and a background which was strong, which means that war cannot destroy their memory of family. During the war soldiers spent their time on the front line, in an infantryman and in front line trenches. The working conditions became very predictable since it was spent mostly in the trenches. Soldiers recall the boredom of life in the dreary, lice-ridden, diseases spreading, muddy and dusty trenches.The writer describes the unsanitary conditions of life at the front as Tjaden, tired of killing lice one by one, scrapes them off his skin into a boot-polish tin. He kills them by heating the tin with a flame. Haie’s lice have red crosses on their heads, and he jokes that he got them at a hospital where they attended the surgeon general. Paul remembers he and his friends were embarrassed to use the general latrines when they were recruits but now they find them a luxury. With Behm’s death, Paul and his classmates lost their innocent trust in authority figures such as Kantorek.Kantorek writes a letter to them filled with the empty phrases of patriotic fervor, calling them “Iron Youth†and glorifying their heroism. The men reflect that they once idolized Kantorek but now despise him; they blame him for pushing them into the army and exposing them to the horror of war. They would wake up middle of the night by hearing loud booms. According to Paul he believed that they “have lost their senses of other consideration because they are artificial since only the facts are real and important to them.Page 21 As Paul sits with Kemmerich who knew his leg has been amputated, he tries to cheer him up, but Kemmerich is convinced he will die, Paul has seen friends die before, but growing up with Kemmerich makes life harder, the orderlies were not helpful, and when they return, Kemmerich has died. Paul collects his things and they remove the body to free up the bed for more wounded. As younger soldiers arrived, Paul and his friends feel like mature veterans. Paul believes every company has one or two resourceful people, but Kat, a cobbler by trade, is the smartest he knows. Page 37.Paul is glad to be his friend, and tells a story to illustrate his strength as a leader. For example Kat, bunking in a small, ravaged factory one night, Kat finding straw for the men to sleep on, and when they are hungry with no food, Kat goes off again and returns with bread and horse-flesh without providing an explanation. page 37 It was assumed that Kat's sixth sense help locating food and his special talent. As men return from the fronts, they see the shells shattered and coffins pilled by the dozens, however they made jokes in order to distance themselves from the unpleasant knowledge that coffin are made for them.Their first front was completely demolished by a direct hit and the second only to discover it has been buried. Captured Russian soldiers, who are reduced to picking through the German soldiers’ garbage for food, which means there might not be any food in the garbage. Food is so scarce that everything is eaten. Looking at the Russian soldiers, Paul can scarcely believe that these men with honest peasant faces are the enemy. Since nothing about them suggests that he is fundamentally different from them or that he should have any reason to want to kill them.Many of the Russians are slowly starving, and they are stricken with dysentery in large numbers. But most people simply ignore the prisoners begging, and a few even kick them. When Paul returns to the front, he finds Kat, Muller, Tjaden, and Kropp still alive and uninjured. He shares his potato cakes with them. There is excitement among the ranks: the Kaiser, the emperor of Germany, is coming to see the army. In preparation for his visit, everything is cleaned thoroughly, and all the soldiers are given new clothes.But when the Kaiser arrives, Paul and the others are disappointed to see that he is not a very remarkable man. After he leaves, the new clothes are taken away. Paul and his friends muse that if a certain thirty people in the world had said “no†to the war, it would not have happened. They conclude that wars are useful only for leaders who want to be in history books. During the Great War millions men lost their lives in one of the greatest acts of barbarity the world has ever seen. The heroism and sacrifice of troops in the trenches is probably without parallel.The pretexts for execution for British soldiers had a common theme: many were suffering shell shock or now recognized as Post Traumatic Stress Disorder. Most of those men were young, defenseless and vulnerable teenagers who had volunteered for duty. Millions of men lost their lives fighting for war and millions of men came home without a leg, an arm, or blind, or deaf, or mentally broken due to the things they had to live through in the trenches. Others had their lives cut short through the effects of poison gas, and injuries due to blast, with collapsed lungs.While others came home whole in body, appearing normal, but with such serious nervous and mental conditions that they could not work, and were confined to mental hospitals for the rest of their lives. It should be noted that most, especially on the Allied side, later believed the war to have been worthless. Technological and military innovations such as poison gas, the machine gun, and trench warfare revolutionized combat during World War I, and Remarque effectively dramatizes how these innovations made the war bloodier, longer, and more costly.In almost every case, military innovations make the soldiers’ lives more dangerous, while medical innovations lag increasingly far behind. Kemmerich, for instance, dies from complications from a relatively light wound. Glory and patriotism cease to be rational ideals in the conflict because advanced technology limits the effect that an individual soldier can have on the conflict and alienates him from the consequences of his actions. Life and death thus become meaningless.
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