Reiki, views on CAM, and inroads into pharmacy

A practitioner considers Reiki to be 'beyond massage therapy.'

Bugs, bikes & brains opines about CAM treatments:

As a member of the media and a sometimes PR person myself, I recognized the "article" for what it was - an ad. I informed the author of the MS website of what he had just published and what it actually was, and he removed it from his site.

Am I against alternative therapies or complimentary medicines? Generally, no. If it works for you, it's not draining your pocket book at the expense of "proven" medicine, and it does no harm to you, then go for it. But remember, most of these therapies or supplements or regimens are not FDA approved (Health Canada in Canada) nor have they any scientific evidence to back them up. As a matter of fact, the website I was directed to, said at the very bottom in small print that nothing on that website had been approved by the FDA. But too many CAMS (complementary and alternative medicine) rely on anecdotal evidence to prove they work.

People with catastrophic illnesses or situations are targeted because many are desperate for a cure or relief from symptoms. As a student of science and the scientific method, I have a healthy skepticism about any treatment or supplement touted to be the "next great cure". Any time I come across these things, I check to see what studies have been done to back up the claims. No scientific studies, no consideration on my part.

If a CAM has a plausible mechanism of action, I will consider it. And chances are good, that if it has a plausible mechanism of action, there are probably current studies under way to determine effectiveness. For example, evening primrose oil has been recommended to me (and other MSers) as a supplement to help with MS symptoms. Turns out that the oil contains essential fatty acids (the good fats) necessary for good health and body function. So a recommendation to take evening primrose oil supplements has merits. But rather than spend money on the supplement, I choose to add nuts and seeds to my diet as a source of both protein and the essential fats I need.

If you want to go beyond massage therapy, try Reiki:

Reiki is a form of complementary and alternative medicine (CAM), similar to the laying on of hands, which channels the universal life force or ki (chi) though the palms into a recipient. The healing energy is intended to open blockages in the body's meridians and to restore energy to depleted areas of the body and aura. This holistic therapy can bring about healing on physical, mental, emotional and spiritual levels.

Developed in 1922 by Mikao Usi in Japan, reiki teachings claim that this "healing energy" is an inexhaustible, universal "life force". Anyone can tap into this spiritual energy which restores our perfect self, reminding each cell of its' God given perfection and induces a healing effect.

A typical Reiki treatment lasts from 45 to 90 minutes with the recipient lying on a massage table wearing loose, comfortable clothing. The practitioner places her hands either on the recipient or a few inches above the body in various positions. The practitioner allows the energy to be drawn through them into the recipients body for the purpose of healing an injury or restoring vitality. Recipients often feel warmth or tingling in the area being treated, even when a non-touching approach is being used. The Reiki treatment is said to be stimulating our natural healing processes. A state of deep relaxation, combined with a general feeling of well-being, is usually the most noticeable immediate effect of the treatment, although emotional releases can occur.

The teaching of Reiki is commonly divided into three levels:

Level I teaches the basic theories and procedures. Four "attunements" are given to the student by the teacher. Students learn the hand placement positions on the recipient's body that are thought to be most conducive to the process in a whole body treatment. Participants finish ready to treat themselves and others with Reiki.

Level II teaches the student to use more Japanese symbols which are said to enhance the strength and distance over which the effect can be exerted. Another attunement is given, which is said to further increase the capacity for Reiki to flow through the student, as well as empowering the use of the symbols. Having completed the second level, the student can work without being physically present with the recipient

Level III further attunes the student and passes on a master-level symbol. Upon completion, the new Reiki Master can attune other people to Reiki and teach the three degrees of Reiki.

Reiki can be used to complement conventional medicine but should not replace clinically proven treatments for serious conditions.

An article addresses Integrating Complementary and Alternative Medicine Education Into the Pharmacy Curriculum:

Objectives. To evaluate the effectiveness of an integrated approach to the teaching of evidence-based complementary and alternative medicine (CAM) in a pharmacy curriculum. Design. Evidence-based CAM education was integrated throughout the third, fourth, and fifth years of the pharmacy curriculum. Specifically, an introductory module focusing on CAM familiarization was added in the third year and integrated, evidence-based teaching related to CAM was incorporated into clinical topics through lectures and clinical case studies in the fourth and fifth years.

Assessment. Students' self-assessed and actual CAM knowledge increased, as did their use of evidence-based CAM resources. However, only 30% of the fourth-year students felt they had learned enough about CAM. Students preferred having CAM teaching integrated into the curriculum beginning in the first year rather than waiting until later in their education.

Conclusion. CAM education integrated over several years of study increases students' knowledge and application.

Keywords: complementary and alternative medicines, curriculum, evidence-based education

INTRODUCTION

More than 50% of the world's population uses complementary and alternative medicine (CAM), mostly in combinationwithconventionalmedication.Thereisgrowing evidence outlining the benefits as well as the possible adverse and side effects of CAM.1 As primary care providers, pharmacists are both accessible to patients and one of the most trusted healthcare professionals. As such they are at the forefront, providing information and guidance to patients about safe and effective use of all medicines.

Pharmacists generally rate their knowledge relating to CAM as inadequate and are not confident in answering patient inquiries.2-5 A survey among Australian community pharmacists showed that 57% of the pharmacists stated that their training had not met their needs regarding CAM knowledge, that they relied heavily on manufacturers' information about CAM, and that their lack of suitable training was one of the perceived barriers to information provision about CAM.6

Studies surveying pharmacy schools in the US concluded that while approximately 80% of schools offer some form of CAM training in the curriculum, CAM education was primarily offered as electives and generally focused on natural products rather than the full range of CAM practices.7-9 Similar to the studies in the US, the extent to which CAM is taught and integrated varies widely among Australian and New Zealand pharmacy schools, which is partly because in Australia the integration of CAM into pharmacy and medical curricula is not mandatory and is handled quite differently at various institutions.10-12

Importantly, most surveys of medical and pharmacy students revealed that the majority of students welcomed the inclusion of CAM education in the medical13-16 and pharmacy curricula.17,18 However, most of the studies indicated that students had insufficient knowledge to be able to recommend or counsel about CAM.13,19

By interviewing practicing Australian community pharmacists, Semple et al identified the need for integrated, nonbiased, evidence- based undergraduate CAM training that is not conducted by CAM manufacturers.6 Such findings support the debate to integrate CAM training as a core component into health professional education instead of offering it as electives, as it will provide students with the expected knowledge.9 Moreover, an elective course could be seen as marginalizing CAM in the minds of students and staff members as a fringe topic only appealing to a few.20 Integrated CAM education provides students not only withCAMspecific knowledge, but also encompasses much broader themes, encouraging them to think outside the box, thus promoting critical evaluation of the evidence.11,21 As such, integrated CAM education can be the "bridge between allopathic medicine and CAM,"22 thus closing the gap between the 2 streams of healthcare and allowing medical pluralism, which is demanded today by patients and students alike.21,23

The integration ofCAMeducation into existing pharmacy curricula aims to increase the understanding and knowledge ofCAMmodalities by broadening students' horizons and instilling a greater acceptance and appreciation of patient choices to achieve better health outcomes....

DISCUSSION

Other studies suggest that medical students have insufficient knowledge to be able to recommend or counsel about CAM.13,19 Moreover, surveys of medical and pharmacy students indicate that the majority of students welcome the inclusion of CAM education in the medical13-16 and pharmacy curricula.17,18

Although schools offering elective CAM education report positive results, such as increased self-assessed knowledge and more positive attitudes towards CAM,30,31 such outcomes pertain only to the students who chose to take the elective. Given that higher self- awareness,24 improved core competencies for conventional health professionals, enhanced cultural competency, and patient centred care have been reported for health professionals with CAM knowledge,25 CAM curricula development should focus on integrated CAM education rather than on standalone elective courses -a notion that is supported by an increasing number of academics.20,25,33

Moreover, a clear comparison between different curricula is impossible because of the lack of an objective measure of knowledge or skills.32,42,43 That is, changes in perceived knowledge, skills, or both may not necessarily translate to actual changes in knowledge or skills.38 Furthermore, some educators reported an attitude change but no knowledge change towards CAM with increasing education.44

Our study investigated students' prior CAM knowledge, self- assessed CAM knowledge, and actual knowledge using an objective knowledge test. We found that less than 10% of pharmacy students had a qualification in complementary medicines and less than a third received some sort of CAM training external to the University, which highlights the necessity for sufficient CAM education during a professional pharmacy degree. Furthermore, our evaluation shows an increase in self-assessed knowledge in the fourth year, and a significant boost in knowledge scores in the fourth-year cohort compared to other cohorts. Increased self-assessed knowledge was also reported by students following a 3-week elective CAM rotation offered as part of their medical curriculum.30 Furthermore, a study integrating CAM training as a 4- week "CAM camp" into a nursing curriculum gave mixed (survey) and more positive results (interviews) regarding the students familiarity with CAM modalities.31 However, objective measures of knowledge gain were not utilized in both studies.

In our study the knowledge scores corresponding to more CAM education in the curriculum increased significantly; however, only a third of the fourth-year students thought they had learned enough about CAM. An additional survey with a detailed analysis regarding the adequacy of the length, coverage, and timing of specific CAM topics is anticipated to aid in a detailed understanding of students' responses to this question. However, qualitative data indicated that students seemed relatively satisfied with the amount of CAM education in our educational setting, but commented on the need for increased contact time to allow for in-depth training and application. This seems to relate to a study investigating healthcare professional's knowledge reporting on deficits, especially in knowledge relating to adverse effects, confidence in reporting side effects, routine communication with patients about CAM, and the reporting of CAM information in the medical record.45 Students suggested the integration ofCAMeducation from the first year onwards, as has been previously recommended by other authors.20,34 Such a change would potentially increase the proportion of fourth-year students that feel they have learned enough and improve learning outcomes as more time could be spent rehearsing and applying CAM knowledge.

Strategies to includeCAMeducation into the first and second year are being currently identified, with implementation anticipated in the near future. Moreover, the suggested extension of the third- year module from 6 weeks to a full semester would allow for more CAM familiarization before the clinical subjects and should be discussed.

Previous surveys reported different CAM information sources used by student health professionals. For example, some papers found the Internet as the main CAM information source for students,42,44,46 whereas others clearly highlighted family and friends as the primary information source.43

In our study, the distribution of students using specific evidence-based information sources shifted from third to fourth year, with a significantly higher proportion of fourth-year students using professional handbooks, whereas the use of peer-reviewed articles and reviews (eg, PubMed and Cochrane) declined significantly from third to fourth year. The higher use of PubMed and Cochrane in the third year may be due to these online resources being introduced and highly promoted as CAMresources in the third- year module. Such a "recency effect" was also reported by Lie et al who concluded that there is a need to repeat teaching of online information on CAM later in the curriculum.42 Moreover, the high usage of clinical handbooks as a CAM resource by fourth-year students was probably due to an increase in clinical teaching and awareness of professional guidelines, and highlights the importance of having up-to-date CAM content in professional pharmacy handbooks and formularies.

Our students frequently used CAM coursework material as a source of information (58%-90%), which is in contrast to other studies which reported that formal training or coursework was only used by up to 38% of pharmacy students.47 Our study also revealed that the placement experience is not sufficiently utilized for CAM training, possibly due to limited exposure of students to CAM problems and the limited CAMknowledge of some preceptors. The utilization of the placement for CAM education should be further investigated especially as a study investigating herbal medicine education highlighted the desire of students for practice-related information.48 Considering that positive clinical experiences are more likely related to how valued and supported students feel rather than the physical aspects of a placement, it is imperative that educators assess how the placements/preceptors chosen by the students offer a supportive learning environment.49

In Australia, a national strategy for pharmacy preceptor education and support has been developed for online and CD-ROM delivery.50 It contains general and specific advice including ethics, expectations, types of teaching, and learning activities, but it does not focus on specific clinical content, as this is usually covered by continuing professional education (CPE) seminars. However, CPE seminars focusing on CAM are rare. A specifically designed CAM training program for preceptors would prepare pharmacists for their role as educators, thereby improving educational outcomes for students, while also improving outcomes in pharmacy practice. For example, a study of community pharmacists, who had undergone a specific educational intervention to provide specialized asthma care demonstrated the effectiveness of an educational approach, inducing behavioral changes in pharmacypractitioners resulting in improved patient outcomes.51

Multiprofessional education for health professionals is feasible and results in positive learning outcomes such as increased interprofessional collaboration, improved communication skills, mutual respect, increased confidence levels, increased understanding of others' professional roles, and personal development.52-54 Research into interprofessional and multiprofessional education specifically focusing on CAM training is lacking, although the basis for its importance exists. For example, some community pharmacists have reported that doctor's disagree with their CAM recommendation, possibly due to insufficient information,6 leading to confusion and noncompliance by the patient. However, the content of multiprofessional training must be carefully evaluated as differences in educational preferences and needs among health professional students exist. In our study, students reported significantly more complementary medicine than complementary therapy knowledge use in their placements. This reflects the results from previous studies showing that pharmacy students prefer education in complementary medicines over complementary therapies, whereas medical and nursing students preferred education in specific complementary therapies.18,47 Nevertheless, an overlap of CAM skill and knowledge base among health care practitioners is optimal for high-quality patient care and should therefore be designed and evaluated for existing and future health professional curricula.

Given the consumer-driven development towards holistic and integrative healthcare,23 clinical knowledge including beneficial effects of CAM, as well as compounding training using ingredients regarded as complementary medicine, are a high pharmaceutical education priority55 that might be essential for future registration as a pharmacist. Thus, firm recommendations and required competencies from professional and educational bodies to assist CAM curriculum development are urgently needed.6,8,48

Further development of the CAM curriculum in our School of Pharmacy will focus on integrating CAM education into the pharmacy curriculum from the first year of study, expanding CAM familiarization at the third-year level, enhancing the integration of CAM into clinical cases, designing placement exercises, and developing preceptor CAM training, as well as conducting research into multidisciplinary teaching of CAM in undergraduate curricula for health professionals. Nevertheless, theCAM education described here could be adapted by other pharmacy schools. At a minimum it should provide the impetus for an open debate regarding what level of CAM education is sufficient in pharmacy curricula.

CONCLUSION

An integrated CAM teaching approach was effective in generating knowledge of generalCAMphilosophies and specific CAM modalities. It influenced CAM knowledge use during placements and students' use of evidence-based CAM resources. Students would prefer integrated evidence- based CAM education throughout their program of study. Further research into the content and focus of CAM education is necessary tomeet the educational needs of our future pharmacists.

An unexceptional conclusion but research that shows inroads of CAM into the pharmacy profssion.