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American Journal of Public Health | October 2002, Vol 92, No.
101604 | Research and Practice | Peer Reviewed | Lewith et al.
RESEARCH AND PRACTICE
CONCLUSIONS
Where does all of this leave us when at-
tempting a riskbenefit analysis? On one side
we have uncertain benefits; on the other we
must consider common nonserious adverse
effects as well as serious complications that
occur at an unknown rate. Given this situa-
tion, a tentative riskbenefit analysis cannot
produce a positive result. The conclusion
must therefore be that, according to the evi-
dence to date, chiropractic spinal manipula-
tion does not demonstrably do more good
than harm. In view of the incompleteness of
our current knowledge and the popularity of
chiropractic, research into this complex area
should be intensified.
About the AuthorThe author i s with the Department of
Complementary
Medicine, School of Sport and Health Sciences, Uni versity
of Exeter, England.
Requests for reprin ts should be sent to E. Ernst, MD,
PhD, FRCP, Depar tment of Complementar y Medicine,
School of Sport and Health Sciences, Uni versity of Exeter,
25 Vi ctoria Park Rd, Exeter EX2 4NT, England (e-mail:
[email protected]).
This brief was accepted May 27 , 20 02.
Human Participant ProtectionNo protocol approval was needed for
this study.
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Hays R, Shekelle PG. Patients using chiropractors in
North America. Spine. 2002;27:291298.
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alternative medicine: a systematic review. Bull World
Health Organ. 2000;78:252257.
3. Shekelle PG, Adams AH, Chassin MR, Hurwitz
EL, Brook RH. Spinal manipulation for low back pain.
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4. Meeker WC, Haldeman S. Chiropractic: a profes-
sion at the crossroads of mainstream and alternative
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Do Attitudes Towardand Beliefs AboutComplementaryMedicine
Affect
Treatment Outcomes?| George T. Lewith, MA, DM, FRCP, MRCGP,
Michael E. Hyland, PhD, BSc, and StephenShaw, PhD, MSc
Many patients seek help from practitioners of
complementary and alternative medicine
(CAM). Patients prior knowledge of CAM and
desire for egalitarian relationships with med-
ical practitioners have been shown to increase
CAM use,1,2 as have higher scores on the Ab-
sorption scale (a measure of anxiety and self-
absorption).3 Other personality scales do not
predict CAM use.4
Although users of CAM might not agree, a
common view among scientists is that CAM
outcomes are mediated through a placebo ef-
fect5,6; that is, patients improve because they
expect to do so. Our aims in the study de-
scribed here were to assess the validity of the
Attitudes toward Alternative Medicine Scale
(AAMS) and to determine whether asthmatic
patients who had positive attitudes toward
and beliefs about CAM showed greater posi-
tive changes in outcomes.
METHODS
During 1996 through 1998, we conducted
a randomized, double-blind, placebo-
controlled trial among 327 patients allergic to
house dust mites. The study, which took place
in the counties of Hampshire and Dorset in
England, was designed to evaluate the effects
of a homeopathic dilution of this allergen.7
Patients completed the AAMS and the Posi-
tive and Negative Affect Scales (PANAS) on 2
occasions: 4 weeks before and 16 weeks after
study randomization. Higher scores on the
AAMS indicate more positive attitudes to-ward CAM.8,9 Higher
scores on the 2 sub-
scales of the PANAS indicate higher levels of
the variable assessed (i.e., positive or negative
affect).10
Spirometry and a measure of quality of
life (the Asthma Bother Profile [ABP]11) were
completed at baseline and at 6, 12, and 16
weeks. Patient diaries were completed on al-
ternate weeks throughout the 20-week
study; these diaries included information on
diurnal peak expiratory flow, among other
outcomes.7 Spirometry, peak expiratory flow,
and ABP scores were the primary outcomesassessed.
The AAMS has received only limited vali-
dation, so we carried out a factor analysis.
Correlationsof baseline AAMS scores with all
other baseline values were computed to de-
termine whether personality factorsor asthma
severity determined attitudes toward CAM. To
test whether beliefsor other baseline factors
predicted outcomes, we calculated spirometry,
ABP, and peak expiratory flow change scores
(final scoresminusbaseline scores).Three
multiple regression analyseswere conducted
with each of the 3 change variables in turn as
the dependent variable; all baseline variables
were considered independent.
Pearson correlations for the 2 AAMS
scores (prerandomization and postrandomiza-
tion) were calculated to examine AAMS score
changes. Changes in AAMS scores were cor-
related with changes in peak expiratory flow,
spirometry, and ABP scores. An analysis of
variance compared baseline and posttreat-
