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The MedSchool Project: EPQ Project: To What Extent Should Traditional Chinese Medicine Be Available as a Complementary and Alternative Therapy in the NHS for Pain Relief in Palliative Care?
After a gruelling months-long wait for exam results, I proudly announce that my EPQ (Extended Project Qualification) has officially been graded an A*! The EPQ has definitely helped me to become a much more critical and reflective person as well as improving myself as an independent learner. My first idea for a topic is to determine the extent to which complementary and alternative medicine (CAM) should be used in the NHS.
The problem with conventional medicine is that it was not always treating the patient holistically and in some patients, it could create further health problems such as liver or kidney damage if the drugs given are toxic amongst other side effects such as nausea, vomiting, etc. My first ideas for the research and development of the project were to research and compare the recovery times of patients who are being treated using complementary and alternative medicines against those who are being treated on conventional medicines. We have garnered a strong position for ourselves in the global market for manufacturing an ayurvedic remedy for the most common disease faced by people these days, i.e. Complementary and alternative medicine, also known as CAM, has had a long and controversial history. There are different types of CAM (see Figure 1), placed into discrete categories according to how they work: biologically-based therapies that involve the consumption of products, energy therapies that consist of channelling healing energy, mind-body interventions that use the mind to create a positive effect on the body and manipulative therapies that involve the movement or manipulation of the body.
Traditional Chinese Medicine, or TCM, is a whole medical system that has received controversy recently (see Figure 2) due to an absence of regulation, lack of scientific basis, use of animal products in its medicinal treatments and the toxicity of some of the herbal medicines used. Amidst all the controversy, according to the Oxford Handbook of Palliative Care and the Nursing Times, it is becoming more frequently used by patients (Ernst & White, 2000), especially terminally ill patients, for pain relief, for many reasons, including desperation and the many side effects of conventional medicine. Palliative care is a branch of medicine that aims to prevent and relieve suffering and to support the best possible quality of life for patients with advanced, progressive or life-limiting conditions, many of whom are terminally ill. Although there are many different types of pain, the one thing, however, that is common in all patients with pain is that pain limits the patient’s quality of life, and this is why it is very important for patients to achieve analgesia, the state of being pain-free. Pain can also be controlled by CAM, the main principles of which usually involve a holistic therapy (the whole body is being treated, not just the cause of an ailment) and the support of physical, psychosocial and emotional factors. These holistic principles make CAM increasingly popular with patients, with an average of 40% of patients with life-threatening or chronic illness using CAM compared to 28% of the general UK population (Watson, et al., 2005). Some reasons for an increased reliability on CAM include the holistic nature of the therapy, dissatisfaction with conventional medicine being ineffective, side effects of conventional medicine, poor patient-physician relationship, long waiting lists, desperation and rejection of orthodox medicine (see Figure 4).
Information such as evidence for the efficacy or the QALY of a therapy would be considered.
For example, acupuncture, which is part of Traditional Chinese Medicine, has already been approved to be used in the NHS for the early management of persistent non-specific low back pain.

This study has been done to determine the extent to which Traditional Chinese Medicine should be available in the NHS as a complementary and alternative therapy to treat pain in palliative care patients. This will involve researching how TCM is used in pain relief, including its risks and benefits; how cost-effective TCM is, including a comparison between conventional medicines and whether freedom of choice of therapy is more important in palliative care pain relief than the cost of the drug.
From early on in the project, I predicted that TCM will be more expensive and less cost-effective than conventional medicine and that this has been a barrier for its acceptance onto the NHS, but that people will feel that freedom of choice is very important. For those of you who do not know what an EPQ is, it is a research project which involves a self-directed project of my own choice and design. Throughout the project, I have had to further my planning, research, analysis, evaluation and presentation skills as well as help me learn to apply problem-solving skills when I encounter problems.
Having done work experience at the general ward of a local hospital, I was not surprised that all of the patients were being treated with only conventional medicine, however they were causing further problems in patients. However, complementary medicine may not always work, and it is often difficult to gauge how well they work. I also wanted to look in to the costs of alternative and complementary medicine compared to conventional medicine, to weigh up the cost-effectiveness of the medicine, compared with its efficacy, and to ascertain whether the more holistic use of alternative and complementary medicine is better than conventional medicine for certain aspects of medicine such as palliative care.
The topic did not allow me to research a small area in great depth and so he advised me to narrow down to subjects that I would find easy to research - topics to which I would have access to information - and would not pose any issues with confidentiality.
I was wondering if you have an example on how to write the research review as i am struggling on that part of the project?
The Oxford Handbook of Complementary Medicine states that if CAM is used alongside conventional medical treatment, then the therapy or treatment is used as a complementary treatment. Palliative care also involves enhancing the quality of life and helping patients to live as actively as possible, and alleviating the side effects of medication, like chemotherapy. This can be achieved using analgesics, painkilling drugs, which are given on an analgesic ladder (as pain increases, the medication given is also increased and adjuvants, additional medication to increase the benefits of the analgesics are given). However, there are many reasons, more than just the treatment’s efficacy (how well it works), which allows a therapy to be approved on to the NHS by the National Institute for Health and Clinical Excellence (NICE). The QALY or the quality-adjusted life year is a measure of how much long a quality life a patient can be expected to gain from having the therapy, taking into account a patient’s well-being, independence and other factors.
But why is not Traditional Chinese Medicine approved, especially for something as important to quality of life as for pain relief?
This will be done through surveys, interviews and careful consideration of existing literature. No patients were being given natural products or herbs or other interventions such as acupuncture, to help with the recovery and to decrease the amount of conventional drugs needed.

My initial project idea would determine the extent to which these unconventional medicines should be available for all NHS patients.
He also commented that although the project has a lot of potential, I should take great care in narrowing down to a more specific topic, since the one I chose may have sensitive and controversial undertones. Our Ayurvedic Diabetes Medicines are safe and does not contain nay kind of harmful chemical or steroid. CAM comprises a group of diagnostic or therapeutic systems of healthcare that is separate from conventional medicine (also known as western medicine).
However, if CAM is used instead of conventional treatment, then the therapy is described as alternative medicine. Palliative care neither aims to prolong or curtail the lifespan of the patient (Watson, et al., 2005), but is mainly concerned with maximising the quality of life of patients through the management of symptoms (see Figure 3), especially pain, which is the most frequently seen symptom in palliative care.
These medications do, however, carry side effects, which often push people away from conventional medicine.
Other factors are taken into account including the benefit to the patient, cost and cost-effectiveness and whether the therapy would help the NHS achieve set targets, gaining information and evidence from doctors, drug companies and patients. Indeed, TCM does have its own system of diagnosing and treating pain that is vastly different to conventional medicine, but if palliative care is all about reducing symptoms like pain, then perhaps TCM should be approved as a method of pain relief in the NHS. He also advised me to narrow down to focusing on the extent in which alternative and complementary medicine should be used in end of life care, because the issue of alternative medicine becomes a lot more significant in patients who are at the end of life.
Good for people suffering from diabetesMadhumehari Granules : Effective remedy for diabetes. Conventional medicine is distinct from CAM because of its evidence-based or scientific nature as opposed to a set of cultural practices that may be seen in CAM. Others may refer to CAM being used to help maximise the benefits of conventional treatment, and this is known as integrative medicine.
50% of all cancer patients experience some level of pain (Running & Turnbeaugh, 2011) and many patients are increasingly relying on an integrative approach of CAM to achieve a state of analgesia.

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