People with epilepsy (PWE) are less physically active compared with the general population. Explanations include prejudice, overprotection, unawareness, stigma, fear of seizure induction and lack of knowledge of health professionals. At present, there is no consensus on the role of exercise in epilepsy. This paper reviews the current evidence surrounding the risks and benefits associated with physical activity (PA) in this group of patients. In the last decade, several publications indicate significant benefits in physiological and psychological health parameters, including mood and cognition, physical conditioning, social interaction, quality of life, as well as potential prevention of seizure presentation. Moreover, experimental studies suggest that PA provides mechanisms of neuronal protection, related to biochemical and structural changes including release of β-endorphins and steroids, which may exert an inhibitory effect on the occurrence of abnormal electrical activity. Epileptic discharges can decrease or disappear during exercise, which may translate into reduced seizure recurrence. In some patients, exercise may precipitate seizures. Available evidence suggests that PA should be encouraged in PWE in order to promote wellbeing and quality of life. There is a need for prospective randomized controlled studies that provide stronger clinical evidence before definitive recommendations can be made.

For countries faced with much talk but little action on healthcare reform, China’s National Health Guiding Principles (CNHGP), with its 60-year history, may provide a new perspective. There are four values of CNHGP for healthcare reform. First, these principles provide an innovative strategic framework for healthcare reform with three levels, from ‘One priority population’ to ‘Four approaches’ and then to ‘Two aims.’ The second is the importance of mass/grassroots participation, which runs through all three levels of CNHGP. The third value is that the CNHGP used nonspecific social approaches, an innovation in healthcare delivery that addressed the social determinants of health. The fourth value is the integration between Chinese traditional medicine and Western medicine.

The increasing prevalence of complementary and alternative medicine (CAM) use is a significant health care issue in contemporary societies and researchers have identified CAM as holding potential for treating and coping with chronic illness and other conditions experienced in later life. This paper focuses upon contemporary research literature to provide a critical review of the prevalence, correlates, conditions, perceptions and communication of CAM use in later life. Evidence from recent research illustrates the substantial prevalence and complexity of CAM use amongst older people and such ‘community’ use requires all providers, regardless of their experience or perception of the worth of CAM, to at least acknowledge and enquire with their older patients about the potential use of these other medicines.

In the last 50 years science has provided new perspectives on the ancient art of herbal medicine. The present article discusses ways in which the evidence base for the professional use of 'Western' herbal medicine, as therapy to treat disease, known as phytotherapy, can be strengthened and developed. The evidence base for phytotherapy is small and lags behind that for the nutritional sciences, mainly because phytochemicals are ingested as complex mixtures that are incompletely characterised and have only relatively recently been subject to scientific scrutiny. While some methodologies developed for the nutritional sciences can inform phytotherapy research, opportunities for observational studies are more limited, although greater use could be made of patient case notes. Randomised clinical trials of single-herb interventions are relatively easy to undertake and increasing numbers of such studies are being published. Indeed, enough data are available on three herbs (ginkgo (Ginkgo biloba), St John's wort (Hypericum perforatum) and saw palmetto (Serenoa repens)) for meta-analyses to have been undertaken. However, phytotherapy is holistic therapy, using lifestyle advice, nutrition and individually-prescribed mixtures of herbs aimed at reinstating homeostasis. While clinical experience shows that this approach is applicable to a wide range of conditions, including chronic disease, evidence of its efficacy is scarce. Strategies for investigating the full holistic approach of phytotherapy and its main elements are discussed and illustrated through the author's studies at the University of Reading.

During recent years, private sector complementary medicine has grown as a significant provider of health care in the UK, and according to many current definitions, this provision may be classified as primary health care. In the context of a relative paucity of dedicated research investigations, and through a combined questionnaire (n = 426) and interview survey (n = 49), this paper provides some base-line evidence on the national sector, considers the previous employment of private therapists, their reasons for practicing, the range of modalities practiced and the positives they gain from this form of caring and business ownership. Although some younger therapists had moved straight from their education into private practice, the most common scenario was for middle-aged persons to enter the sector directly from skilled professional jobs and hence had radically changed their careers. Many were formerly employed in caring-related professions such as nursing, social work and teaching. Often therapists had been disillusioned with particular aspects of their former jobs. However, more frequently, they were simply attracted by the therapies themselves, the conceptual paradigms which underpin them and to the different experiences of business ownership and caring practices. Little is known about private complementary medicine, and it is argued that dedicated studies could build the initial evidence presented here, particularly within the rubric of primary health care research.

Aims: To compare and contrast how the law relating to medical negligence in England and Wales applies to conventional and complementary practice and to outline some of the legal issues which may arise. Methods: A thorough review of the literature was used to collect relevant information. This involved a comparative analysis of documentation, including Statutory Powers, Statutory Instruments, case law, books and journal publications. Results and discussion: Complementary therapists, regardless of whether they are private or NHS employees, are bound by the same duty of care for their patients as conventional practitioners and the same legal rules apply. If complementary therapists claim to possess special skills, then they are liable for actions arising out of clinical practice, in the same way as conventional practitioners. State registration, for the mainstream complementary therapies, is one way of improving the status of such professions as they become an integral part of the management of cancer patients. However, until they are fully integrated, a balance must be achieved so as to overcome any conflicts of interest between complementary and conventional healthcare practitioners and to facilitate acceptance of the former into the healthcare team. Conclusions: As complementary therapies are integrated into the care of cancer patients, controls and regulations must be implemented, possibly influenced by a legal framework, so as to establish a foundation for enhancing or adding authority to the ethical issues and guidelines which already exist.

Increasing numbers of people are using complementary therapies, and many are in older age groups. Although recent empirical research has considered the demands for complementary medicine, and in particular its recent consumer boom, little acknowledgement is given in research to the different social categories of users, and to the intricacies of their different motivations and consumer behaviours. In the context of a relative paucity of dedicated research investigations, the paper highlights the relevance of social gerontological perspectives. Based on a questionnaire survey of 144 older users, and in-depth interviews with 20 older users in southern England, it considers trends in local use and user actions, attitudes and opinions. From a disciplinary perspective, the paper also contributes to a growing body of research which focuses on older peoples’ self-implemented health and health care strategies. There is a substantial degree of user satisfaction with the therapies used, and many respondents claimed to have benefited in terms of their physical and mental health. Older users are also empowered by their treatment decisions and negotiations, many of which are made either independently, or jointly between themselves and their therapists. Treatment solutions are typically constructed with combinations of complementary therapies, or combinations of complementary therapies and orthodox health services.

Objectives: Use of complementary and alternative medicine (CAM) is growing in all Western countries. The goal of this study was to evaluate quality of randomized controlled trials (RCTs) of CAM interventions for specific diagnoses to inform clinical decision making.

Methods: MEDLINE and related databases were searched for CAM RCTs. Visual review was done of bibliographies, meta-analyses, and CAM journals. Inclusion criteria for review and scoring were blinded RCT, specified diagnosis and intervention, complete study published between January 1, 1966 and July 31, 1998 in an English-language, peer-reviewed journal. Two reviewers independently scored each study.

Results: More than 5,000 trials were found, but only 258 met all study inclusion criteria. The main cause for rejection (> 90%) was that the study was not an RCT or had no blinding. Mean score across 95 diagnosis/intervention categories was 44.7 (S.D. ± 14.3) on a 100-point scale. Ordinary least-squares regression found date of publication, biostatistician as author or consultant, published in one of five widely read English-language medical journals and diagnosis/intervention category of hypertension/relaxation as significant predictors of higher scores.

Conclusions: The overall quality of evidence for CAM RCTs is poor but improving slowly over time, about the same as that of biomedicine. Thus, most services are provided without good evidence of benefit.