COMPLEMENTARY AND ALTERNATIVE MEDICINE
A landmark study in the NEJM in 1993 by Eisenberg and colleagues reported that 34% of U.S. adults used a least 1 unconventional form of health care (defined as practices neither taught widely in US medical school nor generally available in U.S. hospitals) during the preceding year. The most likely people to use alternative therapies were educated, middle class white people between the age of 25 and 49. However, use was not confined to any segment of the population. The researchers estimated that Americans made 425 million visits to alternative health care providers in 1990. That number exceeds the number of visits made to allopathic physicians during the same period.
A follow up study published in 1998 by Astin in the JAMA surveyed 1035 randomly selected individuals. Forty percent of this group had used alternative therapies during the past year. The top 4 categories were chiropractic (15.7%), lifestyle diet (8%), exercise/movement (7.2%), and relaxation (6.9%). The most frequently cited health problems treated were chronic pain (37%), anxiety, chronic fatigue syndrome and “other health condition” (31% each), sprains/muscle strains (26%), addictive problems and arthritis (both 25%), and headaches (24%). Analysis of which therapy was used for which condition revealed that multiple therapies were tried for the majority of health problems.
Multivariate analysis showed a number of variables that were positively associated with use of alternative health care. These include more education, poorer health status, a holistic orientation to health, having had a transformational experience that changed the person’s worldview, having any of the following health problems – anxiety, back pain, chronic pain, urinary tract problems, and classification in a cultural group identifiable by their commitment to environmentalism, commitment to feminism, and interest in spirituality and personal growth psychology. Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% reported relying primarily on alternative therapies. The conclusion by Astin was that users of alternative medicine appear to be doing so largely because they find these alternative modalities to be more congruent with their own values and beliefs.
These 2 studies and others highlight a growing trend in American society for people to seek out alternative therapies. There is a growing body of evidence that many alternative therapies offer a measurable benefit to patient’s health. It is our responsibility as primary care physicians to become aware of the benefits, limitations, indications and complications of alternative treatments so that we can counsel patients on how best to use them. While we do not need to become proficient in providing these services, we do need to inquire if our patients are using them and what results they are having. Access to the Internet is accelerating the trend towards patients doing their own research on their health issues. A shift to a partnership model between physician and patient will lead to increased satisfaction and a better match between treatments and patients. One benefit to most alternative therapies is a much lower incidence of side effects or serious complications compared to medications or surgery.
Most people still have a personal physician and rely upon him/her for advice about their health. By becoming more educated about CAM (complementary and alternative medicine), we can develop a better rapport with patients, offer useful advice, limit the toxicity associated with most medications and improve our financial situation.
Daniel Blodgett MD