Four out of ten Americans used alternative medicine therapies in 1997 and total visits to alternative medicine practitioners increased by 50 % from 1990 and exceeded the visits to all U.S. primary care physicians. Americans paid $21.2 billion for services provided by alternative medicine practitioners
David M. Eisenberg, M.D., of Beth Israel Deaconess Medical Center in Boston, and colleagues surveyed 2,055 adults by telephone in 1997 to study trends in alternative medicine use in the United States. They compared the 1997 data with results from their similar 1990 telephone survey of 1,539 adults. Dr. Eisenberg presented the findings of the study at an American Medical Association media briefing on alternative medicine here today.
The study reports that between 1990 and 1997, the prevalence of alternative medicine increased by 25 percent, with the total number of visits increasing by 47 percent from an estimated 427 million in 1990 to 629 million in 1997 - exceeding total visits to all primary care physicians in the United States (386 million in 1997). During this same period, expenditures for alternative medicine professional services increased by 45 percent. Expenses for these services, conservatively estimated at $21.2 billion, $12.2 billion of which were out-of-pocket, exceeded out-of-pocket expenses for all hospitalizations in 1997.
The researchers surveyed adults on the use of 16 alternative therapies, which included relaxation techniques, herbal medicine, massage, chiropractic, spiritual healing by others, megavitamins, self-help, imagery, commercial diet, folk, lifestyle diet, energy healing, homeopathy, hypnosis, biofeedback and acupuncture. They report that in both the 1990 and 1997 surveys, alternative medicine was used most frequently for chronic conditions, including back and neck problems, anxiety, arthritis and headaches. The use of at least one of 16 alternative therapies increased from 33.8 percent in 1990 to 42.1 percent in 1997.
The therapies that saw the largest increase in usage included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing and homeopathy. Despite the dramatic increase, the researchers point out that the extent to which patients disclose their use of alternative therapies to their physicians remains low (less than 40 percent in both 1990 and 1997), a cause for some concern because an estimated 15 million Americans in 1997 took prescription medications and herbal remedies concurrently.
With one in five people who take prescription medications also taking herbs, high-dose vitamin supplements, or both, the researchers report that millions of adults may be at risk for potential, unintended interactions involving prescription medications and herbs or high-dose vitamins. "The market for alternative medicine is vast and growing," Dr. Eisenberg said in a separate interview. "This trend must be guided by scientific inquiry, clinical judgment, regulatory authority and shared decision-making. The 'don't ask and don't tell' approach to communication in this area must be abandoned."
Use of alternative therapies was significantly more common among women (48.9percent) than men (37.8 percent) and less common among African Americans (33.1 percent) than other racial groups (44.5 percent). People aged 35 to 49 years reported higher rates of use (50.1 percent) than people either older (39.1 percent) or younger (41.8 percent) Use was higher among college-educated people (50.6 percent than people with no college education (36.4 percent), and more common among people with annual incomes above $50,000 (48.1 percent) than with lower incomes (42.6 percent). Use also was higher in the West (50.1 percent) than elsewhere in the United States (42.1 percent). The total out-of-pocket expenditures for alternative therapies in 1997,including professional services herbal products, vitamins, diet products, books and classes, were conservatively estimated to be $27 billion.
Because the demand for alternative therapies depends on how much patients must pay out-of-pocket, current use is likely to underrepresent utilization patterns if insurance coverage for alternative medicine increases in the future. Researchers also found that 42 percent of all alternative therapy use is attributed to the treatment of existing illness, while 58 percent is attributed to prevention of illness and/or health maintenance.
Data from this survey, reflective of the U.S. population, are representative of a predominantly white population, according to the researchers. The authors note that parallel surveys modified to include therapies unique to minority populations and translated when appropriate should be conducted using necessary sampling strategies.
The authors write: "As alternative medicine is introduced by third-party payers as an attractive insurance product, it would be unfair for individuals without health insurance and those with less expendable income to be excluded from useful alternative medical services or consultation (e.g., professional advice on use or avoidance of alternative therapies)."
Alternative medicine, functionally defined in the study as interventions that are neither taught widely in medical schools nor generally available in U.S. hospitals, have garnered increasing attention from the media, the medical community, government agencies and the public in recent years. Surveys and public opinion polls conducted since 1990 have confirmed the extensive use of alternative therapies in the United States. As a result, an increasing number of U.S. insurance companies and managed care organizations now offer some alternative medicine programs and benefits, and the majority of U.S. medical schools now offer courses in alternative therapies.
The authors conclude: "In light of these observations, we suggest that federal agencies, private corporations, foundations and academic institutions adopt a more proactive posture concerning the implementation of clinical and basic science research, the development of relevant educational curricula, credentialing and referral guidelines, improved quality control of dietary supplements, and the establishment of postmarket surveillance of drug-herb (and drug-supplement) interactions."
Read the abstract or full text of the article. (JAMA. 1998;280:1569-1575)
Note: This study was supported in part by the National Institutes of Health, the John E. Fetzer Institute, the American Society of Actuaries, the Friends of Beth Israel Deaconess Medical Center, the Kenneth J. Germeshausen Foundation and the JE and ZB Butler Foundation.
