Alternative Medicine in the U.S.

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Alternative Medicine in the U.S.

• James G. Anderson, Ph.D.
• Purdue University

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Introduction

• " Alternative Medicine encompasses approaches to
  patients and illnesses that are either not widely
  taught or practiced in conventional medical
  schools or that challenge commonly assumed
  viewpoints of the dominant professional health
  care system in the United States." (Hughes, Ellen
  M.D, 1997)
• Treating the patients whole body using a
  holistic approach
• The 1993 Eisenberg Study revealed that about
  one-third of Americans were using alternative
  therapies and spending nearly 14 billion
  annually for health care. (Budrys, Grace, 2001)

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Introduction

• Alternative medicine is broken up into
  subcategories
• Mind/Body Control
• Alternative Systems of Medical Practice
• Manual Healing
• Herbal Medicine
• According to the NCCAM, Americans mostly use it
  for back, neck, head, or joint aches. Also to
  treat or prevent musculoskeletal conditions or
  other conditions involving chronic or recurring
  pain.

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Types of Alternative Medicine

• Acupuncture
• Aromatherapy
• Chiropractic
• Herbal Medicine
• Homeopathy
• Massage
• Nutritional Supplements

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Introduction

• It is becoming more widely used, and socially and
  politically accepted in the United States.
• The supply of alternative medicine clinicians are
  expected to grow by 88 percent between 1994 and
  2010.
• According to a survey given by Dr. John Astin,
  clients usually use alternative medicine for the
  following three reasons
• They are dissatisfied in some way with
  conventional treatment.
• Alternative health care offers more personal
  control.
• The alternatives are more compatible with the
  patients values and beliefs.

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Alternative Health CareA New Social Movement

• Lies outside of the existing institutional
  arrangements
• Information is shared through Web sites,
  cooperative stores, organic farming, health
  fairs, lectures, etc.
• Opportunities for miracle cures, scams and frauds
  blossom when the movement is non-institutionalize
  d

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Studies of Unconventional Medicine in the U.S.

• David Eisneberg 1993
• David Eisenberg 1998
• Goldstein 1999

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Objective

• To document trends in alternative medicine use in
  the U.S. between 1990 and 1997.

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Design

• Nationally representative random household
  telephone surveys using comparable key questions
  were conducted in 1991 and 1997 measuring
  utilization in 1990 and 1997, respectively.
• A total of 1539 adults in 1991 and 2055 in 1997.
• Prevalence, estimated costs and disclosure of
  alternative therapies to physicians were measured.

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Other countries of population who used
alternative medicine during the past 12 months

• 10 Denmark
• 15 Canada
• 33 Finland
• 49 Australia

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Types of Alternative Therapies

• Relaxation techniques
• Herbal medicine
• Massage
• Chiropractic
• Spiritual healing
• Megavitamins
• Self-help group
• Imagery

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Types of Alternative Therapies

• Commercial diet
• Folk remedies
• Lifestyle diet
• Energy healing
• Homeopathy
• Hypnosis
• Biofeedback
• Acupuncture

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Results

• Use of at least 1 of 16 alternative therapies
  during the previous year increased from 33.8 in
  1990 to 42.1 in 1997.
• The probability of users visiting an alternative
  medicine practitioner increased from 36.3 to
  46.3.

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Results

• Therapies increasing the most included
• herbal medicine
• Massage
• megavitamins
• self-help groups
• folk remedies
• energy healing
• homeopathy

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ResultsAlternative therapies used most
frequently for

• Back problems
• Anxiety
• Depression
• Headaches

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Disclosure of Alternative Therapies to Physicians

• 1990 38.5
• 1997 38.5

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Percentage of Users Paying Entirely Out-of-Pocket
for Alternative Therapies

• 1990 64
• 1997 68.3

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Total Visits to Alternative Medicine
Practitioners in the U.S.

• Alternative Practitioners 1990 427
  million 1997 629 million

• Primary Care Physicians 1990 387
  million 1997 385 million

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Estimated Total Expenditures for Alternative
Medicine Services

• 1990 14.6 billion
• 1997 21.2 billion

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Why Patients use Alternative Medicine

• National study of why people in the U.S. use
  alternative medicine.
• Objective to investigate predictors of
  alternative health care use.

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HypothesesPeople seek alternative medicine
because

• (1) they are dissatisfied with conventional
  treatment.
• (2) they see alternative medicine as offering
  more personal autonomy and control over health
  care decisions.
• (3) the alternatives are seen as more compatible
  with their beliefs, values, and world view.

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Design

• Written survey examining use of alternative
  health care and attitudes toward conventional
  medicine.
• 1035 individuals were randomly selected who lived
  throughout the United States.

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Results Predictors of use of alternative
medicine

• More education
• Poorer health status
• Chronic health problems
• Holistic orientation to health
• Experience that changed their world view
• Membership in cultural groups such as
  environmentalism, feminism, spiritualism
• Believing in the importance of body, mind, and
  spirit in treating health problems
• Perceived efficacy (relief of symptoms)

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Results Predictors of use by those who
primarily use alternative medicine

• Distrust of conventional physicians and hospitals
• Desire for control over health decisions
• Dissatisfaction with conventional practitioners
• Belief in importance of ones inner life

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Legitimating Alternative Health Care

• The U.S. Congress prohibited the FDA from
  regulating herbal products
• Professional Associations formed, e.g., American
  Holistic Medical Association
• NIH created the National Center for
  Complementary and Alternative Medicine
• Today 64 of medical schools have at least one
  course on alternative medicine
• Growing third-party reimbursement

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Resistance to Alternative Medicine

• Medicine feels a threat to their scientific
  legitimacy. They argue there is no scientific
  evidence to support most alternative medicine
• Demonstrating effectiveness of alternative
  medicine through clinical trials runs counter to
  the holistic emphasis on patient empowerment,
  individualized treatment regimens, multiple
  modalities
• Alternative medicine threatens physicians income

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The Future of Alternative Medicine

• Institutionalization of alternative medicine
• The pharmaceutical companies are profiting from
  the increased popularity of herbs, minerals,
  vitamins
• Alternative/Complementary health care
  practitioners and clinics will focus more on
  profit making services

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The Future of Alternative Medicine

• Managed care organizations and HMOs have begun
  incorporating elements of alternative medicine in
  order to reduce costs
• Alternative health care practitioners will adopt
  the model of expertise that characterizes the
  medical profession where the doctor is the
  expert and monopolized information

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The Future of Alternative Medicine

• Alternative health care modalities that are the
  least holistic are likely to be the only ones
  that survive the scrutiny of biomedical research.
• Branches of alternative medicine that are
  fundamentally incompatible with conventional
  medicine will be marginalized.
• The movement will lose its creativity and
  innovativeness