Alternative Medicine in the U.S. James G. Anderson, Ph.D. Purdue University

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 patient’s 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)

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.

Types of Alternative Medicine  Acupuncture  Aromatherapy  Chiropractic  Herbal Medicine  Homeopathy  Massage  Nutritional Supplements

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  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.

Alternative Health Care: A 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-institutionalized

Studies of Unconventional Medicine in the U.S.  David Eisneberg 1993  David Eisenberg 1998  Goldstein 1999

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

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  Prevalence, estimated costs and disclosure of alternative therapies to physicians were measured.

Other countries % of population who used alternative medicine during the past 12 months  10% Denmark  15% Canada  33% Finland  49% Australia

Types of Alternative Therapies  Relaxation techniques  Herbal medicine  Massage  Chiropractic  Spiritual healing  Megavitamins  Self-help group  Imagery

Types of Alternative Therapies  Commercial diet  Folk remedies  Lifestyle diet  Energy healing  Homeopathy  Hypnosis  Biofeedback  Acupuncture

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

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

Results Alternative therapies used most frequently for:  Back problems  Anxiety  Depression  Headaches

Disclosure of Alternative Therapies to Physicians  1990: 38.5%  1997:38.5%

Percentage of Users Paying Entirely Out-of-Pocket for Alternative Therapies  1990:64%  1997:68.3%

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

Estimated Total Expenditures for Alternative Medicine Services  1990:$14.6 billion  1997:$21.2 billion

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.

Hypotheses People 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.

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.

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)

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 one’s inner life

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

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

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

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

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