Why do Americans now prefer "Alternative Therapies" over mainstream medicine?

November 12, 1998

 

A year ago, the editors of the Journal of the American Medical Association (JAMA) and the AMA Archives Journals selected alternative medicine as the topic for their annual coordinated theme issues. This month, these 10 journals present more than 80 articles on a wide range of topics in alternative medicine. The November 11, 1998 issue of JAMA was devoted to the theme of examining the effectiveness of so-called "alternative medicine" or "alternative therapies." Alternative medicine, as defined in a study by Dr. David M. Eisenberg of Beth Israel Deaconess Medical Center in Boston and his colleagues, is the use of interventions that are neither taught widely in medical schools nor generally available in U.S. hospitals.

It was just this past May that an editorial in JAMA acknowledged the effectiveness of vitamins. In the May 7, 1997 issue of the JAMA, Dr. Ranjit Kumar Chandra, O.C., M.D., from the Memorial University of Newfoundland, Janeway Child Health Centre, St. John's, wrote: "The era of nutrient supplements to promote health and reduce illness is here to stay." For more details click here.

This week JAMA may have presented several surprises for the medical profession. Many physicians may have been surprised to learn from their own journal that some alternative procedures do indeed work when judged by the same standards as conventional medicine, but most physicians may have been surprised to learn that Americans visited alternative practitioners almost twice as much as they visited primary care physicians (629 million visits vs. 386 million visits). In fact, more than four out of 10 Americans used alternative medicine therapies in 1997. Furthermore, physicians may have been shocked to learn that the total number of visits to "alternative practitioners" dramatically increased by almost 50 percent from 1990 whereas the number of visits to primary care physicians dropped in the same period.

In spite of the fact that today's Americans go to alternative practitioners twice as often as physicians, they pay less. What may be even harder for the physicians to contend with, is that the patients had to pay for the alternative treatments out of their own pockets, whereas mainstream medicine expenses are largely reimbursable by insurance. During the 1990 - 1997 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.

JAMA reported that in both 1990 and 1997, 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, megavitamins, massage, 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). An estimated 15 million Americans in 1997 took prescription medications and herbal remedies concurrently. The JAMA article by Dr. David M. Eisenberg and his colleagues reported 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.

Use of alternative therapies was significantly more common among women (48.9 %) than men (37.8 %) and less common among African Americans (33.1 %) than other racial groups (44.5 %). People aged 35 to 49 years reported higher rates of use (50.1 %) than people either older (39.1 %) or younger (41.8 %) Use was higher among college-educated people (50.6 % than people with no college education (36.4 %), and more common among people with annual incomes above $50,000 (48.1 %) than with lower incomes (42.6 %). Use also was higher in the West (50.1 %) than elsewhere in the United States (42.1 %).

Judging by the fact that the users of alternative medicine tend to be higher educated and more affluent than users of mainstream medicine, there must be reasons beyond cost involved in their choice. Factors such as effectiveness and lack of adverse effects may account for some of the reasoning. This may account for the medical profession finally wanting to scientifically investigate the effectiveness of alternative therapies as opposed to merely dismissing them out of hand. In the six reports published in this issue, two involved dietary supplements. One report, by Drs. Bensoussan and colleagues found that patients with irritable bowel syndrome treated with Chinese herbal medicine formulations had significant improvements in symptoms compared with those treated with placebo. [JAMA. 1998;280:1585] Click here for the research abstract.

A second report by Dr. Heymsfield and colleagues examined an herb used for dieting. This study examined usage along with low-calorie, high-fiber diets and found that losses in body weight and fat mass were no different than in those treated with diet and placebo. The herbs effect on weight loss in those not consciously restricting calories was not studied. [JAMA. 1998;280:1596] Click here for the research abstract.

As JAMA editor Dr. George Lundberg points out, "this is the beginning of acceptance of some forms of alternative therapies into mainstream medicine in the United States. Acceptance by the good, old-fashion way -- by merit."The scientific interest in the alternative therapies has been increasing for some time. In 1994, Congress mandated in the Dietary Supplement and Health Education Act that the National Institutes of Health (NIH) establish a center for the study of alternative therapies and dietary supplements. This was initially called the "Office of Alternative Medicine" (OAM) at NIH. This year Congress has given the office increased status and authority by naming it the National Center for Complementary and Alternative Medicine and has increased its budget from the current $20 million to $50 million. This action means that the newly named Alternative Medicine Center will be in a position to fund its research grants and other projects directly. As an merely an "office," its projects could be funded only through collaboration with other institutes or outside agencies.

Research supported by the office is moving from exploratory phases to evidence-producing studies. The OAM has funded 13 research centers at universities and other institutions throughout the United States that are conducting 50 different research projects. These have stimulated a wide interest in studies into alternative therapies. The OAM has started a number of large clinical trials that may stimulate further research in the field.

Clinical trials that are underway include a study at the National Institute of Mental Health, of using St John's wort (hypericum) to treat depression and a large trial to test the popular dietary supplement glucosamine for treating arthritis, for which contract proposals are now out soliciting applications. They are also evaluating claims of efficacy related to therapies for cancer. They have started two projects, one an evaluation of shark cartilage and the other a complex nutritional program.