ALTERNATIVE MEDICINE I: JAMA Takes A Look
The Journal of the American Medical Association, in devoting this week's entire issue to alternative medicine, shows that while some alternative therapies are clinically effective and others nearly worthless, Americans are utilizing non-standard treatments such as herbal medicine, massage and megavitamins at a skyrocketing rate. The lead article, documenting the prevalence and cost of alternative medicine, compared results of a randomized phone survey of 2,055 adults in 1997 with a comparable survey of 1,539 adults in 1991. Conducted by researchers led by Dr. David Eisenberg of Beth Israel Deaconess Medical Center's Center for Alternative Medicine Research and Education, the study results indicate that the huge number of Americans who utilize alternative medicine will ensure that the debate over alternative medicine is unlikely to fade away.
The Raw Numbers
More than four in 10 Americans -- and one in two baby boomers -- have utilized at least one of the 16 alternative therapies measured by the researchers, with practitioner visits and total out-of-pocket expenditures equaling or exceeding those of primary care doctors. A sampling of the results:
- Use of at least one of the 16 therapies measured increased from 34% to 42% of those surveyed between 1991 and 1997;
- Total visits to alternative practitioners increased from 427 million to 629 million, "thereby exceeding total visits to all U.S. primary care physicians";
- Total out-of-pocket expenditures for alternative medicine equaled $27 billion in 1997;
- Outlays to alternative practitioners increased 45% to $21.2 billion in 1997
The researchers exhaustively explored exactly which demographic groups utilize alternative medicine. Although the authors found that "[u]se of alternative therapies in 1997 was not confined to any narrow segment of society," they did find that women used alternative therapies more than men and that African Americans tended to use therapies less than other racial groups. The highest incidence of alternative medicine use was in people ages 35-49, and those who used alternative medicine were more likely to be college graduates, have incomes above $50,000 and live in the Western United States.
What Was Used And Who Paid
The authors found that "the largest increases were in the use of herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing and homeopathy." However, nearly half of alternative practitioner visits were to chiropractors and massage therapists. Conditions that were commonly treated by alternative practitioners included back problems, neck problems, arthritis and headaches. Although 1997 saw a slight decrease over 1991 in the number of people who paid out-of-pocket for alternative therapies, the authors note that "[n]one of the changes in insurance coverage ... were statistically significant, probably due in part to small sample sizes."
The authors conclude:
- Given the high prevalence of alternative therapies -- often in conjunction with traditional medicine and without a doctor's knowledge, it is troubling but not surprising that "1 in 5 individuals taking prescription medications also was taking herbs, high-dose vitamin supplements, or both." The figures indicate that "15 million adults are at risk for potential adverse interactions." The authors urge doctors to end their "don't ask and don't tell" treatment of alternative medicine.
- Because most alternative medicine users currently pay out-of-pocket, "current use is likely to underrepresent utilization patterns if insurance coverage for alternative therapies increases in the future."
- The researchers suggest that in light of the increasing prevalence of alternative medicine, "federal agencies, private corporations, foundations, and academic institutions [should] 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" (Eisenberg et al, JAMA, 11/11 issue).
Trying To Shed Bias
The New York Times reports that JAMA editor Dr. George Lundberg let the clinical articles -- four of which supported alternative protocols and three debunked them -- speak for themselves, without attempting to impart a statement on alternative medicine's efficacy. He said, "That's just how it shook out. We just wanted good science" (Grady, 11/11). The Boston Globe reports that a New England Journal of Medicine issue in September contained a "sharp critique" of alternative medicine, with an editorial charging that it had been "getting a 'free ride' from the scientific community" (Saltus, 11/11). Lundberg reiterated that JAMA will treat non- standard alternative treatments like any other untested regimen. "There is no 'alternative' medicine," he said. "Treatments either work or don't. We are opening the door to what we hope is an important flow of information between different cultures in subjects that matter to people" (Neergaard, AP/Los Angeles Times, 11/11). The Richmond Times-Dispatch reports that JAMA published a total of about 80 studies and related articles on alternative or complementary medicine in its family of AMA journals this week (Hostetler, 11/11).