On January 28, 1993, the New England Journal of Medicine published:

Unconventional Medicine in the United States Prevalence, Costs, and Patterns of Use

Key Points from the abstract of this article include:

1) Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. The authors conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic.

2) The authors limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. They completed telephone interviews with 1539 adults in a national sample of adults 18 years of age or older in 1990. They asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy.

3) The results indicated that 34 percent reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy.

4) The group seeing providers for unconventional therapy had made an average of 19 visits to such providers during the preceding year, with an average charge per visit of $27.60.

5) The frequency of use of unconventional therapy varied somewhat among sociodemographic groups, with the highest use reported by nonblack persons from 25 to 49 years of age who had relatively more education and higher incomes.

6) The majority used unconventional therapy for chronic, as opposed to life-threatening, medical conditions.

7) Among those who used unconventional therapy for serious medical conditions, the vast majority (83 percent) also sought treatment for the same condition from a medical doctor.

8) Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million).

9) Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States.

10) The authors concluded that the frequency of use of unconventional therapy in the United States is far higher than previously reported.

Five years later, a follow-up study was published in the November 11, 1998 issue of the Journal of the American Medical Association, and titled:

Trends in alternative medicine use in the United States, 1990-1997

Results of a follow-up national survey

Key Points from the abstract of this article include:

1) A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. The objective of this study was to document trends in alternative medicine use in the United States between 1990 and 1997.

2) The authors used a nationally representative random household telephone survey using comparable key questions that were conducted in 1991 and 1997, measuring utilization in 1990 and 1997, respectively. A total of 1539 adults were surveyed in 1991 and 2055 were surveyed in 1997.

3) This second study found that the use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997.

4) The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3%.

5) In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches.

6) The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%).

7) Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians.

8) Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations.

9) Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services.

10) The authors concluded that alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.

A related second follow-up study was published in the August 21, 2001 issue of the Annals of Internal Medicine, and titled:

Long-term trends in the use of complementary and alternative medical therapies in the United States

Key Points from the abstract of this article include:

1) Although recent research has shown that many people in the United States use complementary and alternative medical (CAM) therapies, little is known about time trends in use. Therefore, the objective of this study was to present data on time trends in CAM therapy use in the United States over the past half-century.

2) Once again, a nationally representative telephone survey of 2055 respondents that obtained information on current use, lifetime use, and age at first use for 20 CAM therapies.

3) Previously reported analyses of these data showed that more than one third of the U.S. population was currently using CAM therapy in the year of the interview (1997).

4) Subsequent analyses of lifetime use and age at onset showed that 67.6% of respondents had used at least one CAM therapy in their lifetime.

5) Lifetime use steadily increased with age across three age cohorts: Approximately 3 of every 10 respondents in the pre-baby boom cohort, 5 of 10 in the baby boom cohort, and 7 of 10 in the post-baby boom cohort reported using some type of CAM therapy by age 33 years.

6) Of respondents who ever used a CAM therapy, nearly half continued to use many years later.

7) A wide range of individual CAM therapies increased in use over time, and the growth was similar across all major sociodemographic sectors of the study sample.

8) The authors conclude that the use of CAM therapies by a large proportion of the study sample is the result of a secular trend that began at least a half century ago. This trend suggests a continuing demand for CAM therapies that will affect health care delivery for the foreseeable future.

An assessment of the use of complimentary therapy for musculoskeletal issues was published in the September 21, 1999 issue of the Annals of Internal Medicine, and titled:

Use of complementary therapies for arthritis among patients of rheumatologists

Key Points from this article include:

1) Use of complementary and alternative medicine (CAM) is common among individuals with chronic conditions.

2) For rheumatologic conditions, the authors of this study showed that approximately two thirds of the respondents had used CAM. Of these respondents, 56% currently used CAM and 90% regularly used CAM or had done so in the past. Fifty-five respondents 24% had used three or more types of CAM.

3) Persons who used CAM regularly were more likely to have osteoarthritis, severe pain, and a college degree than patients who had never used CAM.

4) The authors concluded that patients with rheumatologic conditions frequently use CAM, and that severe pain and osteoarthritis predict regular use of CAM.

5) Complementary and alternative medicine (CAM) has recently attracted national attention in the United States because of its widespread use.

6) Four out of 10 Americans used CAM for chronic conditions in 1997 and made an estimated 629 million visits to practitioners of alternative medicine, far exceeding the 388 million visits that were made to primary care physicians during the same year.

7) The total out-of-pocket expenditures related to CAM use in 1997 were an estimated $27 billion, which is comparable to the out-of-pocket expenditures for all physician services.

8) “Rheumatologic conditions, such as osteoarthritis, rheumatoid arthritis, and fibromyalgia, provide an optimal disease framework in which to examine patients’ reasons for using CAM and for discussing this use with their physicians.” “These conditions are prevalent, have no known cause or cure, are characterized by chronic pain and a variable disease course, and often adversely affect functional status.”

9) Studies have shown that 60% – 90% of patients with arthritis, particularly rheumatoid arthritis have used CAM.

10) In this study, complementary and alternative medicine was defined as any intervention not usually prescribed by physicians, including chiropractic.

11) Chiropractic was the CAM most used by the patients in this study, and 73% found chiropractic helpful for their condition. “Among patients who used an individual CAM method, 73% reported that chiropractors were helpful.”

12) The most common diagnoses for those who used CAM were rheumatoid arthritis (41%), fibromyalgia (19%), and osteoarthritis (16%).

13) The overall mean duration of their disease was 10.8 years.

14) On average, patients had used 2.6 types of CAM (range 1 to 11).

15) “The most frequently reported reasons for using CAM were to gain control of pain and to help a rheumatologic condition.”

16) “Nearly 50% of respondents reported using CAM because their prescribed medications were ineffective.”

17) “Surprisingly, 71% of respondents reported that their physicians supported continued use of CAM.” [Key Point]

18) “In multivariate analyses, severe pain, a college degree, and osteoarthritis remained significantly associated with regular CAM use.”

19) Patients with osteoarthritis and with severe pain were more likely to use CAM regularly.

20) “Nearly two thirds of patients reported having used at least one type of CAM for their rheumatologic condition; 56% were using CAM at the time of the survey, and 24% had used three or more types of CAM. These data are remarkable given that our definition of CAM excluded biofeedback, exercise, meditation, or prayer.”

21) “Most patients used CAM regularly and found CAM to be helpful. They most frequently reported using CAM to relieve pain, and nearly half reported that they used CAM because their prescribed medications were ineffective.”

22) “Patients in our sample most frequently reported that they used CAM for symptom relief rather than as a cure for their condition.”

23) “Our results may be subject to underreporting biases because some patients might have been reluctant to reveal their use of CAM.”