CAM Overview
More than one-third of Americans report using at least one modality of Complementary and Alternative Medicine (CAM) and visits to CAM practitioners exceed visits to primary care physicians by a wide margin. The last comprehensive study conducted on CAM expenditures was by DM Eisenberg et al in 1998 and published in JAMA. The study indicated CAM expenditures were as high as $47 billion, with out-of-pocket costs conservatively estimated at $27 billion – a number more than double out-of-pocket costs for all U.S. hospitalizations and comparable to the out-of-pocket expenditures for all U.S. physician services. These figures represented an increase of 45 percent over similar figures in 1990. With the proportion of CAM use in the United States at similar or higher levels today, the market size and out-of-pocket expenditures for CAM are considerably higher.
Certain CAM therapies are widely accepted as effective and mainstream by physicians in other countries. In the United Kingdom, France and Germany, homeopathy and herbal medicine are widely practiced and fully or partially covered by the national health systems. Traditional Chinese Medicine (TCM) is accepted by mainstream medical bodies and practitioners in China and other parts of the world. It is important to note that while some of these modalities are considered alternative in the United States, they are commonly practiced in many Western and civilized nations in conjunction with what Americans call conventional medicine.
While CAM by definition is still seen as “alternative” in the United States, many aspects have become mainstream and widely accepted. Major medical schools (98 and growing) are now teaching CAM courses and have established Integrative and Complementary Medicine departments. The National Institutes of Health has established an entire department devoted to CAM, and annual research dollars from the U.S. government and other sources run in the hundreds of millions. Hospitals (17 percent and growing) are offering CAM therapies, a growing number of physicians are incorporating CAM into their private practices, integrative medicine clinics (many with close ties to medical schools and teaching hospitals) are being established, and health maintenance organizations and insurance companies are starting to cover CAM. All of this has been driven by the desire of the American consumer to add CAM modalities to the choice of treatments for better health.
There have been several surveys conducted in the past 10 years concerning the prevalence of CAM therapies in the United States. The general consensus is that at least one-third of all Americans used at least one CAM therapy in the past 12 months. According to Harvard Medical School, one of every two Americans between the ages of 30 and 50 used at least one alternative therapy in 1997 and that number is even higher today. An Ohio State study found that between 62 percent and 71 percent of adults over the age of 50 use some kind of alternative medicine. The number of visits to CAM providers in 1990 was slightly higher than visits to primary care physicians. However, by 1997, Americans visited CAM providers and estimated 629 million times – a number 50 percent more than primary care physician visits.
The most common forms of alternative therapies include Traditional Chinese Medicine encompassing acupuncture and herbs, chiropractic, massage therapy and homeopathy. CAM is most often used to treat back pain, head or chest colds, neck pain, joint pain or stiffness, and anxiety or depression. A study conducted by DM Eisenberg et al in 2001 found that the overwhelming reason for consumers to seek CAM treatment was that 79 percent perceived the combination of CAM and conventional medicine to be superior to either one alone. In other words, a majority of CAM users see CAM as a complement to conventional medicine rather than as an alternative.
Those using CAM typically visited a physician first or concurrently with their CAM provider (70 percent). However, a startling statistic is that 63 percent to 72 percent did not disclose at least one type of CAM therapy to the medical physician. The rationale for keeping the secrets were: 1) “It wasn’t important for the physician to know” (60 percent); 2) “The physician never asked” (60 percent); 3) “It was not the physician’s business” (31 percent); and, 4) “The physician would not understand” (20 percent). Only 14 percent thought the physician would disapprove or discourage CAM use. (DM Eisenberg et al, Annals of Internal Medicine, 2001). This is particularly relevant as certain CAM modalities can interact with conventional medicines making it crucial for the health care practitioner to not only know everything the patient is doing, but to also be educated in CAM/conventional medicine interactions.
There are many reasons why Americans pursue CAM therapies each year. Adult CAM users were most likely to utilize CAM because they believed that CAM combined with conventional medical treatments would help (55 per cent), that conventional medicine would not help their health care problem (28 percent), a conventional medical professional suggested they try it (26 percent), and conventional medicine was too expensive (13 percent). (2002 NHIS CDC)
The long-term trends for CAM also appear to be strong. In a recent study, it was reported that 68 percent of respondents had used at least one CAM therapy in their lifetime. 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. Of respondents who ever used a CAM therapy, nearly half continued to use it many years later. The authors concluded that 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. (Ronald Kessler et al, Annals of Internal Medicine, 2001)
