Complementary and Alternative Medicine Use in the 1990s

Key Points

• Almost 40% of U.S. adults and 12% of children use CAM therapies.

• The number of adult Americans using CAM rose by 38% between 1990 and 1997 and has remained stable between 2002 and 2007.

• CAM is used more by women, by those with higher levels of education and income, and by those who were recently hospitalized.

• Most patients do not disclose CAM use to their physicians.

• Most patients use CAM and conventional care together.

The first major study of CAM use in the United States was conducted in 1990 by David Eisenberg and colleagues (1993), who published a landmark paper in the New England Journal of Medicine. Serving as a wake-up call to conventional medicine, the data from this national telephone survey of 1539 English-speaking adults estimated that one of three Americans (34%) had used a CAM therapy in the prior year. The study estimated that those using CAM had made 425 million visits to complementary medicine practitioners—more than all office visits to primary care

Table 11-1 Important Events in Complementary and Integrative Medicine

Year

Event

1978

American Holistic Medical Association is founded.

1981

American Holistic Nurses Association is founded.

1992

U.S. Office of Alternative Medicine (OAM) is established.

1996

U.S. Food and Drug Administration (FDA) approves acupuncture needles for use by licensed practitioners.

1998

National Center for Complementary and Alternative Medicine (NCCAM) is established, replacing OAM..

1999

Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) is formed in response to increasing public interest in complementary and alternative medicine (CAM) and grows to 46 members by 2010.

2000

American Board of Medical Acupuncture is established, with a certifying examination for physicians to demonstrate proficiency in the specialty of medical acupuncture.

2000

President Clinton appoints James S. Gordon, MD, to chair the first White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP).

2002

WHCCAMP submits final report with administrative and legislative recommendations for maximizing the benefits of CAM for all Americans.

2005

Institute of Medicine (IOM) releases report on CAM in the United States.

NCCAM releases 5-year strategic plan.

2006

CAHCIM sponsors the first North American Research Conference on Complementary and Integrative Medicine.

2009

IOM Summit on Integrative Medicine and the Health of the Public.

CAHCIM sponsors a second research conference. NCCAM prepares its third strategic plan.

physicians in that same time frame! The out-of-pocket costs for these CAM services were approximately $14 billion a year. The striking statistics alerted mainstream medicine and prompted further inquiry into the growing phenomenon of the public's use of CAM.

In 1997, Eisenberg and colleagues conducted a follow-up to the 1990 study, again using a national telephone survey of English-speaking adults (2055). The findings, published in the Journal of the American Medical Association in 1998, showed that the number of Americans using CAM rose by 38% (60 to 83 million) and that visits to CAM practitioners increased from an estimated 427 million to 629 million. Overall, 42% of Americans were estimated to be using at least one CAM therapy in the prior 12 months. With regard to costs, conservative estimates put expenditures for CAM professional services at $21.2 billion, with approximately $12.2 billion paid as out-of-pocket expenses (Eisenberg et al., 1998).

Most concerning was the finding that although CAM use had increased over the 7-year period, the number of patients informing their doctors of such use had not changed— approximately 60% to 70% of CAM users in 1990 and 1997 did not discuss their use of CAM with their physicians. Lack of communication was noted again in a 2006 NCCAM/ American Association of Retired Persons (AARP) survey of adults 50 or older revealing only one-third of CAM users had talked to their physicians about their CAM use (AARP, 2007). Given this fact and the potential for untoward side effects, it is essential that physicians and all other health professionals ask patients about their use of CAM. In addition to NCCAM's "Time to Talk" campaign, several approaches have been suggested (Eisenberg, 1997); Table 11-2 lists an ABC format especially useful for the busy clinician (Sierpina, 2001).

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