Conventional and UnconventionalMedical Practice

Many people use unconventional (also referred to as alternative, complementary, integrative) therapies for health problems, but the extent of this use and the costs are relatively unknown. Eisenberg and his group conducted a national telephone survey to determine the prevalence, costs, and patterns of use of complementary therapies, such as acupuncture and chiropractic.¹ He limited the treatments studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals (Table 1, p.79). He completed telephone interviews with 1539 adults (response rate, 67%) in a national sample of adults 18 years of age or older in 1990.

One in three respondents (34%) reported using at least one alternative therapy in the past year, and a third of these saw providers for integrative treatment. The latter group had made an average of 19 visits to such therapists during the preceding year, with an average charge per visit of $27.60. The frequency of use of complementary care 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. The majority used unconventional therapy for chronic, as opposed to life threatening, medical conditions.

Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of alternative therapy. This number exceeds the number of visits to all U.S. primary care doctors (388 million). Expenditures associated with use of integrative treatment in 1990 amounted to approximately 13.7 billion, three

1. Park Tower 904/906, 2717 Highland Avenue South, Birmingham, Alabama 35205-1725.

The frequency of use of complementary therapy in the United States is far higher than previously reported.

Table 2 (p.80) summarizes the rates of use of unconventional treatment for the ten most common principal medical conditions. On average, one in four respondents (25%) used alternative therapy and one in ten (10%) went to a provider of complementary treatment for a principal medical condition in 1990. Among all the conditions studied, the frequency of use of unconventional therapy was highest for back problems (36%), anxiety (28%), headaches (27%), chronic pain (26%) and cancer or tumors (24%). Relaxation techniques, chiropractic, and massage were the alternative treatments used most often in 1990.

Almost nine of ten respondents (89%) who saw a provider of unconventional therapy in 1990 did so without the recommendation of their medical doctor.

In 1997, the Clayton College of Natural Health conducted a survey of unconventional therapy as part of their training program. In the course of their investigation, a series of letters was sent to alternative agencies such as naturopaths, homeopaths and herbalogists. Most of the organizations simply sent irrelevant material, for example, the date of the next meeting of the society. Only one of the group, The American Academy of Medical Acupuncture, sent an article describing and published by their organization.²It would be well to review this article and see the differences between conventional and unconventional medicine as judged by an integrative group. The demographics are very close to the Eisenberg study. Most of the physi-Table 1. Prevalence and frequency of use of unconventional therapy among 1539 adult respondents in 1990.

relaxation techniques 13 9 19 chiropractic 10 70 13 massage 7 41 15 imagery 4 15 14 spiritual healing 4 9 14 commercial weight-loss programs 4 24 23 lifestyle diets (e.g., macrobiotics) 4 13 8 herbal medicine 3 10 8 megavitamin therapy 2 12 13 self-help groups 2 38 21 energy healing 1 32 8 biofeedback 1 21 6 hypnosis 1 52 3 homeopathy 1 32 6 acupuncture <1 91 38 folk remedies <1 0 0 exercise** 26 --prayer** 25 --≥1 unconventional therapy*** 34 36 19 95% confidence interval 31-37 31-41 14-24

* percentages are of those who used that type of unconventional therapy.** respondents who used exercise or prayer were not asked for details about this use.*** excluding exercise and prayer.

cians surveyed were in private practice, or referred patients for it) included ma-

either a solo or group practice. The manipulative medicine (60%), nutritional supjority of respondents were generalists (genplements (59%), herbal medicine (54%) and eral practice, family practice, internal medi-homeopathy (49%). cine). Essentially every type of practice was Practitioner’s subjective evaluation of represented, although the number of surefficacy of acupuncture for the most com-

geons (including specialty surgeons), obste-monly treated problems is listed in Table 4 tricians/gynecologists, and psychiatrists (p.81). Musculoskeletal problems were was small. treated by the largest percentage of re-Table 3 (p.81) shows a variety of com-spondents, compared with other general

plementary healing methods used or en-medical conditions. The most common dorsed by the respondents. The more com-disorder managed (low back pain) also had mon alternative modalities that were sanc-the highest success factor. tioned (physician either used the modality In addition, these doctors were given

Table 2. Use of unconventional therapy for the 10 most frequently reported principal medical conditions.

saw percent used unconven-provider reporting tional therapy in past therapies most

back problems 20 36 19 chiropractic, massage allergies 16 9 3 spiritual healing, lifestyle diet arthritis 16 18 7 chiropractic, relaxation techniques insomnia 14 20 4 relaxation techniques, imagery sprains or strains 13 22 10 relaxation techniques, massage headache 13 27 6 relaxation techniques, chiropractic high blood pressure 11 11 3 relaxation techniques, homeopathy digestive problems 10 13 4 relaxation techniques,

*percentages are of those who reported the condition.“Provider” denotes a provider of unconventional therapy.

the opportunity to enter free-text regard-ing why they perform acupuncture. They could give more than one reason. The most common statement made (91 respondents) was efficacy of the treatment; many physi-cians simply said, “It works.” The next most common explanation (76 doctors) was that it was used because the standard medical approach was inadequate, prompting use of the alternative modality of acupuncture. Fifty-three practitioners stated that they used it for pain management. Complete results are given in Table 5 (p.82).

Summary and Conclusions

Eisenberg and his group found that unconventional medicine has an enormous presence in the U.S. health care system. An estimated one in three persons in the U.S. adult population used alternative treat-ment in 1990. However, little is known and little has been said about the merits of American physicians who currently prac-tice complementary medicine or the prac-titioners perception of the efficacy of such therapy. He indicated that in a subsequent paper this matter would be discussed.

Table 3. Respondents’ use or referral for complementary health care methods (n=312).

manipulation 102 33.1 185 60.1 supplements 161 52.3 181 58.8 herbal medicine 138 44-8 166 53.9 homeopathy 106 34.4 151 49.0

Table 4. Percent of respondents that use acupuncture for various conditions, andrespondents’ subjective evaluation of acupuncture’s efficacy for each condition (N=312).

to treat ineffective/ somewhat very condition each condition uncertain effective effective

common conditions* low-back pain 93.2 2.0 39.0 58.9 myofascial pain 91.6 3.9 39.7 56.4 simple headache 89.3 5.5 31.3 63.3

sciatica 88.6 5.5 44.3 50.2 shoulder problems 88.3 5.5 46.2 41.6 tennis elbow 85.1 12.3 46.2 41.6 migraine headache 84.7 10.0 53.3 36.8 osteoarthritis of knee 81.8 15.1 46.8 38.1 whiplash 81.2 6.8 47.2 46.0 ankle sprain 76.0 11.2 32.5 56.4 osteoarthritis of hip 76.0 19.3 52.1 28.6

chronic sinusitis 69.2 11.2 49.3 39.4 gastrointestinal disorders 65.9 16.3 52.2 31.5 smoking cessation 62.7 21.7 50.3 28.0 perimenstrual symptoms 61.0 11.1 45.7 43.1

*conditions mentioned by at least 75% of respondents.** Selected from 11 conditions: common cold, digestive disorders, asthma/ bronchitis, chronic sinusitis,herpes zoster/post-herpetic neuralgia, perimenstrual symptoms, menstrual irregularity, fertility (maleand female), smoking cessation, drug detoxification, and weight reduction.

Table 5. Responses to the open-ended question: “Why do you perform acupuncture?”

number (%) of respondents response

91 (30)Efficacy: “It works.”

76 (25)The standard medical approach is inadequate for many problems; I use it in cases of failed Western therapy.

53 (17)for pain management

36 (12)It offers a multi-dimensional (“body-mind-spirit”) or holistic approach to medical care.

13 (4)Acupuncture provides professional satisfaction; it is fun to do and it is personally rewarding

Respondents could give free-text answers, and many listed more than one reason. The number of

respondents that gave each answer is listed.

Diehl and his cohorts, in their recent survey, found that physicians who incorpo-rate acupuncture into their practice do so mainly to treat pain problems which have been unsuccessful with conventional meth-ods. They found that the doctors are also more likely to use or endorse other com-plementary modalities.

We quote Diehl’s work because it is the only quantative accounting of the efforts of conventional doctors using a non-conventional medium that we could find.

References

Eisenberg DM, KesslerRC, Foster C, et al: Un-conventional medicine in the United States NEJM, 328: #4, 246-252, 28 January 1993.
Diehl DL, Kaplan G, Coulter I, et al: Use of acu-puncture by American physicians J Altern Compl Med, 3: #2, 119-126, 1997.