Issue of
September 23, 1998

Americans mingle complementary techniques with traditional medicine

BY MIKE GOODKIND

Complementary and alternative therapies, such as chiropractic, acupuncture or meditation, are so interwoven in the fabric of American health care that it may no longer be relevant to draw firm lines between complementary and conventional medicine, suggests a nationwide survey conducted by the Stanford Center for Research in Disease Prevention (SCRDP).

Results from the random telephone survey of 1,000 Americans were released at Stanford last Friday at a conference attended by some 500 health professionals. The researchers disclosed that 69 percent of survey respondents had used complementary and/or alternative medicine (CAM) in the past year. Respondents had also seen traditional MDs an average of four times yearly.

"We are getting a clearer picture of how CAM and traditional medicine are becoming interwoven," said William Haskell, PhD, professor of medicine (cardiovascular), principal investigator for the Stanford component of a major NIH study evaluating the effectiveness of various complementary techniques.

More than 56 percent of the respondents in the phone survey said they believe health plans should cover complementary medicine. On average, respond- ents said they would be willing to spend an additional $15.41 per month for health insurance for such services. Respondents said they use similar criteria for choosing their conventional and CAM practitioners, with "technical skills at diagnosis and treatment" rated as the most important criterion for both.

"What we see from this current survey and many other indicators is that people generally want to take control of their own health, using those services they find most effective," Haskell said. "This places responsibility on both traditional care providers and health educators to ensure that responsible information and advice are available to patients."

Health educator Wes Alles, PhD, who directs the SCRDP's Health Improvement Program, presented the new findings at the Sept. 18 conference, "Complementary and Alternative Medicine: Scientific Evidence and Steps Toward Integration."

"The public doesn't choose between alternative and traditional medicine," Alles said. "Rather, they see the options in a single toolbox and want to choose what works best for them instead of being restricted by arbitrary definitions."

He noted that the public's appetite for complementary techniques presents some challenges, obligations and potential benefits for traditional physicians. "Whether we are talking about vitamins, yoga, acupuncture, massage, chiropractic or a variety of other practices, physicians should be candid with their patients about which techniques they feel are most appropriate for each patient ­ since some techniques are undoubtedly more appropriate than others," Alles said.

Haskell noted that a growing number of traditional patient-care organizations, including UCSF Stanford Health Care, now offer complementary services in a dedicated clinic that integrates these services, including insurance reimbursement, with more traditional medicine.

The survey queried respondents on their interest in and use of 19 techniques: acupuncture, herbal medicine, chiropractic, vitamin therapy, massage, naturopathy, homeopathy, chelation, meditation, spiritual health, relaxation, yoga, folk remedies, guided imagery, hypnosis, tai chi, ayurvedic medicine, macrobiotic diet and Chinese medicine.

Although 55 percent of those who use complementary and alternative therapies said they had reduced the traditional medical services they used, the rest said their use of such techniques had no effect on their visits to traditional physicians. Seventy-three percent of men and 87 percent of women said they have a medical doctor they use most often for routine care.

While this survey, compared with earlier ones, indicated that a larger proportion of Americans are using more complementary medical services, Alles warned that "there is still some ambiguity in the mind of the public and researchers about what constitutes CAM, so statistics must be viewed extremely cautiously." For example, he noted that although nearly one-third of the respondents in the new study said they had used vitamin therapy in the past year, it was not clear whether users were taking megadoses to achieve a specific prevention or treatment goal, or were simply taking a daily multivitamin ­ a practice often recommended as a part of a conventional health regimen.

The conference was sponsored by Stanford University in collaboration with American Specialty Health Plans (ASHP), of San Diego, which offers complementary and alternative medicine through HMOs, and by Health Net, a network-model HMO based in Woodland Hills, Calif.SR