This national survey was repeated 7 years later and established the use of CAM in the United States as a significant and growing trend (N = 2,055). When compared with use in 1990, the use of CAM increased from 33.8% to 42.1%. Extrapolations suggest a 47.3% increase in total visits to alternative medicine providers, from 427 million in 1990 to 629 million visits in 1997, again exceeding visits to primary care providers. Most of these users again were women, with 48.9% of women having used CAM that year, compared with 37.8% of men (1). There was no significant improvement in disclosure, with only 39.8% of users disclosing this information to their physicians. Most users were again found to be paying entirely out of pocket, with no significant change between 1990 (64%) and 1997 (58.3%). Estimated expenditures for alternative medicine services increased 45.2%, and total 1997 out-of-pocket expenditures related to alternative therapies were conservatively estimated at $27 billion, which is comparable to the out-of-pocket expenditures for all physician services that year. More recently, the CDC reported that in 2002, 75% of adult Americans reported having used CAM approaches, and 62% had used them in the past year (3). A study of gynecologic oncology patients revealed that 56% were using CAM, and surveys of menopausal women showed that 80% were using “nonprescriptive therapies” (4). The Study of Women’s Health Across the Nation (SWAN) found that approximately one-half of women were actively using herbal, spiritual, or manipulative therapies (4). A study examining the use of CAM by women suffering from nausea and vomiting during pregnancy found that 61% reported using CAM therapies, with the most popular being ginger, vitamin B6, and acupressure (5). A study evaluating the use of CAM therapies by women with advanced-stage breast cancer revealed that 73% of patients used CAM, with relaxation or meditation techniques and botanicals being used most often (6). The reason most often given for the use of CAM was immune support, followed by the second treatment of cancer. A survey in Washington state exploring use of alternative therapies for menopause revealed that 76% of women were using alternative approaches, with 43% of these women using stress-reduction techniques, 37% using over-thecounter alternative approaches, 32% using chiropractic medicine, 30% massage therapy, 23% dietary soy, 10% acupuncture, 9% naturopathy or homeopathy, and 5% herbalists (7). Of these women, 89% to 100% found these approaches to be somewhat or very helpful. Current users of hormone therapy were 50% more likely to use CAM than those who never used hormone therapy.
Following the results of the Women’s Health Initiative indicating the risks associated with hormone therapy, interest in the use of CAM for management of menopausal symptoms increased.
The Attraction A national survey published in 1998 was the first to explore the very intriguing question of why so many patients were turning to CAM (8). Three hypotheses were proposed: 1.
Dissatisfaction with conventional medicine.
2.
Personal control in their health care.
3.
Philosophical congruence of values around life, health, and wellness.