Utilization of Complementary and Alternative Medicines

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The term CAM generally refers to the healthcare practices and professions that do not fit into the culturally dominant medical, educational, and financial paradigms (4). Contrary to popular opinion, patients are generally satisfied with the care they receive from medical physicians, and dissatisfaction with conventional medicine does not predict CAM use (4). Thus, many patients combine both allopathic and CAM therapeutic approaches, deriving benefits from both.

A demographic study by Eisenberg revealed that almost 50% of respondents saw a CAM provider, an almost 50% increase from his original study about seven years earlier (5,6). The researchers calculated that this represented an increase from 427 million total visits in 1990, to 639 million visits (by 22 million people) in 1997, a number that exceeds the total visits to all United States primary care physicians (5). The total cost for CAM providers was conservatively estimated at $21.2 billion in 1997, with $12.2 billion paid for by the patient out-of-pocket. The total out-of-pocket expenditures of alternative therapies of all kinds were conservatively estimated to be $27 billion (5).

Although certain therapies, such as herbal medicines, massage, megavitamin therapy, self-help groups, folk medicine, energy healing, and homeopathy increased most in the years between Eisenberg's two studies, visits to chiropractors and massage therapists accounted for nearly half of all visits to CAM providers in 1997 (5,6). Roughly 11% of respondents in the study sought out chiropractic care, and visits to chiropractors accounted for 30% of CAM total visits. Notably, less than 50% of the respondents told their medical doctor they were under the care of a CAM provider (5).

The average demographic profile of a CAM user was Caucasian, aged 25 to 45 years, and of higher education and higher income than nonusers of CAM services. The largest age group of CAM users were the baby boomers (5).

The most common chief complaints prompting patients to consult a CAM provider were, in descending order, chronic low back and neck pain, anxiety, depression, headache, fatigue, insomnia, arthritis, and sprains and strains (6). Patients with back problems, neck problems, headaches, and sprains and strains were most likely to seek chiropractic care. In addition, a study by Hawk (7) reported that nonmusculoskeletal complaints accounted for 10.3% of chief complaints presented to chiropractors. The percentage of patients with epilepsy seeking chiropractic or other CAM approaches is unknown, and it is also unknown what percentage of patients under the care of a CAM provider have epilepsy.

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