Use of Complementary and Alternative Medicine Among Adults with Chronic Diseases: United States 2002

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Abstract

Use of Complementary and Alternative Medicine (CAM) has increased in recent years. The aim of this study was to determine the use of CAM among people with diagnosed chronic diseases. Cross-sectional analysis was used. The 2002 National Health Interview Survey was the setting. Participants were representative of the noninstitutionalized U.S. population 18 years and older. Respondents answered questions about use of CAM and physician-diagnosed arthritis, cancer, cardiovascular disease, diabetes, and lung disease. Adults with diagnosed chronic diseases are more likely to use CAM compared to adults with none of the reported chronic diseases. Adults with arthritis alone were most likely to report ever use of CAM (59.6%) followed by adults with cancer or lung disease alone or two or more chronic diseases (55%), adults with cardiovascular disease (46.4%), and adults with no chronic diseases (43.6%) and diabetes alone (41.4%). Adults with chronic diseases were also more likely to report use of CAM in the past 12 months (32% to 43.3%), followed by adults with none of these chronic diseases (32%), and adults with diabetes alone (26.2%). Less than 30% of CAM users in the past 12 months reported talking to their healthcare professional about CAM use. Information about CAM use is based on self-report. Use of CAM, particularly biologically based CAM therapies, is common and is more likely to be used by those with chronic diseases.

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Unconventional medicine in the United States. Prevalence, costs, and patterns of use.

D M Eisenberg, R C Kessler, C. Foster … (1993)

Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic. We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy. One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to such providers during the preceding year, with an average charge per visit of $27.60. The frequency of use of unconventional therapy varied somewhat among socio-demographic 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. Among those who used unconventional therapy for serious medical conditions, the vast majority (83 percent) also sought treatment for the same condition from a medical doctor; however, 72 percent of the respondents who used unconventional therapy did not inform their medical doctor that they had done so. Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States. The frequency of use of unconventional therapy in the United States is far higher than previously reported. Medical doctors should ask about their patients' use of unconventional therapy whenever they obtain a medical history.

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Heavy metal content of ayurvedic herbal medicine products.

R Saper, Ian Phillips, Stefanos Kales … (2004)

Lead, mercury, and arsenic intoxication have been associated with the use of Ayurvedic herbal medicine product (HMPs). To determine the prevalence and concentration of heavy metals in Ayurvedic HMPs manufactured in South Asia and sold in Boston-area stores and to compare estimated daily metal ingestion with regulatory standards. Systematic search strategy to identify all stores 20 miles or less from Boston City Hall that sold Ayurvedic HMPs from South Asia by searching online Yellow Pages using the categories markets, supermarkets, and convenience stores, and business names containing the word India, Indian cities, and Indian words. An online national directory of Indian grocery stores, a South Asian community business directory, and a newspaper were also searched. We visited each store and purchased all unique Ayurvedic HMPs between April 25 and October 24, 2003. Concentrations (microg/g) of lead, mercury, and arsenic in each HMP as measured by x-ray fluorescence spectroscopy. Estimates of daily metal ingestion for adults and children estimated using manufacturers' dosage recommendations with comparisons to US Pharmacopeia and US Environmental Protection Agency regulatory standards. A total of 14 (20%) of 70 HMPs (95% confidence interval, 11%-31%) contained heavy metals: lead (n = 13; median concentration, 40 microg/g; range, 5-37,000), mercury (n = 6; median concentration, 20,225 microg/g; range, 28-104,000), and/or arsenic (n = 6; median concentration, 430 microg/g; range, 37-8130). If taken as recommended by the manufacturers, each of these 14 could result in heavy metal intakes above published regulatory standards. One of 5 Ayurvedic HMPs produced in South Asia and available in Boston South Asian grocery stores contains potentially harmful levels of lead, mercury, and/or arsenic. Users of Ayurvedic medicine may be at risk for heavy metal toxicity, and testing of Ayurvedic HMPs for toxic heavy metals should be mandatory.