BETHESDA, M.D.—When traditional medicine fails, patients frequently turn to other sources of hope and healing. In 2007, 83 million adults used some form of complementary or alternative medicine, according to the National Health Interview Survey. This is equal to about 38% of the entire population. Those 83 million people made 354 million visits to complementary and alternative medicine (CAM) providers and spent $33.9 billion doing so, making up more than 10% of the total out-of-pocket health care costs for Americans in 2007.

CAM includes yoga, chiropractic and osteopathic manipulation, massage, meditation, dietary supplements that are not vitamins or minerals, and similar therapies. And according to Richard Nahin, PhD, acting director of the National Center for Complementary and Alternative Medicine’s division of extramural research, CAM plays a significant role in the way Americans seek health care, and that information from the NHIS has helped NIH understand just who is seeking alternative therapies and why.

Who Is Using CAM?

The strongest factors involved in predicting CAM use are health care needs, education, level of physical activity, and age. Those with more health care needs, a higher level of education, and a higher level of physical activity, are all more likely to use alternative medicine. As for age, CAM use rises a little between 18 and 50 years of age before dropping off significantly in the elderly. “When I first saw this data, I was very surprised. CAM is associated with the presence of disease, and you figure that more elderly people have more diseases than younger folks,” Dr. Nahin explained at a symposium on the campuses of NIH last month. “[But,] maybe older generations were not exposed to CAM and so they just didn’t use it. [Also], we know the elderly tend to be on public health insurance, which does not cover CAM. Also, they tend to be on stipends or Social Security, which would not give them a lot of money to spend out of pocket on CAM.”

Race also plays a factor. Because while Caucasian and African Americans use CAM less as they age, Hispanics begin using it more. Beyond these larger predictors, there are some smaller ones. Living in the West is a high predictor of CAM use, as is being of Asian or of Pacific Island decent, or female. Consuming one alcoholic drink or less a day is also associated with higher CAM use. “Delaying conventional care because of cost issues is an indicator,” Dr. Nahin added. “In other words, if you can’t go to your regular health care provider because you can’t afford them, you tend to turn to CAM.”

Why Do People Use CAM?

In the category of CAM-use for treatment, the primary reason for patients seeking therapy is “pain, pain, and more pain,” Dr. Nahin said. “Back pain is by far the biggest reason that people are using CAM. Second is neck pain and joint stiffness.” According to the survey, the top four conditions that people sought to treat through CAM use were back pain, neck pain, joint pain, and arthritis. The most popular therapies sought were acupuncture and manipulation. Massage was also very popular for treatment of back pain. In 2007, about 14 million people used CAM for back pain and 5 million used it for neck pain. “The top four conditions are all conditions that are associated with acute or chronic pain, as well as other conditions on the list,” Dr. Nahin added. “The biggest reason by far that people use complementary or alternative medicine is to manage their pain.”

Other reasons people sought CAM for treatment were anxiety, which many tried to manage through relaxation techniques; head and chest colds, for which homeopathy was very popular; and GI illnesses, for which people used naturopathy, a method of treating disease using food, exercise and heat.

While pain is the biggest reason people sought CAM for treatment, non-vitamin, non-mineral dietary supplements are the most popular CAM sought for prevention, with almost 40 million individuals using them in 2007. According to the survey, the most prevalent reason for their use was to control cholesterol. Also, people used homeopathy to help improve their immune function.

The Relationship Between CAM and Conventional Care

Across the various therapies, at least 50% of the people who use these therapies said they also were using conventional care to treat the primary health conditions for which they were using these therapies, Dr. Nahin explained. Most of that crossover, Dr. Nahin said, is in the pharmaceutical realm. Most people who use conventional care for the same reason they use CAM are doing so in the form of prescription and over-the-counter drugs.

“Also, the people who used therapies to prevent back pain, such as acupuncture, manipulation, and yoga, are also the people who said they used physical therapy,” Dr. Nahin said. “It makes sense—if you have back pain that causes disability, it’s very likely you’re going to physical therapy in order to relieve these disabilities.”

Most responders to the survey said that they had used conventional medicine first before turning to CAM. Less than 20% of people said they tried the CAM intervention first. “The take home message is CAM does not tend to be used first, and prescription drugs and prescription drugs combined with CAM are the first choices,” Dr. Nahin explained.

However, there were relatively few numbers of people who sought a purposeful balance between the conventional medication and the complementary and alternative medications that are meant to support it. “There were a relatively low number of people who started prescription medication and CAM at the same time,” Dr. Nahin said. “The conventional dogma in integrative medicine is that you’re using all of these things together in some kind of harmony. But in fact, that’s not the way people use them. They use first one, and then the other primarily, and not together at the same time.”

But are CAM therapies actually working? According to Dr. Nahin, that question proved a difficult one to answer. “In the 2002 [NHIS] survey, we actually included a question about how much people thought the CAM therapy helped them. But when we were pilot-testing the 2007 survey, that question proved so unreliable that we took it out of the survey,” he declared. “In other words, people may say something, but there was no basis for what they were saying. They couldn’t explain why they were saying it in the quantitative interviews. So, from this survey, we don’t know how much [CAM therapy] is helping.”