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Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey

David M. Eisenberg, MD; Ronald C. Kessler, PhD; Maria I. Van Rompay, BA; Ted J. Kaptchuk, OMD; Sonja A. Wilkey, MD; Scott Appel, MS; and Roger B. Davis, ScD
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From Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.

Acknowledgments: The authors thank Marcia Rich for her technical assistance in preparing this manuscript; the staff of DataStat, Inc., for their assistance with telephone data collection; and John Astin, PhD, for his thoughtful suggestions.

Grant Support: In part by National Institutes of Health (grant U24 AR43441-02S1A1), Bethesda, Maryland; the American Society of Actuaries, Schaumburg, Illinois; and unrestricted educational grants from the John E. Fetzer Institute, Kalamazoo, Michigan, the Friends of Beth Israel Deaconess Medical Center and the Kenneth J. Germeshausen Foundation, Boston, Massachusetts, the J.E. and Z.B. Butler Foundation, New York, New York, and The American Specialties Health Plan, San Diego, California.

Requests for Single Reprints: David M. Eisenberg, MD, Center for Alternative Medicine Research and Education, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail, deisenbe@caregroup.harvard.edu.

Current Author Addresses: Drs. Eisenberg, Kaptchuk, Wilkey, and Davis, Ms. Van Rompay, and Mr. Appel: Center for Alternative Medicine Research and Education, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.

Dr. Kessler: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.

Ann Intern Med. 2001;135(5):344-351. doi:10.7326/0003-4819-135-5-200109040-00011
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Background: Little is known about perceptions of complementary and alternative medical (CAM) therapy relative to conventional therapy among patients who use both.

Objective: To document perceptions about CAM therapies among persons who use CAM and conventional therapies.

Design: Nationally representative, random-household telephone survey.

Setting: The 48 contiguous U.S. states.

Participants: 831 adults who saw a medical doctor and used CAM therapies in 1997.

Measurements: Perceptions about helpfulness and patterns of CAM therapy use relative to conventional therapy use and reasons for nondisclosure of CAM therapies.

Results: Of 831 respondents who saw a medical doctor and used CAM therapies in the previous 12 months, 79% perceived the combination to be superior to either one alone. Of 411 respondents who reported seeing both a medical doctor and a CAM provider, 70% typically saw a medical doctor before or concurrent with their visits to a CAM provider; 15% typically saw a CAM provider before seeing a medical doctor. Perceived confidence in CAM providers was not substantially different from confidence in medical doctors. Among the 831 respondents who in the past year had used a CAM therapy and seen a medical doctor, 63% to 72% did not disclose at least one type of CAM therapy to the medical doctor. Among 507 respondents who reported their reasons for nondisclosure of use of 726 alternative therapies, common reasons for nondisclosure were “It wasn't important for the doctor to know” (61%), “The doctor never asked” (60%), “It was none of the doctor's business” (31%), and “The doctor would not understand” (20%). Fewer respondents (14%) thought their doctor would disapprove of or discourage CAM use, and 2% thought their doctor might not continue as their provider. Respondents judged CAM therapies to be more helpful than conventional care for the treatment of headache and neck and back conditions but considered conventional care to be more helpful than CAM therapy for treatment of hypertension.

Conclusions: National survey data do not support the view that use of CAM therapy in the United States primarily reflects dissatisfaction with conventional care. Adults who use both appear to value both and tend to be less concerned about their medical doctor's disapproval than about their doctor's inability to understand or incorporate CAM therapy use within the context of their medical management.


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Figure 1.
Perceptions about complementary and alternative medical (CAM) therapy relative to conventional therapy.white barsshaded barsdarkly shaded barsnn

Shown for each statement is the frequency of responses—agree ( ), disagree ( ), neither agree nor disagree ( ). *Asked of respondents who had seen a medical doctor and used any CAM therapies (excluding use of self-prayer alone) in the past 12 months ( = 831). †Asked of respondents who had seen both CAM therapy providers and medical doctors within the past 12 months ( = 411).

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Figure 2.
Sequence of seeking care from complementary and alternative medical (CAM) providers and medical doctors.n

Data are for the respondents who saw a medical doctor and a CAM provider during the past year ( = 411). *On further evaluation, this category was found to predominantly represent respondents who sought CAM therapies from a medical doctor. †These response choices were not read but were volunteered by respondents.

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Figure 3.
The amount of confidence patients reported having in complementary and alternative medical (CAM) providers (shaded bars) and conventional medical doctors (white bars).

Data are for respondents who saw both a medical doctor and a CAM provider in the past year. Overall, these 411 respondents reported using a total of 538 CAM therapies.

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Figure 4.
Reasons for nondisclosure of complementary and alternative medical (CAM) therapy use.nnn

*This response choice was not read but was volunteered by respondents. White bars represent reasons for nondisclosure of any therapy included in the survey ( = 726); the lightly shaded bars depict reasons for nondisclosure of therapies with a recognized potential risk for adverse events—namely, herbal remedies, chiropractic, naturopathy, megavitamins, and chelation therapy ( = 188). Our analysis also considered whether reasons for nondisclosure were associated with the severity of the medical condition; the darkly shaded bars summarize reasons for nondisclosure among respondents who reported having a relatively “severe” medical condition—cancer, coronary artery disease, or diabetes mellitus—in the past 12 months ( = 33).

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