Astin, J., Marie, A., Pelletier, K., Hansen E., and Haskell, W. (1998). A Review of the Incorporation of Complementary and Alternative Medicine by Mainstream Physicians. Arch Intern Med, 158(21), 2303-2310.

BACKGROUND

This article presents an attempt to synthesize our current understanding of the trends of CAM use in the major industrialized countries of the West. Searches of current databases were undertaken to identify any studies (mostly surveys) that described either the use of CAM by the general public, or physicians' belief in or use of CAM procedures in their practice. The authors elected to focus their attention on the five most popular forms of CAM treatment: acupuncture, chiropractic, homeopathy, herbal medicine, and massage.

There were a number of trends that appeared consistently throughout these studies. There seems to be an increasing use of CAM among industrialized nations. It is estimated to be somewhere between 30% and 50% of the adult population. The various surveys also indicated that users of CAM tend to be more educated, have higher incomes, and are likely to be between the ages of 30 and 50.

The most frequently cited reason for the increased use of CAM was dissatisfaction with the ability of conventional medicine to treat chronic illness. Several other reasons included dislike of the reductionistic model of conventional medicine and a desire to avoid treatments with adverse effects.

A number of the physicians in the surveys expressed opposition to the inclusion of CAM in medical practice. There are several reasons that were given, including: alternative practitioners don’t have the knowledge to diagnose an illness properly, there is a lack of evidence as to the efficacy of CAM, and CAM can be potentially harmful because patients may fail to seek conventional care that could help them.

DISCUSSION

It is obvious that the general public is very interested in CAM, and will continue to seek the help of CAM practitioners. Yet there is a lack of scientific research to support the use of CAM in many instances. However, the lack of evidence is often a result of the inability of CAM researchers to get funding for studying CAM procedures. It should also be noted that lack of supporting evidence is not the same as evidence indicating CAM is either not useful or harmful.

CAM is not taught extensively at most medical schools. However, many physicians are expressing greater interest in learning about CAM, especially because their patients are using it so much. It is concerning that one study reviewed found 70% of the people who were using CAM did not inform their doctors of this fact. That means that the CAM treatments could be having interactions with conventional treatments that the physicians should really know about.

Numerous studies reported use primarily among patients with higher incomes and better education. Will CAM treatments remain accessible only to this population, or will they be equally available to everyone? A great deal of this will depend on how the insurance industry chooses to deal with CAM treatments in the years to come.

Massage therapy has consistently come up as one of the most promising CAM therapies for various medical complaints. As part of this growing interest I think it is very likely that we will see a continued emphasis placed on validating research. I also anticipate an increased effort towards improvement of training standards for massage practitioners choosing to work with people who have medical complaints.

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