Who uses alternative medicine and for what?

This week CDC's Morbidity and Mortality Weekly Reports (MMWR) has a quick statistical snapshot of the percent of adults (over the age of 18) who used Complementary and Alternative Medicine (CAM) by sex and selected conditions. CDC defines CAM as

A group of diverse health-care systems, practices, and products not presently considered to be part of conventional medicine. CAM includes acupuncture; ayurveda; homeopathic treatment; naturopathy; traditional healers; chelation therapy; nonvitamin, nonmineral, natural products; diet-based therapies; chiropractic or osteopathic manipulation; massage; movement therapies; biofeedback; meditation; guided imagery; progressive relaxation; deep-breathing exercises; hypnosis; yoga; tai chi; qi gong; and energy healing therapy. (MMWR, CDC)

Scienceblogs has a number of bloggers who suffer situational hypertension whenever they hear CAM mentioned and there's a lot of merit to their dismay. Use of CAM when effective scientific alternatives are available is often foolish and sometimes fatal. But as these data show, CAM is used most often for things for which routine medical practice is marginally effective, at best, or worse, sometimes treats in ways that do more harm than good:


Source: MMWR, CDC

Use of CAM for musculoskeletal pain is quite striking and indicative of the failure of more conventional treatment modalities. True, there are a lot of ways to treat back pain in clinical medicine, but that's often a clue to the fact that none of them work particularly well.

I'm not an adherent of CAM. I only tried it once, when I herniated a disk at L4-L5. I was in extreme pain and had two discordant opinions from doctors on what I should do (to cut or not to cut). I gave acupuncture a try (3 treatments). As far as I could tell it didn't do better than anything else and I eventually settled on high dose steroids for a week and a lot of NSAIDs. I got better without surgery. I might have gotten better without the steroids, but I think they worked to quiet the inflammation and cytokine release my orthopedist believed was causing the pain. Who knows. Trying to figure out if a treatment worked in an individual patient is a fruitless exercise in hypothetical counterfactuals. In my case I tend to think one of the conventional medical treatments worked and the CAM not so much.

Having said that, it is perfectly plausible to me why CAM is resorted to for these disease conditions. Some kinds of alternative medicine make more sense to me than others (or perhaps I should say, most of them don't make any sense at all), but that is somewhat a different question than whether they are good or bad. Nineteenth century homeopathy was preferable in most instances to its allopathic counterpart, not because homeopathy made scientific sense or was effective, but because it wasn't as harmful and dangerous as the usual practice of bleeding and purging the patient.

Meanwhile I continue to pop analgesics for my back, my joints and my headaches. I live in a veritable House of Analgesics. It probably doesn't make much sense, either. But after all, I'm a doctor. They say the best placebos are the ones both the patient and the doctor think works. I just hope I don't have a massive GI bleed as a consequence.


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Medicine isn't very good at dealing with musculoskeletal pain or inflammation; the drugs that are produced are either no better than traditional NSAIDS and have significat side effects, are so expensive they will bankrupt you and then screw up your immune system, or will get you addicted. So, it's no wonder that people will try anything else.

I use natural herbs (glucotar v2)and a low/NO carb NO sugar diet to control blood sugar from jon barron . YES natural herbs work!

Get yourself a superfood green drink too! I use Emerald Balance.

Tai chi is CAM? That's news to me. I thought it was a nice, low-impact exercise that improved balance and flexibility.

(Well, maybe if you think there's anything in the whole "meridians" nonsense, but that's not exactly a requirement to do it.)

Tai Chi is a martial art, not CAM.

By Jeff Westbrooks (not verified) on 09 Sep 2008 #permalink

The real trouble with these measures is that some things that really aren't CAM are lumped with those that are. Is someone who gets a massage to treat muscle pain getting CAM? Is someone who uses a meditation technique such as yoga or tai chi to treat anxiety getting CAM? Even if there are nonscientific elements to things like yoga and tai chi, they are unquestionable meditation techniques which do help many people relax.

I've yet to see a good study separate the different types of CAM to say how many people do the really do things like homeopathy (in more than a buy a random pill without knowing what is in it)

I would like to point out that what s35wf said about using

"low/NO carb NO sugar diet to control blood sugar"

is NOT about low nitric oxide. (NO is the chemical symbol for nitric oxide).

High nitric oxide inhibits cytokine release and reduces inflammation. High blood sugar lowers nitric oxide levels by stimulating NADPH oxidase to make more superoxide and that superoxide lowers nitric oxide levels.

A low carbohydrate diet controls blood sugar by inducing ketosis, so your brain and nervous system run on ketones from fat instead of on glucose. The only way you can make glucose on a zero carbohydrate diet is from protein, either from diet, or from your body's protein reserves (those reserves are skeletal muscle).

There are some physiological functions which can only be met by glucose. Storage of glycogen and synthesis of lactose. Fat and ketone bodies cannot substitute for these needs.

I have a sister with advanced RA. For years she tried doctor recommended treatments. None worked especially well. Out of desperation, she began investigating alternative medicine treatments. Nothing from the doctor was working, so try that approach. Unfortunately, CAM did not work well either. I think you pegged it by saying CAM is an approach used when conventional methods fail.

Revere, you are a strong individual. High dose steroids for a week sounds like torture to me. All steroids, be it injections or oral, make me feel terrible.

I live in WV, where life expectancy is actually getting lower due to obesity and prescription drug abuse.

I take enteric coated peppermint pills for gall bladder flares. I got these initially on the Adkins diet. The pains are much rarer now. Since our community has gotten a gym,
I just go swimming.

The pills really did help however. There were a couple times I was ready to go to the hospital and took them and didn't have to go.

Since I hate hospitals and have worked in them as a pharmacist, that is saying something.

Here in Switz. homeopathy is practically mainstream medecine. However the medical faculty does not see that in that light, and it took a referendum and popular vote (in one canton, Geneva, where I live, but similar actions have been undertaken elsewhere) to force the Med. School (a tax-payer funded institution) to give courses in homeopathic treatment.

Result: 3 to 4 students only. So the courses were cancelled. The voters could not order the student s choices.

That said, I find it shameful that low-level labor-intensive "therapies" such as physiotherapy, gymnastics targeted to back pain, tai chi, mud baths, and others, are excluded from the Western modern medecine remit, and usually not reiumbursed by insurance or paid for by the State in semi - National Health care systems. The reasons are obvious: there is no money to be made, except by those who actually do the work, an they are rather modest in their expectations, and drain patient payments to them.

The magic knife and the magic pill offer the possibility of huge profits.

The definition of CAM here is so broad as to be useless. Some of these modalities have reserach behind them like biofeedback, while others do not, like "traditional healers", a category too heterogeneous to be useful. Both Revere and CDC don't really know what they're dealing with/talkining about.

Rich: I think you and others are mistaking the use of CAM to mean "has no basis." Some of it does have a (scientific) basis and some of it doesn't, just as for clinical medicine, much of which has never been adequately tested and some of which is based on theories that we now know are wrong. CAM is used by CDC in the way conventional practitioners and the public use it, as "other" medical practices, some of which are considered plausible and possibly well based (e.g., acupuncture or massage) and some of which not. There are economic aspects of all of this, for docs and drug companies and for practitioners of CAM, not all of which are legit. I also think the definition of CAM misses the point of the post. I think DNA Lady read me correctly. These are things that tend to be used when conventional medicines (including OTCs) fail. This doesn't mean that's true for everyone. There are people who use alternative therapies all the time, exclusively or selectively for various things. But overall, I think the CDC results point to an underlying pattern.

Just my opinion, of course. This issue seems to raise the hackels of all sorts. I'm sure my Sb colleagues will weigh in at some point and say I am going too easy on CAM (however you want to define it).

"The magic knife and the magic pill offer the possibility of huge profits."
Sadly, any time something becomes payable by insurance it switches from affordable to big bucks.

By this definition is Fish Oil CAM? It seems to have a fairly good amount of evidence behind it.

Many evidence based modalities have been lumped into CAM simply because conventional medicine has failed to use them.

Example, hypnosis and self-hypnosis training are safe, effective and affordable and yet these well-documented modalities for pain relief are basically ignored and toxic, addictive, and expensive "treatments" are the treatment of choice.

Sounds like mal-practice to me

Generally 'alternative' 'medicine' appears to me a descent into old night and chaos, mere superstition, which I will oppose with all my dwindling strength.

On the other hand: the pediatric practice my kids go to is run by doctors and PAs who may try homeopathic remedies first, especially for things like ear infections, where antibiotics might not be useful. Initially this made me bristle, but upon reflection I figured that it would do no harm, since they will go to antibiotics etc if warranted. This seems to me a sensible way to use homeopathy.

The equation for the costs of CAM use is completely different in countries which have national health schemes. Here in the UK, since I'm on a low income I can get any conventional treatment I can talk my doctor into prescribing for free - it would be about $15 per prescrition if I wasn't so broke. CAM therapies OTOH cost $70 per hour or more (you can occasionally get certain treatments on the NHS). For a long time this has made CAM the refuge of the desperate and the middle-class 'worried well', although its influence has spread recently.

Given the costs of some of the conventional treatments in the US it makes a lot of sense to me that people would look at CAM first, even as an expensive placebo it could work out cheaper. And from the perspective of an individual patient the results of clinical trials are not necessarily an important part of the calculation.

By Charlotte (not verified) on 09 Sep 2008 #permalink

Like you, Revere, I suffer from two herniated disks in the L4 and L5 region and have for 40 years. Unlike you, I could not stomach the NSAID/steroid solution. Despite my initial misgivings, I have found a routine of daily stretching exercises for prevention and then, when I did something stupid, immediate and regular chiropractic and massage for a short period to provide significant relief. Acupuncture also helped in a couple of acute situations. I would also hasten to say that results depend greatly on the skill and experience of the practitioner.

Finally, I'd like to point out there is a significant base of published scientific research on the positive effect of meditation. The Stress Reduction Clinic at the University of Massachusetts Medical School has been publishing studies for a couple of decades. As a graduate of their stress/pain reduction program, I can testify to its effectiveness.

By Rene Theberge (not verified) on 09 Sep 2008 #permalink

I tend to think that herbals won't do much, but much to my surprise a compress soaked in comfrey tea (from my own plants) shrunk my hemorrhoids down to next to nothing!!!

In considering historical statistics regarding Homeopathy, perhaps a look at dramatically lower cholera epidemic morality rates may prove of interest.
This is often rationalized by pointing out the poor methods of allopathic treatment in the 1800's such as bloodletting or the use of Mercury. However even that does not explain the difference in mortality rates between 50 to 60% mortality if one did nothing as compared to 15% or less if one obtained a Homeopathic treatment. The allopaths, the better ones, could barely hold at 30%, usually much worse. As the numbers show, if Homeopathic remedies were really just water, their nothing seems to have done better than doing nothing. Details about this and the suppression of the statistics favorable to Homeopathy (until their release was forced by Parliament, desirous of getting the skinny on all aspects of the deadly epidemic) can be found here:


By James Pannozzi (not verified) on 10 Sep 2008 #permalink

James: I'm not sure I'd trust 19th century death data but in any event, the treatment for cholera essentially is hydration because death is by dehydration.

Passions tend to run high in discussions about CAM, so it may be worth remembering that what really matters is how safe a medical intervention is and how well it works. Judging interventions by whether they are labeled standard care or CAM may be quick, but is reliable only where adequate studies were done. Labeling cannot replace doing the studies.

Finding examples of ineffective and net harmful CAM may be easy, but you have to apply the same scrutiny to standard care, beginning with the questions of which standard medical interventions are based on evidence and which are net beneficial.

Before summarily panning CAM, you�'d have to produce something like a 2x2 table, or rather 2x3 table: (1.1 Standard; 1.2 CAM) by (2.1 net beneficial; 2.2 undecided; 2.3 net harmful).

By dubiquiabs (not verified) on 10 Sep 2008 #permalink

dubiaqulabs: I wasn't panning CAM. On the contrary. But I wasn't praising it, either. I was making an observation about its use vis a vis conventional medical practice.

I have started to treat my left upper back's pain six months ago. The symptoms were left fingers' numbness and chronic sore muscle in the left upper back.

I started with a kind of qi-kung, it seemed generating some effect, because the sore muscle in the back was moving here and there until about three months ago the joint of the arm was painful enough to make me wake up in the night time. Therefore, I went to see doctor and took pain killer and muscle relaxing medicine. But my stomach could not stand the continuous medication.

I've changed and seen a new doctor and continued to his consultation until now. He advised me to take physical therapy and acupuncture primarily before he will decide the further treatment, for instance the surgery

So far, I have 9 acupuncture and 16 therapies and now I have no acute pain, but chronically sore sometimes. Numbness and stiffness still exist. Overall, I assess that it has made progress. I will continue these treatments for another two months. Good thing is that I don't need to take medicine now.

One point about the acupuncture for me is that it did improve my pulse dramatically; the pulse now is very constant unlike before treatment, every 11 pulses had one stop. According to the acupuncture's doctor who has treated me now; he said, the bone, muscle and blood are relating to kidney, liver which are ultimately mastered by heart. So, he decided the course to treat my heart initially.

According to his records, acupunctures are helping most for heart disease, diabetes and pain. One of the hospital's doctor convinced me that his diabetes has got recovery by combining acupuncture and decreasing body weight, now totally stop medication.

I have patience to continue acupuncture for my back pain treatment, because I don't like the medication. But I rely on conventional medical doctor to rate my situation and make decision. It seems that in Phuket the doctors are more inclusive, for instance this hospital has both systems.

My acupuncture doctor tells me if anyone would like see his diagnosis on heart disease, the recent photo of the patient would help to tell the clue; nevertheless the pulse pattern is most helpful. It is his opinion, not mine. I am his patient now, perhaps if you like to try, I am available for communication. He speaks Chinese and he needs to see the photo. :-)

Revere, the "you" was meant to be a generic "you", not directed at you personally. I should've been more clear (methylxanthine deficiency, ...).

Hope your back is healing OK.

By dubiquiabs (not verified) on 10 Sep 2008 #permalink

I think time is a great healer and needs to get most of the credit for many of therapies promoted by alternative and traditional practitioners. The human body is truly a marvel.

By floormaster squeeze (not verified) on 10 Sep 2008 #permalink

This is a very big topic with my middle class, well-educated suburban Atlanta patients. For 20 years it has been our office SOP is to take a complete written drug history from every patient including vitamins, minerals and non-traditional therapies. I was pretty surprised when an increasing number of these patients began reporting use of "natural" therapies, mega-vitamins, and other "nutracuticals". Now I would say well over 70% use some type of unproven therapy or other on a regular basis.

When asked why, the say that they are "safe" because "they are natural". Other reasons are the "great research and reports these products have" or "it is recommended by a doctor". When you look at the "research" behind most of these products it often falls well short of the standard used in clinical practice today. Most use anecdotal reports from patients or recommendations from this or that MD, DO, or PhD who are promoting the product enthusiastically.

In my experience, every drug I know of and use in clinical practice that has been scientifically proven effective for treatment of a disease also causes unwanted side effects. Some side effects are mild while others are quite serious or even fatal. There is no such thing as a completely "safe and effective" drug. What we have are drugs that have potential benefits and risks that have been pretty well defined by use of the scientific method prior to their release for general use by the U.S. FDA and regulatory agencies in other nations.

In other words, if a substance is safe then it is not effective.

There is no middle ground here. I wish it were not so but it is. What really troubles practitioners like me the most though is the concern that the plethora of substances our patients are taking today that are produced outside the regulatory process might be harmful., i.e. could be a real drug rather than a harmless substance. Another conundrum is the potential for drug-drug interactions that might occur with a "safe and natural" substance that turns out to have real pharmaceutical ingredients that is taken by a patient at the same time as a regulated drug.

Consumers might ask "if these natural treatments present so much risk, why hasn't the U.S. FDA taken action"? The answer is they are prohibited to do so by something called the Nutraceutical Act passed by a sleepy Congress in the late 80s or early 90s before the CAM craze really took off. Apparently there were a couple of legislators who used these treatments and were "believers" that sponsored the legislation which passed with wide margins. There wasn't much opposition to it then as no one saw that it would become the massive problem it has today.

I agree with those above who point out that the CDC list of CAM is too broad and probably should not include methods like message, acupuncture, meditation, yoga, Ti Chi, and biofeedback therapies to name a few that really have considerable beneficial clinical effects that have been established using scientific medical trials. For instance, there is a tremendous interest in studying the effects of meditation plus regular care VS regular care alone on clinical outcomes in patients with other serious medical conditions. I am aware of a number of randomized clinical trials using meditation in this way at several first rate medical institutions including Emory and UMass.

What is a real and potential problem of unknown proportions in my opinion is the use of traditional herbal therapies and other healing techniques that employ substances that are ingested by people.

For instance, these include traditional Chinese herbal therapy, upon which most Eastern approaches are based and Ayurvedic medicine which has its own foundations, there are mixed findings. Many of the compounds used by these practitioners contain active pharmaceuticals and in some case frank poisons that have both effects and serious side effects.

Chinese herbal treatments include a vast number of pharmaceuticals that are naturally present in plants and animals. When active drugs are found in herbs, there are usually a very large number of related compounds that can have complementary or opposing effects on humans. Some are very potent and deadly. For instance, a Chinese herb commonly used for weight loss contains the drug ephedrine that raises blood pressure enough to cause stroke and heart attack in some people.

A recent review of Ayurvedic treatments in JAMA available for sale without a Rx made in the West and in India contained unsafe levels of lead and mercury as well as other harmful heavy metals.

These are just a couple of examples but there are many others. Since the late 1990s a number of randomized placebo controlled scientific trials have performed on treatments commonly used by patients today. Some have been sponsored by the HIH and many have been published in peer review medical journals including JAMA. Two studies come to mind, one investigated garlic to lower cholesterol and the other tested glucosamine/chondrotin sulfate for treatment of osteoarthritis. I was very reassured by results on these studies. Both showed these commonly used substances to be completely safe. These same studies showed them to totally ineffective as well.

Irrespective of the science, some people report that their arthritis is much better on G&C. What is my response, "great, you should continue taking it then". The placebo response is a powerful thing that has real effects on human health. If you don't believe this to be so, just look at virtually every clinical trial that uses hard objective endpoints. Placebo treated patients almost always have an improvement in the objective measure compared with their baseline values.

Scientific medicine really can't cope with the mind/body issue. We can't measure it well or predict its impact. Drug companies can't patent it for profit and the U.S. FDA can't regulate it. So, we medical and scientific types would simply ignore it and wish it would go away. It won't so we should get use to it and learn to live with this force of nature as another anomaly that we simply don't understand but must accept as one of the many influences on human health and disease that we have no control over.

By The Doctor (not verified) on 14 Sep 2008 #permalink