Natural Supplements
Complementary and Alternative Medicine in the New Millennium

Thomas M. Bozzuto, D.O. Medical Director Mind/Body Institute of Florida

 
Consumer interest in Complementary and Alternative Medicine (CAM) has significantly increased in the past decade.1,2 The Institute for Alternative Futures estimates that interest will continue to grow as the next decade progresses (see Figure 1).3

Despite the popularity in the United States, recent data suggests that other countries have a much higher prevalence of usage than we do. (see Figure 2).4

 

In addition to the increased use of CAM by patients, utilizers of these therapies are spending significant amounts of out-of-pocket dollars not only to providers of CAM services, but also in natural medicines and supplements. A research firm specializing in healthcare markets suggests that U.S. sales of natural medicines and supplements will more than double from $2.85 billion in 1994 to $6.5 billion by 2001.5

The increase in CAM usage is not limited to those patients paying out-of-pocket to see individual CAM providers. Two thirds of the HMO's in the United States (67%) offer at least one form of CAM service, the most frequent being chiropractic (65%) and acupuncture (35%). Of those HMO's offering CAM, 38% cite that demand among members and employers compelled them to offer these benefits.6

However we, as physicians, feel about this significant trend, the facts are that one out of every two patients we see will be using some form of CAM within the next few years. This raises several issues:

  • Are we familiar with the therapies (effects, side-effects, indications, contraindications, drug interactions, effects on organ systems, etc.)?
  • Do we know where to get reliable information to pass on to our patients?
  • Are we asking our patients about their CAM usage?
  • Can our patients trust us to be an unbiased source of medical information concerning recommendations or cautions about CAM therapies?
  • Do we know and trust CAM providers in the community who are providing these services to our patients?

The quantity of applied health research on CAM is growing rapidly, and the quality is improving. The number of randomized trials of complementary treatments has approximately doubled every five years,7 and the Cochrane Library now includes nearly 50 systematic reviews of complementary medicine interventions. Much of this evidence involves small numbers of patients and is of poor methodological quality; however, high quality systematic reviews have been published recently which provide a reliable basis for making healthcare decisions.

In 1993, Congress formally established the Office of Alternative Medicine (OAM). Previous legislation provided $2 million in Fiscal year 1992 to establish this office. In 1998, Congress expanded the status, mandate, and authority of the OAM by enacting legislation to create the National Center for Complementary and Alternative Medicine (NCCAM). NCCAM is charged to "conduct basic and applied research (intramural and extramural), research training, and disseminate health information and other programs
with respect to identifying, investigating, and validating CAM treatments, diagnostic modalities, disciplines and systems. After establishment of grant making authority to NCCAM in 1998, funding increased dramatically from $19.5 to $68.3 million in 2000. Total investment in CAM research by the NIH in FY 2000 is approximately $161 million.8

References

  1. Eisenberg DM, Kessler RC, Foster C, et al. Unconventional Medicine in the United States. N Engl J Med 1993:328:246-252.
  2. Eisenberg DM, Davis RB, Ettner SL, Appel S, et al. Trends in Alternative Medicine Use in the United States, 1990-1997: Results of a Follow-Up National Survey. JAMA 1998:280:1569-1575.
  3. Institute for Alternative Futures. The Future of Complementary and Alternative Approaches (CAAs) in US Health Care. Alexandria VA, 1998.
  4. Ernst E. The Role of complementary and alternative medicine. BMJ 2000;321:1133-1135.
  5. Frost & Sullivan. U.S. Natural Medicine and Supplement Markets. (Research Publication) Mountain View, CA. 1995.
  6. Daily L. More HMO's Covering Alternative Treatments and Complementary Care. Physicians Financial News 1999:17(9):S1-S6.
  7. Vickers AJ. Bibliometric analysis of randomized controlled trials in complementary medicine. Complementary Ther Med 1998;6:185-9.
  8. NCCAM. Expanding Horizons of Healthcare: Five-Year Strategic Plan, 2001-2005. NIH, Washington, DC. 2000
December, 2000/ Jacksonville Medicine

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