This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (187)  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in JAMA  Topic Collections  • Complementary and Alternative Medicine  • Alert me on articles by topic

Benjamin G. Druss, MD, MPH; Robert A. Rosenheck, MD

JAMA. 1999;282:651-656.

Context  The terms alternative and complementary medicine suggest 2 contradictory possibilities. Whether individuals use unconventional therapies as a substitute for or as an "add on" to conventional medical treatments is uncertain.

Objective  To determine the association between use of unconventional therapies and conventional medical care in a national sample.

Design, Setting, and Participants  The 1996 Medical Expenditure Panel Survey was distributed to a probability sample of the noninstitutionalized civilian US population. Of 24,676 individuals responding (77.7% response rate), 16,068 adults 18 years or older were included in the analysis.

Main Outcome Measures  Visits to practitioners for unconventional therapies and conventional medical services, including number of inpatient, outpatient, and emergency department visits and use of 8 types of preventive medical services (blood pressure, cholesterol level, physical examination, influenza vaccination, prostate examination, breast examination, mammography, and Papanicolaou test).

Results  During 1996, an estimated 6.5% of the US population had visits for both unconventional therapies and conventional medical care; 1.8% used only unconventional services; 59.5% used only conventional care; and 32.2% used neither. Compared with those with only conventional visits, those who used both types of care had significantly more outpatient physician visits (7.9 vs 5.4; P<.001), and used more of all types of preventive services except mammography. These groups did not differ significantly in inpatient care, prescription drug use, or number of emergency department visits. Individuals in the top quartile of number of physician visits were more than twice as likely as those in the bottom quartile to have used unconventional therapies in the past year (14.5% vs 6.4%; P<.001). The association between unconventional treatments and physician visits remained after adjusting for potential confounders and across different types of unconventional treatment.

Conclusions  In this sample, use of unconventional therapies was substantially lower than has been reported in previous national surveys, but was associated with increased use of physician services. From a health services perspective, practitioner-based unconventional therapies appear to serve more as a complement than an alternative to conventional medicine.

Author Affiliations: Departments of Psychiatry and Public Health, Yale University, West Haven, Conn.

RELATED LETTER

Conventional Medical Care and Unconventional Therapies
David Barzilai, Alfred Rimm, David L. Katz, Benjamin G. Druss, and Robert A. Rosenheck
JAMA. 2000;283(1):56-57.
EXTRACT | FULL TEXT  

RELATED ARTICLE

August 18, 1999
JAMA. 1999;282(7):701-702.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The effects of health status on the utilization of complementary and alternative medicine
Avogo et al.
Health Education Journal 2008;67:258-275.
ABSTRACT  

Public Status and Prevalence of Acupuncture in Japan
Ishizaki et al.
Evid Based Complement Alternat Med 2008;0:nen037v2-nen037.
ABSTRACT | FULL TEXT  

Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use
Bishop and Lewith
Evid Based Complement Alternat Med 2008;0:nen023v1-nen023.
ABSTRACT | FULL TEXT  

U.S. Cambodian Refugees' Use of Complementary and Alternative Medicine for Mental Health Problems
Berthold et al.
Psychiatr. Serv. 2007;58:1212-1218.
ABSTRACT | FULL TEXT  

Use of Herbal Remedies by Hispanic Patients: Do They Inform Their Physician?
Howell et al.
J Am Board Fam Med 2006;19:566-578.
ABSTRACT | FULL TEXT  

Race/Ethnicity and Women's Use of Complementary and Alternative Medicine in the United States: Results of a National Survey
Kronenberg et al.
Am. J. Public Health 2006;96:1236-1242.
ABSTRACT | FULL TEXT  

Medical doctors and complementary and alternative medicine: the context of holistic practice.
Winnick
Health (London) 2006;10:149-173.
ABSTRACT  

Complementary and Alternative Medical Therapy Use Among Chinese and Vietnamese Americans: Prevalence, Associated Factors, and Effects of Patient-Clinician Communication
Ahn et al.
Am. J. Public Health 2006;96:647-653.
ABSTRACT | FULL TEXT  

Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland--an observational study
Busato et al.
Fam Pract 2006;23:116-124.
ABSTRACT | FULL TEXT  

Use of Complementary and Alternative Medicine by Older Adults: An Exploratory Study
Montalto et al.
Complementary Health Practice Review 2006;11:27-46.
ABSTRACT  

Association Between Complementary and Alternative Medicine Use, Preventive Care Practices, and Use of Conventional Medical Services Among Adults With Diabetes
Garrow and Egede
Diabetes Care 2006;29:15-19.
ABSTRACT | FULL TEXT  

Fertilization-Induced Changes in Growth Parameters and Antioxidant Activity of Medicinal Plants Used in Traditional Arab Medicine
Azaizeh et al.
Evid Based Complement Alternat Med 2005;2:549-556.
ABSTRACT | FULL TEXT  

Quality of HIV Care Provided by Nurse Practitioners, Physician Assistants, and Physicians
Wilson et al.
ANN INTERN MED 2005;143:729-736.
ABSTRACT | FULL TEXT  

Use of Complementary Medicine in Older Americans: Results From the Health and Retirement Study
Ness et al.
Gerontologist 2005;45:516-524.
ABSTRACT | FULL TEXT  

Frequency, Predictors, and Expenditures for Pediatric Insurance Claims for Complementary and Alternative Medical Professionals in Washington State
Bellas et al.
Arch Pediatr Adolesc Med 2005;159:367-372.
ABSTRACT | FULL TEXT  

Meridians, Chakras and Psycho-Neuro-Immunology: The Dematerializing Body and the Domestication of Alternative Medicine
Fadlon
Body Society 2004;10:69-86.
ABSTRACT  

Use of Complementary and Alternative Medicines by Ambulatory Patients
Rhee et al.
Arch Intern Med 2004;164:1004-1009.
ABSTRACT | FULL TEXT  

Patient Motivations for Using Complementary and Alternative Medicine
Testerman et al.
Complementary Health Practice Review 2004;9:81-92.
ABSTRACT  

Complementary Medicine Prescription Patterns in Germany
Schneider et al.
The Annals of Pharmacotherapy 2004;38:502-507.
ABSTRACT | FULL TEXT  

Complementary and Alternative Therapies for Cancer
Cassileth and Deng
The Oncologist 2004;9:80-89.
ABSTRACT | FULL TEXT  

Patient Attitudes, Insurance, and Other Determinants of Self-Referral to Medical and Chiropractic Physicians
Sharma et al.
Am. J. Public Health 2003;93:2111-2117.
ABSTRACT | FULL TEXT  

Complementary Medicine Use by Psychiatry Patients of an Australian Hospital
Alderman and Kiepfer
The Annals of Pharmacotherapy 2003;37:1779-1784.
ABSTRACT | FULL TEXT  

The (Alternative) Medicalization of Life
Schneiderman
J Law Med Ethics 2003;31:191-197.
 

Integrating complementary and alternative medicine (CAM) into standard hospice and palliative care
Lewis et al.
AM J HOSP PALLIAT CARE 2003;20:221-228.
ABSTRACT  

Chiropractic Health Care in Health Professional Shortage Areas in the United States
Smith and Carber
Am. J. Public Health 2002;92:2001-2009.
ABSTRACT | FULL TEXT  

Complementary and Alternative Medicine Use in Canada and the United States
McFarland et al.
Am. J. Public Health 2002;92:1616-1618.
FULL TEXT  

The Emerging Socioeconomic and Political Support for Alternative Medicine in the United States
GOLDSTEIN
The ANNALS of the American Academy of Political and Social Science 2002;583:44-63.
ABSTRACT  

Moving Lines and Variable Criteria: Differences/Connections between Allopathic and Alternative Medicine
FROHOCK
The ANNALS of the American Academy of Political and Social Science 2002;583:214-232.
ABSTRACT  

Use and Referral Patterns for 22 Complementary and Alternative Medical Therapies by Members of the American College of Rheumatology: Results of a National Survey
Berman et al.
Arch Intern Med 2002;162:766-770.
ABSTRACT | FULL TEXT  

Insurance Coverage, Medical Conditions, and Visits to Alternative Medicine Providers: Results of a National Survey
Wolsko et al.
Arch Intern Med 2002;162:281-287.
ABSTRACT | FULL TEXT  

The Prevalence and Pattern of Complementary and Alternative Medicine Use in Individuals With Diabetes
Egede et al.
Diabetes Care 2002;25:324-329.
ABSTRACT | FULL TEXT  

Commentary: Alternative Medicine: Is It a Reflection of the Continued Emergence of the Biopsychosocial Paradigm?
Bausell and Berman
American Journal of Medical Quality 2002;17:28-32.
ABSTRACT  

The Use of Herbal Medicine by Older Mexican Americans
Loera et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2001;56:M714-718.
ABSTRACT | FULL TEXT  

Complementary, Alternative, Integrative, or Unconventional Medicine?
Penson et al.
The Oncologist 2001;6:463-473.
ABSTRACT | FULL TEXT  

Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey
Eisenberg et al.
ANN INTERN MED 2001;135:344-351.
ABSTRACT | FULL TEXT  

Long-Term Trends in the Use of Complementary and Alternative Medical Therapies in the United States
Kessler et al.
ANN INTERN MED 2001;135:262-268.
ABSTRACT | FULL TEXT  

President's page: complementary and alternative medicine: ignore at doctors' and patients' peril
Zipes
J Am Coll Cardiol 2001;37:2166-2169.
FULL TEXT  

Determinants of the Use of Complementary Therapies by Patients With Cancer
Paltiel et al.
JCO 2001;19:2439-2448.
ABSTRACT | FULL TEXT  

The Use of Complementary and Alternative Therapies to Treat Anxiety and Depression in the United States
Kessler et al.
Am. J. Psychiatry 2001;158:289-294.
ABSTRACT | FULL TEXT  

Research into complementary and alternative medicine: problems and potential
Nahin and Straus
BMJ 2001;322:161-164.
FULL TEXT  

Can Cultural Competency Reduce Racial and Ethnic Health Disparities? a Review and Conceptual Model
Brach and Fraserirector
Med Care Res Rev 2000;57:181-217.
ABSTRACT  

Mental Disorders and the Use of Alternative Medicine: Results From a National Survey
Unützer et al.
Am. J. Psychiatry 2000;157:1851-1857.
ABSTRACT | FULL TEXT  

Discussing Complementary Therapies With Cancer Patients: What Should We Be Talking About?
Burstein
JCO 2000;18:2501-2504.
FULL TEXT  

Complementary/Alternative Medicine Use in a Comprehensive Cancer Center and the Implications for Oncology
Richardson et al.
JCO 2000;18:2505-2514.
ABSTRACT | FULL TEXT  

Use of Practitioner-Based Complementary Therapies by Persons Reporting Mental Conditions in the United States
Druss and Rosenheck
Arch Gen Psychiatry 2000;57:708-714.
ABSTRACT | FULL TEXT  

Fragmentation of Patient Care Between Chiropractors and Family Physicians
Mainous III et al.
Arch Fam Med 2000;9:446-450.
ABSTRACT | FULL TEXT  

Conventional Medical Care and Unconventional Therapies
Barzilai et al.
JAMA 2000;283:56-57.
FULL TEXT  

Complementary and Alternative Cancer Medicine
Cassileth
JCO 1999;17:44-52.
FULL TEXT  

Do Users of Unconventional Therapies Avoid Conventional Medicine?
JWatch General 1999;1999:6-6.
FULL TEXT