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To the Editor: Drs Druss and Rosenheck¹ found that 8.8% of users of both conventional and unconventional therapies in their study were referred to those unconventional therapies by physicians. We recommend that this be taken into consideration in their analysis, because their conclusion that unconventional therapies were "associated with increased use of physician services" may be the result of physician referrals. If these patients were excluded from their logistic regression analysis (in Table 5 of their article), the results could be substantially different. For example, some physicians may refer patients with unresolved pain or stress for massage, biofeedback, or chiropractic care. It also would be of interest for the authors to present the distribution of referrals of unconventional therapies for these patients.

Furthermore, we note that those who used only unconventional therapy were 3 times as likely as those who received conventional therapy to be uninsured (Table 1 of their . . . [Full Text of this Article]

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Association Between Use of Unconventional Therapies and Conventional Medical Services
Benjamin G. Druss and Robert A. Rosenheck
JAMA. 1999;282(7):651-656.
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