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Survey of Complementary and
Alternative Medicine continued... [South Med J 93(4):375-381, 2000. © 2000 Southern Medical Association] DiscussionOur survey in South Carolina, a rural state with a large minority population, found that consumers' use of complementary and alternative therapies is similar to that found in contemporary national studies.[1-3] The unique characteristics of the state and region do not seem to translate into differences in CAM use, either in terms of overall prevalence or in the use of specific treatments. Recent national surveys by Eisenberg et al[1] and Landmark Healthcare Inc[2] showed that 42% of the American adult public had used at least one CAM therapy during the past 12 months (1997). The comparable figure for the state of South Carolina approximately 1 year later is 44%, and use of therapies such as herbal medicine, lifestyle diets, and vitamin therapy during the past 12 months was virtually identical to that reported by Eisenberg et al.[1] Personal therapies (such as home remedies and herbal medicine) and relaxation therapies were found to be the most prevalent, and about half of the users of these specific treatments used them to maintain health rather than to treat ailments. Middle-aged health care consumers were most likely to report using CAM at least once during their lifetime, and advanced education was the best predictor of use within the past year. With some differences across CAM type, users generally reported positive experiences with these treatments, indicating they would recommend the treatments to family or friends. Judgments of the treatments' effectiveness varied correspondingly: about three quarters of those using healing therapies, life-style diets, and self-help groups reported them extremely or very effective, compared with less than one half of users of commercial weight loss programs.As noted earlier, searching for consensus in defining CAM and its components may obscure more fluid and dynamic social, cultural, and economic realities.[19] Although antiscientific, non-Western, religious, and counter-cultural concepts and therapies are likely to rise and fall in public popularity, well-designed trials using the methods of modern medical research increasingly are being undertaken to determine the effectiveness of various treatments currently being classified as CAM.[20] Therapeutic or preventive approaches and interventions, whether they originate inside mainstream medicine or without, can be found more or less effective by these means. Such evidence may factor into whether a treatment will be widely adopted in alternative provider practice or in self-care, or integrated within mainstream medical practice. Effectiveness is rarely the sole or even predominant determinant of the use and advocacy of particular treatments when health-care beliefs, practices, values, and interests conflict. This is shown even within mainstream medicine in the well-documented problems of aligning professional practice with evidence of effectiveness. At the same time, the relatively affluent, well-educated health care consumers (those we find most likely to use CAM now) may feel competent to judge and feel empowered to demand evidence of effectiveness for preventive or therapeutic interventions. The high level of consumer interest, use, and investment in CAM presage more boundary shifting in the modern medical paradigm and continuing struggles for professional and regulatory control. Our research suggests that in South Carolina, there is not currently a high level of physician involvement in the use of the defined complementary and alternative treatments, though this varies considerably across treatment types. Overall, physicians are aware of CAM use for about 45% of their patients who are users. Those treatments with higher physician recommendation rates conceptually appear to be "complementary" rather than truly "alternative." These more complementary therapies may provide a snapshot of the frontline territory in the integration of CAM with mainstream medical care. Associating CAM therapies with medical practice may increase acceptability and use of certain therapies. About one third of our respondents indicated that a physician's recommendation would make them more likely to try a CAM therapy. Future research is needed to determine the impact of the growing use of CAM on public health, medical training, and medical practice in South Carolina and nationally. Supported by Palmetto
Health Alliance of Columbia, SC to the South Carolina Complementary
Medicine Program. The South Carolina Complementary Medicine Program is a
multidisciplinary partnership initiative of the University of South
Carolina Institute of Public Affairs and Palmetto Health Alliance, and
is housed in the Center for Health Services and Policy Research in
Columbia. |