Context.— A prior national survey documented the high prevalence and costs of
alternative medicine use in the United States in 1990.
Objective.— To document trends in alternative medicine use in the United States
between 1990 and 1997.
Design.— Nationally representative random household telephone surveys using comparable
key questions were conducted in 1991 and 1997 measuring utilization in 1990
and 1997, respectively.
Participants.— A total of 1539 adults in 1991 and 2055 in 1997.
Main Outcomes Measures.— Prevalence, estimated costs, and disclosure of alternative therapies
Results.— Use of at least 1 of 16 alternative therapies during the previous year
increased from 33.8% in 1990 to 42.1% in 1997 (P≤.001).
The therapies increasing the most included herbal medicine, massage, megavitamins,
self-help groups, folk remedies, energy healing, and homeopathy. The probability
of users visiting an alternative medicine practitioner increased from 36.3%
to 46.3% (P=.002). In both surveys alternative therapies
were used most frequently for chronic conditions, including back problems,
anxiety, depression, and headaches. There was no significant change in disclosure
rates between the 2 survey years; 39.8% of alternative therapies were disclosed
to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely
out-of-pocket for services provided by alternative medicine practitioners
did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3%
increase in total visits to alternative medicine practitioners, from 427 million
in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary
care physicians. An estimated 15 million adults in 1997 took prescription
medications concurrently with herbal remedies and/or high-dose vitamins (18.4%
of all prescription users). Estimated expenditures for alternative medicine
professional services increased 45.2% between 1990 and 1997 and were conservatively
estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket.
This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations.
Total 1997 out-of-pocket expenditures relating to alternative therapies were
conservatively estimated at $27.0 billion, which is comparable with the projected
1997 out-of-pocket expenditures for all US physician services.
Conclusions.— Alternative medicine use and expenditures increased substantially between
1990 and 1997, attributable primarily to an increase in the proportion of
the population seeking alternative therapies, rather than increased visits