Thursday, March 15, 2012

Who Uses CAM and Why?

Recently, I wrote a blog post about the safe and appropriate use of homeopathy following the publishing of an English translation of a health technology assessment (HTA) written for the Swiss government’s Complementary Medicine Evaluation Program. I recently received a copy of the book myself and have subsequently dived in. All in all, it’s a fascinating document, as it provides an assessment of complementary and alternative medicine (CAM) as a whole, and not just homeopathy. This assessment includes discussion of appropriate usage, clinical and preclinical (in vitro) studies, the limitations of randomized control trials in assessing a complex medical system, and cost-effectiveness. Not merely a review of homeopathy’s clinical effectiveness, this is an assessment of how all types of complementary therapy operate, and their place in healthcare.

Today, I’m relating some information on complementary medicine’s demographics. People have a lot of opinions regarding who uses complementary medicine, but few of them actually cite studies or hard evidence about on the topic. It’s a fairly important topic, as it helps us to understand the place of CAM in the broader healthcare system, but it also helps NDs and other professionals, as it gives them information on the blind spots in their own practices. I was refreshed to learn that there is actual research in the literature about who uses complementary medicine as well as why they seek it out. In their report, the researchers referenced 52 studies on CAM usage.

Although I’ve argued in the past that NDs and other CAM providers need to reach out to minority communities, and I believe that NDs also need to reach out to male patients (because men utilize healthcare much less frequently than women), the information the researchers culled from studies indicates that users are by in large women between the ages of 30 and 50, who are more highly educated and in higher income brackets than non-users. So much for trying to buck stereotypes, right?

Although this information shouldn’t come as a surprise to anyone who’s worked in a ND or acupuncturist’s office, I will say that while on the one hand it gives us some information about which audiences might be the most receptive to our message regarding natural health alternatives, on the other hand, it also shows us who we’re not reaching, and to whom we need to be directing our efforts. I think it’s also important to mention that 9 of the 52 studies did not find significant differences between users and non-users, although some of these equivocal studies were too small to provide adequate information. In my own experience as a naturopathic student rotating through a drop-in clinic for homeless youth, I can say that sometimes naturopathic doctors’ status as ‘outsiders’ can serve to make us more accessible to some marginalized groups. There may be a typical CAM user, but that doesn’t mean they’re the only ones.

Additionally, it’s worth mentioning that the countries producing the studies may be affecting the demographics of those who use complementary therapies. I have noted in particular that the studies we conducted entirely in Westernized countries (US, Europe, Canada, Australia), and that CAM usage patterns may be remarkably different in, for example, India or China.

The authors went on to discuss reasons why patients sought out CAM providers. The clear winner in this category was, unsurprisingly, a dissatisfaction with conventional medicine. The authors did not go on to discuss the details of the dissatisfaction, perhaps because of lack of detail in the studies they were working from, but even so, NDs and acupuncturists are more than familiar with these complaints.

The next most common reasons given for seeking out CAM providers were: specific use of CAM for particular indications (e.g. food sensitivity elimination for IBS); a good doctor-patient relationship; a good experience with CAM (self of others); and a desire to avoid side effects from conventional medicine. These speak to the pragmatic appeal of complementary therapies to patients. There was no mention of a rejection of conventional medicine, but rather a desire to attain specific benefits – a strong doctor-patient relationship, a positive experience similar to a family member’s, or a low incidence of side effects.

I think this pragmatic approach is mirrored by the fact that, in the studies that examined the topic, about 66% of patients using CAM therapies were also using conventional therapies. The remaining third of patients were a bit harder to parse out – these users either used CAM in place of conventional medicine, used it when conventional medicine had proved ineffective, or used it and did not require conventional medicine. The authors stressed that there were not enough studies to make any conclusions regarding the place of CAM as regards conventional medicine, but I think that most NDs and acupuncturists recognize the importance of cooperation with other medical professionals in treatment.

Stay tuned, readers, for more information gleaned from this fascinating report.