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.
