Americans spend more than a 10th of their out-of-pocket health care dollars on alternative medicine, according to the first national estimate of such spending in more than a decade.
Chiropractors, massage therapists, acupuncturists and herbal remedies are commanding significant consumer dollars as people seek high-touch care in a high-tech society, the report released by the government shows. Altogether, consumers spent an estimated $34 billion on those and other alternative remedies in 2007, the report found.
"We are talking about a very wide range of health practices that range from promising and sensible to potentially harmful," said Josephine Briggs, MD, director of the National Center for Complementary and Alternative Medicine, the federal agency that leads research in this field. More research into which therapies work is critically needed, because the spending on them is "substantial," she said.
The data, gathered in 2007 mostly before the recession was evident, doesn't clearly reflect whether the economy played a role in spending on these therapies. But Briggs noted there has been "speculation that as the number of uninsured grows, there may be increased utilization of some of these approaches, which tend to be relatively inexpensive." Nearly half of those who use alternative medicine say they cannot afford conventional care, according to government data published in a separate report.
Some consumer advocates say people are wasting money on some products that rigorous studies have shown don't work. Sidney Wolfe, MD, who leads Public Citizen's health research, has long criticized the government for what he considers lax regulation of prescription drugs and mainstream medicine. Yet, he also sees problems with the widespread use of dietary supplements. "People think they are cleared," by the Food and Drug Administration, he said, when in fact they do not need proof of safety or effectiveness to go on the market. "Mainly, they're ineffective," he said.
The report is based on a 2007 survey by the U.S. Centers for Disease Control and Prevention of more than 23,000 adults nationwide. An earlier report from this survey, released in December, found that more than one-third of adults use alternative medicine. That includes a wide range of services from meditation and yoga to herbal supplements, such as echinacea and ginseng. Vitamins and minerals are not included in this report but will be addressed in a future one.
Pain was the main reason people tried massage, chiropractic care and other alternative therapies. Among supplement users, most popular were glucosamine for joint pain and fish oil to cut the risk of heart disease.
The new survey results focus on how often Americans use these things, and how much they pay for them. The numbers show that alternative medicine accounts for more than 11% of out-of-pocket spending on health care in the United States.
The study found that about 44 cents out of every dollar spent on alternative medicine was for products like fish oil, glucosamine and echinacea. Spending on these products was nearly $15 billion, or about a third of what Americans spend out-of-pocket for prescription drugs.
"I personally am pretty conservative about supplement use," Briggs said. She believes that research her center has sponsored has affected consumer use. After widely publicized studies showed the ineffectiveness of echinacea for colds and St. John's wort for major depression, their use fell; fish oil use has risen following some research suggesting it might help lower risk of heart problems.
The survey shows about 35 cents of each alternative therapy dollar was for visits to acupuncturists, chiropractors, massage therapists and other practitioners. That totals nearly $12 billion, or about one-quarter of what Americans spend on visits to mainstream physicians. "Some of the useful things chiropractors are doing amounts to physical therapy," Wolfe said. "Medicine is beginning to realize how important physical therapy is."
The last government estimate for out-of-pocket spending on alternative medicine came from a 1997 survey. That research suggested $27 billion was being spent. The new report concludes that 38 million adults visited alternative medicine practitioners in 2007. They paid less than $50 per visit on average, but many paid $75 or more for services such as acupuncture, homeopathy and hypnosis therapy.
The average annual spending per person to see practitioners was about $122, and the average spending on products was $177. A whopping $3 billion was spent on homeopathy, a form of treatment that uses highly diluted drugs made from natural ingredients and based on a theory unverified by mainstream science.
Private insurance paid for about 43% of all alternative medicine in 2007, public insurance paid for 31% and patients paid for the rest, according to a separate government report.
Dianne Shaw, a media relations worker at the University of North Carolina at Chapel Hill, sees value in at least one form of alternative medicine—acupuncture. She says acupuncture helped her recover from a stroke-like facial nerve paralysis that standard drugs didn't remedy. During an exam, one of her doctors commented on her progress, and she revealed that she was getting acupuncture. "They said, 'Well I'm glad it worked,' " Shaw said.
By Marilynn Marchione and Mike Stobbe, Associated Press, July 30, 2009