Unconventional treatments tried most for what ails us Study finds visits to the doctor most often exclude conventional medical profession

January 28, 1993|By Boston Globe

Sounding a "wake-up call" for the medical profession, a study published today says Americans seek treatment from chiropractors, acupuncturists and other unconventional practitioners more often than from internists, pediatricians and other primary-care doctors.

One in 3 adults tried relaxation therapy, herbal cures, massage or some other unorthodox treatment for aches and pains in 1990, the year the nationwide survey was conducted.

When it came to shelling out their own cash, the survey found that Americans spent $10.3 billion on unconventional healers -- nearly as much as they paid in out-of-pocket hospital bills. And most of them did not say a word to their doctor about it, said the survey, which appears in today's edition of the New England Journal of Medicine.

The study "forces those of us in the conventional medical community to look at whether or not those [unconventional] techniques are effective and whether they save money," said Dr. David M. Eisenberg, lead author of the report.

It also suggests that many consumers doubt whether doctors can do the job, said Alan Sager, associate professor at the Boston University School of Public Health, who was not involved in the survey. "Mainstream medicine," he added, "is not adequately addressing the problems of pain and worry."

Can the huge medical bureaucracy change its ways?

It already is, said Dr. M. Roy Schwarz, senior vice president of the American Medical Association. The National Institutes of Health recently set up an Office of Alternative Medicine to explore herbal medicine and other non-mainstream techniques, he said, and the AMA plans to encourage doctors to talk with patients about all the treatments they are receiving.

"The traditional side at least has to ask whether patients are receiving other therapies," Dr. Schwarz said. "In that sense this survey is a wake-up call for us."

Anyone who watches Americans' health-care habits has known for decades that chiropractors, acupuncturists and other unconventional practitioners have large followings. But until today's study, no one knew just how large.

The survey, conducted by researchers at Boston's Beth Israel Hospital and based on telephone interviews with 1,539 adults, found that 34 percent of respondents used at least one unconventional therapy in the previous year. At that rate, the authors concluded, Americans would have visited providers of such therapies 425 million times in 1990 -- slightly more than their 388 million trips to family doctors and other primary-care vTC physicians and about half the visits they made to cardiologists, dermatologists and other medical specialists.

The most commonly used therapies were, in order: Relaxation techniques, chiropractics, massage, imagery, spiritual healing, commercial weight loss, macrobiotic and other lifestyle diets, herbal medicine, mega-vitamins, self-help groups, energy healing, biofeedback, hypnosis, acupuncture and folk remedies.

Those treatments generally were used along with conventional cures and were most often not used for life-threatening illnesses. They were tried most often to battle back troubles, headaches, anxiety, chronic pain and cancer.

One in 4 respondents also said they had used prayer or exercise to attack an ailment, but those treatments were not included in the tally of unconventional remedies.

While Americans of all stripes turned to non-traditional medicine, use was highest among those ages 25 to 49 who had some college education and incomes above $35,000. Westerners were more likely to try them than people living elsewhere; blacks were less likely than people of other races.

The survey also showed that people using unconventional treatments believed in them enough to dig into their own pockets to pay: 55 percent paid for everything themselves, 31 percent were partly reimbursed by insurance or another third party, and only 14 percent were totally reimbursed. Insurers were most willing to cover herbal therapy, biofeedback, chiropractics and mega-vitamins.

Word that 61 million Americans are using unconventional health care isn't news to her, said Molly Rangnath, deputy director of the International Chiropractors Association. "The public is looking for an alternative to medical care," she said. "It's looking for care without drugs. That's what chiropractic care is all about."

Most physicians, however, "will be surprised by the numbers we found," said Dr. Thomas Delbanco, another of the study authors. "But they should expect to be surprised because we learned that 70 percent of the time patients don't talk to us about those therapies."

"The lesson for me as a practicing doctor," Dr. Delbanco said, "is to ask patients about them."

Another lesson, Dr. Eisenberg said, is that medical researchers should conduct thorough studies on the unorthodox treatments, objectively weighing which are effective and which are not. Harvard University, he added, has a course that lets medical students explore possible uses for unconventional therapies.

The study being released today is one in a series of sobering messages for America's physicians. A recent Gallup Poll, for instance, found that only 52 percent of those surveyed have confidence in doctors' honesty and ethical standards, down from 56 percent in 1976. Doctors also have been blamed for soaring medical costs.

Medical specialists disagree about whether the findings of this new study could -- or should -- influence the Clinton administration's thinking on health-care reform.

Nearly $14 billion a year spent on unconventional health care in 1990 was just a fraction of the nation's total health-care bill of $660 billion.

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