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Complementary and Alternative Medicine in the United States
by the American public between 1990 and 1997 (Eisenberg et al., 1998). (See Table 2-1 for a summary of the surveys of CAM use that have been conducted.) Specifically:
The prevalence of CAM use increased by 25 percent from 33.8 percent in 1990 to 42.1 percent in 1997.
The prevalence of herbal remedy use increased by 380 percent.
The prevalence of high-dose vitamin use increased by 130 percent.
The total number of visits to CAM providers increased by 47 percent from 427 million in 1990 to 629 million in 1997.
The total visits to CAM providers (629 million) exceeded the total number of visits to all primary-care physicians (386 million) in 1997.
It was estimated that, in 1997, adults made 33 million office visits to professionals for advice regarding the use of herbs and high-dose vitamins.
An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies or high-dose vitamins or both. These individuals are therefore at risk for potential adverse drug-herb or drug-supplement interactions.
If insurance coverage for CAM therapies increases in the future, current use of CAM services is likely an under-represention of future utilization patterns.
Despite the dramatic increases in the rates of use and the expenditures associated with CAM services, the extent to which patients disclosed their use of CAM therapies to their physicians remains low. In both 1990 and 1997, less than 40 percent of CAM therapy users disclosed to their physicians that they had used such therapies.
Estimated expenditures for CAM professional services increased by 45 percent, exclusive of inflation. In 1997 such expenditures were estimated to be $21.2 billion.
Out-of-pocket expenditures for herbal products and high-dose vitamins in 1997 were estimated to be $8.0 billion.
Out-of-pocket expenditures for CAM professional services in 1997 were estimated to be $12.2 billion. This exceeded the out-of-pocket expenditures for all U.S. hospitalizations.
Total out-of-pocket expenditures relating to CAM therapies were conservatively estimated to be $27.0 billion. This is comparable to the projected out-of-pocket expenditures for all U.S. physician services.
The study also found that among the respondents who in the past year had used CAM and seen their medical doctor, 63 to 72 percent did not disclose to their doctor the fact that they had received at least one type of CAM therapy. Among 507 respondents who reported their reasons for
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