Austin’s study demonstrated that most individuals used alternative medicine as an adjunct to conventional medicine. Only 5% used alternative medicine alone. This finding underscores the need to have a complete history of all treatments to take into account the risk of interactions between therapies. In addition, individuals with poorer health status are more likely to utilize alternative therapies. Here again, sicker patients with more complicated treatment regimens increase the risk of untoward events caused by interaction of treatments. Austin’s data were then examined to determine whether any trends were evident regarding which groups were likely to utilize CAM.

In an examination of CAM use and age (Figure 1), the data suggested substantial CAM use across all age groups. The data were then sorted by race and ethnicity (Figure 2). Although there was substantial use across all ethnicities, there was less use among African-Americans and more use among Native Americans. When educational level was examined (Figure 3), CAM was used across all levels but there was a definite trend toward increased use at higher educational levels. Examination of use across income areas demonstrated no significant differences in prevalence (Figure 4).
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If conventional health care providers operate from the viewpoint that their treatments may be used together with alternative therapies, it is necessary to consider an impact analysis.

Figure 1 Prevalence

Historically, orthodox medicine had combatted alternative practices vigorously by denouncing and attacking them. Access was restricted, and alternative treatments were labeled as unscientific and were considered to be quackery. Often penalties were imposed on practitioners of alternative medicine. When alternative therapies rose in popularity, despite the attitude of the medical establishment, the establishment began to examine them, evaluate them, and consider incorporating them into treatment regimens. Examples include refinement of digitalis into.

RATIONALE FOR INCREASED CAM POPULARITY

Jonas addresses issues leading to the increased popularity of alternative medicine. The aging of the population and advances in medicine have led to an increased prevalence of chronic diseases that call for new treatments. In addition, the increase in public access to information and consumerism has led to a decreased tolerance of paternalism in the medical profession. Patients also have an increased sense of entitlement to a good quality of life and have a declining faith that scientific breakthroughs will have relevance for their personal disease treatments. Prevalence in the literature regarding the adverse effects of existing drug and conventional therapy and escalating costs have fueled the search for alternative approaches to the prevention and management of illness. Because of direct patient access to alternative therapies and a communication gap between the medical establishment and alternative caregivers, there has been a broadening of the communication gap between the public and the profession that serves their health care needs.

Today, a greater effort is being made to integrate alternative practice into mainstream medicine. Medical schools have added this topic to their curricula. Hospitals are creating complementary and integrated medicine programs, and health care suppliers are expanding benefits to include alternative practices. In addition, research organizations such as the NIH Office of Alternative Medicine have developed the National Center for Complementary and Alternative Medicine.With this increased acceptance, however, one must recognize the benefits and risks associated with its use. Alternative medicine, like conventional medicine, is a dynamic process that promotes bad ideas as well as good ones as it changes and modifies itself. It needs the same level of critical assessment that conventional therapies have through organizations such as NIH and FDA. Without critical assessment of what should be accepted and what should not, we risk developing a health care system that is less efficient, less cost-effective, and less safe. There is also the chance that the system will fail to address the management of chronic disease in a publicly responsible manner.

The following risks must be evaluated:

First, quality-of-care issues include the fact that medical physician licensure is not required of alternative medicine practitioners. Length of training, training content, testing, certification, and scope of practice are not delineated. Professional liability, statutory authorization, and codified disciplinary action are not stated. Although chiropractic is licensed, many other practitioners go unmonitored.

Second, the quality of natural products is largely unmoni-tored and uncontrolled. Products are available on the market as dietary supplements and may be contaminated or may vary tremendously in content, quality, and safety. Some products that appear to have some effectiveness are prepared differently according to the manufacturer and may not be effective if processing methods vary. There is no consistency for products developed by competing manufacturers as there is for drugs. In addition, 15 million Americans are taking high-dose vitamins or herbal preparations along with prescription drugs. The adverse effects from these interactions are not well documented.

Third, the quality of science in the development of alternative treatments is not consistent with the methodology utilized for conventional treatments. Some standardization in the trial of products and expressing the evidence for safety and effectiveness must be established. However, attempting to fit alternative medicine into the framework of conventional medicine will not be effective. For one, alternative medicine systems provide more personal contact and participation in the healing process compared with conventional treatments, which often result in a loss of personal contact in the subspecialization, technology, and economics of modern medicine. This is one of the main reasons for the popularity and effectiveness of some complementary treatments, which would be diluted if they were forced into the conventional framework. The integration of conventional and complementary therapies must recognize the need to personalize both the history-taking and treatment processes. erectalis