Responsibilities and Implications for Pharmacy Services: PREVALENCE OF CAM USE

According to a study reported in JAMA, 40% of Americans use some form of alternative medicine. Americans visited alternative therapy practitioners 629 million times in 1997, which is a 47% increase over the 427 million visits made in 1990. Americans spent approximately $27 billion out-of-pocket (not covered by insurance) on alternative medicine treatments. This is equivalent to the out-of pocket expense for the same period on U.S. physician services. The use of herbal medicines increased fivefold between 1990 and 1997; the use of folk remedies increased at a similar rate; and the use of megavitamins and homeopathy more than doubled. According to the National Institutes of Health (NIH) National Cancer Institute, the use of CAM is even more prevalent among cancer patients. One study published in the July 2000 issue of the Journal of Clinical Oncology reported that 83% of 453 cancer patients had utilized at least one CAM therapy as a part of their cancer treatment.

In this article, we discuss herbal and homeopathic remedies. Herbs and homeopathic medicines involve the use of various parts of plants to treat symptoms and promote health. These plant extracts are utilized homeopathically to stimulate the body sufficiently to trigger a healing or prophylactic response. The U.S. Food and Drug Administration (FDA) does not currently regulate herbal products, which can be marketed only as dietary supplements. Manufacturers and distributors cannot make any specific health claims without FDA approval.
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Of the 44% of all respondents in the JAMA study (Eisenberg et al) who indicated that they took prescription medication in 1997, 18.4% indicated that they also utilized herbal products. However, in respondents who had a medical condition requiring treatment, more than 33% used herbal products as well. Therefore, more than 15 million Americans are taking both prescription drugs and herbs or high-dose vitamins.

There is a potential for adverse interactions between prescription drugs and herbal products. This problem is compounded because ample data are available about which prescription medications a particular patient is taking, but poor communication between patients and physicians limits our knowledge of the true extent of alternative therapy usage.

Gray et al demonstrated this gain in popularity by pointing out that 42% of patients reported using at least one CAM therapy, the majority of patients being younger, better educated, and employed. Almost all of these patients integrated CAM as an adjunct to conventional therapies but clearly not as a substitute for conventional preventive health care.

In a Lancet article, Ernst reported that more than 50% of cancer patients were using CAM either with (as supportive care) or before or after conventional therapies.

Cherniack et al studied the prevalence of CAM use in the geriatric population. They reported that 58% of these patients had used at least one CAM in the previous year. A higher proportion of use was reported in patients receiving treatment for thyroid disorders and arthritis. This study also upheld the idea that CAM prevalence exists in highly educated groups.
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Robinson et al studied the prevalence of use in individuals who attended health fairs. In this group, 61% reported CAM use. The investigators also noted that patients using CAM also used conventional care.

Oldendick et al reported that 44% of telephone interview respondents used CAM. This study also associated CAM with a high level of education. The majority of CAM users had a high level of satisfaction with their therapy. The authors also reported that 57% of CAM users had not informed their physicians of their CAM use.

In a study of cancer patients by Bernstein and Grasso, the prevalence of CAM use was even higher. Eighty percent reported some use of CAM, with the majority utilizing herbal products and vitamins.

All of these prevalence studies confirm a high use of CAM by educated individuals who have access to conventional health care. In many cases, conventional health care provider physicians are unaware of the therapies being used by their patients. This further underscores the need for pharmacists to obtain accurate and complete CAM histories for their patient profiles. This information must be utilized to indicate any interactions and reactions between conventional therapies and CAM.

Conventional approaches to treatment have generally been studied for safety and effectiveness through a rigorous scientific process, including clinical trials with large numbers of patients. Often, less is known about the safety and effectiveness of herbal products. In addition, because of the lower level of FDA oversight, similar products from different manufacturers are not required to demonstrate equivalence.

In 1990, 33% of respondents who used alternative therapies used them not for a particular medical condition but rather for health promotion or disease prevention. In 1997, 58% of alternative therapies were used for these purposes. Despite these dramatic increases in use, the extent to which patients are disclosing their use of alternative therapies to their physicians during history-taking remains low. In the 1990 and 1997 studies, fewer than 40% of patients disclosed their use of alternative therapies to their physicians. Therefore, there has been no increase in patient and physician understanding of the need to include alternative therapies as a part of the patient history. Before we embark on a strategy to develop an increased understanding for the need to incorporate herbal therapy history into the conventional medication history of the patient’s medical record, the reasons for the increased use of alternative medicine need to be explored.

At present, there is no definitive response to this question. In a national study of the reasons for alternative medicine use, Austin proposed three theories:

  • Patients have become dissatisfied with conventional treatments. Reasons cited include ineffectiveness, adverse effects, cost, and a health care system that has become too technologically oriented instead of personally oriented.
  • Patients need personal control. Alternative therapies are perceived as less authoritarian, less secretive, and more empowering. Patients see conventional health care as originating from a closed community of doctors who often treat them without providing them with an understanding of the methodology, risks, and benefits of these treatments.

Today’s consumers want care involving some personal autonomy and control over their health care and treatment decisions.

Alternative therapies may seem attractive because they are seen as more compatible and consistent with patient values, such as the patient’s world view and spiritual or religious beliefs regarding the nature of health and illness. eriacta

The following independent variables were used to express rationale for CAM use:

  • the patient’s (dis)satisfaction with conventional medicine
  • the need for patient control over therapy
  • the patient’s philosophy and values regarding health care
  • the patient’s belief in the efficacy of conventional medicine
  • the patient’s health

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Tags: Implications, Pharmacy Services, Responsibilities

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