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National Health Interview Survey 2007 – CAM Use by Adults

The Center for Disease Control (CDC) conducts an ongoing telephone survey of medical problems and health care utilization – called the National Health Interview Survey (NHIS). They recently released their data from 2007. This is the first year for which they specifically broke out questions assessing the use of so-called complementary and alternative medicine (CAM).

CAM is a political/ideological entity, not a scientific one. It is an artificial category created for the purpose of promoting a diverse set of dubious, untested, or fraudulent health practices. It is an excellent example of the (successful) use of language as a propaganda tool.

The fundamental intellectual flaw of “CAM” as a concept is that it is made to include modalities that are extremely diverse, even mutually contradictory, under one umbrella. Very deliberately modalities which are scientific and mainstream, like the proper use of nutrition, are often included under the CAM umbrella by proponents in order to make it seem like CAM is a bigger phenomenon than it actually is, and as a wedge to open the door for the more pseudoscientific modalities.

Historically, surveys of CAM use have been used to claim about about 1/3 of Americans (or more) are using CAM. Such surveys, when carefully examined, bring into focus the absurdity of the CAM label. What counts as “CAM” in these surveys? What are the implications for homeopathy that many people pray for their sick loved-ones?

In the end the very concept of CAM is meant to distract from the only assessment that makes sense – what is the plausibility and evidence for the use of a particular modality for a specific indication? Any treatment that rises above a reasonable threshold to be considered ethical science-based medicine should be, and will be, incorporated into mainstream practice.  The purpose of the label of CAM is to get modalities which do not meet proper criteria in through the back door. This is a strategy that is, unfortunately, working.

The NHIS for 2007

The table below contains the most popular CAM modalities and the ones included in the 2007 survey. The link to the survey contains much more information, but is a bit difficult to slog through, so I pulled out the data for the following table.

Modality                       % used Ever

Acupuncture                    6.55
Ayurveda                         0.56
Biofeedback                     1.23
Chelation                          0.34
Chiropractic or
Osteo Manipulation       21.91
Energy Healing                1.72
Hypnosis                          2.34
Massage                           16.02
Nautropathy                    1.51
Homeopathy                    3.65
tai chi                                 0.9
qi gong                               0.6
yoga                                   9.53

As we can see – most hard-core CAM modalities are used by a very small percentage of the population. Most are less than five percent. Only massage and manipulation are greater than 10 percent. These numbers are also not significantly different from 10 or 20 years ago – belying the claim that CAM use is increasing.

Also, if you look through the specific indications for which these modalities are being used, most are for back pain, with arthritis and other pains next most common. Very few are being used for medical indications.

It is not surprising that 22% of the population have ever used a chiropractor or osteopath for manipulation, given the extent to which these professions are established. There is also some evidence for symptomatic benefit for manipulation in acute uncomplicated lower back strain – and that is the indication for which manipulation is most commonly used.

Massage is the next most commonly used modality in the survey, and it too was mostly used for back pain or other pain syndromes. It is also used for simple relaxation or “wellness” – a nicely vague term.

Back pain is an extremely common ailment, and is difficult to treat with any modality. It is therefore understandable that many patients will seek a variety of symptomatic treatments for their back pain. Use of massage and even manipulation is about as effective as physical therapy, medical management, or simple “back hygeine” – which is to say, not very effective. Massage and manipulation are also used by physical therapists, physiatrists, and sports medicine doctors – in other words, these modalities are mainstream to the extent that they are evidence-based and useful.

Manipulation and massage for back strain do not necessarily represent a different approach to medicine, a change in medical philosophy, or a new world order.  Their use for medical indications, such as manipulation for asthma, is not science-based and therefore should be considered separately. Again we see the contamination of so-called CAM as a category with treatments that can be scientifcally reasonable, but are themselves often mixed with unscientific treatments.

If we put aside physical treatments for back pain, we are left with the truly “alternative” treatments, in that they are not within the realm of science-based medicine. As you can see these modalities are used by a tiny minority of the population. Less than 4% of the US population have ever used homeopathy, despite all the buzz. Acupuncture is less than 7%, despite the nearly weekly press releases falsely claiming new evidence that acupuncture works.

And yet the alleged popularity of CAM, as a category, is used to promote its inclusion in medical schools, on insurance plans, and to justify diverting limited funds for its research.

Posted in: Public Health, Science and Medicine

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20 thoughts on “National Health Interview Survey 2007 – CAM Use by Adults

  1. namidim says:

    I’m going to disagree with your assessment in a very small way regarding homeopathy. I would say under 4% of the US population have knowingly and actively used homeopathy, but I would guess the actual number of users is much higher.

    I say this because the local drug-stores and grocery chains sell all sorts of homeopathic and herbal treatments that are not clearly labeled as such right next to effective science-based treatments.

    Cough drops, ear cleaners, pain killers, etc are all marketed using support claims without clear and explicit “this is BS” labeling.

    I add this note because prior to knowing about the difference between support claims and actual medicine I bought homeopathic cures assuming they were normal science-based products.

    In fact the only reason I noticed at all was that there was a product claiming to cure tinnitus, a condition I have in a mild form, sitting next to legitimate ear wax removers at my local drugstore.

    I knew that had to be either an amazing breakthrough (which I would have heard about) or a load of hooey and looked it up online.

    So I have personally been swindled by companies selling overpriced water as medicine with the blessing of both my government and my drugstore.

  2. mattdick says:

    One additional note: yoga is the 3rd highest CAM modality “used” by Americans. That’s just a strange addition, Yoga is largely a set of stretching and isometric exercises.

    My mother goes to Yoga classes, and they’ve never claimed to heal anything. Sure, the literature from the gym probably notes some garbage about ancient Asian cures for all sorts of crap, but the reason basically everyone is in the class is to get a little stronger, a little more flexible and to feel better from a non-stressful workout.

    So I propose that a very large percentage of the Yoga users are not seeking it for anything other than as an alternative for swimming laps, or lifting weights.

  3. namidim – I agree, and I almost mentioned that in the article. But that is an aside because if people bought a homeopathic remedy without ever knowing it, that would not reflect their attitude toward homeopathy – which is the point of the survey.

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  5. max.dobberstein says:

    Did the survey differentiate people who use yoga and tai chi as CAM and those of use who just enjoy doing it?

  6. David Gorski says:

    That’s an excellent question, one I was wondering myself.

  7. Apreche says:

    I agree with namidim. Homeopathy is much more widespread than you would think because it is put out there just like any other medicine. Someone who goes to the drug store and sees Airborne next to Tylenol Cold doesn’t realize the Airborne is BS. It’s only thanks to the Internet and blogs like this that a person like me even realizes this.

    I see people buying stuff like zicam, occoncalcum(or however you spell it), homeopathic sleeping pills, and such simply because they don’t realize. It’s packaged like real medicine and sold on the same shelf as other real OTC medicine. It says treats symptoms of “X, Y, Z” which is legal for it to say because of the DSHEA.

    Most of the people using it think it is real medicine, and don’t realize they’ve been swindled.

  8. Flex says:

    Pages 755 and on of the survey there are some interesting tables suggesting the answer to the question of how many use yoga and tai chi (and qi gong) as CAM or just enjoy it.

    65% said they use these methods to “enhance energy”*
    82% said they use these methods for “general wellness”*
    Only 5% said they use these methods because medical treatments did not help.

    And 96% mentioned it to their medical doctor.

    (*these are not scare quotes, it’s what the survey reported and I don’t see a precise definition so it looks like the definition of these terms was up to the respondant. Which is why I put them in quotes.)

    And of course, on page 727, 85% of respondants indicated they didn’t use these methods for any specific health problem or condition.

    Most of the reasons given for using these methods when a reason is given are along the lines of joint pain, stiffness, arthiritis, and back or neck pain.

    Which are, in fact, the most common reasons given for using massage or chiropractic for health.

    What I did find amazing was the little tidbit on page 173 where 55% of those who were asked reported side affects from chiropractic manipulation which required medical attention. I’d take that number with a grain of salt because the respondant number is very small (29) and could easily be prone to error. But still, it gave me a giggle. ;)

    Cheers,

    Flex

  9. Zetetic says:

    BTW – Airborne is not really homeopathic, it’s a combination of herbals & vitamins. The vitamins (Multi-Vitamin & Vitamin C) included in each dose can be purchased at Costco for less than 10 cents and the herbals have not been clinically proven to be of any benefit for suppressing viral infections!

  10. dlstone says:

    >Airborne is not really homeopathic

    Yes, this is an example of a disturbing aspect of the current burgeoning of homeopathic remedies in drug stores — the use of the term on OTC remedies that aren’t homeopathic at all, but are merely claiming to be in order to take advantage of the acknowledged harmlessness of “real” homeopathic remedies (as the latter contain virtually nothing of any physiologic consequence) and the fact that they get little oversight. Zicam (a common-cold remedy mentioned by Apreche above), is not homeopathic despite its label claim, and contains enough zinc to do serious damage to the sense of smell (http://www.resource4thepeople.com/defectivedrugs/zicam.html) in a small fraction of users.

  11. dlstone says:

    [prior submission didn't appear, so this is a re-write]
    Zicam is not homeopathic either, and contains enough zinc to apparently do harm in some people: http://zicam.vanosteen.com/
    This is a disturbing trend among the makers of OTC non-homeopathic remedies–label them “homeopathic” to take advantage of the current popularity of homeopathic remedies and the acknowledged harmlessness of “real” homeopathic remedies, and to take advantage of the lack of oversight of the latter.

  12. Harriet Hall says:

    On the Quackwatch Healthfraud discussion list a listmember recently told us about a relative who was an RN who was under the impression that “homeopathic” was a synonym for “herbal medicine.” She was surprised to learn about the dilution delusion. If even an RN can be this uninformed, how can we expect the general public to have any judgment about these things?

  13. Val Jones says:

    Harriet is correct – in my experience, the general public thinks that “vitamins” = “homeopathy” = “natural medicines” = “herbal supplements” They are all interchangeable synonyms. Much education is required.

  14. eldereft says:

    Consumer Reports recently blogged about the potential for consumer confusion between homeopathic woo and actual medicine. They include a picture of two similarly packaged products labeled “Zicam” to illustrate the point, only one of which is medicine. For bonus laughs, read the reply labeled Dana Ullman (CR-blog do not vet real world identities, but from tone, content, and behavior I would not be surprised if the comment is genuine).

  15. CarolynS says:

    The National Health Interview Survey is not a telephone survey. Interviews are face-to-face.

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