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Complementary therapies, such as chiropractic, acupuncture or meditation, are so interwoven in the fabric of American health care that it may no longer be relevant to draw firm lines between complementaryand conventional medicine

Results from the random telephone survey of 1,000 Americans were released at Stanford on Friday, Sept. 18, at a conference attended by some 500 physicians and other health professionals. The researchers disclosed that 69 percent of survey respondents had used some form of complementary and/or alternative medicine (CAM) in the past year. Respondents had also seen traditional MDs an average of four times yearly.

"So, based on this and other details, we are getting a clearer picture of how CAM and traditional medicine are becoming interwoven," said William Haskell, PhD, a Stanford professor of medicine (cardiovascular). Haskell is the principal investigator for the Stanford component of a major federally funded study evaluating the effectiveness of various CAM techniques. The study is funded by the National Institutes of Health's Office of Alternative Medicine.

More than 56 percent of the respondents in the recent telephone survey said they believe their health plan should cover CAM. On average, respondents said they would be willing to spend an additional $15.41 per month for health insurance for complementary services such as chiropractic, massage or acupuncture.

Respondents said they use similar criteria for choosing their conventional and CAM practitioners, with "technical skills at diagnosis and treatment" rated as the most important for both types of practitioners.

"What we see from this current survey and many other indicators is that people generally want to take control of their own health, using those services they find most effective," Haskell said.

"This places responsibility on both traditional care providers and health educators to ensure that responsible information and advice are available to patients," he added.

Health educator Wes Alles, PhD, director of the SCRDP's Health Improvement Program, presented the new findings at the Sept. 18 conference, " Complementary and Alternative Medicine: Scientific Evidence and Steps Toward Integration."

"The public doesn't choose between alternative and traditional medicine, " Alles said in describing the findings. "Rather, they see the options in a single toolbox and want to choose what works best for them instead of being restricted by arbitrary definitions."

Alles noted that the public's appetite for complementary techniques presents some challenges, obligations and potential benefits for traditional physicians.

"Whether we are talking about vitamins, yoga, acupuncture, massage, chiropractic or a variety of other practices, physicians should be candid with their patients about which techniques they feel are most appropriate for each patient -- since some techniques are undoubtedly more appropriate than others, " Alles said.

R. Douglas Metz, DC, chief chiropractic officer and vice president of health services for American Specialty Health Plans (ASHP) in San Diego, said information from the study "will assist doctors and policy makers as decisions are made about effective ways to integrate these services into the American health care system."

The conference was sponsored by Stanford University in collaboration with ASHP, which offers complementary medicine through health maintenance organizations (HMOs), and by Health Net, a network-model HMO based in Woodland Hills, Calif.

ASHP President George DeVries, president of ASHP, said his company " appreciated the opportunity to participate." He added, "Not only did the study reinforce the findings of Dr. David Eisenberg [of Harvard University, author of a pioneering CAM study published in the New England Journal of Medicine in 1993], but it also reflected many of the changes that have occurred in the rapidly growing alternative health care industry."

Haskell noted that a growing number of traditional patient-care organizations, including UCSF Stanford Health Care, now offer complementary services in a dedicated clinic that integrates these services, including insurance reimbursement, with more traditional medicine.

The recent telephone survey queried respondents on their interest in and use of 19 different techniques: acupuncture, herbal medicine, chiropractic, vitamin therapy, massage, naturopathy, homeopathy, chelation, meditation, spiritual health, relaxation, yoga, folk remedies, guided imagery, hypnosis, tai chi, ayurvedic medicine, macrobiotic diet and Chinese medicine.

The study showed that while 55 percent of alternative medicine users had reduced the traditional medical services they used, the rest said their use of CAM had no effect on their visits to traditional physicians. Seventy-three percent of men and 87 percent of women in the study said they have a medical doctor they use most often for routine care.

While this survey, compared with earlier ones, indicated that a larger proportion of Americans are using more CAM services, Alles warned that " there is still some ambiguity in the mind of the public and researchers about what constitutes CAM, so statistics must be viewed extremely cautiously."

For example, he noted that while nearly one-third of the respondents in the new study said they had used vitamin therapy in the past year, it was not clear whether users were taking megadoses to achieve a specific prevention or treatment goal, or were simply taking a daily multivitamin -- a practice often recommended as a part of a conventional health regimen.

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