Complementary Medicine

Xue CC, Zhang AL, Lin V, Myers R, Polus B, Story DF. Acupuncture, chiropractic and osteopathy use in Australia: a national population survey.BMC Public Health.2008 Apr 1; 8:105. For this study there was a cross-sectional, population survey conducted on a representative sample of 1,067 adults from the six states and two territories of Australia in 2005 by computer-assisted telephone interviews. RESULTS: Over a 12-month period, approximately one in four adult Australians used either acupuncture (9.2%), chiropractic (16.1%) or osteopathy (4.6%) at least once. It is estimated that, adult Australians made 32.3 million visits to acupuncturists, chiropractors and osteopaths, incurring personal expenditure estimated to be $1.58 billion in total. The most common conditions treated were back pain and related problems and over 90% of the users of each therapy considered their treatment to be very or somewhat helpful. CONCLUSION: There is substantial use of manipulative therapies by adult Australians, especially for back-related problems. Treatments incur considerable personal expenditure. In general, patient experience is positive. Nearly one fifth of users were referred to manipulative therapy practitioners by medical practitioners.

Wolsko PM, Eisenberg DM et al.  Patterns and Perceptions of Care for Treatment of Back and Neck Pain.  Results of a National Survey.  Spine, 2003: 28(3): 292-298.  This study contained 2055 participants who reported back and neck pain problems over the past 12 months. The study was conducted by the Department of Health Care Policy, HarvardMedicalSchool. 54% consulted a complementary provider, 29% alone and 25% together with a medical doctor.  12% consulted a medical doctor alone and 34% consulted no one.  The most common provider was a chiropractor (20%), massage therapy (14%), relaxation techniques (12%).  61% of the patients rated chiropractic as very helpful while 27% gave this rating for medical care. 

 

January, 2003.  Richard Lawlor, D.C. was named senior outreach specialist in the Centers for Medicare and Medicaid Services (CMS).

 

 

 

Time to Recognize value of Chiropractic Care? Science and patient satisfaction surveys cite usefulness of spinal manipulation.  Orthopedics Today, February 2003: 23(2), pp. 14-15.  This article contains powerful commentary in support of spinal manipulation from Scott Haldeman, D.C., M.D., Ph.D., Jack Zigler, M.D., orthopedic spine surgeon with the Texas Back Institute and Andrew Cole, M.D., associate professor of rehabilitation medicine at the University of Washington and recent past president of the American Academy of Physical Medicine and Rehabilitation.  “There are a lot of myths about chiropractic care,” said Zigler.  “I decided to look into each of these myths, and what I found is that chiropractic education, side-by-side, is more similar to medical education than it is dissimilar.”  In addition to treating patients at the Back Institute, he states that chiropractors also work as screeners for surgical pathology.  Dr. Haldeman mentions that several studies demonstrate that the potential side-effects of spinal manipulation are short-term and relatively common for beginning patients and that no direct relationship links spinal manipulation to any increased risk of stroke.  Dr. Cole comments on instances in which spine surgeons should refer patients to chiropractors.  He also states that manipulation has the advantage of reducing pain, decreasing medication and rapidly advancing physical therapy and requiring fewer passive modalities. 

 

 

 

Eisenberg DM, Kessler RC, Van Rompay MI, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: Results from a national survey. Annals of Internal Medicine, September 4, 2001:135(5), pp. 344-351.  This study was aimed to determine perceptions regarding the helpfulness of CAM use relative to conventional medicine, a study in a recent issue of the Annals of Internal Medicine involved over 800 adults who had seen both an alternative medicine provider and a medical doctor in a one-year period. The researchers conducted a national telephone survey to gather information. Far more patients perceived CAM therapies as more effective than conventional medicine for back, neck, and head pain. Conventional medicine was perceived to be better for high blood pressure and lung and digestive conditions.  Regarding an integration of therapies, patients perceived a combination of CAM and conventional medicine as superior to either by itself.  Regarding sequence of use, most people sought a medical doctor prior to a CAM therapist or remedy.

 

 

 

Curtis P, Carey TS, Evans P, Rowane MP, Garrett JM, Jackman A. Training primary care physicians to give limited manual therapy for low back pain.  Spine 2000; 25: 2954-2961.  The study was designed to determine whether training primary care physicians in techniques of limited manual therapy would result in improve outcomes for their patients with acute low back pain.  Perhaps the most interesting aspect of the study is the effect it had on the MD’s: Two years after training, most physicians in the study reported continued use of manual therapy.  They reported that they had changed their management by performing more complete examinations, more touching, less use of narcotics, reduced referrals to specialists, and increased referrals to chiropractors.  The referral rate to chiropractors increased from 17% before training to roughly 50% at one year follow up.  The authors warn that “the physicians were not experts in manual therapy” and that these results “should therefore not be generalized to the effectiveness of manual therapy performed by expert practitioners”.

 

 

2/12/2001: For approximately 2 years Blue Cross Blue Shield of Illinois, that states largest managed care plan, has given their more than 700,000 members an option of choosing a chiropractor as their primary care physician.  The goal is to evaluate a true prevention-based health care system as opposed to an after-the-fact disease care system.  The results of this program as supplied by BC/BS of Illinois, compared to similar managed care plans employing medical doctors as PCP’s is the following.  Hospitalizations reduced by approximately 60%.  Outpatient surgery reduced by approximately 85%.  Usage of pharmaceuticals reduced by approximately 56%.  Reduction of Cesarean sections by over 22 percent.  Higher patient satisfaction rates.

 

 

 

Eisenberg M.D. et al.  Trends in Alternative Medicine Use in the US, 1990-1997: Journal of American Medical Association 1998; 280: 1569-1575.  National Survey of 2055 people measures utilization of alternative care in US between 1990 and 1997.  Use of alternative therapies increased from 33.8% (22 million) in 1990 to 42.1% (39 million) in 1997. Alternative therapies were most frequently used for chronic conditions (back problems, anxiety, depression and headaches).  There was a 47.3% increase in total visits to alternative providers, from 427 million in 1990 to 629 million in 1997 and exceeds total visits to all US primary care physicians by 243 million visits.  Expenditures for alternative providers increased 45.2% between 1090 and 1997.  In 1997 five therapies had a majority of users consulting a practitioner: Chiropractic, massage, hypnosis, biofeedback and acupuncture.  Increases in use of alternative therapies for medical conditions occurred for back problems, allergies, arthritis, and digestive problems.  The highest condition specific rates of alternative care use in 1997 were: neck (57%) and back (47.6%) problems.  In 1997, 11% had seen a chiropractor with a mean number of 9.8 visits for an estimated total in the US of 191,886,000 visits.

 

 

 

Eisenberg, M.D.  New England Journal of Medicine 1993; 328(4): 246-52.  A phone survey of 1539 people with a medical problem in previous year found that there were more visits to unconventional providers than general practitioners in the year of 1990.  425 million to 388 million.

 

McKenna MAJ. Cox News Service (3-2-98).  Alternative medicine has moved so far into the American mainstream that it no longer requires uncritical support and can withstand close questioning about usefulness and cost says David Eisenberg, M.D., professor at Harvard, addressing an audience of almost 750 health care practitioners at an annual conference sponsored by HarvardMedicalSchool.

 

 

 

Little P, Everitt H, Williamson I, et al. Preferences for patient-centered approach to consultation in primary care: observational study. British Medical Journal 2001: Vol. 322: 1-7.  Previous studies have shown that what your doctor tells you can have a major impact on the your belief system. This has led some doctors to adopt a more patient-centeredapproach - one in which your doctor works to understand you as a whole, finds common ground, and uses this approach in managing your problem.  This study in the investigated 865 patients' preferences for a patient-centered approach to care in the general practice setting.  Patients were asked to complete a questionnaire before and after a consultation with a primary care practitioner; questions were asked about patient-centered approaches to care and about examination and prescription preferences.  Results showed that 88-99% of the respondents wanted communication with their doctor; 77-87% desired a sense of partnership; and 85-89% emphasized health promotion. Only 63% of the patients prioritized the actual examination, and even fewer had interest in their doctor giving a prescription.

Gordon, M.D.  American Family Physician 1996; Nov 15: 2205-2212.  Since Eisenberg’s article (1993) the use of alternative medicine has most likely increased to more than 40% of the US population.  Not only do family MD’s need to understand alternative treatments, they need to develop a reliable network of referrals.

 

Petersen D. Office of Alternative Medicine gets Promotion.  Dynamic Chiropractic 1998; 16(24): 1, 49.  On October 20, 1998, Congress passed a bill with the provision to elevate the Office of Alternative Medicine to the Center of Complementary and Alternative Medicine.  Going from an office to a center designation increases funding from 20 to 50 million, provides for greater autonomy and ability to make grants.

 

 

 

Wiesel, M.D.  Chiropractic continues to grow.  Backletter 1997; 12(5): 60.  The chiropractic profession continues to grow in popularity worldwide.  It is now the third largest primary health care profession in the western world after medicine and dentistry.

 

Chapman-Smith.  Federal funding of Chiropractic Research Projects: 8/97-11/97.  1998; Jan: N1, 2.  The office of Complementary and Alternative Medicine at the National Institutes of Health awarded over 2.5 million dollars over 5 years to William Meeker, D.C., MPH at PalmerUniversity to establish the “ConsortialCenter for Chiropractic Research”.  This is the first time the NIH will be spending its money on an ongoing basis to recognize the value and significance of chiropractic evaluation and care.

 

Drivdahl Christine F, M.D., MC et al.  The use of Alternative Health Care by a Family Practice Population.  Journal of American Board of Family Practice 1998; 11: 193-199.  Questionnaire sent to 250 randomly selected adults in a military family practice clinic got a response of 71%.  Most common methods use Chiropractic (64%), then massage at (36%). 

 

 

 

Goldberg, D.O. Gilroy Branch, Permanente Medical Group.  Medicine in the Nineties.  Alternative Care Chiropractic. Aug 14, 1997.  In reality what is happening, members are requesting chiropractic services.  Now, our large purchasers are demanding that we provide chiropractic services.  What is driving these market forces is the satisfaction issue. 

 

Elder Nancy C, M.D., MSPH et al.  Archives of Family Medicine 1997; 6(March/April): 181-184.  Use of alternative care in family practice patients.  113 family practice patients from 4 practices in Portland, Oregon were asked if they used alternative health care.  50% had or were using some form.  Chiropractic was used most at 42%, massage at 32%, herbal remedies at 30%.

 

 

 

Haldeman S, D.C., M.D., Ph.D. et al.  Spine 1999; 24(8): 785-794.  There are an estimated 250 million office visits to chiropractors in the US each year.

 

Carey, M.D., MPH.  Spine 1996; 2(3): 339-344.  Use of DC’s is so common that one hesitates to use the terms alternative or nonstandard. 

 

Kaptchuk, OMD, Eisenberg, M.D. Chiropractic Origins, Controversies, and Contributions. Archives of Internal Medicine 1998; 158: 2215-2224. (HarvardMedicalSchool- funded by NIH grant) Many large surveys leave little doubt that patient’s believe chiropractic works for them.  Patients perceive chiropractic as a valuable component of their health care. 

 

 

 

Landmark Healthcare Inc/National Market Measures Inc.  Survey conducted late Nov 1998 through Jan 1999.  Telephone interviews with 114 randomly selected senior executives at HMO’s.  43% of HMO’s do not consider chiropractic alternative further validating the mainstreaming of this approach.  65% of HMO’s offer chiropractic, acupuncture is 2^nd at 31%.  Reasons why HMO’s add alternative care, 38% say member and employer groups ask for it. 

 

Oxford launches alternative medicine network.  March 5, 1998.  Oxford Health Plans in 1997 became the first health plan in the US to offer alternative medicine coverage and now it is looking to expand and improve the program.  Referrals are strong with 500 or more coming in each week just for DC’s. 

 

MacLennan et al.  Lancet 1996; 347(March 2): 569-573.  3004 adults in South Australia were surveyed to assess rate of use and types of alternative care in 1993.  At least 1 non-medically prescribed alternative therapy was used by 48.5% of people.  20.3% had visited an alternative practitioner, most commonly DC’s (15%)

 

 

 

Millar WJ, MA, Msc.  Canadian Journal of Public Health 1997; 88(3): 154-158.  Use of alternative care practitioners in 1994-5 according to a National Population Health Survey.   Sample size of 22,000.  About 15% of Canadians used some form of alternative health care.  11% of the 15% used chiropractors. 

 

The Landmark Report on Public Perception of Alternative Care.  Sacramento, CA, Jan 27, 1998.  A nationwide phone survey of 1500 interviews in November 1997 found Americans embraced alternative care.  42% of adults in the US used some type of alternative care in the past year and many report a likelihood of future usage.  45% said they’d pay more in order to have access to alternative care.  Most prevalent types of care used in the past year were herbal therapy (17%), Chiropractic (16%).  74% using alternative care use it along with traditional care.

 

Astin JA, PhD.  Why patients use alternative medicine.  Journal of American Medical Association 1998; 279(19): 1548-1553.  Survey of 1035 randomly selected subjects to determine reasons and frequency of using alternative health care.  40% of respondents reported using some form of alt care in the past year.  Top 4 treatments were Chiropractic (15.7%), lifestyle diet (8%), exercise/movement (7.2%) and relaxation.  The top health problem listed was back pain, second was allergies. 

 

 

 

Institute of Alternative Futures 1998.  This “ wellness demand” now accounts for a significant part of some Complementary and Alternative Approaches workloads.  For DC’s, an estimated 14% to 35% of all current visits are routine maintenance or wellness visits not related to a specific problem. 

 

Shekelle, M.D. Ph.D.  Medical Care 1995; 33(8): 842-850.  Evidence continues to accumulate that DC’s are more popular than MD’s with their back pain patients.  DC’s retain a greater percent of their patients who have a subsequent episode of back pain than do other providers.  They retained 92% of their patients for a second episode.  The new message in this study is the degree to which DC’s retain their patients.  With a 92% retention rate, DC’s seem to be extremely popular with their patients.  This is compatible with previous research of patient satisfaction with DC’s. 

 

Deyo RA, M.D. MPH. Low back pain Scientific American 1998; Aug: 48-53.  Chiropractic is the most common alternative care choice for back pain.

 

 

 

Carey Benedict.  Health 1998; May/June: 108-112.   DC’s are now being added to hospitals, HMO’s, are widely reimbursed by Medicare and Medicaid, work comp and private insurers.  Last year some 20 million back pain sufferers visited a DC, a throng that by 2010 is expected to double in size.  Founder of the Texas Back Institute, Ralph Rashbaum, M.D., states. “the

surgeons at the TBI are still very busy handling accident victims and chronic spinal pain or fractures.  But, in striking change, they see themselves as doctors of last resort.  Chiropractors, like John Triano, are emerging as the bearers of conservative care.  Triano states, “The wonderful thing is that you get a response right away and the risk is almost zero.  We have wonderful surgeons at TBI and we are certainly not going to lose any of them.  But we’ve just hired 2 more DC’s.  I think that tells you which direction we are headed.”

 

 

 

Curtis P, Carey TS, Evans P, Rowane MP, Garrett JM, Jackman A.  Training primary care physicians to give limited manual therapy for low back pain.  Spine 2000;25:2954-2961.  The study was designed to determine whether training primary care physicians in techniques of limited manual therapy would result in improved outcomes for their patients with acute low back pain.  Perhaps the most interesting aspect of the study is the effect it had on the MD’s: "Two years after training, most physicians in the study reported continued use of manual therapy.  They reported that they had changed their management by performing more complete examinations, more touching, less use of narcotics, reduced referrals to specialists, and increased referrals to chiropractors. The take rate of the training appeared to be approximately 50%.  The authors warn that "the physicians were not experts in manual therapy" and that these results "should therefore not be generalized to the effectiveness of manual therapy performed by expert practitioners."  However, they conclude that the "addition of limited manual therapy (to the training of physicians) offers little extra benefit."

 

 

 

Wiesel M.D.  Backletter 1997; 12(6): 63.  Carey examined the impact, over 12 months, of a 2-day intensive training on manual therapy skills on a group of 30 family physicians and internists.  Confidence in the ability to treat back pain increased substantially.  15% of MD’s felt well prepared to treat low back pain prior to the course and 67% at 1 year.  90% felt comfortable explaining the rationale of spinal manipulation to their patients.  The MD’s didn’t perform many spinal manipulations as a result of the course treating roughly one new patient per month with manipulation.  The program seemed to build bridges between MD’s and DC’s.  Prior to training 17% of MD’s said they frequently or occasionally suggested referral to DC’s.  47% did so at 1 year. 

 

Eisenberg, M.D.  Annals of Internal Medicine 1997; 127(1): 61-69.  More than 70% of patient who used alternative therapy never mentioned it to their MD’s.  We as a profession must address the challenge of discussing alternative therapies with our patient’s.

 

Shelton, D. American Medical News 1997; April 7: 13-18.  AMA recognized the demand for alternative health care.  There are now many practices offering integrated medical care.

 

Fontanarosa, M.D., Lundberg, M.D.  Journal of the American Medical Association 1997; 278(23) Dec 17: 2111-2112.  Alternative medicine is increasingly popular.  Current developments indicate, however, changing attitudes among MD’s.  A recent survey found that MD’s perceive acupuncture and spinal manipulation as moderately effective.  Given this growing interest, the JAMA editorial board, senior staff and editors of AMA Archives Journals, ranged alternative medicine among the top 3 subjects (of 86) for the journals to address in the coming year. 

 

TrianoD.C., MA.  Dynamic Chiropractic 1996; 14(16) July 29:1, 25, 26, 31.  In June 1996,  University of Texas Medical Branch held annual Current Concepts on Surgery of the Spine over 3 days.  Over 120 orthopedists and neurosurgeons attended a 4-hour program devoted to learning about the appropriate use of chiropractic services.  Most MD’s don’t know or understand what DC’s do, nor what to expect when a referral is made.  None of the MD’s expressed an interest in performing manipulation in their practice.  Their discovery of the skill necessary to diagnose patients and administer treatment served as a “reality check”.  Attendees expressed a newfound respect for chiropractic and its skills.  It is unrealistic for MD’s to attempt to learn to perform spinal manipulation based on weekend training.  What is desirable is to teach MD’s how to triage patients needing chiropractic care, achieved by developing trust in the skills, competence and ethics of DC’s, and imparting an understanding of appropriate indications for referral.  The vast majority of MD’s have no desire to learn spinal manipulation.  As weekend seminars are completely inadequate to produce competence, MD’s and DC’s need to develop cooperative, respectful working relationships that will allow each to serve patients in their respective area of expertise. 

 

Astin JA, Marie A, Pelletier KR, Hansen E, Haskell WL.  A Review of the incorporation of complementary and alternative medicine by mainstream physicians.  Archives of Internal Medicine 1998; 158: 2303-2310.

 

- 53% of MDs believe in efficacy of chiropractors

- 51% of MDs believe in efficacy of acupuncture

- 48% of MDs believe in efficacy of massage

- 26% of MDs believe in efficacy of homeopathy

- 13% of MDs believe in efficacy of herbal medicine

 

 

 

Blais, PhD et al.  Canadian Journal of Public Health 1997; 8(3): 159-162.  Users of alternative medicine are relatively socially advantaged, well off, better-educated and younger adults who are in better health than non-users.  They generally consume less medical care. 

 

 

 

Cowley.  Going Mainstream.  Newsweek 1995; June 26: 56-57.  There is a growing awareness among health insurers that patients seeking unconventional care represent a huge potential market and that alternative care doesn’t cost the insurer very much.

 

 

 

Executive Summary: “New” Health Care Consumer.  Institute for the Future 1999.  People with the sophistication that comes with information technologies are growing from 5% of the population 20 years ago to 45% today.  By 2005 they will constitute 52% and will impact on the purchase and delivery of health care services.  The consumers want to be involved in the choices related to their health care.  They are more active, more engaged, demand superior, personalized customer service.  These consumers are hungry for information about health and their health care.  They will shift the perception of patients from passive recipients of medical care to active consumers of health services.  The growth of accessible and inexpensive sources of information about health care will accelerate the move toward consumer driven health care.

 

 

 

Institute of Alternative Futures, By 2010 at least 2/3rds will be using one or more of the approaches we now consider complementary. 

 

Blevins, (health policy consultant).  Policy Analysis 1995; Dec 15:1-36.  Nearly 70% of cost of unconventional care was paid by the consumer not the insurer.  By contrast, only 17% of total MD bill was paid out of pocket.

 

 

 

Micozzi MS, M.D., Ph.D.  Complementary Care: When is it appropriate?  Who will provide it? Annals of Internal Medicine 1998; 129(1): 65-66.  In 1994 The Agency for Health Care Policy and Research (AHCPR) made history concluding that spinal manipulation is the most effective and cost effective treatment for acute low back pain and that it hastens recovery.  Most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement.  When all is said and done, what works will no longer be called mainstream or complementary-it will just be called good medicine.