Cost Concerns Turning More Americans to CAM Therapies
A growing number of consumers are turning to complementary and alternative medicine (CAM)—and it might not be whom you think. New survey data show that not only are cost concerns driving more lower-income, uninsured patients to try alternative therapies, but many of these patients aren’t telling their health care providers about these treatments.
The people who are concerned about the cost of their health care may be particularly vulnerable as they seek cheaper—and potentially ineffective or unsafe—care outside the realm of conventional medicine, says Ha T. Tu, MPH, a health researcher for the Center for Studying Health System Change (HSC) in Washington, DC. HSC is a nonpartisan policy research organization funded principally by the Robert Wood Foundation.
HSC recently released data showing that nearly six million adults in America have turned to CAM because they say their conventional medical treatment is too expensive. The study is based on the 2002 National Health Interview Survey, a nationally representative government survey conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Tu is a co-author of the study.
When originally looking at the data, Tu and her co-author had a particular interest in people with certain chronic conditions and how they use CAM. The information, however, was not very good for that purpose. "So we just looked at what was interesting in the data," she says. "It led us to analyze this subgroup of people who resort to CAM because they say the cost of conventional medical treatment is too high for them."
This was a bit surprising to the researchers because the impression is usually that most CAM users tend to be somewhat better off and more educated than other people. "People who use certain CAM treatments like massage and yoga for general well-being generally have more disposable income. They choose those CAM treatments to enhance their lifestyle and their overall health and well-being," Tu says.
The millions of adults who use CAM because of cost concerns, however, were four times as likely to be uninsured as the 38 million Americans who use CAM to treat specific health conditions without citing cost as a reason, according to the study. In addition, they were almost twice as likely to have low incomes, defined as below 200% of the federal poverty level.
"It is somewhat troubling because the evidence seems to show that they are resorting to CAM because they can’t afford conventional care," Tu says. The situation may not improve soon. "Our organization tracks a lot of trends in the health system over time, such as looking at the implications of rising costs. It seems to us that as health care costs keep rising well above the rate of income growth, this group of six million people is likely to grow."
Tu also is concerned about another finding in the data—in more than half of the cases where CAM is being used because of cost concerns, the patients did not tell their health care providers about using the therapies. Or if they did, the providers were not always well-versed about the therapies’ potential side effects. "It’s difficult to keep up with all the herbal remedies as well as prescription drugs. [The herbal remedies] can number in the thousands," Tu says.
She is quick to point out that not all of the six million CAM users are a cause for concern for heath care providers—she and her colleagues tried to emphasize this in their analysis. For example, some of these people are using CAM to treat conditions (i.e., echinacea to treat colds). "While the jury might be out about whether that is an effective treatment, there is no evidence it does any harm," she says.
Instead, the researchers highlight the use of two herbal remedies that are thought to cause serious side effects. St. John’s wort was used by one in eight of all CAM users citing cost concerns. Known as a potential treatment for depression, the herbal remedy may have potentially dangerous side effects when used with other drugs. Kava was used by one in 12 of this subgroup of the study. Kava is used to treat anxiety, stress, and insomnia, and has been linked to liver damage.
It might not occur to patients that an herbal remedy might react with a prescription drug, Tu says. "Consumers often think that because a product is natural,’ it is likely to be safe." Patients with multiple health conditions also might not be able to recall all the medications—CAM remedies included—that they have taken. For these reasons, Tu urges health care providers to be proactive and ask patients about possible CAM use. "Asking is something the health system can do without adding to cost," she says. It also may be the only opportunity to provide basic education to the patients about CAM therapies.
New Dietary Guidelines Emphasize Decreased Caloric Intake and Increased Physical Activity
In January, the Departments of Health and Human Services (HHS) and Agriculture jointly announced the release of the Dietary Guidelines for Americans 2005, which places stronger emphasis on reducing calorie consumption and increasing physical activity in an effort to promote health and reduce the risk of chronic diseases.
The Dietary Guidelines are science-based advice to help Americans live longer and healthier lives. The report includes steps Americans can take to reach goals in controlling weight, developing stronger muscles and bones, and achieving balanced nutrition to prevent heart disease, diabetes, certain cancers, and other chronic conditions.
Although eating a healthy balance of nutritious foods is essential, balancing nutrients is not enough for health. Total calories also are critical, especially as more Americans are gaining weight. Almost two-thirds of Americans are overweight or obese, and more than half get too little physical activity. The 2005 Dietary Guidelines place a stronger emphasis on calorie control and physical activity.
Based on the latest scientific information including medical knowledge, the Dietary Guidelines were prepared in three stages. First, a 13-member Dietary Guidelines Advisory Committee prepared a report based on the best available science. Next government scientists and officials developed the Dietary Guidelines after reviewing the advisory committee’s report and agency and public comments. Finally, experts worked to translate the Dietary Guidelines into meaningful messages for the public and educators.
The report identifies 41 key recommendations—23 for the general public and 18 for special populations. They are grouped into the following nine general topics: adequate nutrients within calorie needs, weight management, physical activity, food groups to encourage, fats, carbohydrates, sodium and potassium, alcoholic beverages, and food safety.
The Food Guide Pyramid currently is being revised and will be released in the spring of 2005.
A complete copy of the report is available at www.healthierus.gov/dietaryguidelines/.