Pharmacists urged to ask patients about CAM use

More turning to alternative therapies due to cost

Health trend researchers are urging pharmacists more than ever to ask patients about possible use of complementary and alternative medicine (CAM). 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 Johnson Foundation.

HSC recently released data showing that nearly 6 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.

These millions of adults who use CAM because of cost concerns 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. 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 6 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 6 million CAM users are a cause for concern for heath care providers. "We try not to say that in our analysis. The conditions some of these people are . . . [treating] with CAM are conditions like colds, and they are using echinacea to treat it. While the jury might be out about whether that is an effective treatment, there is no evidence it does any harm."

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 pharmacists 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.

The study did not indicate where these CAM users found information about the therapies. Tu suggests that pharmacists direct patients to the web site of the National Center for Complementary and Alternative Medicine, a center of the National Institutes of Health. The site, http://nccam.nih.gov, has a comprehensive health information site, which includes alerts on drug interactions, harmful side effects, and public health advisories.