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 Johnson Foundation.

HSC recently released data showing that nearly six million Americans have turned to CAM because 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.

Tu and her co-author originally had a particular interest in how people with certain chronic conditions 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. "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.

She is quick to point out that not all of the six 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 using to treat with CAM are conditions like colds, and [the CAM consumers] 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 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.