of Americans willing to ingest capsules of pulverized garlic or other
herbal supplements in the name of health.
Complementary and alternative medicine (CAM), which includes a
range of practices outside of conventional medicine such as herbs,
homeopathy, massage, yoga, and acupuncture, holds increasing
appeal for Americans. In fact, according to one estimate, 42% of
Americans have used alternative therapies. A Harvard Medical School
survey found that young adults (those born between 1965 and 1979)
are the most likely to use alternative treatments, whereas people born
before 1945 are the least likely to use these therapies. Nonetheless, in
all age groups, the use of unconventional healthcare practices has
steadily increased since the 1950s, and the trend is likely to continue.
CAM has become a big business as Americans dip into their wallets
to pay for alternative treatments. A 1997 American Medical Associa-
tion study estimated that the public spent $21.2 billion for alternative
medicine therapies in that year, more than half of which were “out-of-
pocket” expenditures, meaning they were not covered by health insur-
ance. Indeed, Americans made more out-of-pocket expenditures for
alternative services than they did for out-of-pocket payments for hos-
pital stays in 1997. In addition, the number of total visits to alterna-
tive medicine providers (about 629 million) exceeded the tally of visits
to primary care physicians (386 million) in that year.
However, the public has not abandoned conventional medicine for
alternative healthcare. Most Americans seek out alternative therapies
as a complement to their conventional healthcare whereas only a small
percentage of Americans rely primarily on alternative care. Why have
so many patients turned to alternative therapies? Frustrated by the
time constraints of managed care and alienated by conventional med-
icine’s focus on technology, some feel that a holistic approach to
healthcare better reflects their beliefs and values. Others seek thera-
pies that will relieve symptoms associated with chronic disease, symp-
toms that mainstream medicine cannot treat.
Some alternative therapies have crossed the line into mainstream
medicine as scientific investigation has confirmed their safety and effi-
cacy. For example, today physicians may prescribe acupuncture for
pain management or to control the nausea associated with chemother-
apy. Most U.S. medical schools teach courses in alternative therapies
and many health insurance companies offer some alternative medicine
benefits. Yet, despite their gaining acceptance, the majority of alter-
native therapies have not been researched in controlled studies. New
research efforts aim at testing alternative methods and providing the(5)
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