Nearly 6 million American adults turned to complementary and alternative medicine (CAM) in the past year to treat such conditions as depression and chronic pain because conventional medical treatment was too expensive, according to a national study released today by the Center for Studying Health System Change (HSC).
People using CAM because of cost concerns were four times as likely to be uninsured (37% vs. 9%) as the 38 million adults who used CAM to treat specific health conditions but who did not cite cost of conventional medicine as a reason for doing so, according to the study based on the 2002 National Health Interview Survey, a nationally representative government survey that includes information on about 31,000 adults.
People using complementary medicine because of cost concerns were almost twice as likely to have low incomes-defined as below 200 percent of the federal poverty level, or $36,200 for a family of four in 2002-and were much more likely to report fair or poor health status and lack a regular place to go to receive medical care, the study found. They also were much more likely to report overall unmet medical needs—and unmet mental health and prescription drug needs—because of costs
"The high cost of conventional medical care is prompting many Americans to seek alternatives that may be of questionable value," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.
The study's findings are detailed in a new HSC Data Bulletin—High Cost of Medical Care Prompts Consumers to Seek Alternatives.
Herbal remedies were by far the most widely used form of complementary and alternative medicine among people with cost concerns: Almost two out of three (63%) used herbal remedies. Among the more popular herbal remedies are some known to cause serious side effects, including St. John's wort—used by one in eight of all CAM users citing cost concerns—and kava—used by one in 12. Widely publicized as a depression treatment, St. John's wort can interact dangerously with other drugs, and recent studies indicate St. John's wort may be ineffective against moderate to severe cases of major depression. Kava, used to treat anxiety, stress and insomnia, has been shown in clinical trials to cause liver damage
"Another troubling finding is that in more than half of the cases where people used complementary and alternative medicine because of cost concerns, a conventional medical professional was unaware of the alternative treatment," said HSC Health Researcher Ha T. Tu, M.P.A., who coauthored the study with J. Lee Hargraves, Ph.D., an HSC consulting researcher and associate professor at the University of Massachusetts Medical School.
The study points out that the Food and Drug Administration (FDA) has limited authority to oversee herbal remedies. Unlike with prescription drugs, where safety and efficacy must be proved before a drug can be sold, the FDA must demonstrate that natural supplements are dangerous before taking enforcement action.
"Clearly, public health concerns about natural products apply to all consumers, not just those who resort to them because of the high cost of conventional medicine," Tu said. "But people worried about costs may be particularly vulnerable as they seek cheaper—and potentially ineffective or unsafe—care outside the realm of conventional medicine."