Mainstream Medicine Diversifies: But what does CAM have to do with it?

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Nearly 75 percent of adults in the United States have used some form of complementary or alternative medicine (CAM) and more than 60 percent have done so within the past 12 months, according to the U.S. Centers for Disease Control and Prevention’s latest report on the subject. Among the most commonly used CAM therapies were prayer for health reasons, natural products, chiropractic care and yoga. Among Blacks, however, prayer was the most common CAM therapy. In fact, when prayer and megavitamins were excluded, the proportion of Blacks who reported using some form of complementary or alternative medicine dropped to 26 percent from 73 percent.

No surprise there for Genetta Greer Mitchell, a doctor of chiropractic based on New York’s Long Island. Blacks and whites have been “programmed to think of drugs and surgery before alternative methods of treatment. They go right for the knife or pop a pill,” she says.  Sheila Mason, a New Jersey-based licensed acupuncturist, says her African-American clients are “definitely in the minority.” Mason, who has been in practice since 1988, says, “It’s still a matter of education and exposure.”

Yet, the CAM industry has experienced significant growth in recent years.

Popular CAM Therapies

Several types of complementary and alternative therapies are increasingly common in New York alone, according to the New York State Education Department’s Office of the Professions. In fewer than 10 years, the number of registered massage therapists doubled to 12,360 from 6,181 in 1997, while the pool of chiropractic practitioners grew to 6,251 from 5,076. There also has been a more than threefold increase in the number of individuals licensed and registered to practice acupuncture—2,391 individuals in 2004 versus 710 in 1997. “CAM utilization by the American public has been steadily on the rise,” says Sita Ananth, project director, CAM for Health Forum/American Hospital Association.

Some of the reasons for this include the public’s increased access to information, greater need to be involved in their own care and “dissatisfaction with the conventional medical system, particularly among baby boomers and those with chronic illnesses,” she explains. Findings from the CDC survey suggest that many adults also try CAM out of curiosity, while others use it to avoid the high cost of conventional medicines or because they do not think conventional treatments will help. Most adults, however, seem to use CAM because they believe that combining it with conventional treatments will help their condition. In response, hospitals increasingly offer CAM services, says Ananth. Many also provide CAM therapies because of their “clinical effectiveness” or to attract new
patients, according to the latest Health Forum/American Hospital Association’s survey of more than 4,000 community hospitals. 

Integrated Care

In the AHA survey, nearly 20 percent of hospitals reported offering some complementary service, including massage therapy, yoga or acupuncture. For example, both Lincoln Hospital in the Bronx and Kings County Hospital Center in Brooklyn use acupuncture in their detoxification programs. Many rehabilitation centers affiliated with the New York University Medical Center use acupuncture as well. Further, the We CoPE integrated medicine program in the neurology department of Mount Sinai Hospital offers patients acupuncture, Qigong, yoga, Tai Chi Chuan, massage, chiropractic care and nutritional therapy, as well as imagery and exercise training.

Many physicians integrate their practice of conventional medicine with some complementary therapy. Nicole Sasson of the New York University School of Medicine, for example, is a physical medicine and rehabilitation physician as well as a certified acupuncturist. Pain is a common complaint among many of her patients. With last year’s Vioxx recall, and subsequent reports of an increased heart attack risk associated with Celebrex and Bextra, conventional doctors’ pain management options are shrinking, Sasson says. “Lots of patients come to me because they don’t want to take medication,” she says.

Currently, the American Board of Medical Acupuncture certifies 353 physicians, up from 56 physicians in 2000, when the board was created.

Physicians like Sasson may be in the minority, but some patients may still benefit from integrated health care approaches. “Even medical doctors are in tune with the fact that chiropractic works,” says Mitchell, the chiropractor, explaining that she receives many referrals from doctors. In fact, many of the CAM users in the CDC survey said they were following the suggestion of a conventional health care professional. Such referrals often go both ways, since some CAM practitioners also refer patients to medical doctors. 

CAM Use Among Minorities

Despite the explosive growth of the CAM industry, little is known about its impact upon minority populations. Most CAM-related organizations and societies do not keep demographic information about members’ race or ethnicity and it is illegal for state licensing boards to do so. Still, anecdotal evidence suggests that many minorities do use complementary therapies and have done so for generations.

Sheila Thorne, president and CEO of the New Jersey-based Multicultural Healthcare Marketing Group LLC, tells her pharmaceutical industry clients that multicultural individuals, including African-Americans, Africans, Hispanics, Asians and Native Americans, “have been raised and weaned on alternative and complementary medications.” Historically, those therapies often were the only medications available because of discrimination or lack of access to conventional medicines, she says.

Julie Spooner, a licensed psychologist in private practice in New York, agrees that many African-Americans have a history of CAM use, herbs in particular. But, she says, “a lot of us have forgotten that.” Spooner, who incorporates meditation and other holistic techniques into her practice, wants to reacquaint African-Americans with that history. To that end, she plans to create the tentatively named Sakhu Center—from the Kemetic (Egyptian) word “sakhu,” meaning “illumination”—that will offer “different healing arts” and yoga.

CAM Research in Multicultural Populations

As various studies have shown, complementary and alternative medicines usually are more complementary than alternative. Many people supplement their prescription medications with garlic, herbs and various home remedies, often without considering any potential counteractive effects. Doctors may often be aware that patients are using complementary remedies, but they may be unaware of “how strongly people believe them to be successful,” says Thorne, the multicultural health care marketing expert. So when a doctor tells a patient to stop using an herbal preparation, for example, they may be inadvertently asking a patient to choose between a “tried and trusted” home remedy and a prescription medication, she says.

Calling for increased cultural sensitivity among physicians, Thorne explains that a physician’s ignorance of the importance of certain products or remedies may alienate the patient who makes what the doctor believes is the wrong choice. This can create another barrier to effective health care. Patients may take their family member’s word that “that drug may kill you but this tea is not going to hurt you,” Thorne says. But, she says, for the person with chronic diabetes, “Tea is not going to do a thing.”

On the other hand, studies of conventional medications often do not include sufficient numbers of minority participants to validate their effectiveness. “That’s why these populations don’t trust Western medicine,” Thorne says. “There really is no sound science to tell these patients how these drugs really work in [their] bodies.” Yet, when racial and ethnic minorities do trust conventional health care systems, too often they are rewarded with substandard medical care, various studies have shown.

To address such racial and ethnic health disparities, the National Center for Complementary and Alternative Medicine at the National Institutes of Health aims to create a health system that integrates trusted CAM therapies with conventional medicines in order to more effectively promote health and treat disease. The center’s Office of Special Populations has outlined several research objectives to accomplish this, including ones involving more minorities in CAM-related research, understanding how various diseases develop and progress in minority populations and developing better approaches to treatment based on CAM studies.

Another objective is to determine which therapies are safe and effective for specific conditions. In doing so, the center has funded studies ranging in scope from the use of vedic medicine, a traditional Indian medicine that incorporates herbs and meditation, in the treatment of cardiovascular disease in older African-Americans, the impact of prayer on the immune response of Black women with breast cancer and the effect of ginseng on Type 2 diabetes.

CAM’s Increased Respectability

All of this illustrates CAM’s increasing popularity and influence on conventional medical systems. Christine Wade of the Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine at Columbia University says the “climate has changed” toward a more accepting view of CAM. Today there is a “much more favorable atmosphere for research and practice,” in comparison to 10 years ago, she says.

More CAM opportunities also are available, due in part to increased educational attention. In the early 1990s, for example, there were no acupuncture schools in New York, Wade says. Now, seven of the 46 accredited colleges of acupuncture in the United States are located in New York and New Jersey, according to the Accreditation Commission for Acupuncture and Oriental Medicine. An additional 10 schools  in the nation are awaiting accreditation, including Touro College in New York City.

More research funding is also becoming available for CAM-related studies. The budget for the NCCAM has swelled to more than $123.1 million in 2005 from $2 million in 1992. Such funding allows more questions to be raised, more areas to be explored. “There’s just a lot more exposure and dialogue” about CAM in comparison to just a few years ago, says Wade.

Some of that dialogue is expected to take place Sept.19-20, 2005, at the first annual Multicultural Summit on Complementary and Alternative Medicine. Sponsored by The Network Journal in collaboration with the New York chapter of the National Association of Healthcare Executives, the Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine at Columbia University and the Association of Hispanic Health Executives, the summit will explore the impact of CAM on multicultural populations, a sorely under-addressed field of research.