Background Many people use unconventional therapies for healthproblems, but the extent of this use and the costs are not known.We conducted a national survey to determine the prevalence,costs, and patterns of use of unconventional therapies, suchas acupuncture and chiropractic.
Methods We limited the therapies studied to 16 commonly usedinterventions neither taught widely in U.S. medical schoolsnor generally available in U.S. hospitals. We completed telephoneinterviews with 1539 adults (response rate, 67 percent) in anational sample of adults 18 years of age or older in 1990.We asked respondents to report any serious or bothersome medicalconditions and details of their use of conventional medicalservices; we then inquired about their use of unconventionaltherapy.
Results One in three respondents (34 percent) reported usingat least one unconventional therapy in the past year, and athird of these saw providers for unconventional therapy. Thelatter group had made an average of 19 visits to such providersduring the preceding year, with an average charge per visitof $27.60. The frequency of use of unconventional therapy variedsomewhat among sociodemographic groups, with the highest usereported by nonblack persons from 25 to 49 years of age whohad relatively more education and higher incomes. The majorityused unconventional therapy for chronic, as opposed to life-threatening,medical conditions. Among those who used unconventional therapyfor serious medical conditions, the vast majority (83 percent)also sought treatment for the same condition from a medicaldoctor; however, 72 percent of the respondents who used unconventionaltherapy did not inform their medical doctor that they had doneso. Extrapolation to the U.S. population suggests that in 1990Americans made an estimated 425 million visits to providersof unconventional therapy. This number exceeds the number ofvisits to all U.S. primary care physicians (388 million). Expendituresassociated with use of unconventional therapy in 1990 amountedto approximately $13.7 billion, three quarters of which ($10.3billion) was paid out of pocket. This figure is comparable tothe $12.8 billion spent out of pocket annually for all hospitalizationsin the United States.
Conclusions The frequency of use of unconventional therapy inthe United States is far higher than previously reported. Medicaldoctors should ask about their patients' use of unconventionaltherapy whenever they obtain a medical history.
Unconventional, alternative, or unorthodox therapies are difficultto define, because they encompass a broad spectrum of practicesand beliefs. As Murray and Rubel have written, "Many are wellknown, others are exotic or mysterious, and some are dangerous"1.From a sociological standpoint, unconventional therapy refersto medical practices that are not in conformity with the standardsof the medical community2. Here we define unconventional therapiesas medical interventions not taught widely at U.S. medical schoolsor generally available at U.S. hospitals. Examples include acupuncture,chiropractic, and massage therapy.
Studies based on samples in limited geographic areas suggestthat the use of unconventional therapy is widespread3,4,5. Inparticular, unconventional therapies are frequently used bypatients with cancer,6,7,8,9,10,11 arthritis,11,12,13 chronicback pain,3,14 the acquired immunodeficiency syndrome,15 gastrointestinalproblems,16,17 chronic renal failure,18 and eating disorders19.Little is known, however, about the overall prevalence, cost,and patterns of use of unconventional therapy in the UnitedStates1,20.
To improve our understanding of the use of unconventional therapy,we conducted a national telephone survey focusing on 16 interventionsfound, on the basis of pilot research, to be representativeof unconventional therapies used commonly in the United States.Our study focused on the following questions: What is the extentof use of unconventional therapy in the United States? How muchis spent annually on these therapies, including out-of-pocketand third-party payments? What sociodemographic factors distinguishusers of unconventional therapy from nonusers? For what medicalconditions do people most commonly use unconventional therapy?And to what extent are medical doctors responsible for or informedabout the use of unconventional therapy by their patients?
Methods
Sample
We conducted our survey by telephone between January 18 andMarch 7, 1991. The sample was selected by means of random-digitdialing21. We limited eligibility to English-speaking persons,18 years of age or older, in whom cognitive or physical impairmentdid not prevent the completion of the interview. We designedthe survey with a target sample of 1500. Assuming an estimatedprevalence of use of unconventional therapy between 10 and 50percent, we calculated that 1500 interviews should produce estimatedprevalence rates with 95 percent confidence intervals of 2 to3 percent.
Of the initial sample of 5158 telephone numbers, 38 percentwere nonworking, and 13 percent were not assigned to households.We declared 221 respondents ineligible because they did notspeak English (97), because of cognitive or physical incapacity(96), or because they were temporarily unavailable (28). Amongthe remaining 2295 eligible respondents, 1539 completed theinterview, 653 declined to participate (81 of them before wecould establish eligibility), and 103 began the interview butstopped before completing all questions. These figures correspondto a 67 percent overall response rate among eligible respondents.Only one respondent per household was eligible to be interviewed.This person was selected by computer randomization from thelist of household members given by the first household membercontacted. Persons with responses substantially different fromthe remainder of the sample (for example, those with frequentvisits to a provider of unconventional therapy at no cost) werecontacted again by a supervisor for verification or clarificationof their responses. Since we asked respondents about the useof unconventional therapy during the 12 months before the interview,we considered the results representative of 1990.
The Interview
We described the interview to the respondents as a survey byinvestigators from Harvard Medical School that was designedto assess the health care practices of Americans. We made nomention of unconventional therapy while recruiting the respondents.The interviews, which averaged 25 minutes in length, began withquestions on the respondents' health, health worries, days inbed at home or in the hospital, and indicators of functionalimpairment caused by health problems. We then asked the respondentsabout their interactions with medical doctors during the past12 months. A "medical doctor" was defined early in the interviewas "a medical doctor (M.D.) or an osteopath (D.O.), not a chiropractoror other nonmedical doctor." Throughout the remainder of theinterview we used the term "medical doctor." We use the sameterm in this report when referring to a respondent's providerof conventional medical care.
We next assessed the respondents' medical problems. The interviewersstated: "Now I'm going to read a list of conditions. Pleasetell me if you have had any of these conditions in the past12 months." The interviewers then asked about 24 medical conditionsand offered a follow-up question, "What other important conditionsdid you have?" The 24 conditions included common symptoms (suchas back problems, digestive problems, dizziness, headache, andallergies), as well as specific diagnoses (such as high bloodpressure, diabetes, and cancer). Only 8 percent of the respondentsreported conditions not included in our list.
The respondents were then asked to identify the three (or fewer)"most bothersome or serious" health problems from the list theyhad just provided. These health problems are referred to hereas "principal medical conditions." We asked the respondentswhether they had seen their medical doctor for each principalmedical condition during the past 12 months and what their perceptionsof these interactions had been.
At this point we asked respondents about their use of unconventionaltherapy. The interviewers' text read as follows: "Now I'd liketo ask you about your use of some other kinds of therapies andtreatments." The respondents were asked whether they had everused 1 or more of 16 unconventional therapies for their principalmedical conditions and, if so, whether they had used any ofthem in the past 12 months. For example, a respondent listingback problems as a principal medical condition was asked whetherhe or she had used any of the 16 unconventional therapies forthis problem during the past 12 months. The respondents werenext asked whether they had used "any other therapy not generallyprovided by most clinics and hospitals." Only a small number(1 percent of the sample) reported using any other unconventionaltherapy.
Some of the unconventional therapies studied warrant furtherclarification. For example, "massage therapy" or "relaxationtherapy" may mean different things to different people. A respondentwho used "massage therapy" for a specific principal medicalcondition was asked, "Could you tell me more about your useof massage therapy? For example, what technique do you use?"Similar questions followed a report of the use of herbal therapy,spiritual or religious healing by others, commercial weight-lossprograms, lifestyle diets, energy healing, folk remedies, andmegavitamin therapy. (With regard to megavitamin use, the interviewersspecifically stated that "megavitamin therapy does not includetaking a daily vitamin.") Given that some unconventional therapies,such as massage, were available in more than 100 reported varieties,further subclassification of each of the 16 unconventional therapiesis beyond the scope of this paper.
When respondents reported the use of unconventional therapyduring the past 12 months, we asked whether a "professional"was involved. Specifically, the interviewers described a professionalas "someone who provides care or gives advice and is paid forhis or her services." Such persons are referred to in this reportas "providers of unconventional therapy." Some forms of unconventionaltherapy typically involve a provider (for example, a chiropractoror acupuncturist), whereas others do not (for example, lifestylediet or self-help groups). In addition, some users of unconventionaltherapy may visit a provider less often than once a year butmay continue to use the prescribed unconventional therapy. Inorder to learn more about these variations, we asked about lifetimevisits and recent visits (in the past 12 months) to providersof unconventional therapy. We did not ask whether the respondents'providers of unconventional therapy were medical doctors. Weasked about total charges for visits to providers of unconventionaltherapy during the past 12 months and whether insurance paidany of these charges. The interviewers asked whether the respondentshad discussed the use of each unconventional therapy with theirmedical doctors and collected data on the respondents' demographiccharacteristics. We also asked questions pertaining to the respondents'perceptions of the efficacy of unconventional therapies andthe quality of their interactions with the providers. We shallreport these data separately.
Pilot research suggested that, in addition to the 16 unconventionaltherapies we studied, prayer and exercise are commonly usedin the United States for purposes related to health. We thereforeasked respondents whether they had used prayer or exercise asa medical "therapy or treatment" in the past year. No additionalquestions were asked about these two activities. In the caseof prayer, we thought such questions would be inappropriate.As for exercise, we thought the term was too vague and the practicesufficiently ubiquitous to preclude the gathering of usefuldata. Unless they are explicitly mentioned, all analyses describedhere excluded prayer and exercise.
Statistical Analysis
We weighted the data to adjust for variations among householdsin the number of telephones and number of household memberseligible to participate in the survey. We also weighted thedata to match our sample to the distribution of the U.S. population,as reported in the U.S. Census, for age, sex, and education.Using the Taylor series approximation method for calculatingstandard errors, we carried out tests of significance appropriatefor weighted data using the SUDAAN software system22. We basedour extrapolations of the estimates from the survey to the totalU.S. household population (which, according to the U.S. CensusBureau, excludes homeless and institutionalized persons) onpreliminary figures from the 1990 U.S. Census, which reportsthe total U.S. population as 242 million, with 74 percent (approximately180 million persons) made up of adults 18 years of age or olderliving in U.S. households.
Results
Characteristics of the Respondents and Generalizability of the Sample
The characteristics of the subjects we interviewed are shownin Table 1. The sociodemographic characteristics of the surveypopulation were similar to those in the 1989 U.S. National HealthInterview Survey23 with respect to age, sex, race, education,marital status, and region of the country.
Table 1. Characteristics of the 1539 Subjects Interviewed.
Table 2 summarizes the use of unconventional therapy in the12 months before the survey for all 1539 respondents interviewed.Excluding exercise and prayer, one in three respondents (34percent) used at least one unconventional therapy in 1990. Nearlytwo thirds (64 percent) of those who used unconventional therapydid so without visiting a provider of unconventional therapyduring the 12 months before the interview, whereas the one thirdwho did see a provider made an average of 19 visits.
Table 2. Prevalence and Frequency of Use of Unconventional Therapy among 1539 Adult Respondents in 1990.
The use of unconventional therapy was not confined to any narrowsegment of U.S. society. The rates of use ranged from 23 to53 percent in all sociodemographic groups we considered. Therewere no significant differences according to sex or insurancestatus and only small variations according to the size of thecommunity. The use of unconventional therapy was significantlymore common among people 25 to 49 years of age (38 percent)than among those who were younger (33 percent) or older (28percent) (P<0.05 for both comparisons). The use of unconventionaltherapy was significantly less common among blacks (23 percent)than among members of other racial groups (35 percent; P<0.05).It was significantly more common among persons with some collegeeducation (44 percent) than among those with no college education(27 percent; P<0.05) and significantly more common amongpeople with annual incomes above $35,000 (39 percent) than amongthose with lower incomes (31 percent; P<0.05). Use was alsosignificantly more common among those living in the West (44percent) than among those living in the rest of the country(31 percent; P<0.05).
Patterns of Use
The vast majority of respondents (83 percent) reported one ormore principal medical conditions in 1990. More than half (58percent) of respondents with at least one principal medicalcondition saw a medical doctor but not a provider of unconventionaltherapy in 1990; 3 percent saw only a provider of unconventionaltherapy; 7 percent saw both a medical doctor and a providerof unconventional therapy; and 33 percent saw neither for atleast one principal medical condition (Figure 1).
Figure 1. Percentage of Respondents Reporting at Least One Principal Medical Condition Who Saw a Medical Doctor or Provider of Unconventional Therapy in 1990.
Eighty-three percent (1279) of the 1539 respondents reported one or more principal medical conditions. "Provider" denotes a provider of unconventional therapy.
Table 3 summarizes the rates of use of unconventional therapyfor the 10 most common principal medical conditions. On average,1 in 4 respondents (25 percent) used unconventional therapyand 1 in 10 (10 percent) went to a provider of unconventionaltherapy for a principal medical condition in 1990. Among allthe conditions studied, the frequency of use of unconventionaltherapy was highest for back problems (36 percent), anxiety(28 percent), headaches (27 percent), chronic pain (26 percent),and cancer or tumors (24 percent). Consistent with the prevalenceof cancer in the general population, the use of unconventionaltherapy for cancer accounted for less than 3 percent of alluse. Relaxation techniques, chiropractic, and massage were theunconventional therapies used most often in 1990.
Table 3. Use of Unconventional Therapy for the 10 Most Frequently Reported Principal Medical Conditions.
Among respondents who reported a principal medical conditionand used unconventional therapy for that condition, only 4 percentsaw a provider of unconventional therapy without also seeinga medical doctor. No respondent saw a provider of unconventionaltherapy, but not a medical doctor, for the treatment of cancer,diabetes, lung problems, skin problems, high blood pressure,urinary tract problems, or dental problems.
To clarify further the patterns of use of unconventional therapy,we defined and investigated two predominant patterns of carefor each principal medical condition: the conventional pattern(in which the respondent sought the services of a medical doctorbut did not use unconventional therapies) and the unconventionalpattern (the respondent used unconventional therapy with orwithout seeing a medical doctor). The unconventional patternwas more common than the conventional pattern for 5 of the 10most frequently cited principal medical conditions: back problems,insomnia, headache, anxiety, and depression.
Among respondents who saw a medical doctor for at least oneprincipal medical condition, more than one in four (28 percent)also used unconventional therapy, and one in nine (11 percent)saw a provider of unconventional therapy for the same conditionduring the 12 months before the survey (Figure 2). The ratesof use of unconventional therapy among those who consulted amedical doctor varied from condition to condition. The probabilitythat an individual patient who saw a medical doctor also usedunconventional therapy in 1990 was higher than one in threefor patients with anxiety (45 percent), obesity (41 percent),back problems (36 percent), depression (35 percent), or chronicpain (34 percent). Respondents who consulted a medical doctorused unconventional therapy least often for diabetes (2 percent),dermatologic problems (7 percent), urinary problems (10 percent),gynecologic problems (11 percent), dental problems (11 percent),pulmonary problems (11 percent), and high blood pressure (12percent).
Figure 2. Use of Unconventional Therapy by Respondents Who Saw a Medical Doctor for a Principal Medical Condition in 1990.
The 10 most commonly reported conditions are shown in descending order of prevalence.
Almost 9 of 10 respondents (89 percent) who saw a provider ofunconventional therapy in 1990 did so without the recommendationof their medical doctor. In more than 7 of 10 instances (72percent), users of unconventional therapy did not inform theirmedical doctor of their use of the therapy. Medical doctorswere most likely to be informed about the use of homeopathy(73 percent), megavitamin therapy (72 percent), and self-helpgroups (61 percent) and least likely to be informed about folkremedies (11 percent), religious or spiritual healing by others(17 percent), or imagery (19 percent).
As shown in Figure 1, respondents with one or more principalmedical conditions were far more likely to see a medical doctor(65 percent) than a provider of unconventional therapy (10 percent).We observed a similar pattern favoring conventional medicalcare among the group of respondents who reported principal medicalconditions and who used unconventional therapy for these conditions.Such persons were far more likely to have sought treatment froma conventional medical doctor (83 percent) during the past 12months than they were to have seen a provider of unconventionaltherapy (36 percent). However, as mentioned earlier, the majorityof users of unconventional therapy did not inform their medicaldoctors of their use of unconventional therapy. As a result,nearly half (47 percent) of respondents who used unconventionaltherapy for their principal medical condition did so withoutany professional supervision; that is, without either visitinga provider of unconventional therapy or discussing their unconventionaltherapy with their medical doctor.
Payment for Unconventional Therapy
Data on reimbursement for expenditures for unconventional therapyare shown in Table 4. The majority of respondents (55 percent)paid the entire cost of their visits out of pocket. Third-partypayment was most common for the services of herbal therapists(83 percent), providers of biofeedback (40 percent), chiropractors(39 percent), and providers of megavitamins (30 percent).
Table 4. Payment for Unconventional Therapy in the United States in 1990.
National Projections of Use and Expenditures
Extrapolation to the total U.S. household population suggeststhat in 1990 an estimated 61 million Americans used at least1 of the 16 unconventional therapies we studied and approximately22 million Americans saw providers of unconventional therapyfor a principal medical condition. Fourteen of the 16 unconventionaltherapies studied were used by an estimated million or morepersons in 1990.
The estimated number of ambulatory visits to providers of unconventionaltherapy in 1990 was 425 million (95 percent confidence interval,302 million to 548 million). This number exceeds the estimated388 million visits in 1990 to all primary care physicians (generaland family practitioners, pediatricians, and specialists ininternal medicine) combined24.
National projections of expenditures for unconventional therapyare summarized in Table 5. If one assumes that charges for visitsto providers of unconventional therapy were paid in full, Americansspent approximately $11.7 billion for these services in 1990.This estimate refers only to the services of providers and doesnot include expenditures for drugs such as herbs or for medicalequipment, devices, books, and other materials.
Table 5. National Projections of Expenditures for Unconventional Therapy in the United States in 1990.
We investigated two additional expenditures by asking respondentsabout their use of commercial diet supplements (such as instantdiet formulas, diet pills, and prepackaged meals) and over-the-countermegavitamins. Respondents who used these supplements reportedout-of-pocket expenditures averaging $228 per person per yearfor diet supplements and $203 per person per year for megavitamins.These results yield national projections of approximately $1.2billion and $0.8 billion, respectively. Adding these supplementalexpenses to the projected expenditures for all visits to providersof unconventional therapy, we estimate that expenditures in1990 amounted to $13.7 billion.
The total projected out-of-pocket expenditure for unconventionaltherapy plus supplements was $10.3 billion in 1990. This iscomparable to the out-of-pocket expenditure for all hospitalcare in the United States in 1990 ($12.8 billion), and it isnearly half the amount spent out of pocket for all physicians'services in the United States ($23.5 billion)25.
Discussion
We found that unconventional medicine has an enormous presencein the U.S. health care system. An estimated one in three personsin the U.S. adult population used unconventional therapy in1990. The estimated number of visits made in 1990 to providersof unconventional therapy was greater than the number of visitsto all primary care medical doctors nationwide, and the amountspent out of pocket on unconventional therapy was comparableto the amount spent out of pocket by Americans for all hospitalizations.Roughly 1 in 4 Americans who see their medical doctors for aserious health problem may be using unconventional therapy inaddition to conventional medicine for that problem, and 7 of10 such encounters take place without patients' telling theirmedical doctors that they use unconventional therapy. Furthermore,use is distributed widely across all sociodemographic groups.
There are limits to the representativeness of our sample becauseit was confined to households with telephones. People livingin households without telephones, those in shelters or on thestreet, and those in institutions were not sampled. In addition,we excluded non-English-speakers and persons for whom the interviewwould be burdensome because of physical or mental impairment.The frequency and patterns of use of unconventional therapyamong these subgroups (and among children) are not known.
As regards the generalizability of the responses of the 67 percentof the respondents who completed the interview, we made twosets of comparisons with preexisting national surveys. Our samplecorresponded with the distribution of the subjects of the NationalHealth Interview Survey23 with respect to age, sex, race, socialclass, and other sociodemographic variables, suggesting thatour sample was representative of the U.S. household population.Compared with the national Health and Nutrition ExaminationSurvey,26 however, our survey involved fewer people who reportedpoor health on a five-point scale of health status (3 percentvs. 7 percent). This underrepresentation of respondents withpoor health reflects our exclusion of those for whom the surveywould have been burdensome because of their physical incapacity.Since we found that persons who reported poor health had substantiallyhigher rates of use of unconventional therapy than those whoperceived themselves to be in better health (52 percent vs.33 percent), the study design may have resulted in an underestimateof the use of unconventional therapy.
Unconventional therapies are generally used as adjuncts to conventionaltherapy, rather than as replacements for it. Users of unconventionaltherapy were more likely to see a medical doctor than a providerof unconventional therapy, and visits to providers for seriousmedical conditions in the absence of contact with a medicaldoctor were rare. Moreover, in contrast to previous reportsof research involving patients with cancer,6,7,9 no respondentsin this national survey who identified cancer as a principalmedical problem reported seeing a provider of unconventionaltherapy without also seeing a medical doctor for this condition.
Although much of the literature dealing with unconventionalmedical practices focuses on potentially life-threatening ordebilitating illness, the use of unconventional therapy wasnot limited to life-threatening conditions. Projections fromsurvey data indicate that millions of Americans used unconventionaltherapy for each of the conditions we studied, the majorityof which are not life-threatening. Put somewhat differently,it is likely that virtually all medical doctors see patientswho routinely use unconventional therapies. Indeed, for medicaldoctors currently caring for patients with back problems, anxiety,depression, or chronic pain, the odds are greater than one inthree that a patient is simultaneously using unconventionaltherapy for these medical problems without disclosing this fact.
Our results also suggest that the use of unconventional therapyis not limited to the person's principal medical conditions.A full third of the respondents who used unconventional therapyin 1990 did not use it for any of their principal medical conditions.From this fact we infer that a substantial amount of unconventionaltherapy is used for nonserious medical conditions, health promotion,or disease prevention. However, these issues were not a focusof our inquiry.
Although users of unconventional therapy are more likely tobe in contact with medical doctors than with providers of unconventionaltherapy, fewer than 3 in 10 users of unconventional therapymention its use to their medical doctors. Moreover, roughlyhalf of those who use unconventional therapy for their principalmedical conditions have no supervision of this treatment byeither a medical doctor or a provider of unconventional therapy.Extrapolations to the U.S. population suggest that approximately20 million Americans fall into this unsupervised category.
Our observation that the majority of users of unconventionaltherapy did not discuss this therapy with their medical doctorssuggests a deficiency in current patient-doctor relations. Perhapsthis lack of communication derives from medical doctors' mistakenassumption that their patients do not routinely use unconventionaltherapies for serious medical problems. Perhaps medical doctorsdo not discuss the use of unconventional therapies because theylack adequate knowledge of these techniques. In either case,this failure to communicate is not in the best interest of thepatients, since the use of unconventional therapy, especiallyif it is totally unsupervised, may be harmful11,27.
Medical doctors should begin to ask their patients about theiruse of unconventional therapy whenever they obtain a history.Some doctors may be uncomfortable with this line of questioning.Nonetheless, as Kleinman and colleagues suggested more thana decade ago,28,29 an exploration of the use of unconventionaltherapy and enhanced understanding of these practices will improveboth communication between patients and doctors and clinicalcare. We suggest that medical schools include information aboutunconventional therapies and the clinical social sciences (anthropologyand sociology) in their curriculums. The newly established NationalInstitutes of Health Office for the Study of UnconventionalMedical Practices should help promote scholarly research andeducation in this area.
Supported by a contract with the John E. Fetzer Institute anda grant from the Nathan Cummings Foundation.
We are indebted to Ms. Debi Arcarese for technical and editorialassistance.
Source Information
From the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Hospital and Harvard Medical School, Boston (D.M.E., T.L.D.); the Institute for Social Research, University of Michigan, Ann Arbor (R.C.K., C.F.); the Division of General Medicine, Department of Medicine, New England Deaconess Hospital and Harvard Medical School, Boston (D.R.C.); and Chicago College for Osteopathic Medicine, Chicago (F.E.N.).
Address reprint requests to Dr. Eisenberg at the Division of General Medicine and Primary Care, Beth Israel Hospital, 330 Brookline Ave., Boston, MA 02215.
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Unconventional Medicine
Amoils S., Korte D., Nelson C. F., Rosner A. L., Friedman R., Zuttermeister P., Benson H., Roter B., Meserole L., Rahlmann J., Santosh S., Stackhouse F. A., Dawson H. R., Stotland N. L., Gellert G. A., Campion T., Eisenberg D., Delbanco T., Kessler R., Campion E. W.
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Correspondence
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26: 266-279
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(2009). Complementary Therapy Use and Health Self-Management Among Rural Older Adults. J Gerontol B Psychol Sci Soc Sci
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(2009). Prelude to Music and Medicine. Music and Medicine
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Cheng, K. J.
(2009). Neuroanatomical basis of acupuncture treatment for some common illnesses. Acupuncture in Medicine
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Nathan, P. C., Ford, J. S., Henderson, T. O., Hudson, M. M., Emmons, K. M., Casillas, J. N., Lown, E. A., Ness, K. K., Oeffinger, K. C.
(2009). Health Behaviors, Medical Care, and Interventions to Promote Healthy Living in the Childhood Cancer Survivor Study Cohort. JCO
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Jacobson, G. M., Cain, J. M.
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(2009). Complementary and alternative medicine (CAM) usage in Singaporean adult cancer patients. Ann Oncol
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(2009). Patients' Interactions With Physicians and Complementary and Alternative Medicine Practitioners: Older Women With Breast Cancer and Self-Managed Health Care. Integr Cancer Ther
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(2009). South Texas Mexican American Use of Traditional Folk and Mainstream Alternative Therapies. Hispanic Journal of Behavioral Sciences
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(2009). Health Perceptions of Latinos With Intellectual Disabilities: The Results of a Qualitative Pilot Study. Health Promot Pract
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(2009). The 'Natural Health Service': natural does not mean safe. Adv. Psychiatr. Treat.
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(2008). Complementary and alternative medicine approaches to blood pressure reduction: An evidence-based review. cfp
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Fries, C. J.
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Ju, Y. H., Doerge, D. R., Woodling, K. A., Hartman, J. A., Kwak, J., Helferich, W. G.
(2008). Dietary genistein negates the inhibitory effect of letrozole on the growth of aromatase-expressing estrogen-dependent human breast cancer cells (MCF-7Ca) in vivo. Carcinogenesis
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Bruguier, E.
(2008). Allied Health and Nursing Academic Programs at New Jersey county colleges: Holistic Health and Complementary and Alternative Medicine Content. Complementary Health Practice Review
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Hsiao, A.-F., Wong, M. D., Miller, M. F., Ambs, A. H., Goldstein, M. S., Smith, A., Ballard-Barbash, R., Becerra, L. S., Cheng, E. M., Wenger, N. S.
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Jena, S, Witt, C., Brinkhaus, B, Wegscheider, K, Willich, S.
(2008). Acupuncture in Patients With Headache. Cephalalgia
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Bishop, F. L., Yardley, L., Lewith, G. T.
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Willms, L., St Pierre-Hansen, N.
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Willms, L., St-Pierre-Hansen, N.
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Trevithick, S. G.
(2008). Integrative Health and the Management of Pain at the End of Life. Home Health Care Management Practice
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(2008). Quality of Efficacy Research in Complementary and Alternative Medicine. JAMA
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Bristol, M. N., Sonnad, S. S., Guerra, C.
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Morris, C. E., Skalak, T. C.
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(2007). Perspectives of Family Medicine Physicians and Licensed Acupuncture Clinicians on Caring for Persons With Unexplained Chronic Fatigue. Complementary Health Practice Review
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Picciano, M. F., Dwyer, J. T., Radimer, K. L., Wilson, D. H., Fisher, K. D., Thomas, P. R., Yetley, E. A., Moshfegh, A. J., Levy, P. S., Nielsen, S. J., Marriott, B. M.
(2007). Dietary Supplement Use Among Infants, Children, and Adolescents in the United States, 1999-2002. Arch Pediatr Adolesc Med
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Berthold, S. M., Wong, E. C., Schell, T. L., Marshall, G. N., Elliott, M. N., Takeuchi, D., Hambarsoomians, K.
(2007). U.S. Cambodian Refugees' Use of Complementary and Alternative Medicine for Mental Health Problems. Psychiatr. Serv.
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Fluri, F., Lyrer, P., Gratwohl, A., Raetz-Bravo, A. E., Steck, A. J.
(2007). LEAD POISONING FROM THE BEAUTY CASE: NEUROLOGIC MANIFESTATIONS IN AN ELDERLY WOMAN. Neurology
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Morris, C. E., Skalak, T. C.
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Ganz, M. L.
(2007). The Lifetime Distribution of the Incremental Societal Costs of Autism. Arch Pediatr Adolesc Med
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Wu, P., Fuller, C., Liu, X., Lee, H.-C., Fan, B., Hoven, C. W., Mandell, D., Wade, C., Kronenberg, F.
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Grzywacz, J. G., Suerken, C. K., Neiberg, R. H., Lang, W., Bell, R. A., Quandt, S. A., Arcury, T. A.
(2007). Age, Ethnicity, and Use of Complementary and Alternative Medicine in Health Self-Management. Journal of Health and Social Behavior
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Hlubocky, F. J., Ratain, M. J., Wen, M., Daugherty, C. K.
(2007). Complementary and Alternative Medicine Among Advanced Cancer Patients Enrolled on Phase I Trials: A Study of Prognosis, Quality of Life, and Preferences for Decision Making. JCO
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Marinac, J. S., Buchinger, C. L., Godfrey, L. A., Wooten, J. M., Sun, C., Willsie, S. K.
(2007). Herbal Products and Dietary Supplements: A Survey of Use, Attitudes, and Knowledge Among Older Adults. JAOA: Journal of the American Osteopathic Association
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Wahner-Roedler, D. L., Vincent, A., Elkin, P. L., Loehrer, L. L., Cha, S. S., Bauer, B. A.
(2006). Physicians' Attitudes Toward Complementary and Alternative Medicine and Their Knowledge of Specific Therapies: A Survey at an Academic Medical Center. Evid Based Complement Alternat Med
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Carrese, J. A., Sugarman, J.
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Mukai, H., Watanabe, T., Ando, M., Katsumata, N.
(2006). An Alternative Medicine, Agaricus blazei, May Have Induced Severe Hepatic Dysfunction in Cancer Patients. Jpn J Clin Oncol
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Howell, L., Kochhar, K., Saywell, R. Jr, Zollinger, T., Koehler, J., Mandzuk, C., Sutton, B., Sevilla-Martir, J., Allen, D.
(2006). Use of Herbal Remedies by Hispanic Patients: Do They Inform Their Physician?. J Am Board Fam Med
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Gawarammana, I B, Dargan, P I, Woodcock, S, Sculley, M, House, I M, Wood, D M, Jones, A L
(2006). Should all patients with unexplained anaemia be screened for chronic lead poisoning?. Hum Exp Toxicol
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Davies, A. A., Davey Smith, G., Harbord, R., Bekkering, G. E., Sterne, J. A. C., Beynon, R., Thomas, S.
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WISNIOSKI, S. W. III
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Kronenberg, F., Cushman, L. F., Wade, C. M., Kalmuss, D., Chao, M. T.
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Wong, V. C.N., Sun, J.-G., Yeung, D. W.C.
(2006). Pilot Study of Positron Emission Tomography (PET) Brain Glucose Metabolism to Assess the Efficacy of Tongue and Body Acupuncture in Cerebral Palsy. J Child Neurol
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Hanje, A. J., Fortune, B., Song, M., Hill, D., McClain, C.
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Lewith, G., Verhoef, M., Koithan, M., Zick, S. M.
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Shmueli, A., Shuval, J.
(2006). Satisfaction with Family Physicians and Specialists and the use of Complementary and Alternative Medicine in Israel. Evid Based Complement Alternat Med
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Stumpf, S. H., Shapiro, S. J.
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Tester, F. J., McNicoll, P.
(2006). 'Why Don't they Get It?' Talk of Medicine as Science. St Luke's Hospital, Panniqtuuq, Baffin Island. Soc Hist Med
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Clay, P. G, Glaros, A. G, Clauson, K. A
(2006). Perceived Efficacy, Indications, and Information Sources for Medically Indigent Patients and Their Healthcare Providers Regarding Dietary Supplements. The Annals of Pharmacotherapy
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WERNEKE, U., TURNER, T., PRIEBE, S.
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Borneman, J. P., Field, R. I.
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Montalto, C. P., Bhargava, V., Hong, G. S.
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Garrow, D., Egede, L. E.
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Azaizeh, H., Ljubuncic, P., Portnaya, I., Said, O., Cogan, U., Bomzon, A.
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Menefee, L. A., Monti, D. A.
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Kang, J. X., Liu, J., Wang, J., He, C., Li, F. P.
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Grzywacz, J. G., Lang, W., Suerken, C., Quandt, S. A., Bell, R. A., Arcury, T. A.
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Tovey, P., Chatwin, J., Ahmad, S.
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Winemiller, M. H., Billow, R. G., Laskowski, E. R., Harmsen, W. S.
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Vogel, J. H.K., Bolling, S. F., Costello, R. B., Guarneri, E. M., Krucoff, M. W., Longhurst, J. C., Olshansky, B., Pelletier, K. R., Tracy, C. M., Vogel, R. A., Vogel, R. A., Abrams, J., Anderson, J. L., Bates, E. R., Brodie, B. R., Grines, C. L., Danias, P. G., Gregoratos, G., Hlatky, M. A., Hochman, J. S., Kaul, S., Lichtenberg, R. C., Lindner, J. R., O'Rourke, R. A., Pohost, G. M., Schofield, R. S., Shubrooks, S. J., Tracy, C. M., Winters, W. L. Jr
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