New Report Details Billions Americans Spend on Complementary, Alternative Medicine

A recently released government report (15-page PDF; About PDFs) found that U.S. adults are spending almost $34 billion a year on complementary and alternative medicine, or CAM, products and therapies, as well as on visits to CAM practitioners. And that popularity can translate into extra dollars for family physicians, says one FP.

There's no reason CAM techniques and remedies can't be incorporated into family medicine practices, says Reid Blackwelder, M.D., of Kingsport, Tenn. -- especially when doing so can help many diverse patients and earn FPs added compensation.

According to Blackwelder, who practices integrative medicine, "CAM providers may not do much more than we do or can do. We can recommend or use self-help tools just as well as they can, with the extra 'oomph' of our medical knowledge."

According to the report, "Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners, United States, 2007," U.S. adults spent a total of $33.9 billion out-of-pocket on CAM products, classes and materials and on visits to CAM professionals in 2007. Ten years earlier, that out-of-pocket figure was estimated at $27 billion.

The report also estimates that 38.3 percent, or 83 million, of American adults and 11.8 percent, or 8.5 million, of children younger than 18 use CAM products and treatments.

Developed by the NIH's National Center for Complementary and Alternative Medicine and based on information gathered during the CDC's 2007 National Health Interview Survey, the report defines CAM as "a group of diverse medical and health care systems, practices and products not presently considered to be part of conventional medicine." Examples include acupuncture, chiropractic care, relaxation techniques, massage therapy and herbal remedies.

About two-thirds, or $22 billion, of the 2007 total went for self-care therapies, such as nonvitamin, nonmineral natural products, including herbs and botanicals; homeopathic products; and yoga. The remaining $11.9 billion was spent on visits to CAM practitioners, particularly those who offer manipulative and body-based therapies.

Out-of-pocket spending on nonvitamin, nonmineral natural products topped the list at $14.8 billion for the year, followed by $4.1 billion on yoga, tai chi and qigong classes. Nearly $4 billion went for chiropractic care, and almost $3 billion was spent on homeopathic remedies.

"Family doctors should recognize many patients use such approaches, and explore for them in an open and nonjudgmental way," said Blackwelder, who is a professor and program director of the East Tennessee State University Family Physicians of Kingsport family medicine residency. He's also a former chair of the AAFP Commission on Continuing Professional Development.

"First and foremost, family physicians can use their best tool -- bedside manner," Blackwelder said. "That is a key aspect of many alternative processes and providers," and FPs would do well to use that empathy to connect with patients.

"In many ways, the physician-patient encounter creates a suggestible moment similar to what is done in a hypnosis session," said Blackwelder. "Use that power!"

Family physicians can build in discussions of CAM during face-to-face office visits for specific complaints, he said, by suggesting, for example, nasal irrigation for allergies and respiratory problems; yoga relaxation breathing for insomnia and anxiety; yin yoga for back, hip and flexibility problems; journaling for grief, depression, rheumatoid arthritis and asthma; and meditation and prayer for hypertension, stress and depression.

Blackwelder also said family physicians can take advantage of patients' interest in osteopathic manipulation by making it part of their family medicine practices. "Less than 5 percent of DOs do OMT (osteopathic manipulation treatment)," he said. "Courses are open to MDs."

The same goes for acupuncture, Blackwelder added. Techniques can be learned in a weekend, and they're helpful when working with patients who have addictions, such as smoking.

According to Blackwelder, he and other physicians are becoming more comfortable with botanicals and supplements now because such products can be standardized and specific dosages recommended. But he cautioned that it's important to remember that these products are still drugs, and physicians should have good resources, experience or tools available to help them evaluate patients using these agents for adverse reactions and interactions.

A number of CAM remedies now have solid study data demonstrating their efficacy and safety, Blackwelder said. Some examples are

As for payment, Blackwelder said techniques such as OMT are supported with specific CPT codes and can be billed along with an appropriate evaluation and management service. Moreover, he added, if a physician spends more than half of a face-to-face visit of 25 minutes' duration counseling a patient about various health issues and treatment options, including CAM techniques, he or she can code that visit as a 99214 -- even in the absence of history, physical exam or medical decision-making elements.