Integrating Complementary and Alternative Medicine with Primary Health Care

Complementary/alternative medicine (CAM) has been described as “diagnosis, treatment, and/or prevention which complements mainstream medicine by contributing to a common whole, satisfying a demand not met by orthodoxy, or diversifying the conceptual frameworks of medicine” [1]. Approximately, 1500 articles on CAM are published annually in the literature covered by MEDLINE [2]. In the United Kingdom, the market for herbal and homoeopathic remedies and aromatherapy oils increased by 41% between 1992 and 1996 [3]. In Germany, a herbal remedy (St. John's wort) is now the most frequently prescribed drug for depression. In the USA, the sales of St. John's wort rose by 2800% between 1997 and 1998, and the total market for medicinal botanicals was worth US$ 3.87 billion in 1998 [4]. Most experts agree that the interest in and practice of CAM are driven mainly by consumer pressure. A 1990 national survey of alternative medicine prevalence in US, costs, and patterns of use [5] demonstrated that alternative medicine has a substantial presence in the US health care system. Data from a survey in 1994 [6] and a public opinion poll in 1997 [7] confirmed the extensive use of alternative medical therapies in the United States. An increasing number of US insurers and managed care organizations now offer alternative medicine programs and benefits [8]. The majority of US medical schools now offer courses on alternative medicine [9]. In western Europe and Australia, 20–70% of the population regularly use complementary and alternative medicine [10, 11]. In the USA, it was estimated in 1992 that at least one in three Americans utilized one of those methods, and the number of annual visits to providers of alternative medicine exceeds the number of visits to all primary care physicians [12]. These therapies include acupuncture, chiropractic, herbal medicine and dietary supplements, nutraceuticals, homeopathy, mind-body techniques, spirituality, and faith healing, massage, and therapeutic touch. In a 1998 follow-up study, the percentage of CAM patients had increased to 42% of the US population [13]. Subsequent analyses showed that 67.6% of respondents had used at least one CAM therapy in their lifetime. This trend suggests a continuing demand for CAM therapies that will affect health care delivery for the foreseeable future [14]. The WHO report of 2002 states that at least 70% of the world population still believes in alternative medicine, and therapies which include homeopathy, Ayurveda, Siddha, Unani, Amchi, acupuncture, aromatherapy, herbal medicine in general, dietary supplements, nutraceuticals, Yoga, mind-body techniques, spirituality and faith healing, and massage. The current trend is indicative of a continuing demand for CAM therapies which will definitely have its impact on health care delivery in the future [15].