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The Not-So-'Alternative' Alternative
Benjamin G. Druss, M.D., M.P.H., is an assistant professor of public health and psychiatry at Yale University.
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Business New Haven
9/6/1999
By: BNH
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What was the basic premise behind your recent experiment with alternative medicine?
We were interested in looking at how people use unconventional therapies - whether they really use them as an alternative to conventional medical care or not. We used a large population-based survey which looked at about 16, 000 adults. We asked them questions about both their use of conventional therapies - that is things like physician visits and emergency-room visits and in-patient visits - and then also a variety of questions about 'alternative' therapies.
How was the survey conducted?
It was an interview. People would basically knock on people's doors. It's a population-based health survey that's given out by the [state's] Department of Health & Human Services.
What were your major findings?
We found that, to a great extent, people don't use alternative therapies as 'alternatives' after all, but in fact tend to use them in conjunction with conventional medical care. In fact, people who are most likely to use them are people who use a high amount of traditional medical care.
What kinds of therapies did you consider 'alternative'?
Clearly that is, in some ways, a moving target. We used the definition that had been used by most former studies. In David Eisenberg's original study, he defined a set of treatments, including chiropractic and herbal remedies. Originally he had defined them as treatments that weren't used extensively either in medicine, medical-school curricula or insurance packages. All that, of course, is changing every day. We focused specifically on therapies that were delivered through a practitioner. We looked less at people who were, say buying herbal tea over the counter or taking a ginseng extract. Rather we looked at people who, if they were using any of those, had gone through the practitioner to use them.
What conclusions can be drawn from the results of your survey?
First, that people who are using alternative therapies are not necessarily rejecting mainstream medicine. Instead, a typical picture of someone using these treatments might be someone who is already in treatment and whose symptoms aren't being adequately addressed through their traditional medical care. So they're looking to the alternative system for additional treatment. Most of the people who have used the alternative therapies had visited a physician. Only about one-fifth of those who had visited a physician and used alternative therapies told the physician. So it does again speak to the importance of physicians asking patients about these types of therapies.
Why do you think patients don't volunteer that information?
It's complicated. You know, physicians are busy, they often don't have a lot of time to start off with. Then, these are things that they either don't know that much about or that make them uncomfortable in one way or another. I think it's easy for patients to feel uncomfortable about bringing it up or for physicians to feel uncomfortable raising the issue. I see it as somewhat analogous to issues like mental health and substance abuse, that people recognize at some level are important but, both from the patients' point of view and from the physicians' point of view, cause discomfort in raising the problem.
How did you first become interested in this type of study?
I'm interested in health systems and how they affect delivery of services. In particular I've studied the interface between mental health-care systems and general health-care systems. This to me seemed to raise a lot of the same kinds of issues. What does the interface between the two systems look like? How do people use both systems of care? People with mental-health stress tend to use a lot of medical services. So there was a thought that if mental-health services were provided in a timely fashion, they could sort of pay for themselves. It's turned out to be somewhat more complicated, in that often people who use a lot of services just use a lot of services. It's not a zero-sum game where if you add some in one place, you can take some away in another place.
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