The CDC conducts an ongoing National Health Interview Survey (NHIS) to track various aspects of American’s use of health care. Since 2002 they have been tracking use of so-called alternative medicine services as part of the survey. The most recent results of this survey are available, including data through 2012.

The headline is that Americans spent $30.2 billion (out of pocket) on “alternative medicine” in 2012. That figure is alarming to anyone who cares about having a science-based standard in health care, and about consumers being scammed, but it is also highly misleading.

The core problem is that the category “alternative” (whether you call in complementary, integrative, functional, or whatever) is vague, poorly defined, and nonsensical. It is nothing but a marketing term meant to give an impression of hip acceptability to what was previously known simply (and more accurately) as health fraud.

To increase the apparent popularity of the false category, proponents have always inflated the numbers by including things that are not, by any reasonable definition, alternative. This survey is not exception.

The number one “alternative” modality used by Americans in 2012 was – dietary supplements, specifically non-vitamin non-mineral supplements. This is clearly the result of deregulating the supplement industry in 1994 with DSHEA. The industry can now sell just about anything, as long as it is not already considered a drug, make fake “structure function” claims for it, and not have to do any research on safety or efficacy.

The good news is that the industry has seemed to peak, at 18.9% in 2002 down to 17.7% in 2007 and 2012. The most popular supplement in 2012 was fish oil, which again stretches the definition of “alternative.” Fish oil contains omega 3 fatty acids, and the evidence for a health benefit is complex and mixed. In 2002 their use was recommended by the American Heart Association (that sounds mainstream to me). But later research failed to find a consistent health benefit to routine use. At present their benefit remains unproven but an open question.

Fish oil is followed by glucosamine or chondroitin (don’t work), probiotics or prebiotics (might work in selected situations), and melatonin (doesn’t work for insomnia, may be slightly effective for jet lag). In the vast majority of cases the popular supplements range from somewhat plausible to implausible, and the evidence ranges from preliminary and mixed to negative.

Some of these supplements are drugs (herbal drugs) and some are actually dietary supplements, like fish oil. The only thing “alternative” about them is that the evidence for their benefit is questionable or negative. This is a manifestation of a poorly regulated industry.

After dietary supplements we have deep breathing. Included in this category is any relaxation or meditation modality that includes deep breathing (previous surveys did not include these). This is a great example of rebranding basic lifestyle factors, like relaxation, as “alternative.”

Even more so is the next item, yoga. Yoga (tai chi and qi gong are also included) is stretching and exercise. This is not alternative. This is physical activity, which is definitely good for you. Admittedly, with these forms of exercise you get some gratuitous vitalism nonsense thrown in. While you are exercising your instructor will likely tell you how this will improve the flow of chi through your core, or some equally worthless superstition. If you ignore that, it’s just exercise.

After that we have chiropractic at 8.4%. This is the first truly alternative modality, even though most of what chiropractors do is very similar to physical therapy – treatments for acute lower back pain. But many chiropractors do mix in a lot of pseudoscience.

What I would consider the true alternative modalities are all clustered at the bottom of the list in very low single digits: homeopathy at 2.2%, acupuncture 1.5%, naturopathy 0.4%. These numbers are similar to 2002.

Conclusion

Any use of treatments and products that are not based on reasonable scientific evidence and plausibility is a complete waste of money, most of which is out of pocket. These treatments can also distract from actually effective treatments, or use up limited resources so that patients do not have the money for effective treatments. There is real harm to relying on nonsense for health care.

But the numbers are not as bad as the headlines make it seem, because they are grossly inflated by “gray zone” products and services, and basic lifestyle factors like diet, exercise, and relaxation.

Alternative medicine, in other words, remains on the fringe. Proponents, however, have made unfortunate progress in infiltrating the health care system, largely through inflating its apparent popularity.