Dec 11 2008

New Stats on CAM Usage

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The Wall Street Journal declares, “Alternative Therapies Have Gone Mainstream.” The Washington Post claims, “Survey Documents Rise in Alternative Treatments.” (That headline was in the RSS feed.) Reuters writes, “Many Americans turning to unconventional medicine.”

Fail!

They are talking about the 2007 National Health Statistics report on CAM use by Americans.  This data was actually released in September. I went through the statistics at the time and reported on them for Science-Based Medicine. I guess that was too much work for most journalists, so they waited three months to be spoon-fed the data by the NCCAM. They also appear to have been spoon-fed their conclusions, for none of the outlets even comes close to getting it right.

In fact, the statistics show the opposite of what the headlines proclaim – for as long as statistics have been gathered on CAM use the numbers have been remarkably stable – not increasing.

Here are the actual numbers reported by the survey:

Modality                       % used Ever             2002                 2007

Acupuncture                    6.55                          1.1                    1.4
Ayurveda                         0.56
Biofeedback                     1.23                           0.1                    0.2
Chelation                          0.34
Chiropractic or
Osteo Manipulation       21.91                         7.5                    8.6
Energy Healing                1.72                          0.5                   0.5
Hypnosis                          2.34                          0.2                    0.2
Massage                           16.02                        5.0                    8.3
Naturopathy                    1.51                          0.2                    0.3
Homeopathy                    3.65                          1.7                     1.8
tai chi                                 0.9
qi gong                               0.6
yoga                                   9.53                          5.1                     6.1

These numbers are not significantly different than 20 years ago. Also, the “significant increase” that proponents are crowing about and the press are parroting are hardly significant. The numbers for manipulative therapies in 2007 include chiropractic and osteopathy while the 2002 numbers include chiropractic only, so the comparison is not valid. Massage increased by 3.3 percent. Otherwise the numbers are static or just slightly increased.

Also, the numbers reveal the hollowness of the CAM label – what does CAM really mean? The numbers are inflated by including items that are not necessarily out of the mainstream. Massage is a perfectly reasonable modality for muscle relaxation. I would only consider it “alternative” if pseudoscientific therapeutic claims were being made for it, and this survey does not capture that information. Biofeedback is established for stress reduction and some symptomatic relief of tension headache and similar conditions. Yoga is exercise and stretching. Also, manipulative therapy is reasonable for uncomplicated acute lower back strain, with is what about 60% of manipulation is used for.

If you factor out these modalities (and also legitimate use of nutrition), the numbers remaining are all quite low – in the single digits, and not significantly increasing. Only 1.8% of the population used homeopathy, 1.4 acupuncture, 0.3 naturopathy, and 0.5 energy healing. For these hard-core CAM modalities usage is still marginal and not really changing.

What the headline should read is, “Despite unfounded hype, political activism, poor regulation, and promotion by gullible media – use of CAM modalities remains minimal and fringe.”

The Washington post reports “38% of Adults use Alternative Medicine.” But as should now be clear, that 38% figure is inflated and misleading. They also did not question or explore the “alternative” label. What they did do is quote Dr. David Eisenberg, who has been misrepresenting CAM statistics for years:

“I think it’s fair to say we can conclude that this is part of the steady state of medical care in the United States,” said David Eisenberg, director of the Harvard Medical School’s division for research and education in complementary and integrative medical therapies. “I think the news is complementary and alternative medicine use by the U.S. public is here to stay.”

I think it is fair to say that the abuse of statistics by CAM proponents to create the illusion of mainstream acceptance, despite the numbers, is here to stay. This is nothing more than pro-CAM propaganda, unfiltered by journalism.

For balance they did interview Wallace Sampson, who also blogs with me at SBM.

“They are either unproven or disproven,” said Wallace Sampson, founding editor of the Scientific Review of Alternative Medicine. “Acupuncture is a placebo. Homeopathy is one step above fraud. It goes on and on. The fact that they are so widely used is evidence for how gullible large segments of our society are.”

I know from my prior discussions with him that Wally believes the numbers to be inflated exactly as I have discussed, so I suspect he was selectively quoted here. His point is legitimate, but does not address the bigger deception that I discuss.

They also quote Stephen Barrett from Quackwatch.

“There’s a tremendous amount of money being wasted on this,” said Stephen Barrett, who runs Quackwatch (http://www.quackwatch.org), which monitors false medical claims. “That money could be used to do research on something that has been waiting in line to get money.”

Again – a legitimate point. But there was nothing in the article discussing the misrepresentation of the numbers, and if the reporter, Rob Stein, spoke to Wally Sampson and Steve Barrett it is very likely that he was made aware of this concern. (I will ask them about this and add an addendum when I have more information.) It seems as if the media had their story – CAM gone mainstream – and that was the story they were going to write. Quotes from skeptics are usually just plug ins, they don’t alter the main theme of the story itself. This is a disturbing habit among journalists – writing the story prior to doing the research, and conducting interviews only to provide quotes to plug into the existing story framework.

While I am always annoyed by such journalistic failures when dealing with CAM, I am at least heartened that the numbers for use of core CAM modalities remains so low and are barely fluctuating. And at least now the media are (sometimes) adding at least token scientific comments. Perhaps there’s hope after all.

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Addendum added 12/16/08

At least one mainstream outlet, US News and World Report, saw through the spin and hype to the real numbers. Avery Comarow gets it right.

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