A skeptical theme that crops up very frequently is the fact that there is a huge disconnect between popular beliefs and the findings of science. There is a tendency for people to overestimate their own knowledge even when they have no basis for their confidence (even skeptics – we all do this). Often this amounts to just making up answers because they feel right and then assuming they are correct. We all do this – believers and skeptics alike. This is the default mode of human thinking. It takes discipline to insert the critical thinking filter – “is this really true? what does the evidence actually say?”

The specific topic at hand is attitudes toward so-called complementary and alternative medicine (CAM) – how popular is it, and what is the basis for its popularity? I have dealt before with the former question. Here’s the summary: most surveys that site huge numbers of people using CAM are grossly inflating the numbers by including things such as exercise, prayer, or taking a multivitamin. I exercise, so by some measures I am a CAM user. This, of course, reflects the confusion caused by the dubious category of CAM itself – it is a pseudo-category, containing a wide variety of modalities, some mutually exclusive, with very fuzzy boundaries.

It is more meaningful to consider individual claims and practices, and to use somewhat tighter categories (such as energy-medicine). If we consider the “hard-core” CAM practices – like homeopathy, acupuncture, and energy medicine – we find that their use is still in the tiny minority – single digits. And these numbers are not significantly changing over time. The popularity of CAM is overblown.

The other question (actually two questions) is also interesting – who is using CAM and why? As evidenced by my many discussions on the topic and comments left on my blogs (and others), the most common answer is some variation of  “I guess people must be dissatisfied with mainstream medicine.” In a blog post for SBM this week, in fact, a commenter noted:

I suspect that the reason many people turn to CAM is because they feel that the medical practice they have experienced isn’t that good.

This is not an unreasonable assumption, but like many reasonable assumptions it turns out to be wrong. There have been many surveys and a common theme among them is that most people who use CAM do so because it was in line with their philosophy. The classic study is this one, a 1998 survey published in JAMA.  It concludes:

Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.

People who use CAM have disposable income (which makes sense as most CAM is paid for out of pocket), which itself correlates with older age and more education. CAM use also correlates with having some chronic medical complaints, which also makes sense and happens to be true. Surveys also show that the most common CAM modalities (if you don’t include prayer and exercise) are for musculoskeletal complaints – massage, manipulation, yoga, and relaxation.

So if we put this all together the profile of the average CAM user is a middle-aged or older adult with cash on hand who is having the typical aches and pains of that stage of life and is looking for a touchy-feely therapy that fits their overall world view. Of course, this is just the typical user, and the numbers also include other profiles, but they seem to be in the minority. The profile we worry about the most are those with a serious life-threatening illness who are drawn to a hard-core CAM modality by desperation or the alure of false hope.

There is now a new survery, this one Flemish, adding another wrinkle to the data on who is using CAM and why. This survey of Flemish adults was about belief, and not necessarily use. They asked the typical questions, but also surveyed belief in the paranormal. The study concludes:

Support of CAM was very prevalent in this Flemish adult population. CAM beliefs were strongly associated with paranormal beliefs.

They also confirmed an associated with older age, which again is likely explained by disposable income. Belief in the paranormal and age were the only factors that predicted positive attitudes toward CAM. There was a positive relationship also with level of education and the social desirability of CAM, but these factors were not strongly enough correlated to be predictive.

I admit that this result is highly satisfying, and fits well with not only previous data but my personal biases. A world-view that includes belief in magic and the supernatural accords well with many of the claims made within the broad CAM umbrella. This may also reflect a poor understanding of or respect for science.

While paranormal belief was the strongest correlate of belief in CAM in this survey, this and other data also reflect that attitudes toward CAM is a complex and multifarious cultural and social phenomenon. It may be dominated by the worried and wonky well, but there are many other types mixed in as well.