HOW WIDESPREAD IS CAM USE?

Globally, it is estimated that 70% of all health care is provided by traditional, nonconventional medicine.8 The World Health Organization (WHO) Traditional Medicine Fact Sheet states ''countries in Africa, Asia and Latin America use traditional medicine to help meet some of their primary health care needs. In Africa, up to 80% of the population still relies on traditional medicine for primary health care.''9 One of the most commonly used forms of traditional medicine worldwide is botanical medicine.

Surveys indicate that as many as 50% (or more) of all Americans acknowledge using CAM therapies.10-13 The actual rate of use is likely higher than reported in the United States, suggested by the fact that as many as 50% of patients do not report CAM use to their conventional doctors.8,14 Surveys typically exclude non-Englishspeaking respondents, thereby eliminating from the statistical pool those demographic pockets of Americans whose use may be even higher that in the average popu-lation;for example, large numbers of Hispanic Americans in certain locales regularly use herbs and spiritual healing practices.7

David Eisenberg's seminal surveys on CAM use by Americans, conducted between 1990 and 1997, revealed a 45% increase in the use of CAM therapies during that period with estimated out-of-pocket expenses of up to $27 billion in 1997—up from $14 billion in 1990.7 American patients' visits to CAM practitioners have been estimated at $600 million per year, exceeding the sum of all visits to primary care physicians.3,5-8,14'15 Because these visits are mostly out of pocket, fewer individuals might currently use CAM therapies than if they were fully reimbursed by insurance or deductibles were lower. It is likely that there will be a significant increase in CAM use as more coverage is available from insurance companies, and as greater numbers of conventional practitioners integrate their practices to include a broader range of therapies or increase their number of referrals to a wider range of complementary therapists, such as acupuncturists, naturopathic physicians, and herbalists.

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