In a time of trillion-dollar stimulus packages and billion-dollar bailouts, what once seemed like staggering amounts of money now sound almost ordinary. Even so, it got my attention when I read that Americans spend $33.9 billion a year on complementary and alternative medicine. That's $33.9 billion out of people's own pockets, not counting anything paid for by insurance companies, and not counting money spent on vitamin or mineral supplements. It's about the same as Canada's total drug bill for a year. It sounds less sensational when you work out that every adult in the U.S. spends just shy of $150 each year, but even so, it's clear that alternative medicine is a huge industry.
The obvious question is: Are people wasting their money? One person who'd argue that they are is British pharmacologist Professor David Colquhoun. He says that one of the main problems with complementary and alternative medicine is the definition dilemma
. It goes like this. Once a treatment is shown to work, it stops being alternative, and becomes part of mainstream medicine. For example, willow bark was a traditional remedy for pains and fever, but discoveries in the 1800s led to the isolation of the active ingredient, salicylic acid
. With some further development, this became aspirin
, and it’s now a mainstream medicine.
A large chunk of the money ($14.8 billion) was spent on supplements (other than vitamins) and herbal remedies, such as fish oil, glucosamine, and echinacea. To pick one example, glucosamine is a supplement made from shellfish that aims to help with joint pain. While there have been some promising studies, these tend to be poor quality. In the good-quality trials, pain relief was no better with glucosamine than with inactive, placebo pills.
Given the uncertainty surrounding alternative medicine, what attracts the 4 in 10 Americans who choose to use it? It must be more complicated that the fact that people don't always have access to good
information about how well the products work. Some people might have been disappointed by mainstream medicine, perhaps because of treatments that didn't help, unpleasant side effects, or poor communication with their doctor. Using alternative treatments can be a way to make your own decisions and take control of your treatment, which may help reduce anxiety.
It seems to me that there's nothing wrong with choosing to use borderline-effective or unproven treatments, as long as everyone's clear about what's happening, and people get what they pay for. However, this brings us to another problem with alternative medicine. To keep using glucosamine as an example, researchers have warned that "in North America, glucosamine is not regulated, and the pills may or may not truly contain the amount described on the label."
Given the billions spent on complementary and alternative medicine in the U.S., it's clear there's not a shortage of buyers. It may be helpful to remember that old piece of advice: let the buyer beware.
What you need to know. If you choose complementary or alternative medicine, try to do your research and be clear about the risks and benefits you can expect. Don't assume natural products are always safe, and make sure you tell your doctor if you're taking alternative products on top of conventional medicines.
—Philip Wilson, patient editor, BMJ Group
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