A REVIEW OF THE INCORPORATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE BY MAINSTREAM PHYSICIANS

Background: Studies suggest that between 30% and 50% of the adult popu lation in industrialized nations use some form of complementary and/or alternative medicine (CAM) to prevent or treat a variety of health-re lated problems. Method: A comprehensive literature search identified 2 5 surveys conducted between 1982 and 1995 that examined the practices and beliefs of conventional physicians with regard to 5 of the more pr ominent CAM therapies: acupuncture, chiropractic, homeopathy, herbal m edicine, and massage. Six studies were excluded owing to their methodo logical. limitations. Results: Across surveys, acupuncture had the hig hest rate of physician referral (43%) among the 5 CAM therapies, follo wed by chiropractic (40%) and massage (21%). Rates of CAM practice by conventional physicians varied from a low of 9% for homeopathy to a hi gh of 19% for chiropractic and massage therapy. Approximately half of the surveyed physicians believed in the efficacy of acupuncture (51%), chiropractic (53%), and massage (48%), while fewer believed in the va lue of homeopathy (26%) and herbal approaches (13%). Conclusions: This review suggests that large numbers of physicians are either referring to or practicing some of the more prominent and well-known forms of C AM and that many physicians believe that these therapies are useful or efficacious. These data vary considerably across surveys, most likely because of regional differences and sampling methods, suggesting the need for more rigorous surveys using national, representative samples. Finally, outcomes studies are needed so that physicians can make deci sions about the use of CAM based on scientific evidence of efficacy ra ther than on regional economics and cultural norms.