The Center for Disease Control (CDC) conducts an ongoing telephone survey of medical problems and health care utilization – called the National Health Interview Survey (NHIS). They recently released their data from 2007. This is the first year for which they specifically broke out questions assessing the use of so-called complementary and alternative medicine (CAM).

CAM is a political/ideological entity, not a scientific one. It is an artificial category created for the purpose of promoting a diverse set of dubious, untested, or fraudulent health practices. It is an excellent example of the (successful) use of language as a propaganda tool.

The fundamental intellectual flaw of “CAM” as a concept is that it is made to include modalities that are extremely diverse, even mutually contradictory, under one umbrella. Very deliberately modalities which are scientific and mainstream, like the proper use of nutrition, are often included under the CAM umbrella by proponents in order to make it seem like CAM is a bigger phenomenon than it actually is, and as a wedge to open the door for the more pseudoscientific modalities.

Historically, surveys of CAM use have been used to claim about about 1/3 of Americans (or more) are using CAM. Such surveys, when carefully examined, bring into focus the absurdity of the CAM label. What counts as “CAM” in these surveys? What are the implications for homeopathy that many people pray for their sick loved-ones?

In the end the very concept of CAM is meant to distract from the only assessment that makes sense – what is the plausibility and evidence for the use of a particular modality for a specific indication? Any treatment that rises above a reasonable threshold to be considered ethical science-based medicine should be, and will be, incorporated into mainstream practice.  The purpose of the label of CAM is to get modalities which do not meet proper criteria in through the back door. This is a strategy that is, unfortunately, working.

The NHIS for 2007

The table below contains the most popular CAM modalities and the ones included in the 2007 survey. The link to the survey contains much more information, but is a bit difficult to slog through, so I pulled out the data for the following table.

Modality                       % used Ever

Acupuncture                    6.55
Ayurveda                         0.56
Biofeedback                     1.23
Chelation                          0.34
Chiropractic or
Osteo Manipulation       21.91
Energy Healing                1.72
Hypnosis                          2.34
Massage                           16.02
Nautropathy                    1.51
Homeopathy                    3.65
tai chi                                 0.9
qi gong                               0.6
yoga                                   9.53

As we can see – most hard-core CAM modalities are used by a very small percentage of the population. Most are less than five percent. Only massage and manipulation are greater than 10 percent. These numbers are also not significantly different from 10 or 20 years ago – belying the claim that CAM use is increasing.

Also, if you look through the specific indications for which these modalities are being used, most are for back pain, with arthritis and other pains next most common. Very few are being used for medical indications.

It is not surprising that 22% of the population have ever used a chiropractor or osteopath for manipulation, given the extent to which these professions are established. There is also some evidence for symptomatic benefit for manipulation in acute uncomplicated lower back strain – and that is the indication for which manipulation is most commonly used.

Massage is the next most commonly used modality in the survey, and it too was mostly used for back pain or other pain syndromes. It is also used for simple relaxation or “wellness” – a nicely vague term.

Back pain is an extremely common ailment, and is difficult to treat with any modality. It is therefore understandable that many patients will seek a variety of symptomatic treatments for their back pain. Use of massage and even manipulation is about as effective as physical therapy, medical management, or simple “back hygeine” – which is to say, not very effective. Massage and manipulation are also used by physical therapists, physiatrists, and sports medicine doctors – in other words, these modalities are mainstream to the extent that they are evidence-based and useful.

Manipulation and massage for back strain do not necessarily represent a different approach to medicine, a change in medical philosophy, or a new world order.  Their use for medical indications, such as manipulation for asthma, is not science-based and therefore should be considered separately. Again we see the contamination of so-called CAM as a category with treatments that can be scientifcally reasonable, but are themselves often mixed with unscientific treatments.

If we put aside physical treatments for back pain, we are left with the truly “alternative” treatments, in that they are not within the realm of science-based medicine. As you can see these modalities are used by a tiny minority of the population. Less than 4% of the US population have ever used homeopathy, despite all the buzz. Acupuncture is less than 7%, despite the nearly weekly press releases falsely claiming new evidence that acupuncture works.

And yet the alleged popularity of CAM, as a category, is used to promote its inclusion in medical schools, on insurance plans, and to justify diverting limited funds for its research.

Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the president and co-founder of the New England Skeptical Society, the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also contributes every Sunday to The Rogues Gallery, the official blog of the SGU.