MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Some people seem to believe that the field of alternative medicine resembles a quaint little cottage industry where money hardly matters. A new analysis shows how far from the truth this impression is.

In the 2007 US National Health Interview Survey, use of complementary health approaches, reasons for this use, and associated out of pocket (OOP) costs were captured in a nationally representative sample of 5,467 US adults. Ordinary least square regression models that controlled for co-morbid conditions were used to estimate aggregate and per person OOP costs associated with 14 painful health conditions.

The analyses suggest that individuals using complementary approaches spent a total of $14.9 billion OOP on these approaches to manage three painful conditions: arthritis, back pain and fibromyalgia. Around 7.5 billion of that total was spent on consulting practitioners such as chiropractors and acupuncturists. Total OOP expenditures seen in those using complementary approaches for their back pain ($8.7 billion) far outstripped that of any other condition, with the majority of these costs ($4.7 billion) resulting from visits to complementary providers. Annual condition-specific per-person OOP costs varied from a low of $568 for regular headaches, to a high of $895 for fibromyalgia. The total expenditure on complementary medicine was comparable to that on conventional care.

The authors concluded that adults in the United States spent $14.9 billion OOP on complementary health approaches (e.g., acupuncture, chiropractic, herbal medicines) to manage painful conditions including back pain ($8.7 billion). This back pain estimate is almost 1/3rd of total conventional healthcare expenditures for back pain ($30.4 billion) and 2/3rds higher than conventional OOP expenditures ($5.1 billion).

These are truly eye-watering sums. The obvious question is: IS THIS MONEY WELL-SPENT?

The short answer, I fear, is NO!

The alternative therapies in question are not based on compelling evidence in the management of these painful conditions. Some are clearly not better than placebo, and others are apparently supported by some research but its quality is hardly good enough to rely upon.

This level expenditure is both impressive and worrying. It highlights an enormous waste of resources, alerts us to an urgent need for truly rigorous research, and demonstrates how high the stakes really are.

5 Responses to Alternative treatments of pain = mega business, huge waste

  • “…alerts us to an urgent need for truly rigorous research, ”

    While I understand your long involvement with rigorous research, I question whether this is a solution. We live in a world with ideas promoted by “contemporary academic liberalism”, where all facts are considered to have equal merit. The biggest consumers of alt-med in the US are educated white women usually with degrees in the humanities. These people have little respect for science and have all the facts they need now. All the good science in the world does little to persuade such people that what they believe should be questioned. They already know for a fact that alt-med is natural, Organic is good and GMOs are bad. Unfortunately many of them are politically active. We need a better “sales pitch”; Science alone will not do.

  • Biopsychosocial management of pain seems to be no more effective than placebo either, yet takes much more time and effort from patients than just necking the odd sugar pill. They still tend to get away with non-blinded trials that rely on self report measures and are often classed as being ‘evidence based’. Though it’s a vile waste of money, it wouldn’t surprise me if homeopathy was preferable to a lot of ‘mainstream’ approaches to pain management.

    • “Biopsychosocial management of pain seems to be no more effective than placebo either, yet takes much more time and effort from patients than just necking the odd sugar pill. They still tend to get away with non-blinded trials that rely on self report measures and are often classed as being ‘evidence based’. Though it’s a vile waste of money, it wouldn’t surprise me if homeopathy was preferable to a lot of ‘mainstream’ approaches to pain management.”

      Can you provide references for this as i have understood that the biopsychosocial approach was the best method for chronic pain?

      • I just googled ‘biopsychosocial pain cochrane’ and this review came up top: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000963.pub3/full

        Non-blinded trials with some improvement in self-reported pain compared to (but nothing that would be surprising for placebo) and no improvement in work status (one of their primary outcomes, and the one least likely to be affected by bias). Figure 15 is pretty clear on the benefits of biopsychosocial rehabilitation.

        As with chiropractors, and others, the difficulty with blinding can be used to allow biopsychosocial approaches to claim that trials with clear methodological problems should still allow them to claim to be ‘evidence based’. I’m far from convinced.

  • Professor Ernst wrote: “The alternative therapies in question are not based on compelling evidence in the management of these painful conditions. Some are clearly not better than placebo, and others are apparently supported by some research but its quality is hardly good enough to rely upon.”

    Perhaps the answer to the problem ultimately lies with the regulators – i.e. they should be required to discipline their registrants when they waste their patients’ money or dupe them. For example, the Chiropractic Board of Australia recently looked at widening the definition of ‘harm’, to include financial and emotional harm:
    http://www.scienceinmedicine.org.au/images/pdf/newsletter11.pdf (see p.2)

    Presumably, the emotional harm would be related to unnecessary treatment and exposure to false beliefs. Another harm worth including would be decreased use of immunisation through misinformation given to parents.

    Of course, the above isn’t likely to happen otherwise it would destroy most CAM industries.

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