MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

If you ask me, the field of alternative medicine is plagued with surveys; too many are published and most are complete, meaningless rubbish which serve merely the purpose of being misinterpreted as a means of popularising bogus treatments. Yet, every now and then, a decent and informative article appears – like this survey from Canada.

It yields a number of fascinating findings:

  • More than three-quarters of Canadians (79%) had used at least one from of CAM sometime in their lives in 2016 (74% in 2006 and 73% in 1997). British Columbians were most likely to have used an alternative therapy during their lifetime (89%), followed by Albertans (84%) and Ontarians (81%).
  • More than half (56%) of Canadians had used at least one CAM therapy in the year prior to the 2016 survey, compared to 54% in 2006 and 50% in 1997.
  • In 2016, massage was the most common type of therapy that Canadians used over their lifetime with 44 percent having tried it, followed by chiropractic care (42%), yoga (27%), relaxation techniques (25%), and acupuncture (22%).
  • The most rapidly expanding therapies over the past two decades were massage, yoga, acupuncture, chiropractic care, osteopathy, and naturopathy.
  • High dose/mega vitamins, herbal therapies, and folk remedies were in declining use over that same time period.
  • The most likely users of CAM over the past 12 months in 2016 were from the 35- to 44-year-old age group (61%). The use of CAM diminished with age, and generally rose with both income and education. These trends are similar to those observed in 2006 and 1997.
  • The majority of people choosing to use CAM in the 12 months preceding the 2016 survey did so for “wellness”.
  • Canadians spent an estimated $8.8 billion on CAM in the last 12 months ($8.0 billion in 2005/06 and $6.3 billion in 1996/97.
  • Of the $8.8 billion spent in 2016, more than $6.5 billion was spent on providers of CAM, while another $2.3 billion was spent on herbs, vitamins, special diet programs, books, classes, and equipment.
  • The majority of Canadians believe that CAM should be paid for privately and not by provincial health.

The strengths of this survey are that it is methodologically rigorous, and that it provides longitudinal data (this is in sharp contrast to the plethora of CAM surveys published recently). Many of its findings confirm what has already been known. Yet some results are new and noteworthy.

To many readers of this blog, the high CAM-usage will be disturbing. However, I am mildly encouraged by the results of this survey.

  • Firstly, the choice of CAM by Canadians seems rather more reasonable than that by other nations. Canadians seem to avoid the more ridiculous types of CAM, such as homeopathy or para-normal healing.
  • Secondly, many Canadians seem to view CAM not as medicine, but as a sort of luxurious pampering that they use to relax and feel well. Consequently, most are not pushing to get it reimbursed which I find more sensible than consumers’ attitudes in many other countries.

7 Responses to Canada’s love affair with alternative medicine/CAM

  • Most interesting.
    I share the view that pampering is fine, as long as the pampee (?) recognises it for what it is – a variety of TLC and mediated through placebo responses. Certainly not ‘medicine’ (for the treatment of specific conditions) – and certainly not to be paid for by tax payers. Nor insurance, unless the premiums specifically cover pampering, and clients can choose other (cheaper) policies which do not.
    What next – hair cuts/styling on the state or covered by insurance?

    Rather than ‘CAM’ I prefer ‘camistry’ – administered by camists to camees.
    For me, such terminology gently moves the mind set away from claims of specific therapeutic benefit which so bedevils the domain, and which leads to the perverse ‘integrated or integrative medicine’ faith/movement which is so harmful to attempts to progress evidence based therapies.
    (And which is intended to do harm, as proponents of ‘IM’ seek to drag us back to their comfort zone and delusions.)

    • exactly!
      and therapeutic claims would be easily recognisable as loony – like a hairdresser saying ‘my perm will cure your breast cancer’.

  • Dr. Ernst, I am hoping that you would opine on this recent study published in a Canadian medical journal,

    https://www.ncbi.nlm.nih.gov/pubmed/28878418

    as it shows a willingness of a well respected journal to publish outlandish conclusions and “take home message” sound bites.

    Reading and discussing the study , it revealed itself to be flawed in so many ways that it seems the only rational reaction to the paper would be that no conclusions could be drawn from it. Both in its statistical analysis and the way the authors stretched the definition of what acupuncture is ( are dry needle and electroacupuncture the same treatment, I think not) .

    In ref. to the semantics of language, I asked a fellow veterinarian who markets , sells , essential oils for pet maladies, if the “remedy” had a guaranteed analysis. The response was “what’s that” and “we don’t have to”…. I then asked whether just because they can sell the oracles proprietary secret blends, does that make it good medicine and how does doing such help our patients and teach our clients. Transparency in medicine is paramount to consumer trust and support which will garner public respect and patronage. Consumer advocacy is one way forward to rebuild the respect for the guild.

    My question to you professor Ernst, is how do articles and studies that can so easily be deconstructed into merely confusion and noise by someone the likes of me self (lowly gp) get by the critical eye of an editorial board and be allowed to embarrass the good name of the very journal the scientists are looking to uphold.

    Thanks for any consideration

    • i can only see the abstract; from that it seems that your judgements are correct.
      how does such rubbish get past the peer-review of a respected journal?
      i am not sure i know the answer. there are several possibilities, as i see it:
      sloppiness
      laziness of reviewers
      eagerness of editors to be in the media
      bad luck

      • It looks like the full text will be available (for free) only after after 1 Mar 2018.

        • It will be fascinating to read the full article and learn how the animals were randomised, how the owners (who assessed the degree of pain) were blinded as to whether the dogs had acupuncture, sham acupuncture (placebo) or only regular care.

          If the article does not make these features clear, the journal’s editors should consider their position – or is the journal a front for pseudo-science and quackery?

      • One common dodge for editors confronted with a paper in a subfield about which they know nothing is to scan the paper’s references to find referees. This works reasonably well until the editor is confronted with a wackaloon paper like this one: it may have been reviewed only by fans of acupuncture. So I’d add ‘laziness of editors’ to your list.

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