Millions of US adults use so-called alternative medicine (SCAM). In 2012, 55 million adults spent $28.3 billion on SCAMs, comparable to 9% of total out-of-pocket health care expenditures. A recent analysis conducted by the US National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) suggests a substantial increase in the overall use of SCAM by American adults from 2002 to 2022. The paper published in the Journal of the American Medical Association, highlights a surge in the use of SCAM particularly for pain management.

Data from the 2002, 2012, and 2022 National Health Interview Surveys (NHISs) were employed to evaluate changes in the use of 7 SCAMs:

  1. yoga,
  2. meditation,
  3. massage therapy,
  4. chiropractic,
  5. acupuncture,
  6. naturopathy,
  7. guided imagery/progressive muscle relaxation.

The key findings include:

  • The percentage of individuals who reported using at least one of the SCAMs increased from 19.2% in 2002 to 36.7% in 2022.
  • The use of yoga, meditation, and massage therapy experienced the most significant growth.
  • Use of yoga increased from 5% in 2002 to 16% in 2022.
  • Meditation became the most popular SCAM in 2022, with an increase from 7.5% in 2002 to 17.3% in 2022.
  • Acupuncture saw an increase from 1% in 2002 to 2.2% in 2022.
  • The smallest rise was noted for chiropractic, from 79 to 86%

The analyses also suggested a rise in the proportion of US adults using SCAMs specifically for pain management. Among participants using any SCAM, the percentage reporting use for pain management increased from 42% in 2002 to 49% in 2022.

Limitations of the survey include:

  • decreasing NHIS response rates over time,
  • possible recall bias,
  • cross-sectional data,
  • differences in the wording of the surveys.

The NCCIH researchers like such surveys and tend to put a positive spin on them, i.e. SCAM is becoming more and more popular because it is supported by better and better evidence. Therefore, SCAM should be available to everyone who wants is.

But, of course, the spin could also turn in the opposite direction, i.e. the risk/benefit balance for most SCAMs is either negative or uncertain, and their cost-benefit remains unclear – as seen regularly on this blog. Therefore, the fact that SCAM seems to be getting more popular is of increasing concern. In particular, more consideration ought to be given to the indirect risks of SCAM (think, for instance, only of the influence SCAM practitioners have on the vaccination rates) that we often discuss here but that the NCCIH conveniently tends to ignore.

27 Responses to REASON FOR CONCERN: The use of so-called alternative medicine (SCAM) in the US is increasing

  • Dear Edzard,
    your really should make a difference between things people learn somewhere and then practice for themselves (like usually Yoga, Taiji, Meditation) and things done to them by physicians or so-called “healers” (usually collecting excessive prices). Most of the exercises that people do themselves are useful, if only because they help them go to the doctor less often. All the rest … well, we know your position. However, you should take care of your image: not being a man who just hates anything that smells like “alternative medicine” but rather an experienced scientist and physician who sees things with appropriate skepticism.

    • thanks for the advice and your concern about my image.
      how very touching!

      • I find your “touching” comment inappropriate. My remark about your image is no fatherly advice, but simply an expression of my experiences: When I mention Edzard Ernst in discussions with colleagues, more and more often I hear the answer: “Oh, that old barker … is there anyone who still takes him seriously?” I think you deserve better.

        I got the impression that sometimes you don’t differentiate enough. Your use of the word “alternative” (and ridiculing it altogether as “SCAM”) shows this. However, there is a crucial difference between the so-called “alternative medicine” (claiming that a different and even better medicine does exist) and “alternatives TO medicine” (meaning non-medical forms of dealing with slight discomfort on the one hand and incurable illnesses on the other). Would you really doubt that it is necessary to look for alternatives to medical treatment in case of discomfort as well as in cases close to death?

        • personally, I find your remarks navive and pompous.
          do you really think that I have not contemplated these issues in some depth – possibly in more depth that you?
          and you you really think that I care much what your colleagues say or think about me?
          perhaps they should do some proper research into SCAM rather than waffle about it?

          • Exactly!

            To bow to the critics is the wrong way to handle the situation.

            Sail on! Ride the waves!

          • Hanjo puts things into perspective and puts his finger on the sore spot.

            Encouraging ‘black and white’ thinking like Edzard with rigid SCAM views,
            will find approval only among a relatively small group of orthodox skeptics.
            Edzard preaches for his own parish and does not reach the people he would
            like to reach. A little more wisdom and ability to put things into perspective would
            earn him much more respect.

          • I admire your ability of clairvoyance – it even seems to tell you which people I would like to read. Bravo!

        • Perhaps you should explain to your colleagues that Edzard isn’t someone who “just hates anything” but “an experienced scientist and physician who sees things with appropriate skepticism”?

          I’d be more concerned about the image you’re giving of your colleagues and the institution where they work.

      • Am I right in assuming that you are the following Hanjo Lehmann?

        Hanjo Lehmann was born in Berlin in 1946. He studied German and philosophy in Cologne. From 1977 to 1980 he was a lecturer in German language at the University of Oviedo (Spain), then lecturer at Tongji University in Shanghai (China) until 1985. Studied traditional Chinese medicine. Completed medical studies at the Free University of Berlin.

        This would at least explain your defense of SCAM.

        • Herr Lehmann ist sicherlich gerade mit seinem fliegenden Teppich unterwegs.
          Translation: Herr Lehmann is surely just traveling on his flying carpet.

      • Hanjo made some valid points Edzard. Perhaps you should suppress your ego?

        • for example?

          • If you want to persuade people it’s not enough just to be right. There are times to be antagonistic and times to be more understanding. And sweeping generalisations can get people’s backs up unnecessarily. For example dismissing meditation as a SCAM isn’t helpful – telling people it will cure their cancer is certainly a SCAM but suggesting it might help to bring a little calm into their lives is not unreasonable.

          • thanks for the advice.
            SCAM – in capital letters – is an abbreviation for so-called alternative medicine;
            do you deny that meditation is a SCAM?

          • I thought I’d answered that. When promoted as a medicine it is certainly.

            Do you deny that mistletoe is a traditional Xmas decoration, and also when promoted as a cancer cure a SCAM?

          • thanks; so meditation is, in the context of the focus of this blog, a SCAM.

          • Do we know whether the reported increase in people using yoga and meditation was an increase in those using it in total or those using it for reasons which can fairly be described as SCAM?

            Some people just enjoy yoga, perhaps as a social activity, and have no expectation that it has any specific curative effect.

  • The NCCIH researchers like such surveys and tend to put a positive spin on them, i.e. SCAM is becoming more and more popular because it is supported by better and better evidence.

    (emphasis mine)
    This latter is blatantly untrue.
    The NCCIH was initially established as the Office for Alternative Medicine (OAM) for mostly the same reason that Edzard’s department at Exeter was founded, i.e. to study alternative modalities, and determine once and for all which ones were effective and which ones weren’t. Unfortunately, OAM and its subsequent incarnations were taken over by SCAM proponents almost right away, with its core mission changed into validating (NOT ‘studying’) SCAM modalities – a small but crucial difference that will all but guarantee that even long-obsolete and totally ineffective quackery will continue to be ‘researched’ and promoted.

    So what’s the score now, after more than 30 years and well over 4 billion dollars in taxpayers’ money? How many SCAM modalities have they managed to ‘validate’, i.e. definitively proven to be effective? The answer is: none, for all intents and purposes. Even their research into herbal medicine – one of the most effective (or should I say: least ineffective) SCAMs out there – is best described as woefully lacking. Their list of herbs and plants names just 55 species of plants, and the individual descriptions are mostly to the tune of ‘a lot of research was done, but we can’t say anything definite’.

    If you ask me, the main reason for SCAM’s rising popularity is the ongoing demolition of regular healthcare, together with hugely increased misinformation and hate-mongering about said regular healthcare and its practitioners (i.e. real doctors).

  • Dear Edzard,
    Is this not a symptom of a growing culture of anti-science, irrationality and conspiracy theories? Aided and abetted by social media.

    • yes, quite possibly.

    • Yes, it’s a culture of anti-science, irrationality and conspiracy theories that I see supported by the US for-profit insurance companies – many owned or partially owned by big pharma and big pharmacy-store chains.

      Example: CVS, the largest pharmacy chain in the US (it put many others out of business), bought AETNA, which had bought the second largest insurance company in the US, Humana before CVS decided they wanted to force some insured people to get their prescription drugs at their CVS stores.)

      They don’t pay for yoga classes but put out newsletters telling people that yoga is “as good as ” going to physical therapy: saves them money if patients don’t get PT.

      They promote naturopathy (and do pay for it) because they sell some of the products in their drug stores.

      The naturopathy may cut down on patients getting more expensive evidence-based treatment that works, too, and those who have serious health problems such as heart disease or cancer, and only see NotDoctors will save CVS a lot when they die from lack of treatment, eh?

      The pharmacies, all of them, not just CVS, promote pseudoscience heavily. They have sections called “ALTERNATE MEDICINE” in their stores, and they include company brands. The pharmacists are told to give out information about the pseudoscience BS as “patient consultation”.

      I just got a Rite Aide (a competitor of CVS) customer survey after picking up a prescription. One question included a list of services or reasons why I went to Rite Aide instead of another pharmacy. The first item they listed? “I prefer Rite Aide because of the large selection of Alternate Medicine, Natural Remedies, and Essential Oils”. Seriously.

  • Chiropractic is not growing as fast as other SCAMS? I live in US and I see a chiro in most strip malls in our region. Maybe the market for chiropractors is saturated? Maybe yogis and massage therapists are eating chiros lunches?

  • The USA have a terrible healthcare system: unreliable, extremely expensive, and NOT for everybody. So the citizens, in contrast to us over here in Europe, simply can not afford the health care which we are accustomed to. Their only way to cope with that fate: try something cheaper and/or die.

    THIS is the reason why so many SCAMmers are so successful in the USA. This and the stupidity and the religiosity of the citizens.

    If the healthcare system were affordable for all citizens, SCAM would be much less.

    • Yes, the US has the most expensive not-health not-care not-system of all wealthy nations, and over 77% of people couldn’t afford a heart attack or cancer. We have the worst patient outcomes for the highest costs. We don’t have coordinated care, we do have the longest wait times for management of chronic disorders, and no prevention. Matter of fact, if there’s a physician here (US) I’d like to know if it’s true that physician training focuses on disease treatment and not so much on prevention (saw that this morning in one of the medical journals).

      So many people can’t afford health care at all. The fear and anxiety that comes with not being able to get health care is what drives them to a rejection of science-based medicine as a whole, because it has been denied to them anyway. They end up getting SCAM treatments – but they can just buy them at the store, or order them on Amazon, or see a NotDoctor who is personable and treats them better than the MDs/DOs who have 6 minutes a patient in typical corporate clinics.

  • This is probably a sign of the general rise of obscurantist and anti-science beliefs. It’s a stupid ideology. But as alarming as this trend may appear to be, it might also have positive effects. For example, for minor ailments, if people find relief in SCAM therapies due to the placebo effect, it would free medical services to have more time and resources to deal with more serious cases. And if placebo turns out not to be sufficiently effective, SCAM believers would hopefully go back to real medicine.

    • Most people in the US can’t just “go back”: they never could afford it to begin with. The majority of working people in the US are food insecure at least during 1 week a month. They’re worried their car will fail and they’ll lose their jobs (so many have more than one now), and their homes. They were driven into SCAM fakery by the worst un-health un-care un-system on the planet, which now costs about 6 times what it should.

      Many of the patients I’ve seen in inpatient psych (the majority of whom work FT or a few jobs that add up to that) don’t have health insurance at all, and the county is paying for their mental health crisis brought on by the stress of not having insurance for a serious physiological health issue. They talk about taking colloidal silver “for hypertension” or OTC “treatments” for cancer they had diagnosed but can’t get treatment for. They don’t usually have a choice, and that’s our biggest problem in trying to stop SCAMs.

      • That’s horrific. I wasn’t aware the situation is so bad in the States. And since the USA is still the cultural hegemon, we see the SCAMming spillover toward the rest of the world, through social media, which makes the abysmal lack of medical security in the USA a global problem.

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