Why many people do NOT use so-called alternative medicine

Tons of research (mostly surveys) exist on the reasons why some people – between 20 and 60% – use so-called alternative medicine (SCAM). But these people are often the minority, and few of us ask why the majority do NOT employ SCAM. The research that does exist suggests that people decline SCAM for a variety of inter‑related reasons. It also suggests that non‑use is often a rational, deliberated position grounded in both experience and reason.

Satisfaction with conventional medicine

Across different conditions and populations, the most frequently cited reason for not using SCAM is that conventional treatment is perceived as sufficient. In an oncology sample, for example, 76% of non‑users reported that they saw “no need” for SCAM because standard therapy was considered adequate. Similar findings emerged in gastroenterology and primary‑care cohorts, in which effective conventional treatment was the single most common reason for non‑use, and many non‑users stated that they would only consider SCAM if standard treatments turned out to be ineffective.

Good health

Good self‑rated health also predicts SCAM non‑use. Population surveys consistently show that SCAM use is higher among those with chronic conditions, poorer functional status, or unresolved symptoms, whereas people who feel generally healthy are less likely to seek any additional, especially out‑of‑pocket, interventions. In that sense, non‑use is often an epiphenomenon of a relatively positive health trajectory: people tend to look beyond biomedicine only when they experience persistent suffering, side‑effects, or perceived medical failure.

Lack of good evidence of effectiveness

For many non‑users of SCAM, the absence of convincing scientific evidence is central. They perceive SCAM modalities as “unproven” or “insufficiently tested” and prefer interventions that have been evaluated in rigorous randomized trials, meta‑analyses, and regulatory assessment. A recent scoping review of SCAM identified “insufficient scientific evidence” as one of the most frequently reported barriers to use across multiple settings. In an Egyptian survey, almost 80% of non‑users reported “insufficient information and evidence to prove effectiveness” as a main reason for avoiding SCAM, and nearly three‑quarters stated that they were “not convinced” by it.

Safety concerns

Safety concerns are closely tied to this evidence gap. Non‑users often highlight the lack of robust regulation of SCAM products and practitioners, worries about adulteration or contamination of herbal preparations, and the risk of interactions with prescription medicines. In cancer cohorts, substantial proportions of non‑users explicitly mention fears of fraud and of harmful interactions between SCAM and chemotherapy or other oncological treatments. These concerns are reinforced by data documenting variable product quality and under‑reporting of adverse events in the SCAM sector, which for some patients strengthens the perception that, in the absence of solid evidence and oversight, the safest option is non‑use.

Money

Even among people who are in principle open to SCAM, structural barriers can make uptake impractical. Economic factors are salient: in most healthcare systems, SCAM services are not reimbursed or are only partially covered and therefore require substantial out‑of‑pocket payments. US survey data have shown that SCAM users incur meaningful additional financial burden, and that out‑of‑pocket spending on SCAM can be associated with self‑reported financial distress. For those on lower incomes, this cost gradient effectively acts as a barrier to ever starting SCAM.

Time

Time and access constraints constitute further deterrents. Many SCAM modalities require repeated sessions, travel, and scheduling flexibility, which can be difficult for people in full‑time employment or with caregiving responsibilities. A scoping review identified limited availability of services, a shortage of qualified professionals, logistical difficulties in reaching SCAM practitioners, and lack of public provision as recurrent obstacles to use, particularly in rural or underserved regions. When an intervention demands substantial time investment and travel, while its efficacy is uncertain and it is not covered by insurance, non‑use becomes a straightforward opportunity‑cost calculation.​

Physician stance

Physician stance plays a powerful role in shaping decisions. Patients often look to their primary care physicians or specialists as gatekeepers of legitimate treatment options; when doctors do not recommend SCAM, or express doubts about it, patients tend to refrain from using it. Reviews of physician attitudes suggest that many are cautious about SCAM because of concerns about evidence, safety, and the risk that some patients might replace effective conventional treatment with unproven SCAMs. This caution, whether expressed explicitly or implicitly, contributes to the social norm that poorly evidenced therapies lie outside the mainstream of responsible care.

Lack of knowledge

Lack of knowledge about specific SCAM modalities is another consistent reason for non‑use. The National Health Interview Survey showed that “not knowing enough” about practices such as acupuncture, chiropractic, natural products, and yoga was commonly endorsed as a reason for never having tried them, even among individuals with back pain that might otherwise motivate experimentation. Meta‑analyses and scoping reviews corroborate “insufficient knowledge” and “inadequate information” as personal barriers across diverse settings.

Worldview

Finally, the decision not to use SCAM is also shaped by broader worldviews. Studies mapping attitudes underlying SCAM use and non‑use suggest that commitment to a scientific, reductionist understanding of illness, trust in biomedicine, and low levels of “holistic” or spiritual health beliefs predict lower SCAM uptake. Non‑use of SCAM thus reflects an active alignment with the epistemic norms of evidence‑based medicine and a preference for treatments that are conceptually compatible with biomedical explanations of disease.

Conclusions

Users of SCAM tend to score relatively high in intuitive thinking, while non-users of SCAM tend to score higher in analytical thinking. People who do not use SCAM are often employing a cautious, risk‑averse strategy. They prefer treatments that have demonstrable effectiveness beyond placebo and safety within regulated systems, particularly when their health is reasonably good, and they see little to gain from investing scarce time and resources in therapies they regard as weakly evidenced, commercially driven, or ideologically suspect. Non‑use, then, is  a principled stance grounded in satisfaction with conventional care, skepticism about unproven claims, and a desire to minimise both medical and financial risk. In a word: non-use of SCAM seems to be a sign of prudence, common sense and an ability to think critically.

References

Astin, J. A. (1998). Why patients use alternative medicine: Results of a national study. JAMA, 279(19), 1548–1553.​

Li, J., Verhoef, M. J., Best, A., Otley, A., & Hilsden, R. J. (2005). Why patients use or do not use complementary and alternative medicine: A qualitative study exploring beliefs about conventional medicine and CAM in patients with inflammatory bowel disease. Canadian Journal of Gastroenterology, 19(9), 567–572.​

Lindeman, M. (2011). Biases in intuitive reasoning and belief in complementary and alternative medicine. Psychology & Health, 26(3), 371–382.

Najibi, S. M., Sarikhani, Y., Hajimonfarednejad, M., Nimrouzi, M., & Hashempur, M. H. (2025). A scoping review of the barriers and facilitators in the use of traditional, complementary, and integrative medicine: Insights for health policy development. Journal of Health, Population and Nutrition, 44(1), 188

Paepke, D., et al. (2020). Prevalence and predictors for nonuse of complementary and alternative medicine in cancer patients. Journal of Cancer Research and Clinical Oncology, 146 (8), 2157–2166.​

Rosenberg, E. I., et al. (1998). A review of the incorporation of complementary and alternative medicine by mainstream physicians. Archives of Internal Medicine, 158(21), 2303–2310.​