Complementary/Alternative Medicine Use: Responsibilities and Implications for Pharmacy Services

spent approximately $27 billion out-of-pocket (not covered by insurance) on alternative medicine treatments. This is equivalent to the out-of pocket expense for the same period on U.S. physician services. The use of herbal medicines increased fivefold between 1990 and 1997; the use of folk remedies increased at a similar rate; and the use of megavitamins and homeopathy more than doubled.1 According to the National Institutes of Health (NIH) National Cancer Institute, the use of CAM is even more prevalent among cancer patients. One study published in the July 2000 issue of the Journal of Clinical Oncology reported that 83% of 453 cancer patients had utilized at least one CAM therapy as a part of their cancer treatment.2 In this article, we discuss herbal and homeopathic remedies. Herbs and homeopathic medicines involve the use of various parts of plants to treat symptoms and promote health. These plant extracts are utilized homeopathically to stimulate the body sufficiently to trigger a healing or prophylactic response. The U.S. Food and Drug Administration (FDA) does not currently regulate herbal products, which can be marketed only as dietary supplements. Manufacturers and distributors cannot make any specific health claims without FDA approval.3 Of the 44% of all respondents in the JAMA study (Eisenberg et al1) who indicated that they took prescription medication in 1997, 18.4% indicated that they also utilized herbal products. However, in respondents who had a medical condition requiring treatment, more than 33% used herbal products as well. Therefore, more than 15 million Americans are taking both prescription drugs and herbs or high-dose vitamins. There is a potential for adverse interactions between prescription drugs and herbal products. This problem is compounded because ample data are available about which prescription medications a particular patient is taking, but poor communication between patients and physicians limits our knowledge of the true extent of alternative therapy usage. Gray et al4 demonstrated this gain in popularity by pointing out that 42% of patients reported using at least one CAM therapy, the majority of patients being younger, better educated, and employed. Almost all of these patients integrated CAM as an adjunct to conventional therapies but clearly not as a substitute for conventional preventive health care. In a Lancet article, Ernst5 reported that more than 50% of cancer patients were using CAM either with (as supportive care) or before or after conventional therapies. Cherniack et al6 studied the prevalence of CAM use in the geriatric population. They reported that 58% of these patients had used at least one CAM in the previous year. A higher proportion of use was reported in patients receiving treatment for thyroid disorders and arthritis. This study also upheld the idea that CAM prevalence exists in highly educated groups. Complementary/Alternative Medicine Use: Responsibilities and Implications for Pharmacy Services