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Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology

  • Mandi L Furlow1,
  • Divya A Patel2,
  • Ananda Sen3 and
  • J Rebecca Liu2Email author
BMC Complementary and Alternative MedicineThe official journal of the International Society for Complementary Medicine Research (ISCMR)20088:35

DOI: 10.1186/1472-6882-8-35

Received: 11 January 2008

Accepted: 26 June 2008

Published: 26 June 2008

Abstract

Background

In the U.S., complementary and alternative medicine (CAM) use is most prevalent among reproductive age, educated women. We sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians.

Methods

Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized.

Results

Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM.

Conclusion

Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care.

Background

Complementary and Alternative Medicine (CAM) is defined by the U.S. National Center for Complementary and Alternative Medicine (NCCAM) as a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine [1]. A landmark study by Eisenberg et al. published in 1993 was the first national survey of the use of CAM by the adult American public. This study estimated that one in three adults (34%) had used at least one complementary therapy during the past year and that this population made an estimated 425 million visits to practitioners of complementary therapy [2]. A follow-up national survey documented a 25% increase in prevalence of CAM use between 1990–1997 [3]. Between 1997 and 2002, these trends remained stable, and CAM use was reported by 72 million U.S. adults.

Although the use of CAM to supplement conventional medical treatment is common among patients, attitudes and use of CAM among physicians is more controversial. A study by Jump et. al. demonstrated that the majority of physicians located in a southeastern city in the United States still viewed the majority of CAM therapies as not part of legitimate medical practice [4]. In addition, Milden et. al. found that while a random sample of California physicians demonstrated an overall positive attitude toward CAM, 61% still found themselves discouraging CAM therapies because they are not knowledgeable enough about the safety or efficacy of CAM treatments. The majority (80%) of physicians preferred to rely exclusively on conventional biomedical treatments [5]. Similarly, at the Mayo Clinic in Rochester, MN, a survey of internal medicine physicians revealed that although most physicians agreed that some CAM therapies hold promise for the treatment of symptoms or diseases, most physicians were not comfortable in counseling patients about CAM treatments [6]. In contrast, meta-analysis of the survey literature as well as several individual national surveys indicate that there is significant interest in CAM among physicians from varying subspecialties [710].

The high prevalence of CAM use among adults in the United States suggests that there is a positive attitude towards CAM use among this population [11]. Disparate attitudes and use of CAM among physicians and patients could result in limited disclosure of the patient's use of alternative therapies to their physician. In a study by Eisenberg et. al., 72% of the patients used alternative medicine without informing their physicians [3]. This could lead to significant risks to the patient including delay or avoidance in obtaining the appropriate conventional treatment, incorrect diagnosis, interference with the mechanism of action of a prescribed medication, or harmful reactions from ingested substances [12]. On the other hand, while the study by Jump et. al. found that the most physicians feel that CAM modalities are not part of legitimate medical practice, nearly two-thirds of these same physicians had prescribed or referred patients for at least one complementary therapy [4]. Furthermore, CAM is becoming more mainstream within the healthcare system as demonstrated by the integration into medical school curriculum, reimbursement by some third-party payers for selected alternative therapies, and the development of the U.S. National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health [3, 1215]. In fact, NCCAM established a CAM education project in 2000, with the goal of incorporating CAM information into medical, dental, nursing, and allied health professions schools' curricula, into residency training programs, and into continuing education courses [16, 17]. In 2004, curriculum guidelines in integrative medicine for medical schools were published by the Education Working Group of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) [18]. To date, thirty-nine medical schools in North America currently belong to CAHCIM, all of whom offer medical education, research, and/or clinical services in integrative medicine [19]. The ability of physicians to inquire and educate about CAM modalities is becoming increasingly important.

With one of the largest subgroups of CAM users being reproductive age, educated, employed women [20], the obstetrician gynecologist plays an integral role in incorporating CAM use with conventional medicine. In 1999, The American College of Obstetricians and Gynecologists (ACOG) published a Committee Opinion on the role of CAM in clinical practice encouraging its members to counsel their patients about their motivation for and use of CAM and to provide information on its safety and effectiveness [21]. The goal of the current study was to examine the attitudes toward and use of CAM specifically among obstetrics and gynecology patients and physicians.

Methods

The surveys used in this study were reviewed by the Institutional Review Board of the University of Michigan Medical School (IRBMED). The study was exempted from IRBMED review as completion of the surveys were considered consent to participate. Furthermore, no direct identifiers were included on the surveys.

Physician survey

All practicing obstetrician/gynecologists in the state of Michigan who were members of the American Medical Association in 2004–2005 were included in the sample (n = 1009). A packet containing a cover letter and the survey was mailed to all physicians in the sample. The survey instrument ascertained information regarding the physician's view of the effectiveness of 17 different CAM modalities, use of each CAM modality within their medical practice, and general attitudes and beliefs toward CAM. Demographic information, including age, gender, type of medical degree, year of medical school graduation, specialty, and ethnicity, was ascertained. No direct identifiers were included on the surveys, and return of the survey was considered consent to participate.

As the initial response rate was below 23% (n = 231) and those who returned surveys could not be identified, the survey was mailed to the entire sample a second time. Physicians were requested to return surveys only if they had not responded to the first request. The response rate after the second mailing was 41.0% (n = 401). Twenty (5.0%) surveys were excluded from the statistical analyses due to substantially incomplete data.

Patient survey

A convenience sample of all women who presented to the University of Michigan Taubman Health Care Center during May 2005 for an obstetric/gynecologic visit comprised the patient sample in this study. Patients were given a questionnaire with their check-in paperwork, and completion of the survey was considered consent to participate. During the survey collection period, 1519 patients were seen, and 483 women completed questionnaires, resulting in a response rate of 32%. Three surveys (0.6%) were excluded from the statistical analyses due to substantially incomplete data. The survey ascertained information regarding patients use of one or more CAM modalities specifically for the treatment of obstetric or gynecologic problems, including menstrual or menopausal symptoms, pelvic pain, libido, infertility, contraception, pregnancy symptoms, or labor induction or augmentation. Further information regarding how the patient learned about CAM, average monthly expenditures on CAM, general attitudes toward CAM, and income level was collected. No personal identifying information was included on the surveys.

Statistical Analysis

Attitudes and practices of physicians and patients regarding CAM were characterized. On the physician survey, three sets of questions (i.e., view of effectiveness of CAM modalities, use of CAM approaches in practice, and general attitudes towards CAM) were categorized for purposes of statistical analysis. With respect to effectiveness, responses were categorized as highly/moderately, seldom/not at all/neutral, or harmful. Regarding use of CAM approaches in practice, responses were categorized as endorse/provide/refer or would not recommend. For general attitudes, responses were categorized as agree, disagree, or neutral/skipped. Multivariable logistic regression analyses were conducted to examine associations of physician age, gender, and race with (1) the belief that CAM approaches hold promise for the treatment of symptoms, conditions, and/or diseases; and (2) the belief that CAM approaches have no true impact on treatment of symptoms, conditions, and/or diseases.

Patients were asked if they had ever used specific CAM modalities for a variety of obstetric and/or gynecologic problems (i.e., menstrual or menopausal symptoms, pelvic pain, libido, infertility, contraception, pregnancy symptoms, and labor induction or augmentation). The respondent was considered to have used a specific CAM modality if she indicated ever using it for any of the obstetric and/or gynecologic problems queried; the respondent was considered to have never used a specific CAM modality if she indicated "have not used." Five items under general attitudes were positively framed with the remaining two framed negatively. The latter were reverse coded before calculating the attitude block-score so that an overall lower score would be indicative of a positive attitude. Additionally, a dichotomous measure was created from the responses of each of the seven items under general attitudes scale that is coded as 1 for responses "strongly agree" or "agree" and as 0 otherwise. These dichotomous variables thus can be envisioned as indicator of agreement to the item statement. General attitudes of physicians and patients towards CAM were compared by means of two sample chi-square tests of proportion applied to each item. All statistical analyses were conducted using SPSS version 15 (SPSS Inc., 2006, Chicago, IL) for Windows and SAS version 9.1 statistical software (SAS Institute, Inc., Cary, NC).

Results

Characteristics of the Study Population

Physicians

We received 401 surveys from physicians, for a final response rate of 41%. Of these 401 surveys, 396 (98.8%) had complete information and were included in the analyses. Over half (57%) of physician respondents were male; 41% were female and 2% did not report gender. Most physicians self-identified as Caucasian (81.4%), and the rest as African American (4.2%), Asian (7.1%), Hispanic (1.3%), multi-racial (0.8%), or other (1.3%). Median age of physicians was 48 years (range: 30–83) and the median year of graduation from medical school was 1984 (range: 1945–2002). Most physicians had attained an M.D. degree (95.8%), and the remaining respondents either had a D.O. degree (1.8%) or did not report their degree (2.4%).

Patients

We received 483 surveys from patients who were seen at the University of Michigan outpatient obstetrics and gynecology clinic during the study period, with a final response rate of 32%. 480 patient surveys with complete information were included in the analyses.

General Attitudes towards CAM

Surprisingly, physicians appeared to have a more positive attitude towards CAM as compared to general obstetric/gynecology patients (Table 1). Most physicians indicated that clinical care should integrate the best conventional and CAM practices (73.8%), whereas only 40.8% of patients agreed with this statement (p < .05, 95% confidence interval [0.27, 0.39]). Similarly, more than half of the physicians respondents indicated that CAM includes areas and methods from which conventional medicine could benefit (73.2%), that CAM approaches hold promise for treatment of symptoms, conditions and diseases (59.3%), that health professionals should be able to advise their patients about commonly used CAM methods (68%), and that knowledge about CAM is important to them as patients (54.9%). Less than 50% of patients agreed with each of these statements (p < .05 for all statements). Although both physicians and patients disagreed with the statements: while a few CAM approaches may have limited health benefits, they have no true impact on treatment of symptoms, conditions and/or diseases, or CAM is a threat to public health, a higher proportion of physicians disagreed with these statements (p < .05, confidence intervals [0.13, 0.26] and [0.17, 0.30] respectively).
Table 1

Physician and patient attitudes towards complementary and alternative medicine (CAM)

Statement

Agree (%)

Disagree (%)

Neutral/Skipped (%)

Clinical care should integrate the best conventional and CAM practices.*

   

   Physician

281 (73.8)

29 (7.6)

71 (18.6)

   Patient

196 (40.8)

4 (0.8)

280 (58.3)

CAM includes areas and methods from which conventional medicine could benefit.*

   

   Physician

279 (73.2)

23 (6.0)

79 (20.7)

   Patient

192 (40.0)

10 (2.1)

278 (57.9)

CAM approaches hold promise for treatment of symptoms, conditions and/or diseases.*

   

   Physician

226 (59.3)

39 (10.2)

116 (30.5)

   Patient

169 (35.2)

12 (2.5)

299 (62.3)

While a few CAM approaches may have limited health benefits, they have no true impact on treatment of symptoms, conditions and/or diseases.*

   

   Physician

93 (24.4)

178 (46.7)

110 (28.9)

   Patient

51 (10.6)

129 (26.9)

300 (62.5)

Health professionals should be able to advise their patients about commonly used CAM methods.*

   

   Physician

259 (68.0)

26 (6.8)

96 (25.2)

   Patient

209 (43.5)

19 (4.0)

252 (52.5)

CAM is a threat to public health.*

   

   Physician

34 (8.9)

252 (66.1)

95 (24.9)

   Patient

23 (4.8)

205 (42.7)

252 (52.5)

Knowledge about CAM is important to me as a patient.*

   

   Physician

209 (54.9)

56 (14.7)

116 (30.5)

   Patient

171 (35.6)

20 (4.2)

289 (60.2)

* P-value is for comparison of strongly agree/agree vs. disagree/neutral/skipped; all p values < .001.

Among physicians, female physicians were 5.9 times more likely (95% CI: 1.7–21.3) to believe that CAM approaches hold promise for the treatment of symptoms, conditions and/or diseases, after adjusting for age and race. Increasing physician age, after adjusting for race and gender, was significantly associated with the belief that CAM approaches have no true impact on treatment of symptoms, conditions, and/or diseases (OR = 1.03; 95% CI: 1.01–1.06).

Physician Attitudes Regarding Effectiveness of Specific CAM Modalities

Overall, most physicians had a positive attitude regarding the effectiveness of specific CAM modalities. As shown in Table 2, CAM modalities most frequently cited by physicians as being highly or moderately effective included biofeedback (73.8%), chiropractic (65.6%), acupuncture (62.4%), and meditation (61.9%). Few physicians viewed any of the CAM modalities queried as harmful to patients.
Table 2

Physician opinion of effectiveness of CAM modalities.

CAM Modality

Highly/Moderately Effective (%)

Biofeedback

73.8

Chiropractic

65.6

Acupuncture

62.4

Meditation

61.9

Hypnosis/Guided imagery

46.2

Herbal medicine

41.2

Music therapy

36.8

Therapeutic touch

36.8

Traditional Chinese medicine

27.8

Homeopathy

24.9

Special diets

23.4

Bioelectromagnetic therapies

20.2

Aromatherapy

13.6

Physician Approaches to CAM in Practice

Most (97.6%) physicians surveyed routinely endorsed, provided or referred patients for treatment utilizing at least one CAM modality. Many did so for a wide variety of CAM modalities. As shown in Table 3, the most commonly reported CAM modalities endorsed, provided or referred by physicians included movement therapies (86.4%), biofeedback (80.3%), acupuncture (79.8%), meditation (78.0%), chiropractic (70.9%), and hypnosis/guided imagery (70.1%). On the other hand, over half of physicians would not recommend the use of homeopathy, bioelectromagnetic therapies, or aromatherapy. In addition, a sizeable proportion of physicians would not recommend special diets (47.8%) or traditional Chinese medicine (47.2%). While the greatest proportion of physicians viewed herbal medicine and homeopathy as harmful, over 40% of physicians reported that they endorse, provide or refer their patients for those modalities.
Table 3

Physician approach to CAM in practice

CAM Modality

Endorse/Provide/Refer (%)

Would Not Recommend (%)

Missing (%)

Movement therapies

86.4

10.5

3.1

Biofeedback

80.3

12.1

7.6

Acupuncture

79.8

18.1

2.1

Meditation

78.0

17.6

4.4

Chiropractic

70.9

25.5

3.6

Hypnosis/Guided imagery

70.1

25.2

4.7

Herbal medicine

61.4

33.4

5.2

Music therapy

59.3

34.7

6.0

Therapeutic touch

56.7

37.5

5.8

Special diets

45.9

47.8

6.3

Traditional Chinese medicine

43.3

47.2

9.5

Homeopathy

41.7

52.0

6.3

Bioelectromagnetic therapies

40.4

52.5

7.1

Aromatherapy

32.3

61.7

6.0

Patient Use of CAM

Overall, 262 (54.5%) patients reported ever using at least one type of CAM modality for obstetric and/or gynecologic problems. As shown in Table 4, the most commonly cited CAM modalities included yoga (14.0%), evening primrose (13.1%), imagery/visualization (10.4%), meditation (7.7%) and music therapy (5.6%). Similarly, physicians rated meditation and guided imagery as highly or moderately effective forms of CAM. However, other CAM modalities rated as highly or moderately effective by physicians (biofeedback, chiropractic and acupuncture) were not commonly used by patients. It also notable that CAM modalities least recommended by physicians (such as aromatherapy, bioelectromagnetic therapies, and homeopathy) were rarely used by patients.
Table 4

Patients' ever use of CAM modalities for obstetric and/or gynecologic problems

Modality

Ever Used for Obstetric and/or Gynecologic Problems (%)

Yoga

14.0

Evening primrose

13.1

Imagery/visualization

10.4

Meditation

7.7

Music therapy

5.6

Soy

4.8

Chiropractic

4.8

Journaling

3.7

Acupuncture

3.3

Ginger

3.1

Black cohosh

2.9

Chinese herbs

2.9

Aromatherapy

2.7

Homeopathy

2.3

Vegetarian diet

2.5

Tai chi/Chi gong

1.9

Juicing diet

1.9

Ayurvedic remedies

1.7

Energy healing

1.7

Echinacea

1.5

Osteopathic

1.5

Vegan diet

1.3

Magnet therapy

1.0

Hypnosis

0.8

Biofeedback

0.8

Immune therapy

0.8

False unicorn root

0.6

Macrobiotic diet

0.2

Healing touch

0

Reflexology

0

The most commonly used dietary supplements were evening primrose and soy. The majority of patients reported using CAM interventions for pregnancy symptoms, menstrual, or menopausal symptoms. Other frequently reported reasons for CAM use included infertility, pelvic pain, and libido.

Sources of CAM Information

Two hundred eighty seven patients responded to the question, "If you currently use or have used alternative therapies, how did you find out about them?" The most commonly cited source of CAM information was through family and friends (n = 104, 36.2%). Other less commonly cited sources of CAM information included the Internet (n = 48, 16.7%), a health care professional (n = 45, 15.7%), and books (n = 45, 15.7%). Most patients (63%) did not consult with a health care provider prior to starting the alternative therapy. The most commonly cited reason (43%) was that their health care provider never asked about their use of other therapies. Among the patients who did consult their healthcare provider prior to starting CAM therapy (29.2%), most patients noted that physicians' response was positive and that they encouraged continued use of CAM (58%).

Discussion

In the U.S., CAM use is prevalent, particularly among women, where 39% have reported using CAM [11]. Our data is consistent with CAM use reported previously for women in the state of Michigan in 2001 (53.8%) [22]. The obstetrician gynecologist may play an integral role in incorporating CAM use with conventional medicine among this patient population. We therefore sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians. Despite the fact that both physicians' and patients' attitudes toward CAM were generally positive in this study, physicians' and patients' responses were not identical. Surprisingly, we found that physicians appeared to have a more positive attitude towards CAM as compared to general obstetric/gynecology patients.

Differences between physician and patient attitudes towards CAM may be influenced by several factors. It is notable that among the patients surveyed, a significant portion of respondents had neutral responses to the general attitude questions (Table 1), or skipped the question altogether, possibly indicative of an ambivalent stance. If the neutral/skipped responses had not been included in the chi squared analysis, differences between physician and patient responses may not have been as pronounced. Physician and patient beliefs regarding different types of CAM may be influenced by personal experience. Furthermore, physicians and patients perception of the definition of CAM may vary. For example, the concept of "faith healing" may be difficult to distinguish from "spiritualism" or from "prayer" in general [2325]. It has been reported that one of the largest subgroups of CAM users is educated, employed women [3, 11]. Although we did not have demographic data available from the patients surveyed, differences in age, education level, and other demographic factors may contribute towards the differences seen between physician and patient attitudes towards CAM.

Although the overwhelming majority of physicians surveyed indicated that they referred patients for at least one CAM modality, we found that over 63% of obstetric/gynecologic patients surveyed that used CAM, initiated CAM therapy without consulting a physician. It is not surprising then that physicians' view of the most effective CAM therapies were incongruent with the therapies most used by patients. Physicians most commonly cited biofeedback, chiropractic, acupuncture, meditation and hypnosis/guided imagery as being highly/moderately effective. In contrast, the most commonly cited CAM modalities used by patients were yoga, evening primrose and music therapy. In addition, in contrast to the physician survey, the patient survey fragmented the herbal remedies surveyed into different plants. If all herbal remedies surveyed are combined, herbal remedies are the most common modality used by patients in this study. In general, although more than 50% of physicians endorsed the use of movement therapies, biofeedback, acupuncture, meditation, chiropractic, and hypnosis/guided imagery, these modalities were rarely used among patients (Tables 3 and 4).

The majority of patients who initiated CAM without consulting their healthcare provider prior to initiating a CAM therapy indicated that they did so because their physicians never asked them about their use of CAM. In contrast, 83% of physicians surveyed indicated that they routinely query their patients about CAM use. This discrepancy could be due to the fact that physicians only ask a portion of their patients about CAM use and not all patients. Due to a trend toward managed care and shorter office visits, physicians have limited time to spend with patients. Time constraints may render discussion and integration of CAM therapies into mainstream practice difficult. For example, there is some evidence that incorporating discussion of CAM may double consultation time [26]. However, without discussion of CAM therapies, a patient's medical record is incomplete and the possibility of medical risk cannot be addressed.

While some CAM therapies impose risks to patients, there are several CAM therapies which have shown benefit. For example, it has been demonstrated that the use of moxibustion can increase the rate of spontaneous version from breech to vertex in pregnant women at term [27, 28]. CAM interventions such as Tai Chi, acupuncture, acupressure, yoga, and meditation have improved sleep parameters in a limited number of early clinical trials [29]. On the other hand, herbal remedies, considered to be both safe and effective by most consumers, may interact with conventional drugs, such as Coumadin [30]. An increasing number of CAM therapies have shown evidence based benefits, which is likely why the majority of patients indicated that physicians encouraged continued use of CAM.

It is important for obstetrician gynecologists to remember that many CAM therapies are still not subject to standardized manufacturing or regulation by the U.S. Food and Drug Administration. Thus, there can be extreme variation in each therapy and safety is still a prominent issue. Physicians must be responsible for discussing the safety of CAM modalities and how they may be incorporated with conventional medicine. In our study, 98.4% percent of physicians have endorsed/provided/or referred a patient for at least one CAM therapy. Healthcare networks do exist which aim to integrate both medical doctors and alternative medicine practitioners. Some of these networks provide access to credentialing information on CAM practitioners and offer a centralized medical record system which creates an avenue for both medical doctors and CAM practitioners to communicate, enhancing the care of the patient [31].

Our study has several limitations. First, the response rate for physicians was 41% and 32% for physicians and patients respectively, which may reflect self selection and lead to response bias. Questionnaires for this study were modified from previously published studies [32, 33]. We did not obtain demographic data for patients which may have added important information regarding CAM use in this population. In addition, the physician questionnaires did not delineate effectiveness of CAM modalities "for what," nor whether a modality was being judged as complementary or alternative. Questionnaires were designed to be very basic and abbreviated in order to encourage response. In addition, all data was self-reported and therefore subject to recall bias. Our survey was further limited by sample size which required us to combine CAM modalities when determining factors that correlated with view of effectiveness and use of CAM in patients and physician practice. Small sample size leads to limited power to detect small differences. Finally, the prevalence of CAM use among patients and physicians is oftentimes reported as any use of CAM during the last year; in our study, we queried "ever use" of various CAM modalities. Comparisons between our study and previously published work must take this into consideration.

It is also important to note that our patient population was limited to one University-based outpatient clinic and the physician population was limited to the state of Michigan which may not be representative of other states. The results of this survey should be generalized in a cautious manner secondary to the limitations noted above. Additional studies are necessary to incorporate larger patient samples which would be more representative of the population in the United States for both patients and obstetrician gynecologists. In future studies, it would be important to examine objective measures of physicians' use of CAM modalities in contrast to self-report. Longitudinal studies are necessary to follow physicians' use of and attitude toward CAM as it becomes further integrated into medical education and more evidence based information is obtained.

Despite these limitations, it is clear that physicians must educate themselves in the field of complementary and alternative medicine in order to give accurate advice to patients to optimize their care. In 1998, incorporation of CAM training occurred in 64% of academic medical institutions [34]. Options for integrating CAM instruction at the postgraduate levels are more limited; at present there are only a few academic institutions in the U.S. with formal CAM education programs in place. The need for dialogue between physician and patients regarding CAM use is clear, as patients are increasingly seeking physicians who are well-informed in the realms of both conventional medicine and CAM.

Declarations

Acknowledgements

We are grateful to Ms. Dawn Harper for her assistance with data collection. This work was supported by the Ansbacher Resident and Fellow Education and Research Fund

Authors’ Affiliations

(1)
Department of Obstetrics and Gynecology, Harvard University
(2)
Department of Obstetrics and Gynecology, University of Michigan
(3)
Center for Statistical Consultation and Research, University of Michigan

References

  1. National Center for Complementary and Alternative Medicine. [http://nccam.nih.gov/health/whatiscam/]
  2. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL: Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993, 328 (4): 246-252. 10.1056/NEJM199301283280406.View ArticlePubMedGoogle Scholar
  3. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC: Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. Jama. 1998, 280 (18): 1569-1575. 10.1001/jama.280.18.1569.View ArticlePubMedGoogle Scholar
  4. Jump J, Yarbrough L, Kilpatrick S, Cable T: Physicians' Attitudes Toward Complementary and Alternative Medicine. Integrative Medicine. 1998, 1 (4): 149-153. 10.1016/S1096-2190(98)00038-9.View ArticleGoogle Scholar
  5. Milden SP, Stokols D: Physicians' attitudes and practices regarding complementary and alternative medicine. Behav Med. 2004, 30 (2): 73-82. 10.3200/BMED.30.2.73-84.View ArticlePubMedGoogle Scholar
  6. Wahner-Roedler DL, Vincent A, Elkin PL, Loehrer LL, Cha SS, Bauer BA: Physicians' attitudes toward complementary and alternative medicine and their knowledge of specific therapies: a survey at an academic medical center. Evid Based Complement Alternat Med. 2006, 3 (4): 495-501. 10.1093/ecam/nel036.View ArticlePubMedPubMed CentralGoogle Scholar
  7. Astin JA, Marie A, Pelletier KR, Hansen E, Haskell WL: A review of the incorporation of complementary and alternative medicine by mainstream physicians. Arch Intern Med. 1998, 158 (21): 2303-2310. 10.1001/archinte.158.21.2303.View ArticlePubMedGoogle Scholar
  8. Ernst E, Cassileth BR: The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer. 1998, 83 (4): 777-782. 10.1002/(SICI)1097-0142(19980815)83:4<777::AID-CNCR22>3.0.CO;2-O.View ArticlePubMedGoogle Scholar
  9. Berman BM, Bausell RB, Lee WL: Use and referral patterns for 22 complementary and alternative medical therapies by members of the American College of Rheumatology: results of a national survey. Arch Intern Med. 2002, 162 (7): 766-770. 10.1001/archinte.162.7.766.View ArticlePubMedGoogle Scholar
  10. Kemper KJ, O'Connor KG: Pediatricians' recommendations for complementary and alternative medical (CAM) therapies. Ambul Pediatr. 2004, 4 (6): 482-487. 10.1367/A04-050R.1.View ArticlePubMedGoogle Scholar
  11. Tindle HA, Davis RB, Phillips RS, Eisenberg DM: Trends in use of complementary and alternative medicine by US adults: 1997–2002. Altern Ther Health Med. 2005, 11 (1): 42-49.PubMedGoogle Scholar
  12. Complementary and Alternative Medicine. ACOG Committee Opinion. 1999, 227:
  13. Carlston M, Stuart MR, Jonas W: Alternative medicine instruction in medical schools and family practice residency programs. Fam Med. 1997, 29 (8): 559-562.PubMedGoogle Scholar
  14. Daly D: Alternative medicine courses taught at U.S. medical schools: an ongoing listing. J Altern Complement Med. 1995, 1 (2): 205-207. 10.1089/acm.1995.1.205.View ArticlePubMedGoogle Scholar
  15. Wetzel MS, Kaptchuk TJ, Haramati A, Eisenberg DM: Complementary and alternative medical therapies: implications for medical education. Ann Intern Med. 2003, 138 (3): 191-196.View ArticlePubMedGoogle Scholar
  16. Pearson NJ, Chesney MA: The National Center for Complementary and Alternative Medicine. Acad Med. 2007, 82 (10): 967-View ArticlePubMedGoogle Scholar
  17. Pearson NJ, Chesney MA: The CAM Education Program of the National Center for Complementary and Alternative Medicine: an overview. Acad Med. 2007, 82 (10): 921-926.View ArticlePubMedGoogle Scholar
  18. Kligler B, Maizes V, Schachter S, Park CM, Gaudet T, Benn R, Lee R, Remen RN: Core competencies in integrative medicine for medical school curricula: a proposal. Acad Med. 2004, 79 (6): 521-531. 10.1097/00001888-200406000-00006.View ArticlePubMedGoogle Scholar
  19. Consortium of Academic Health Centers for Integrative Medicine. [http://www.ahc.umn.edu/cahcim/home.html]
  20. Barnes PM, Powell-Griner E, McFann K, Nahin RL: Complementary and alternative medicine use among adults: United States, 2002. Adv Data. 2004, 1-19. 343
  21. Complementary and Alternative Medicine: ACOG Committee Opinion. 1999, 227:
  22. Rafferty AP, McGee HB, Miller CE, Reyes M: Prevalence of complementary and alternative medicine use: state-specific estimates from the 2001 Behavioral Risk Factor Surveillance System. Am J Public Health. 2002, 92 (10): 1598-1600.View ArticlePubMedPubMed CentralGoogle Scholar
  23. Newell S, Sanson-Fisher RW: Australian oncologists' self-reported knowledge and attitudes about non-traditional therapies used by cancer patients. Med J Aust. 2000, 172 (3): 110-113.PubMedGoogle Scholar
  24. Upchurch DM, Chyu L: Use of complementary and alternative medicine among American women. Womens Health Issues. 2005, 15 (1): 5-13. 10.1016/j.whi.2004.08.010.View ArticlePubMedGoogle Scholar
  25. Upchurch DM, Chyu L, Greendale GA, Utts J, Bair YA, Zhang G, Gold EB: Complementary and alternative medicine use among American women: findings from The National Health Interview Survey, 2002. J Womens Health (Larchmt). 2007, 16 (1): 102-113.View ArticleGoogle Scholar
  26. Adams J: Direct integrative practice, time constraints and reactive strategy: an examination of GP therapists' perceptions of their complementary medicine. J Manag Med. 2001, 15 (4–5): 312-322. 10.1108/EUM0000000005921.View ArticlePubMedGoogle Scholar
  27. Cardini F, Weixin H: Moxibustion for correction of breech presentation: a randomized controlled trial. Jama. 1998, 280 (18): 1580-1584. 10.1001/jama.280.18.1580.View ArticlePubMedGoogle Scholar
  28. Neri I, Airola G, Contu G, Allais G, Facchinetti F, Benedetto C: Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study. J Matern Fetal Neonatal Med. 2004, 15 (4): 247-252. 10.1080/14767050410001668644.View ArticlePubMedGoogle Scholar
  29. Gooneratne NS: Complementary and alternative medicine for sleep disturbances in older adults. Clin Geriatr Med. 2008, 24 (1): 121-138. 10.1016/j.cger.2007.08.002.View ArticlePubMedPubMed CentralGoogle Scholar
  30. Samuels N: Herbal remedies and anticoagulant therapy. Thromb Haemost. 2005, 93 (1): 3-7.PubMedGoogle Scholar
  31. [https://www.yellowcourtyard.com]
  32. Richardson M: Complemenatry/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol. 2000, 18 (13): 2505-2514.PubMedGoogle Scholar
  33. Lie D, Boker J: Development and validation of the CAM Health Belief Questionnaire (CHBQ) and CAM use and attitudes amongst medical students. BMC Med Educ. 2004, 4: 2-10.1186/1472-6920-4-2.View ArticlePubMedPubMed CentralGoogle Scholar
  34. Wetzel MS, Eisenberg DM, Kaptchuk TJ: Courses involving complementary and alternative medicine at US medical schools. Jama. 1998, 280 (9): 784-787. 10.1001/jama.280.9.784.View ArticlePubMedGoogle Scholar
  35. Pre-publication history

    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6882/8/35/prepub

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© Furlow et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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