David M. Eisenberg's CAM Articles (First to Last)

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:     Frankp@chiro.org

	Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use New England Journal of Medicine 1993 (Jan 28); 328 (4): 246–252 ~ FULL TEXT This is the article that started it all. This article slowly opened organized medicine's eyes to how many folks were coming to see “alt-med” practitioners. This spurred NIH to form their new department of “Alternative Medicine”, and is also what prompted me to name my practice Alternative Care Chiropractic.
	Advising Patients Who Seek Alternative Medical Therapies Annals of Internal Medicine 1997 (Jul 1); 127: 61–69 ~ FULL TEXT Dr. Eisenberg's suggestions that medical doctors learn more about alt-med practices, so that they may advise and monitor their patient's care draws a lot of “fire” from his profession (see Related Letters ).
	David Eisenberg: Testimony before U.S. Senate on 10–9–1997 ~ FULL TEXT My remarks are intended to address the following themes: (1) definitions and terminology; (2) prevalence, cost and patterns of use; (3) education; (4) research challenges, and (5) priorities and mechanisms of support. Detailed references for many of my comments can be found in written materials prepared for the American Board of Internal Medicine and submitted to Senator Frist's staff.
	Courses Involving Complementary and Alternative Medicine at US Medical Schools Journal American Medical Association 1998 (Sep 2); 280 (9): 784–787 ~ FULL TEXT Of schools that replied, 75 (64%) reported offering elective courses in complementary or alternative medicine or including these topics in required courses. Of the 123 courses reported, 84 (68%) were stand-alone electives, 38 (31%) were part of required courses, and one (1%) was part of an elective.
	Patterns of Use, Expenditures, and Perceived Efficacy of Complementary and Alternative Therapies in HIV-Infected Patients Archives of Internal Medicine 1998 (Nov 9); 158 (20): 2257–2264 ~ FULL TEXT Patients with HIV infection use CAM, including marijuana, at a high rate; make frequent visits to CAM providers; incur substantial expenditures; and report considerable improvement with these treatments. Clinical trials of frequently used CAMs are needed to inform physicians and patients about therapies that may have measurable benefit or measurable risk.
	Chiropractic: Origins, Controversies, and Contributions Archives of Internal Medicine 1998 (Nov 9); 158 (20): 2215–2224 ~ FULL TEXT Chiropractic is an important component of the US health care system and the largest alternative medical profession. In this overview of chiropractic, we examine its history, theory, and development; its scientific evidence; and its approach to the art of medicine. Chiropractic's position in society is contradictory, and we reveal a complex dynamic of conflict and diversity. Internally, chiropractic has a dramatic legacy of strife and factionalism. Externally, it has defended itself from vigorous opposition by conventional medicine. Despite such tensions, chiropractors have maintained a unified profession with an uninterrupted commitment to clinical care.
	Trends in Alternative Medicine Use in the United States, from 1990 to 1997: Results of a Follow-up National Survey Journal American Medical Association 1998 (Nov 11); 280 (18): 1569–1575 ~ FULL TEXT The move towards alternative forms of care continues. Eisenberg and colleagues noted that 34% (60 million) of the general public in the United States reported using 1 or more forms of unconventional medicine in 1990. The most frequently used unconventional modalities are various forms of relaxation therapy, chiropractic, acupuncture, massage therapy, and herbal/mineral/vitamin supplements. The number of visits to unconventional providers in the United States in 1990 was greater than the number of visits to all primary care physicians. The total expenditures for unconventional therapy in 1990 amounted to $13.7 billion, $10.3 billion of which was paid out-of-pocket. In the vast majority of cases (89%), these visits to unconventional providers were not prescribed by a physician, and 72% of the patients did not discuss these visits with their physicians.
	Medical Malpractice Implications of Alternative Medicine Journal American Medical Association 1998 (Nov 11); 280 (18): 1610–1615 This article reviews the liability for medical doctors who refer to chiropractors (and other “alt-med” practitioners). They found that claims against DC's were considerably lower than against MD's: 2.67 claims per 100 policy-holders for DC's versus 7.61 claims for MD's.
	The Persuasive Appeal of Alternative Medicine Annals of Internal Medicine 1998 (Dec 15); 129: 1061–1065 ~ FULL TEXT Alternative medicine has a major presence and persuasive attraction in the industrialized western world. The extent to which these practices have clinical efficacy according to biomedical criteria is a matter of ongoing research and debate. It may be that independent of any such efficacy, the attraction of alternative medicine is related to the power of its underlying shared beliefs and cultural assumptions. The fundamental premises are an advocacy of nature, vitalism, “science,” and spirituality. These themes offer patients a participatory experience of empowerment, authenticity, and enlarged self-identity when illness threatens their sense of intactness and connection to the world. A discussion of these themes may enable conventionally trained clinicians to better understand their patients' attraction to and acceptance of alternative medical therapies.
	Alternative Medicine Use in Older Americans Journal of the American Geriatrics Society 2000 (Dec); 48 (12): 1560–1565 Thirty percent of Americans aged 65 and older reported using alternative medicine (amounting to 10 million Americans based on extrapolations to census data) and 19% visited an alternative medicine provider (making 63 million visits based on extrapolations to census data) within the past year.
	Dr. Eisenberg speaks to the WHCCAMP on 5-15-2001 ~ FULL TEXT This testimony to the White House Commission on Complementary and Alternative Medicine Policy was given on May 15, 2001.
	Varieties of Healing 2: A Taxonomy of Unconventional Healing Practices Annals of Internal Medicine 2001 (Aug 7); 135 (3): 196–204 ~ FULL TEXT Two broad categories of unconventional medicine are described here: a more prominent, "mainstream" complementary and alternative medicine (CAM) and a more culture-bound, "parochial" unconventional medicine.
	Long-Term Trends in the Use of Complementary and Alternative Medical Therapies in the United States Annals of Internal Medicine 2001 (Aug 21); 135 (4): 262–268 ~ FULL TEXT Previously reported analyses of these data showed that more than one third of the U.S. population was currently using CAM therapy in the year of the interview (1997). Subsequent analyses of lifetime use and age at onset showed that 67.6% of respondents had used at least one CAM therapy in their lifetime. Lifetime use steadily increased with age across three age cohorts: Approximately 3 of every 10 respondents in the pre–baby boom cohort, 5 of 10 in the baby boom cohort, and 7 of 10 in the post–baby boom cohort reported using some type of CAM therapy by age 33 years.
	Perceptions About Complementary Therapies Relative To Conventional Therapies Among Adults Who Use Both: Results From A National Survey Annals of Internal Medicine 2001 (Sep 4); 135 (5): 344–351 Adults who use both forms of care appear to value both and tend to be less concerned about their medical doctor's disapproval than about their doctor's inability to understand or incorporate CAM therapy use within the context of their medical management.
	Ethical Considerations of Ccmplementary and Alternative Medical Therapies in Conventional Medical Settings Annals of Internal Medicine 2002 (Oct 15); 137 (8): 660–664 ~ FULL TEXT Increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. The authors present a risk-benefit framework that can be applied to determine the appropriateness of using CAM therapies in various clinical scenarios. The major relevant issues are the severity and acuteness of illness; the curability of the illness by conventional forms of treatment; the degree of invasiveness, associated toxicities, and side effects of the conventional treatment; the availability and quality of evidence of utility and safety of the desired CAM treatment; the level of understanding of risks and benefits of the CAM treatment combined with the patient's knowing and voluntary acceptance of those risks; and the patient's persistence of intention to use CAM therapies. Even in the absence of scientific evidence for CAM therapies, by considering these relevant issues, providers can formulate a plan that is clinically sound, ethically appropriate, and targeted to the unique circumstances of individual patients. Physicians are encouraged to remain engaged in problem-solving with their patients and to attempt to elucidate and clarify the patient's core values and beliefs when counseling about CAM therapies.

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