The Physician: Healthy, Wealthy, and Wise?

Carol Peckham

Disclosures

January 23, 2014

In This Article

Physicians and CAM

Using CAM for Medical Treatments

In a Medscape commentary,[26] Paul Offit, MD, Chief, Division of Infectious Diseases, The Children's Hospital of Philadelphia, pointed out that since its founding in 1992, the National Center for Complementary and Alternative Medicine (NCCAM) "has received about $1.6 billion of federal money to study a variety of things...[T]he disappointing part of these studies is that they are not based on any biological principle. In fact, they seem to hark back to a much more distant time, before we really understood the pathophysiologic basis of diseases and were able to direct treatments towards them." In spite of such limited evidence, 38% of adults in the United States are using some form of alternative medicine, according to NCCAM.[27] And this percentage matches the general Medscape survey responses, in which, regardless of age, about 38% of physicians admitted taking CAM treatments for medical conditions. Female physicians, at 48%, had an even higher rate than both the general population and their male peers (32%). Furthermore, specific professionals were more likely to use CAM (Figure 3). At 52%, family physicians are the most likely among all doctors to use alternative treatments for medical conditions, followed at 49% by psychiatrists, who were also the most likely to take supplements (71%).

In the United States, according to NCCAM, pain conditions are the most common reasons for CAM use: back pain (17.1%), neck pain (5.9%), joint pain and arthritis (6.3%).[27] This corresponds with the verbal responses physicians made in the Medscape survey, where pain was the most common reason for using CAM, including acupuncture. Chiropractic or osteopathic manipulations were the most commonly cited practices. An interesting 2003 review analyzed results from randomized controlled trials that had unambiguous allocation concealment and were assessed for risk of bias from blinding. The review supported the National Institute for Health and Care Excellence (NICE) pragmatic recommendations of acupuncture in certain circumstances for treatment of back pain and headache.[28] In the Medscape survey, glucosamine, chondroitin, or both came up often as a treatment among physicians for arthritis. Studies on the effects of glucosamine and recommendations for its use have been mixed,[29] but a recent review suggested that specific glucosamine compounds may have beneficial effects.[30] Eastern practices, including yoga, meditation, and tai chi, were also popular among physician responders to the survey.

Figure 3.

Physicians Who Use CAM

Supplement Use

Nearly one half of all Americans take some type of dietary supplement, according to a study published in 2011 using NHANES 2003-2006 survey data.[31] Differences in age and gender appear to influence supplement usage, with more women than men taking them and with use increasing with age. Of physicians who participated in the Medscape survey, 62% of those over 46 years old take supplements compared with 48% of physicians 45 and under. When looking at gender, as in the general population, more female than male physicians use them (61% of women and 54% of men). Of interest, these results differed from a recent analysis of the Nurses' Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS), which reported higher supplement use and an increase among both medical professional women (71.3% to 88.3%) and men (56.4% to 80.7%) between 1986 and 2006.[32] The NHANES survey data also showed an increase in usage over the previous decades in the general population.

Despite a lack of evidence on the value of a multivitamin supplement,[33,34,35] a third of male and 37% of female physicians who responded to the Medscape survey take a multivitamin, which, according to the NHANES data, is similar to usage rates among the general US population.[31] In general, physician usage corresponds with a survey conducted by consumerlab.com, which found that the most popular supplements among its subscribers were fish oil, multivitamins, vitamin D, calcium, and coenzyme Q10, in that order.[36] (Figure 4) More female physicians reported taking vitamin D (36%) and calcium (27%) than males (24% and 10%, respectively). Both genders reported the same rate of use of omega-3 fatty acids (about 22%). In spite of the faulty evidence supporting the value of antioxidant supplements, 19% of male and 17% of female physicians who responded use them. Eleven percent of men and 8% of women take coenzyme Q10, mostly to prevent statin-related myalgia, according to verbal responses to the question on what CAM therapies they use. In the NHS/HPFS analysis,[32] supplement use increased among health professionals between1986 and 2006, particularly in women using vitamin D (2.2% to 32.2%) and folic acid (0.8% to 10.7%). Use of fish oil increased significantly for both genders (1.6% to 18.1% for women and 3.3% to 22.2% for men). On the other hand, use of antioxidants (vitamin A, beta-carotene, vitamin C, and vitamin E) declined steadily.

Figure 4.

Physicians Who Take Supplements

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