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One American in three uses complementary
therapies at some time. Two recent articles outlined the scope
of the new-age medical world.1,2 Sales of herbals, botanicals,
and other nutritional additives, many of which are in fact
"crude drugs," amounted to $ 1.5 billion, with herbs and herbal
tea sales alone totaling $467 million in sales.
The true magnitude of the alternative health
market is hard to estimate, but it presently is thought to
be around $6 to $8 billion a year. Americans spend $94 million
on books on herbs and related topics. Sales in the more than
8,000 natural and health food stores in the United States
have increased 15% annually in recent years. The use of folk
medicines and healers appears in virtually all cultures in
all countries.
The European market for botanicals is three
times larger than that in the United States, with European
pharmaceutical houses such as Boehringer, Boots, and Ciba-Geigy,
marketing botanical products along separate but parallel tracks
alongside their conventional pharmaceutical lines. In Germany
alone, over-the-counter botanical sales have reached $7 billion.
Physicians routinely prescribe botanicals along with conventional
pharmaceuticals for many illnesses. Many of agents were found
in the United States Pharmacopeia (USP) until FDA review failed
to find evidence of efficacy.
Supporters of plant medicines assert that
with the cost of bringing a new drug to market being more
than $231 million manufacturers have little interest in old
plant drugs that cannot be patented.3 Proponents of plant
medicines argue that safe and effective treatments are being
ignored and that the public being pushed by physicians into
using more toxic, potent "synthetic" drugs.Research exists
documenting the efficacy of botanical medicines, but much
of that literature is not available in English. The German
government reviews research on botanicals, publishes 410 monographs
on plant medicines, and distributes patient information pamphlets
on botanicals in pharmacies. The English version will be published
in September 1997. Health food and supplement shops exist
in almost mall in the United States, in even remote communities.
Practitioners in every community will encounter traditional
Chinese medicine, stress reduction, chiropractic manipulation,
homeopathy, and plant medicine practice. Complications and
poisoning from improper use of alternatives are not confined
to large urban centers on the East and West Coast.
Much of alternative care operates outside
the mazelike, set of obstacles created by third-party health
payers; alternative care may actually be more easily accessible
to American health consumers. The lay public often does not
know what distinguishes clinically trained and licensed health
professionals from alternative practitioners, some of whom
have impressive credentials, but many of whom have no formal
training or licensing. For example, health consumers might
be hard-pressed to distinguish a massage therapist from a
physical therapist or a homeopath from an osteopath.
Often, consumers seem not to care about
training and credentialing. A large segment of the lay community
has come to believe that alternative providers are more sincere
and honest than medical personnel and that natural remedies
hold fewer risks. Patients believe that the commercial forces
driving medical practices in the United States are subverting
quality and compassion.
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