The number of visits to alternative care practitioners in the United States rose from 427 million in 1990 to 629 million in 1997. This latter figure is remarkable, because it exceeds the number of visits made to all primary care physicians in the United States during the same year. The 1998 data, when available, are expected to show continuing explosive growth. Out-of-pocket spending (not covered by insurance) for alternative therapies in 1997 was estimated at 27 billion dollars, which was about the same as the out-of-pocket expenses for all services provided by physicians in the United States.<sup>4 Complementary and Alternative Medicine [entire issue] JAMA 1998 ;  280 : 1549-1640

Cliccare qui per andare alla sezione Riferimenti</sup> Current estimates indicate that at least 50% of the population in the United States is using some form of alternative therapy and that, furthermore, very few of these persons will tell their primary care physician of their use of these therapies for fear of criticism and humiliation.

Public awareness of and use of complementary and alternative medicine (CAM) are complex phenomena that have grown extraordinarily in the past decade. This seemingly insatiable desire for ancient philosophies and approaches to medical care by the general public seems particularly odd because it comes at a time of unprecedented technological and therapeutic advances.

One reason for this phenomenon no doubt is the enormous increase in public access to worldwide information through the world wide web and widespread newsmedia coverage. Commercial advertising and an endless exposure through the lay press, ranging from tabloid publications to magazines, medical journals, and books, have vigorously promoted the concepts of disease prevention and healing by unconventional means, striking a sensitive (and highly lucrative) chord in a truly global population.

Another reason for the popularity of CAM is the upwardly spiraling cost of modern allopathic medical care. New technologies have been developed at a record pace, producing many medical, surgical and diagnostic innovations, most of which are unquestionably improvements but which also are very expensive. The expense and the resulting rationing of these new modalities by managed care programs in an attempt to reduce the costs of medical care have placed them out of reach of a large segment of the population. One consequence appears to be the creation of a strong public desire for a wide range of complementary and alternative modalities to prevent and treat the full gamut of human illness. The younger generation, in particular, seems to be developing distrust of the technological innovations of the medical profession and their potential for adverse effects, while becoming more interested in CAM and preventive medicine. The elderly population has also turned to CAM, but perhaps for different reasons.

Whatever the reasons, a veritable blitz of advertising and recommendations for CAM products has arrived and has received strong public interest and approval, with very little support or encouragement from the medical community. Many patients are more informed of alternative therapies than their physicians, a situation that, in itself, should encourage physicians to learn more about CAM. No matter how a physician feels about the usefulness of CAM, it is no longer adequate simply to brush off the patients' questions with an uninformed answer; doing so only serves to broaden the communication gap between the public and the medical profession.

It seems ironic that modern Western allopathic, evidence-based medicine “magic bullets” should be challenged by ancient Eastern Oriental medicine, which is based almost entirely on prevention, mainly because that was all its practitioners had to offer their patients. When someone became ill, the doctor was often blamed for not prescribing the proper preventive measures. (Malpractice attorneys did not exist, or the entire medical profession would have been eliminated in short order.) Nonetheless, many of the herbal and nonherbal remedies now advertised in the United States had their origins in ancient Oriental medicine.<sup>8 Koo J., Arain S. Traditional Chinese medicine for the treatment of dermatologic disorders Arch Dermatol 1998 ;  134 : 1388-1393  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 9 Oumeish O.Y. The philosophical, cultural and historical aspect of complementary, alternative, unconventional and integrative medicine in the Old World Arch Dermatol 1998 ;  134 : 1373-1386  [cross-ref]

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