The use of complementary and/or alternative medical treatments, to traditional, allopathic medicine, is steadily increasing. Data, generated in 2002, by the National Health Interview Survey suggest that a staggering 62% of adult U.S. citizens do use at least one example of such treatment. Not surprising, women use even more (69%) than men (54%). In other words, over two-thirds of all women use non-traditional medical services and/or treatments, outside of the conventional medical system. Total annual sales of dietary supplements alone has been estimated at $18 billion!

The adjacent table summarizes the main types of complementary/alternative medical treatments, which are in wide use:

The most widely used alternative/complementary treatments, reported in a study of women’s health in 3302 women, involved nutritional remedies (32%), followed by psychological (20%), herbal (18%), physical (17%) and, finally, folk medicines (6%). In the year 2002, alone, the annual use of supplements in the U.S. was reported to have increased by 19% and to have doubled in women above age 65. In a study, reported in 2002 (Bair YA et al., Am J Public Health 2002; 92:1832-40), the authors, quite interestingly, noted considerable differences in the utilization of complementary/ alternative approaches between different ethnicities. Surprisingly, Caucasian and Japanese women appeared to utilize them much more frequently than Hispanics, African Americans and even Chinese females.

Industry has, of course, taken note of this growing interest in alternatives to traditional medicine, and has developed a plethora of products to satisfy market demands. Unfortunately, the controls of this extremely rapidly growing market have remained somewhat suspect. As a consequence there have been cases of mislabeled and contaminated dietary supplements in the U.S. market. Our sister organization, CHR, when starting to experiment with the over-the-counter available dehydroepiandrosterone (DHEA), therefore, strongly suggested the use of pharmaceutical grade DHEA in place of over-the-counter products (see also above the section on Alternative/Supplemental Treatment).

There, indeed, should be real concern when prescribing alternative medications. Botanical supplements are almost universally contaminated by bacterial, fungi or both (Raman et al., J Agric Food Chem 2004; 52:7822-27). Especially Asian patent medicines were in approximately one third of cases found to be contaminated by undeclared pharmaceuticals or heavy metals (Ko RJ, N Engl J Med 1998; 339:847). The reasons are quite obvious: The regulatory supervision of alternative drugs, and of so-called dietary supplements, in the U.S., is not at par to that of standard drugs. Federal manufacturing controls, which are routine in the traditional pharma industry, do not exist. In addition, these alternative medications do not have to be approved for safety and efficacy, as standard medications do. Finally, as long as no specific health claims are made, and claims are restricted to “nutritional content”, “well being”, “general health”, etc., no federal premarket approval is needed. We all, of course, know how long, tedious and expensive premarket approval for traditional drugs is. As a consequence, bringing alternative drugs to market is comparatively easy, and rather inexpensive, resulting in an overabundance of product.

The choice of product is, therefore, of crucial importance and should not be left to chance.

(This section drew selected information from an article by Wysocki and Thorneycroft in The Forum; 2005:3:18-25)