Adults who use complementary and alternative medical therapies (CAM) in addition to conventional medicine appear to value both - and tend to be more concerned about their physician's inability to understand or incorporate CAM therapy than they are in their physician's disapproval, researchers at Boston's Berth Israel Deaconess Medical Center and Harvard Medical School have found.

A nationwide survey conducted by the Center for Alternative Medicine Research and Education at Beth Israel Deaconess found that 79 percent of the respondents perceived the combination of traditional and CAM therapies to be superior to either one alone - and found equal levels of trust in physicians and CAM practitioners.

A majority of respondents did not share their use of CAM therapies - such as acupuncture, chiropractic, herbal remedies and massage - with their physicians believing "it was not important for the doctor to know" (61 percent) or "the doctor never asked" (60 percent). In addition, 31 percent thought their use of CAM therapies was "none of the doctor's business" - and 20 percent believed "the doctor would not understand."

Only 14 percent thought their doctor would disapprove or discourage CAM therapies and just 2 percent thought that a doctor might not continue as their provider because of the alternative therapies.

The findings are reported in the Sept. 4 edition of The Annals of Internal Medicine, published by the American College of Physicians.

A national random survey provided responses from 831 adults who used both traditional and CAM therapies in the previous 12 months. Of the 411 respondents who saw both physicians and practitioners, 70 percent typically saw a medical doctor before or concurrent with a CAM provider, while 15 percent typical saw the CAM provider before the medical doctor.

"The overwhelming majority of patients who seek the professional services of CAM practitioners do so after they see their medical doctor or at the same time that they are being evaluated by their medical doctor," said David M. Eisenberg, M.D., lead author, Director of the Division for Research and Education in Complementary and Integrative Medical Therapies and Associate Professor of Medicine at Harvard Medical School.

"Medical doctors and other conventional caregivers who are knowledgeable about CAM practices have a unique opportunity to advise patients about the use or avoidance of these therapies. Clearly, that is what our patients want."

Nearly four-fifths of the respondents expressed support for a combination of CAM and traditional therapies - and only 21 percent considered CAM therapies superior. More than half of the respondents disagreed with the notion that CAM providers were better listeners or that they did a better job of explaining medical conditions. The percentage of respondents who expressed "total" or "a lot of" confidence in their health care provider was virtually identical for both forms of therapy.

The study also found CAM therapies were judged more helpful than conventional care in the treatment of headache and neck and back conditions, while conventional care was considered more helpful in the treatment of hypertension.

The study concluded that the popularity of CAM therapies cannot be attributed solely to a dissatisfaction with, or a lack of attraction to, high-tech, scientifically validated orthodox care. Rather, the authors believe, patients increasingly view medical doctors as members of a larger, patient-selected health care team.

"These are sobering results for the medical profession," said Eisenberg. "We need more scientific evaluation of CAM therapies, more pre- and post-graduate medical education in this area, and we, as conventional medical caregivers, need to be more proactive in responsibly advising patients about the use or avoidance of CAM therapies."

Study co-authors include Ronald C. Kessler, Ph.D., Maria I. Van Rompay, BA, Ted J. Kaptchuk, OMD, Sonja Wilkey, MD, Scott Appel, MS and Roger B. Davis, ScD.

The study was funded by grants from the National Institutes of Health, the John E. Fetzer Institute and the American Society of Actuaries. Additional support for the completion of analyses and manuscript preparation was provided by unrestricted gifts from the friends of Beth Israel Deaconess Medical Center, the Kenneth J. Germeshausen Foundation, the J.E. and Z.B. Butler Foundation and the American Specialty Health Networks.

Beth Israel Deaconess Medical Center is a major patient care, research and teaching affiliate of Harvard Medical School and a founding member of CareGroup Healthcare System. Beth Israel Deaconess is the fourth largest recipient of National Institutes of Health research funding among independent U.S. teaching hospitals.