Another year, another report on the ostensibly growing embrace by hospitals of complementary and alternative medicine—or integrative medicine, as many practitioners prefer to call CAM because "alternative" has dubious vibes. The American Hospital Association has just released a new survey showing that about 37 percent of the hospitals that responded offer one or more CAM therapies such as acupuncture, massage therapy, and guided imagery, up from about 26 percent in an AHA survey in 2005.
I requested the survey and looked it over. I've walked the CAM beat for more than three decades, and my antennae are always sniffing for data true and false. Early this year, a cover story I wrote about CAM's spread into academic medical centers took heat from CAM detractors (for buying into a passel of woo-woo nonsense) and supporters (for mindlessly rejecting effective treatments just because they haven't passed conventional standards of evidence) alike. There's no middle ground with these folks.
For what it's worth, my position hasn't changed in the three-plus decades I've walked the CAM beat: I won't reject anything out of hand, but please don't feed me success stories from grateful patients and results from poorly designed or executed studies. There is no substitute for good clinical trials.
There's also no substitute for good surveys, and I'm not sure this one qualifies. The claim of CAM growth is based on a paltry survey response of 12 percent—748 hospitals out of 6,439 surveyed. And while 748 may seem high enough, such a low response rate all but guarantees that hospitals offering CAM were likelier to respond. The AHA staff member who ran the survey (he didn't design it) agrees that such a "positive bias" is unquestionable.
A likelier indication of the use of CAM in U.S. hospitals comes from the AHA's annual survey of the same 6,000-plus hospitals. The survey, which has a response rate of well over 80 percent, feeds a database that yields a detailed statistical profile of the hospital universe, down to individual centers. One of the questions in the 2007 survey's 22 pages asks whether the hospital provides complementary medical services. Acupuncture, herbal medicine, homeopathy, and others are listed as examples. From 2002 to 2006, the year-to-year totals do reflect a small overall rise but hardly any in recent years and not anywhere close to 37 percent (17.3 percent in 2002, 19.2 percent in 2003, 19.9 percent in 2004, 21.0 percent in 2005, and 21.0 percent in 2006).
Broken down, some of the CAM survey findings are interesting—for instance, that hospitals with fewer than 200 beds are more likely than behemoths of 400 beds or more to offer CAM services. And that the most popular form of CAM offered to inpatients is pet therapy (46 percent) and to outpatients is massage therapy (54 percent).
But without the sense that the survey presents a statistically valid picture, the findings are interesting factoids and not much more. Certainly not a snapshot of the CAM movement.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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