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Cam in Australia

Cam in Australia

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Here's a description of Complementary Medicine & Homeopathy in Australian sub-continent.
Here's a description of Complementary Medicine & Homeopathy in Australian sub-continent.

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Published by: Dr.Parikshit Mahimkar MD (Hom.) on Nov 18, 2010
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MJA
Volume 184 Number 1
2 January 2006
27COMPLEMENTARY MEDICINE — RESEARCH
The Medical Journal of AustraliaISSN: 0025-729X 2 January 2006 184 127-31 ©The Medical Journal of Australia 2006www.mja.com.auComplementary medicine — Research
 
on-representative surveys in manycountries have suggested that thereis a high use of complementary andalternative medicine (CAM). CAMs includeherbal medicines, traditional medicines(Ayurvedic or Chinese), vitamin, mineraland nutritional supplements, homeopathicmedicines and aromatherapy products.CAM practices include a diverse groupo therapies such as herbal medicine, chiro-practic, osteopathy, naturopathy, homeopa-thy and acupuncture. In the United States,about a third of adults aged 18 years orolder use CAMs.
1
In Australia, we previously conductedtwo representative population surveys inSouth Australia examining the use and costof CAMs, using the South Australian HealthOmnibus Surveys. We found that, between1995 and 2000, there had been an increasein the use of CAMs and over-the-countermedicines.
In 2004, we conducted a third representa-tive population survey in South Australia,surveying the trend in CAM use since thePan Pharmaceutical crisis (in which a sub-stantial quantity of CAM products wasremoved from retail stores) and asking fur-ther questions about the public’s beliefsconcerning the CAMs and their quality of life.
METHODS
Data were collected via the South AustralianHealth Omnibus Survey conducted inMarch–April 2004. The Health OmnibusSurvey is a large representative populationsurvey that has been undertaken annually inSouth Australia since 1990 using a clus-tered, multistage, systematic, random, self-weighting area sample. Weighting ensuresthat every household has the same probabil-ity of being selected. This approach has beenused consistently from the inception of thesurvey and involves sampling people aged15 years and over living in metropolitan Adelaide and major country towns with apopulation exceeding 1000.
4
South Aus-tralia has a slightly older population onaverage than other Australian states, butotherwise the population is generally similarto Australian demographic data.The survey data were weighted to the2002 Australian Bureau of Statistics Esti-mated Residential Population data by sex, 5-year age groups and geographic area so thatthe findings apply to the demographic pro-file of South Australia. To estimate reliability,10% of the respondents were resurveyed. Age, sex, marital status, education,employment status, area of residence, coun-try of birth, and household income levelwere recorded.The respondents were given the followingdefinition:
The following questions are about com-plementary and alternative medicines,including over-the-counter medicines,alternative therapies or remedies andherbal medicine.
They were asked whether they had usedany complementary or alternative medicinesor health products over the past year, withseven main types listed on a prompt cardwith samples of each type (
herbal medicines
,
vitamins
,
mineral supplements
,
Chinese medi-cines
,
homeopathic medicines
,
soy products
,
aromatherapy oils
,
other
or
none
). Excludedwere calcium, iron or vitamins prescribed bya medical practitioner. The respondentswere asked to estimate, to the nearest dollar,the monthly cost of these products. A prompt card was used to seek the mainreasons for the use of these medicines, withthe categories
 general health
;
blood or circula-tion
;
bladder or kidneys
;
muscles, bones or joints
;
lungs or sinuses
;
immune system
;
nervesor stress
;
stomach and bowels
;
 prostate
;
PMS/ menopause
;
skin
;
other
; and
don’t know
.
The continuing use of complementary and alternative medicinein South Australia: costs and beliefs in 2004
Alastair H MacLennan, Stephen P Myers and Anne W Taylor
ABSTRACT
Objective:
To survey the use, cost, beliefs and quality of life of users of complementaryand alternative medicine (CAM).
Design:
A representative population survey conducted in 2004 with longitudinalcomparison to similar 1993 and 2000 surveys.
Participants:
3015 South Australian respondents over the age of 15 years (71.7%participation).
Results:
In 2004, CAMs were used by 52.2% of the population. Greatest use was inwomen aged 25–34 years, with higher income and education levels. CAM therapists hadbeen visited by 26.5% of the population. In those with children, 29.9% administeredCAMs to them and 17.5% of the children had visited CAM therapists. The totalextrapolated cost in Australia of CAMs and CAM therapists in 2004 was AUD$1.8 billion,which was a decrease from AUD$2.3 billion in 2000. CAMs were used mostly to maintaingeneral health. The users of CAM had lower quality-of-life scores than non-users.Among CAM users, 49.7% used conventional medicines on the same day and 57.2% didnot report the use of CAMs to their doctor. About half of the respondents assumed thatCAMs were independently tested by a government agency; of these, 74.8% believedthey were tested for quality and safety, 21.8% for what they claimed, and 17.9% forefficacy.
Conclusions:
Australians continue to use high levels of CAMs and CAM therapists.The public is often unaware that CAMs are not tested by the Therapeutic Goods
MJA 2006; 184: 27–31
Administration for efficacy or safety.
Department of Obstetrics and Gynaecology, University of Adelaide, North Adelaide, SA.
Alastair H MacLennan,
MD, FRCOG, FRANZCOG, Professor.
Australian Centre for Complementary Medicine Education and Research, Southern CrossUniversity, Lismore, NSW.
Stephen P Myers,
PhD, BMed, ND, Professor.
Population Research and Outcomes Unit, South Australian Department of Health, Adelaide, SA.
Anne W Taylor,
BA, MPH, Director.Reprints will not be available from the authors. Correspondence: Professor AH MacLennan,Department of Obstetrics and Gynaecology, University of Adelaide, Women’s & Children’s Hospital,72 King William Road, North Adelaide, SA 5006.
alastair.maclennan@adelaide.edu.au
N
 
28MJA
Volume 184 Number 1
2 January 2006
COMPLEMENTARY MEDICINE — RESEARCH
Respondents were asked if their medicalpractitioner knew about the complementarymedicines being taken and whether theyused these medicines on the same day thatthey took conventional medicines.They were also asked if they had visitedany of the following therapists listed on aprompt card in the last year:
herbal therapist/ herbalist
;
naturopath/natural therapist
;
aroma-therapist
;
homeopath
;
acupuncturist
;
iridolo- gist
;
osteopath
;
chiropractor
;
reflexologist
;
other
;
none
;
 
and
don’t know
. The approximatetotal yearly cost of these therapists (notincluding the cost of any medicine theyprescribed or sold) was asked.Respondents were asked if any children intheir household were ever given CAM medi-cines or therapies with the followingoptions:
no children in household
;
children butalternative medicine and therapies not used
;
 yes — non-prescribed vitamins
;
 yes — other alter-native medicines/products
;
 yes — therapistslisted on the above prompt card
;
other alterna-tive therapists
; and
don’t know
.Respondents were asked: “Do you thinkthat complementary or alternative medi-cines are independently tested by a govern-ment agency such as the Therapeutic Goods Administration before being sold?” and“What do you think they are tested for?”.Possible answers were
quality/safety/sideeffects
;
efficacy/strength/effect
;
that they dowhat they claim to do
;
other
; and
don’t know
.Similar questions, but not all, had beenasked using the same method in surveys of the same population in 1993 and 2000.
2,3
 Where possible, the answers to the samequestions were compared between surveys.The data were analysed using SPSS ver-sion 12.0 (SPSS Inc, Chicago, Ill, USA) andEpi Info version 6.04 (Centers for DiseaseControl and Prevention, Atlanta, Ga, USA). All cost data were adjusted using the con-sumer price index.The South Australian Health Omnibus Advisory Committee independently vettedall questions in the survey and gave itsethical approval.
RESULTS
Response rate
In total, 3015 interviews were conducted,with a participation rate (completed inter-views/initial sample) of 71.7%. Theresponse rates were similar in the threesurveys (73.0%, 73.6% and 71.7%).
Use of CAMs
In the 2004 representative population sam-ple, 52.2% (
n
= 1574) of the sample saidthey had used a CAM over the past year.CAM use was greatest in women, individu-als with post-secondary school education, inthe 25–44-year age bracket, respondentswith household income over $30000, thosewho live in the metropolitan area, and inthose who were born in Australia (Box 1).Lower use was reported for those older than65 years, separated or divorced, with nopost-secondary school education, and thosewho lived in a household with incomestotalling less than $30000.Respondents reported self-prescribedvitamins as the most used (39.2% of allrespondents), followed by herbal medicines(20.6%) and mineral supplements (13.6%). Aromatherapy (11.2%) was the only othercategory mentioned by more than 5% of thesample (Box 2).Longitudinal comparison with similarstudies
2,3
carried out in 1993 and 2000showed a strong consistency among the totalCAM use in South Australia (50% in 1993,52.1% in 1993 and 52.2% in 2004) (Box 2).The use of herbal medicine has risen in bothmen and women, with women’s use increas-ing from 16.6% of female respondents in2000 to 24.9% in 2004 (
χ
2
=35.1;
P
<0.01).
1CAM users by demographicvariables
n
% (95% CI)Age (years)
152426353.0% (48.3%57.7%)253429659.9% (55.2%64.5%)354431857.5% (53.0%61.9%)455428454.5% (49.9%59.0%)556420952.4% (47.1%57.6%)
6520437.0% (32.8%41.4%)
Sex
Male67945.9% (43.2%48.6%)Female89658.4% (55.7%60.9%)
Country of birth
Australia120253.6% (51.4%55.8%)UK and Ireland18249.6% (44.1%–55.1%)Europe (minusUK/Ireland)9447.7% (40.0%–55.0%)Asian country4645.1% (34.9%–55.8%)Other5048.1% (37.8%58.5%)
Marital status
Married/defacto99753.5% (51.0%–55.9%)Never married14255.3% (48.6%–61.7%)Separated/divorced6035.9% (28.2%–43.9%)Widowed37551.7% (47.8%55.6%)
Post-secondary school education
No70746.1% (43.5%48.7%) Yes86858.6% (55.9%61.3%)
Household income (AUD$)
$3000037540.5% (37.2%43.9%)$30001–8000067658.5% (55.5%–61.5%)>$8000036760.9% (56.5%64.8%)Not stated15647.3% (41.7%52.7%)
Area
Metro114554.2% (51.9%56.4%)Country42947.6% (44.1%51.0%)
OVERALL157452.2% (50.3%54.1%)
Statistically significant differences between CAMusers and non-users are highlighted (
<0.05).
2Longitudinal comparison of the useof CAMs
199320002004
 Vitamins*Total37.6%36.4%39.2%Males33.8%31.5%35.6%Females41.2%41.2%42.7%HerbalmedicinesTotal9.9%13.4%20.6%Males8.6%10.3%16.1%Females11.1%16.6%24.9%MineralsupplementsTotal9.2%10.6%13.6%Males8.1%9.6%11.2%Females10.3%11.5%16.0%AromatherapyoilsTotal3.5%15.3%11.2%Males1.9%8.2%5.4%Females5.2%22.2%16.7%Soy productsTotal3.8%Males2.3%Females5.2%ChinesemedicinesTotal1.8%3.2%2.3%Males1.6%2.6%2.0%Females2.1%3.7%2.7%HomeopathicmedicinesTotal4.4%4.3%2.2%Males3.2%3.2%1.5%Females5.5%5.2%2.9%OtherTotal15.8%11.3%6.1%Males9.9%9.3%5.5%Females21.5%13.3%6.7%Total CAMusers
 
(at leastone product)Total48.5%52.1%52.2%Males42.0%43.9%45.9%Females54.8%60.0%58.4%
*Not calcium, iron or vitamins prescribed by adoctor. Shaded rows are significant at
<0.05 by
χ
2
 test.
 
MJA
Volume 184 Number 1
2 January 2006
29COMPLEMENTARY MEDICINE — RESEARCH
Reasons for use
The primary reason for using CAMs was for
 general health
(Box 3). The reasons for use of CAMs differed with age, marital status andeducation. For example, use of CAMs for
blood or circulation
and
muscles, bones or joints
increased with age, whereas use for the
immune system
decreased with age; thosewho had never married had a higher use of CAMs for the
immune system
(23.3%); thosewho were separated or divorced had higheruse for
nerves or stress
(27.3%); and thosewho had completed a bachelor degree orhigher had a higher use of CAM products forboth
 general health
(77.7%) and the
immunesystem
(25.7%), and a lower use for
muscles,bones and joints
(13.6%).
Cost of CAMs
The mean expenditure reported by all CAMusers on the cost of CAM per month was$21.23 (range, $1 to $650 per month). Women spent significantly more on CAMper month ($23.24) than men did ($18.50)(
t
=2.5, df=1248,
P
<0.01). The extrapo-lated expenditure for the Australian publicin 1993, 2000 and 2004 is shown inBox 4.There has been a reduction in total expendi-ture on CAMs since 2000, from $1671million to $1308 million.
Use of CAM therapists
The use of CAM therapists in the threesurveys is shown inBox 5. In the past year,26.5% of respondents had visited at leastone CAM therapist. Chiropractors were themost commonly used CAM therapist. Women (29.3%) used CAM therapists moreoften than men did (23.6%) (
χ
2
=12.6,
P
<0.01). With the exception of herbal ther-apists and “other”, there has been no escala-tion in the use of CAM therapists since2000.Use of CAM therapists peaked in themiddle age brackets (35–44 years, 31.6%;45–54 years, 32.6%) and tailed off at eitherend of the age spectrum (under 25 years,25.8%; over 65 years, 16.5%). Use washigher in country areas (29.4%) than metro-politan areas (25.3%). High use of CAMtherapists was reported by respondentsborn in Australia (28.7%). Low use wasreported for those who left school before theage of 15 years (17.2%). Use also increasedas household income increased, with indi-viduals reporting an annual income up to$12000 using them substantially less thanthose reporting an income greater than$80000 per annum (17.2% compared with31.5%;
χ
2
=16.3,
P
<0.01).
Cost of CAM therapists visited
The mean annual expenditure on CAM ther-apists was AUD$225 (range, $5 to $5000per year). The extrapolated Australianexpenditure for CAM therapists and thetotal cost of CAM in 1993, 2000 and 2004 isshown inBox 4. The cost of CAM therapistsin 2004 has decreased since 2000, from$616 million to $494 million.
General practitioner awarenessof CAMs used
Respondents who had used CAMs in thepreceding year were asked whether theirgeneral practitioner knew — 53.2% weretaking these products without their GP’sknowledge. This is consistent with the 2000survey, which found that 57.2% of users didnot report their use. In the current survey,women (47.8%) were more likely to telltheir GPs than men were (36.4%) (
χ
2
=20.5,
P
<0.01).
Using CAM products and conventionalmedicines
Respondents who had used CAMs in thepreceding year were asked if they had usedthem along with conventional medicines onthe same day. About half (49.7%) of thosewho had used CAMs had taken them on thesame day as conventional medicines. Thispractice was more common in metropolitanareas (51.6%) than in country areas(44.6%). It was also more common withwidowed respondents (76.9%); women(52.4%); those who left school before 15years of age (65.6%); low-income respond-ents (up to $12000, 68.1%; $12000–$20000, 64.3%); and older respondents(55–64 years, 69.8%; over 65 years, 80%).
Paediatric CAM use
 All respondents were asked about the use of CAM products and therapies by children inthe household. Most households were with-out children (68.5%). In the householdswith children (
n
=659), 30.6% of those saidthat children in their household had usedCAMs or CAM therapists. Of these, 66.7%(
n
=194) had given their children non-pre-scribed vitamins, 29.9% (
n
=87) had giventheir children other specified CAMs, and17.5% (
n
=51) of respondents had childrenwho had visited a CAM therapist.
Perception of testing of CAMs
 About half (48.8%) of the total samplebelieved (erroneously) that CAMs are inde-pendently tested by a government agencysuch as the Therapeutic Goods Administra-tion (TGA) before being sold. This belief washeld by a relatively higher proportion of people younger than 35 years (55.0%) and acorrespondingly lower proportion of peopleolder than 55 years (42.6%). Respondentswho had completed a certificate or diploma(52.5%) were more likely to consider thatthese products had been tested independ-ently. Respondents in the lower incomebrackets (up to $12000, 42.3%; $12000–$20000, 43.5%) were less likely to thinkthese products had been independentlytested.The 1471 respondents who believed thatCAMs are independently tested by a govern-ment agency were further asked to statewhat they believed were the nature of thesetests. Most (74.8%) believed that these
4Extrapolated cost of CAMs andCAM therapists in Australia
0500100015002000250020042000
Year
1993
CAM therapistsCAM medicines
   C  o  s   t   (   $  m   i   l   l   i  o  n   )
3Reasons given for using CAMs
MaleFemaleAll
General health68.7%71.1%70.1%Muscles, bones or joints21.6%20.3%20.9%Immune system18.9%17.7%18.2%Nerves or stress8.8%16.2%13.0%Blood orcirculation8.9%10.0%9.5%PMS/menopause14.8%8.4%Skin6.0%9.6%8.1%Lung or sinuses6.4%5.5%5.9%Stomach or bowel3.2%6.9%5.3%Bladder or kidneys1.5%3.2%2.5%Prostate2.9%1.3%Other10.3%12.1%11.3%Dont know1.6%0.6%1.0%
Multiple responses allowed. Significant differences(
<0.05) between sexes are shaded.

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