Regulating the use of complementary and alternative medicines
(CAM) has always been an uphill battle for Canadian health
authorities and physicians alike. Although Health Canada
does some regulatory work on CAM, "Health Canada's focus,
rather, is on the regulation of natural health products
(NHPs)," says Nathalie Lalonde, a media spokesperson for
Health Canada in Vancouver. NHPs only include a smaller
subset of CAM like vitamins, minerals, herbal remedies,
probiotics and essential fatty acids. These days more
patients are consulting their doctors about drugs that
they pick up from their local naturopath but there's still
not enough evidence for their benefit and safety. If that
isn't bad enough, there's a new trend that practitioners
will have to look out for — CAM use in kids.
There's an alarming lack of clinical
studies on prescription drugs in kids, let alone CAM
products. Research on the use of complementary and alternative
healthcare in children is in its infancy, according
to Dr Sunita Vohra, a pediatrician from the Complementary
And Alternative Research and Education (CARE) program
in Alberta.
WHAT
THEY CLAIM
A recent Washington State study has taken a step in
the right direction and aims to get a clearer picture
of this trend. The study published in the April 2005
issue of Archives of Pediatrics and Adolescent Medicine
attempts to gauge the extent of CAM use in kids through
insurance claims reports. Since 2000, Washington State
private insurers have been required to cover claims
for services from CAM-licensed professionals, such as
acupuncturists, massage therapists, naturopathic doctors
and chiropractors.
Seeking to find answers to frequency,
predictors and expenditures for the use of CAM in an
insured pediatric population, researcher Allen Bellas,
PhD, of Metropolitan State University, Minneapolis,
and colleagues analyzed the claims data obtained from
two large private health insurers.
Of 187,323 children covered by
the insurance companies 83.6% had claims during 2002.
"For those with claims, 6.2% of children used an alternative
professional during the year," say the authors in their
article. So, how would this compare to extent of use
and costs in Canada? The 6.2% annual rate of use in
the US is "approximately half the reported rate of 11%
seen in Canada," report the analysts in their paper.
In the US, "more than $185 million for pediatric care
was spent by the insurance companies and claimants,
and of this amount $2.5 million (1.3%) was spent on
CAM services."
DATED
DATA
The Canadian percentage cited (11%) referred to a 1992
survey done by researchers from a Montreal-based general
pediatric outpatient clinic. The investigators looked
at 1,911 completed questionnaires and reported that
208 children previously consulted one or more alternative
medicine practitioners. Unfortunately, it's hard to
tell what this figure would be today, more than 10 years
later — although the data can still give us a very
rough idea.
Treatment modalities in the 1992
Canadian survey listed chiropractic, naturopathy, acupuncture
and homeopathy, stating that these four forms
accounted for 85% of alternative medicine use in their
study. The US analysis of insurance costs and CAM use
in kids did not mention homeopathy, which could also
explain the discrepancy between frequency of use between
Canada and the US. In fact, the authors admit that variance
in their findings with other studies could be attributed
to "types of professionals studied."
They conclude in their study that
although insured pediatric patients did use CAM professional
services, this only amounted to a small part of total
insurance expenditures. "Not surprisingly, the most
significant factor that determined whether a pediatric
patient would use CAM is whether an adult in the family
used CAM," they state.
It would be interesting to see
if pediatric CAM use will expand if more of these products
are covered by insurance. The researchers from the Washington
State study predict that increased use and expenditures
due to insurance coverage would be modest. For more
information for you and your patients, see "A parents
guide for kids and complementary health" at www.canadian-health-network.ca.
Arch Pediatr Adolesc Med Apr
2005;159(4):367-72
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