PUBLIC POLICY SOURCES NUMBER 87 / MAY 2007 Complementary and Alternative Medicine in Canada: Trends in Use and Public Attitudes, 1997-2006 by Nadeem Esmail, The Fraser Institute Contents Executive Summary . 3 Introduction . 6 Methodology in Brief . 7 Results . 9 Discussion . 38 Appendix A: Detailed Survey Methodology . 40 Appendix B: Descriptions of Select Complementary and Alternative Medicines and Therapies . 45 Acknowledgements . 52 References . 53 About the Author . 53 A FRASER INSTITUTE OCCASIONAL PAPER Public Policy Sources is published periodically throughout the year by The Fraser Institute, Vancouver, B.C., Canada. The Fraser Institute’s vision is a free and prosperous world where individuals benefit from greater choice, competitive markets, and personal responsibility. Our mission is to measure, study, and communicate the impact of competitive markets and government interventions on the welfare of individuals. 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Printed and bound in Canada. ISSN 1206-6257 Date of issue: May 2007 Executive Summary Background Respondents were asked to report any health conditions, details of their use of conventional medi- In 1999, The Fraser Institute published the first ever cal services in treating their conditions, and whether comprehensive study of Canadians’ use of and public they had tried any alternative therapies as treatment attitudes towards complementary and alternative for these conditions. With respect to alternative medicine (CAM) (Ramsay et al., 1999). In the years medicine use, respondents were asked to indicate since that survey, the health care world has changed whether they had used any of 22 commonly used significantly. These changes led to the question of complementary and alternative medicines and ther- whether or not, and to what degree Canadians’ use of apies. Lastly, respondents were also asked about and public attitudes towards CAM, such as their attitudes toward health, health care, medical chiropractic, naturopathic, and herbal therapies, care, and public policy. had changed since 1997. To answer this question, The Fraser Institute commissioned Ipsos Reid to conduct a second Canadian national survey to de- Results termine the prevalence, costs, and patterns of CAM With respect to self-reported health, little has use in 2006. changed between 1997 and 2006. In both cases, more than 60 percent of respondents reported their health to be very good or excellent, and 11 percent of re- Methodology spondents reported their health to be fair or poor. The methodology used in the 2006 survey was in Less than one fifth (18% in 2006 and 19% in 1997) felt most cases similar to that used in the first survey their daily activities were limited by their health. The (1997). In 2006, a total of 2,000 interviews were con- most common health conditions reported in the 12 ducted with a randomly selected sample of adults 18 months prior to both the 2006 and 1997 surveys were years of age and older. This increase of 500 interviews allergies (29% each time), back or neck problems (28% from the 1,500 completed in 1997 was implemented and 30%) and arthritis or rheumatism (21% and 20%). to allow greater statistical accuracy in examining With respect to the use of conventional health changes between 1997 and 2006.1 In order to mini- care services, 87 percent of respondents in 2006 mize any potential seasonal bias in responses, the “usually” sought medical care from a particular doc- 2006 survey was completed at the same time of year tor’s office, clinic or health centre, compared to 88 as the 1997 survey. In 2006, the response rate was 18.8 percent in 1997. On the other hand, only 80 percent percent, compared to a response rate of 25.7 percent of respondents in 2006 “usually” saw a particular in 1997. The drop in the response rate from 1997 is doctor, a 2 percentage point decrease from 1997 largely driven by a secular trend in lower survey re- (82%). As Canadians’ confidence in their physicians sponses. increases, so does the likelihood that they will seek 1 With regard to the accuracy of the findings, there is a 95 percent chance that the average values for the entire Canadian population are within 2.2 percentage points of the survey percentages in 2006. In 1997, the margin of error was 2.5 percentage points. In addi- tion, the increase in the number of interviews completed in 2006 allows for 95 percent statistical confidence in detecting a 3 percent- age point change in the percent of Canadians who have used complementary and alternative medical therapies sometime in their lives (73% in 1997). The Fraser Institute 3 Complementary and Alternative Medicine PUBLIC POLICY SOURCES, NUMBER 87 care from a particular doctor’s office or clinic—a pat- pies in 2006, and, in both cases, the percentage of tern similar to that in 1997. In both 2006 and 1997, Canadians who had tried these therapies had fallen 73 percent of respondents had “total” or “a lot” of since 1997, though the decreases were not statisti- confidence that their doctor could help them man- cally significant. Acupuncture rounded out the five age their overall health. On average, 73 percent of most common therapies used by Canadians over respondents suffering from one of the conditions their lifetime, with 17 percent of Canadians having listed sought medical attention for their health prob- used acupuncture (a statistically significant increase lems during the previous year in 2006, as was the case of 5 percentage points from 1997). in 1997. Those people who received care for their In 2006, more than one-half (54%) of Canadians condition in the year prior to the survey in both 2006 reported using at least one alternative therapy in the and 1997 often felt that care was very or somewhat year prior to the survey, which was a statistically sig- helpful (81% and 77%, on average, respectively). nificant 4 percentage point increase over the rate of With respect to prescription medicine use, nearly use in 1997 (50%). In the 12 months prior to the 2006 half of respondents (47%) said they’re taking pre- survey, the most commonly used complementary scription medication in 2006, a significant increase of and alternative medicines and therapies were massage 8 percentage points since 1997, when 39 percent (19%), prayer (16%), chiropractic care (15%), relax- answered “yes” to the same question. ation techniques (14%), and herbal therapies (10%). In 2006, nearly three-quarters of Canadians Though the top 5 list was the same in 1997, the order (74%) had used at least one alternative therapy some- was different. time in their lives. This is very similar to the propor- Canadians used alternative therapies an average tion of Canadians in 1997 (73%), suggesting that of 8.6 times during the year previous to the 2006 sur- there has been no change in the overall usage of com- vey, which was similar to their use in 1996/97 (8.7 plementary and alternative medicine or therapies times). Most people choosing to use alternative ther- over the past nine years. In 2006, Albertans (84%) apies in the 12 months preceding the survey did so to were most likely to have used an alternative therapy prevent future illness from occurring or to maintain during their lifetime, followed closely by British health and vitality. Of those who used alternative Columbians (83%), while Quebecers (67%) and medicine in the 12 months prior, 53 percent of Atlantic Canadians (63%) were least likely to have respondents in 2006 (down slightly from 56 percent done so. Similar patterns were observed in 1997, in 1997) had not discussed their use of alternative though in that year British Columbians were most medicine with their doctor. likely (84%) and Quebecers least likely (66%) to have The average amount paid out of pocket per user used an alternative therapy during their lifetime. to an alternative health care provider in the year In 2006, chiropractic care was the most common prior to the survey in 2006 was $173, which was a siz- type of therapy used by Canadians over their lifetime, able increase from the $93 paid out of pocket on with 40 percent having tried it—a significant 4 per- average in 1997.2 Extrapolation for the Canadian centage point increase over 1997.