About 10 percent of Americans obtained health care services in 1990 from unconventional medical practitioners, according to a survey reported in the January 27, 1993 New England Journal of Medicine. The practitioners included chiropractors, herbal healers, and massage therapists.

About 25 percent more used some sort of unconventional therapy without going to a practitioner, according to the report.  Unconventional therapy often consisted of taking large doses of vitamins, participating in self-help groups, or lifestyle changes.

The recent survey represents the largest effort yet to assess the use and cost of unconventional and alternative medicine in the United States.  According to the report, Americans spent $13.7 billion ($10.3 billion out-of-pocket) for alternative medical care in 1990.

That same year, they spent just over $2.5 billion more (or $12.8 billion) in out-of-pocket expenses for hospital bills.  The total amount spent on hospitalization through insurance claims in the United States was more than $250 billion.

The therapies included in the study were:

1. Relaxation techniques
2. Chiropractic
3. Message
4. Therapeutic imagery
5. Spiritual healing
6. Commercial weigh-loss programs
7. Lifestyle diets such as macrobiotics
8. Herbal medicine
9. Megavitamin therapy
10. Energy healing
11. Biofeedback
12. Hypnosis
13. Homeopathy
14. Acupuncture
15. Folk remedies
16. Self-help groups

The survey consisted of interviews with 1,539 English-speaking American adults about the types of medical care they had used in the previous 12 months.  While part of the interview included questions about the 16 unconventional medical therapies listed above, researchers did not tell the interviewees that alternative health care was the subject of the study.

Researchers were unable to conclude, however, how much of the therapy (for example relaxation training, biofeedback and self-help groups) was obtained as part of recommended therapy by “conventional” health care practitioners in mainstream medicine.

For example, many medical doctors (M.D.s) now prescribe:

1. Relaxation therapy for individuals with heart problems.
2. Biofeedback for individuals who suffer frequent headaches.
3. Self-help groups.
4. Lifestyle modification.

According to the researchers, about 55 percent of the treatments were covered at all by health insurance, and 90 percent were undertaken without the recommendation of a physician.

The survey also found that:

1. Among those reporting a “principal medical condition” (including arthritis, back pain, digestive problems, depression and several other disorders) only 4 percent visited an unconventional practitioner without also seeing a physician.
2. No person who had cancer, diabetes, lung disease, skin disease, high blood pressure, urinary problems or dental problems saw an unconventional therapist exclusively, without also seeing a physician.
3. Unconventional therapies were sought most often for back problems, anxiety, headaches, chronic pain, and cancer. The prevalence of use ranged from 36 percent of back-pain sufferers to 24 percent of cancer patients.
4. Unconventional therapies was used most often among people between the ages of 25 and 49, those with some college education, and individuals with annual incomes greater than $35,000.
5. Unconventional therapies were less commonly used among black Americans. (Latin-Americans and Asian-Americans who did not speak English were not included in the survey.)
6. In seven of 10 cases, individuals using unconventional therapy did not tell their physicians about it.