Despite dire warnings from the American Medical Association and other conventional health advocates, Americans are continuing to follow their instincts and use alternative therapies to ease their ills.

A new study by David Eisenberg, M.D., author of groundbreaking research on alternative medicine conducted in 1990, has found that more Americans than ever are using alternative medicine, and even preferring to see alternative practitioners over their primary-care doctors. Total visits to alternative medicine practitioners jumped 47% from 427 million in 1990, to 629 million in 1997. And, during that period, the 629 million trips to alternative providers easily topped the 386 million visits to primary-care doctors.

The research team, led by Eisenberg, of Beth Israel Deaconess Medical Center in Boston, conducted a telephone survey of over 1,500 adults in 1990, then repeated the survey among more than 2,000 adults in 1997. They discovered that four out of 10 Americans paid an estimated $21.2 billion for alternative services including herbal medicine, megavitamins, homeopathy, chiropractic and acupuncture. Of this sum, $12.2 billion was out-of-pocket (not reimbursed by insurance companies).

The study, published in The Journal of the American Medical Association (Nov. 11, 1998), found that in both the 1990 and 1997 surveys, alternative medicine was used most frequently for chronic conditions including back and neck problems, anxiety, arthritis and headaches. The researchers also found, however, that patients still tend not to tell their primary care physicians about their forays into alternative medicine. Less than 40% in both the 1990 and 1997 surveys disclosed use of alternative therapies to their conventional physicians. This caused some concern among the researchers because they also determined that one in five people take prescription medications while taking herbs or high-dose vitamins.

Use of alternative therapies was significantly more common among women (48.9%) than men (37.8%), and less common among African Americans (33.1%) than other racial groups (44.5%). People aged 35 to 49 years reported higher rates of use (50.1%) than people either older (39.1%) or younger (41.8%).

The researchers also found that 42% of all alternative therapies are used to treat existing illness, while 58% are used to prevent illness or enhance health maintenance.

Alternative medicine, defined in the study as medical interventions that are neither taught widely in medical schools nor generally available in U.S. hospitals, have garnered increased attention from the media, the medical community, government agencies and the public in recent years. As a result, an increasing number of U.S. insurance companies and managed care organizations now offer some alternative medicine programs and benefits, and the majority of U.S. medical schools offer courses in alternative therapies.