Number 18 n July 30, 2009

Costs of Complementary and Alternative Medicine

(CAM) and Frequency of Visits to CAM Practitioners:

United States, 2007

by Richard L. Nahin, Ph.D., M.P.H., National Institutes of Health; Patricia M. Barnes, M.A.;

Barbara J. Stussman, B.A.; and Barbara Bloom, M.P.A., Division of Health Interview Statistics

Abstract

Objective—This report presents selected estimates of costs of complementary

and alternative medicine (CAM) use among U.S. adults, the frequency of visits

made to CAM providers, and the frequency of purchases of self-care CAM

therapies. Data from the 2007 National Health Interview Survey (NHIS), which

is conducted by the Centers for Disease Control and Prevention’s National Center

for Health Statistics, are used in this report.

Methods—Estimates were derived from the Complementary and Alternative

Medicine Supplement of the 2007 NHIS, sponsored by the National Center for

Complementary and Alternative Medicine, which is part of the National Institutes

of Health. Estimates were generated using the SUDAAN statistical package to

account for the NHIS complex sample design.

Results—In 2007, adults in the United States spent $33.9 billion out of

pocket on visits to CAM practitioners and purchases of CAM products, classes,

and materials. Nearly two-thirds of the total out-of-pocket costs that adults spent

on CAM were for self-care purchases of CAM products, classes, and materials

during the past 12 months ($22.0 billion), compared with about one-third spent

on practitioner visits ($11.9 billion). Despite this emphasis on self-care therapies,

38.1 million adults made an estimated 354.2 million visits to practitioners of

CAM. About three-quarters of both visits to CAM practitioners and total

out-of-pocket costs spent on CAM practitioners were associated with

manipulative and body-based therapies. A total of 44% of all out-of-pocket costs

for CAM, or about $14.8 billion, was spent on the purchase of nonvitamin,

nonmineral, natural products.

Keywords: complementary and alternative medicine c National Health Interview

Survey

Introduction

Complementary and alternative

medicine (CAM) comprises a diverse set

of healing philosophies, therapies, and

products (1). Over the last decade, the

U.S. public has shown a steady and

substantial use of complementary and

alternative medicine, with 2007

estimates placing overall prevalence of

use at 38.3% of adults (83 million

persons) and 11.8% of children (8.5

million children under age 18 years) (2).

The most recent national estimates of

out-of-pocket expenditures for CAM

therapies are now more than a decade

old (3). In their 1997 telephone survey,

Eisenberg et al (3) contacted a

nationally representative sample of

2,055 individuals aged 18 years or older,

with a weighted response rate of 60%.

At that time, the total out-of-pocket

expenditure for CAM use in adults was

estimated at $27.0 billion per year, with

$12.2 billion of the total going toward

payment of CAM professionals such as

acupuncturists, chiropractors, and

massage therapists.

This report is based on a CAM

survey supplement administered as part

of the sample adult questionnaire of the

2007 National Health Interview Survey

(NHIS). The report focuses on the

out-of-pocket expenditures on CAM.

Estimates of total cost and cost per visit

for all CAM therapies used, as well as

prevalence of use of individual CAM

therapies and the associated per-visit

costs to a CAM provider, are presented.

The report also examines the number of

visits made to CAM providers in a

12-month period. A previous report

discussed the prevalence of CAM use

among adults and children (2).

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2	 National Health Statistics Reports n Number 18 n July 30, 2009

Methods

Data source

The statistics shown in this report

are based on data from the Adult

Complementary and Alternative

Medicine supplement of the 2007 NHIS

(4). NHIS, which is in the field

continuously, is conducted by the

Centers for Disease Control and

Prevention’s National Center for Health

Statistics. It is a survey of a nationally

representative sample of the civilian,

noninstitutionalized household

population of the United States. In the

family section, basic health and

demographic information is collected on

all household members. All adult

members of the household who are

home at the time of the interview are

invited to participate and respond for

themselves, with proxy responses

allowed for persons unavailable at the

time of the interview. Additional

information is collected on one

randomly selected adult aged 18 years

or over (sample adult) and one

randomly selected child aged 0–17 years

(sample child) in each family.

Information on the sample adult is

self-reported except in rare cases when

the sample adult is physically or

mentally incapable of responding, and

information on the sample child is

collected from an adult who is

knowledgeable about the child’s health,

usually a parent.

The 2007 CAM supplement was

administered to sample adults and

respondents for sample children. It

included questions on 36 types of CAM

therapies used in the United States,

including 10 types of provider-based

CAM therapies (e.g., acupuncture,

chiropractic and osteopathic

manipulation, traditional healers) and 26

other CAM therapies for which the

services of a provider are not necessary

(e.g., nonvitamin, nonmineral, natural

products; special diets; movement

therapies); see ‘‘Technical Notes,’’

‘‘Definition of terms,’’ for a list and

descriptions of all 36 CAM therapies.

Following the taxonomy of

unconventional health care proposed by

Kaptchuk and Eisenberg (1), stress

management classes, support groups,

and religious (faith) healing are not

included in the definition of CAM used

in this report, although questions on

their use were included in the CAM

supplement. Within the CAM

supplement, one section asked about

participants’ use of ‘‘herbal

supplements.’’ This section queried

participants on a list of 45 dietary

supplements that went beyond the

category of ‘‘herbal supplements’’ to

include such items as androstenedione,

carnitine, creatine, DHEA, fish oils,

glucosamine, lutein, lycopene,

melatonin, omega fatty acids, prebiotics

or probiotics, and SAM-e, but not

vitamins or minerals. Therefore, to more

correctly label this extensive set of

dietary supplements in this report, this

group of supplements is referred to as

nonvitamin, nonmineral, natural

products.

Inclusion and development of the

2007 CAM supplement was supported

by seven institutes, centers, or offices of

the National Institutes of Health:

+	 National Center for Complementary

and Alternative Medicine

+	 National Heart, Lung and Blood

Institute

+	 National Institute of Allergy and

Infectious Disease

+	 National Institute of Child Health and

Human Development

+ National Institute of Mental Health

+	 Office of Behavioral and Social

Science Research

+ Office of Dietary Supplements

Strengths and limitations of

the data

A major strength of the NHIS CAM

data is that they were collected for a

nationally representative sample of U.S.

adults, allowing estimation of CAM use

for a wide variety of population

subgroups. The large sample size also

facilitates investigation of the

association between CAM and a wide

range of other self-reported health

characteristics included in the NHIS,

such as health behaviors, chronic health

conditions, injury and poisoning

episodes, access to medical care, and

health insurance coverage.

The NHIS questions have several

limitations: 1) The questions are

dependent on respondents’ memory and

their willingness to report use

accurately. 2) The collection of survey

data at a single point in time results in

an inability to produce consecutive

annual prevalence estimates, and can

reduce the ability to produce reliable

prevalence estimates for small

population subgroups, as this could

require a larger sample and more than

one year of data. 3) The total costs per

person for nonvitamin, nonmineral,

natural products and homeopathy were

calculated by multiplying the amount

spent at the most recent purchase by the

number of purchases per year. Because

data were not available for the exact

cost at each purchase, and the most

recent purchase may not have been

typical of the respondent’s usual

purchase of CAM products, the

estimates may contain errors.

Statistical analysis

In 2007, NHIS interviews were

completed in 29,266 households, which

yielded 75,764 persons in 29,915

families and a household response rate

of 87.1%. This report is based on data

from 23,393 completed interviews with

sample adults aged 18 years and over.

The final 2007 sample adult response

rate was 67.8%. Procedures used in

calculating response rates are detailed in

Appendix I of the Survey Description

Document, NHIS data files (5).

All estimates and associated

standard errors shown in this report

were generated using SUDAAN, a

software package designed to account

for a complex sample design such as

that of NHIS (6). All estimates for

adults were weighted, using the sample

adult record weight, to represent the

U.S. civilian, noninstitutionalized

population aged 18 years and over.

Estimates were calculated using

recodes for the number of times the

respondent saw various CAM

practitioners, the amount paid out of

pocket for each CAM practitioner visit,
National Health Statistics Reports n Number 18 n July 30, 2009	 Page 3

the number of times self-care therapies

were purchased, and the amount paid

out of pocket for the self-care therapy

(see ‘‘Technical Notes,’’ ‘‘Calculation of

estimates,’’ for a detailed explanation of

the recodes and ‘‘Definition of terms’’

for definitions of CAM practitioner and

self-care therapies). Persons with

unknown CAM information have been

excluded from the analysis.

In tables shown in this report,

estimates with a relative standard error

of more than 30% but less than or equal

to 50% are identified with an asterisk

(*), indicating that they are statistically

unstable due to small sample size.

Estimates with a relative standard error

of greater than 50% are indicated with a

dagger (†) and are not shown.

Results

Out-of-pocket costs for CAM

(figure)

+ In 2007, adults in the United States

spent $33.9 billion out of pocket on

visits to CAM practitioners and

purchases of CAM products, classes,

and materials (see figure).

+ Nearly two-thirds of the total

out-of-pocket costs that adults spent

on CAM were for self-care purchases

of CAM products, classes, and

materials during the past 12 months

($22.0 billion) compared with about

one-third spent on practitioner visits

($11.9 billion) (see figure).

+ A total of 44% of all out-of-pocket

costs for CAM was spent on the

purchase of nonvitamin, nonmineral,

natural products (see figure).

CAM practitioner therapies

(Tables 1–3)

+ In 2007, 38.1 million adults made an

estimated 354.2 million visits to

CAM practitioners, at an estimated

out-of-pocket cost of $11.9 billion

dollars (Table 1).

+ About three-quarters of both visits to

CAM practitioners and total out-ofpocket costs spent on CAM

practitioners during the past 12

months were associated with

Total costs: $33.9 billion 

Self-care costs 

$22.0 billion 

(64.8%) 

Practitioner costs 

$11.9 billion 

(35.2%) 

1 Nonvitamin, nonmineral, natural products. 

NOTES: Percentage refer to the total out-of-pocket costs in 2007. Totaling individual self-care cost percentages is affected by 

rounding. Estimates are based on household interviews of a sample of the civilian, noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2007. 

Figure. Out-of-pocket costs for complementary and alternative medicine among adults

aged 18 years and over: United States, 2007

manipulative and body-based

therapies (Table 1).

+	 On average, adults in the United

States spent $121.92 per person for

visits to CAM providers and paid

$29.37 out of pocket per visit. Some

of the highest per-person, out-ofpocket costs are associated with visits

to practitioners of naturopathy and

chelation therapy, while one of the

lowest per-person, out-of-pocket costs

is associated with visits to

practitioners of chiropractic or

osteopathic manipulation therapy

(Table 2).

+	 For most types of CAM therapies, the

majority of adults spent less than $50

per visit to a practitioner. However, at

least 20% of persons visiting

practitioners of acupuncture,

homeopathy, naturopathy, massage,

and hypnosis therapy paid $75 or

more per visit (Table 3).

CAM self-care therapies

(Tables 4–5)

+	 Nonvitamin, nonmineral, natural

products ($14.8 billion) accounted for

the majority of out-of-pocket dollars

spent on CAM self-care purchases

(Table 4).

+	 Adults who made CAM self-care

purchases spent a total of $4.1 billion

out of pocket on yoga, tai chi, or

qigong classes (Table 4).

NVNMNP1 

$14.8 billion (43.7%) 

Yoga, tai chi, qigong classes 

$4.1 billion (12.0%) 

Homeopathic medicine 

$2.9 billion (8.7%) 

Relaxation techniques 

$0.2 billion (0.6%) 

+	 Adults spent $2.9 billion out of

pocket on the purchase of

homeopathic medicine in 2007

(Table 4).

+	 Across categories of self-care CAM

products, most adults who purchased

the products spent less than $30 per

purchase. However, about 5% of

individuals who bought nonvitamin,

nonmineral, natural products or who

purchased self-help materials to learn

relaxation techniques spent more than

$120 per purchase (Table 5).

Discussion

Using data from the 2007 NHIS, we

estimate that U.S. adults spent about

$33.9 billion out of pocket on visits to

CAM practitioners and on purchases of

CAM products, classes, and materials.

This equates to 1.5% of total health-care

expenditures in the United States and to

11.2% of out-of-pocket health-care

expenditures (7). Almost two-thirds of

CAM costs were associated with

self-care therapies such as nonvitamin,

nonmineral, natural products;

homeopathic products; and yoga. Of

this, the public spent $14.8 billion out

of pocket to purchase nonvitamin,

nonmineral, natural products—about

31% of the amount that the public spent

out of pocket to buy pharmaceutical

drugs in 2007 ($47.6 billion) (7). The

public also spent $12.4 billion out of

pocket on visits to CAM providers, or
Page 4 National Health Statistics Reports n Number 18 n July 30, 2009

25% of that spent out of pocket for

conventional physician services ($49.6

billion) (7).

It has been 10 years since the last

national estimates on the cost of CAM

and on the number of visits to CAM

providers were made by Eisenberg and

colleagues (3). That survey varied from

the 2007 NHIS in several ways,

including being a telephone survey and

collecting information differently on the

cost of CAM therapies. Nevertheless,

comparisons between the two surveys

are of special interest given that they

collected information on an overlapping,

if not identical, set of CAM therapies

and that both provide national estimates

of costs and visits.

The greatest contrast between the

two surveys concerns the relative

amount of out-of-pocket dollars spent on

CAM providers compared with self-care

CAM therapies such as homeopathic

products, yoga, and nonvitamin,

nonmineral, natural products. The

present observation that about two-thirds

of CAM costs were associated with

self-care therapies contrasts with the

findings of Eisenberg et al. (3), who

reported that the majority of CAM costs

resulted from consultations with

health-care professionals offering CAM

services (3). While these differences

may be partly attributed to variations in

survey methodology, they are consistent

with the hypothesis that the use of

self-care therapies has increased and the

use of CAM health-care professionals

has decreased. For instance, using the

Consumer Price Index and expressing

1997 costs in 2007 dollars, the out-ofpocket costs in 2007 for CAM

practitioner services ($11.9 billion) fell

outside the range calculated by

Eisenberg et al. ($15.8 billion–$25.3

billion) (3), while the NHIS cost

estimate of nonvitamin, nonmineral,

natural products is more than twice that

estimated by Eisenberg et al. ($14.8

billion vs. $6.6 billion). Some of these

differences in estimated expenditures

may be the result of differences in how

nonvitamin, nonmineral, natural

products were operationally defined in

the two surveys, or in how cost per

purchase was determined, or other

differences in survey design and

implementation. However, these

estimated expenditures are broadly

consistent with industry sales data that

also demonstrate a large increase in

expenditures for nonvitamin,

nonmineral, natural products between

1997 and 2007 (8). Industry sales data,

however, suggest lower total

expenditures for homeopathic medicine

than the estimates derived here (9).

Comparison of the two surveys

suggests that the number of visits U.S.

adults make to CAM practitioners has

dropped by about 50% since

1997—628.8 million or 3,176 visits per

1,000 adults in 1997 (3) compared with

354.2 million or 1,592 visits per 1,000

adults in 2007. The Eisenberg et al.

estimate of visits to CAM providers (3)

was even somewhat similar in size to

the total number of office visits to

physicians [M.D. and doctor of

osteopathy (D.O.)] in 1997 (787.4

million) (10). However, the estimated

number of office visits to CAM

providers in the 2007 NHIS is

substantially lower than the projected

number of visits to physicians (M.D.

and D.O.) for 2007 (more than 902.0

million visits) (11). While some of these

discrepancies may result from the

different methodologies used in the two

surveys, as well as the different types of

CAM therapies queried, the 2007 NHIS

data suggest that a major factor in the

reduction in visits to CAM providers in

2007 compared with 1997 was a decline

in the number of adults who sought care

from these practitioners and the

frequency of this care.

The two practitioner groups that had

the largest reduction in visits in 2007

compared with 1997 were practitioners

of energy-healing therapies and the

various relaxation techniques. Together,

the drop in visits to these two groups of

practitioners accounted for about half of

the total decrease in 2007 from 10 years

earlier. Visits to practitioners of

relaxation techniques declined from

103.2 million in 1997 (521.2 visits per

1,000 adults) (3) to 28.9 million in 2007

(128.9 visits per 1,000 adults), while

visits to energy healers decreased from

40.0 million in 1997 (201.9 visits per

1,000 adults) (3) to 7.2 million in 2007

(32.4 visits per 1,000 adults).

Underlying these declines in the number

of visits is a corresponding decrease in

the numbers of persons who sought care

from practitioners. While 15.3% of

persons who used relaxation techniques

sought care from a practitioner of

relaxation techniques in 1997 (3), the

proportion dropped to 9.0% in 2007. For

those who saw a practitioner, the

number of visits per person in 2007 was

about one-fifth of that observed in 1997:

3.5 visits per person compared with 20.9

visits per person (3), respectively.

Approximately twice as many

individuals bought a self-help book or

other materials to learn relaxation

techniques in 2007 (6.4 million) as saw

a practitioner (3.1 million), suggesting

that relaxation techniques are used

primarily as self-care. Similarly, the

percentage of the adult population who

saw a practitioner of energy-healing

therapy declined by half in 2007 (0.5%)

compared with 1997 (1.0%), while the

number of visits per person dropped by

almost 90%, from 20.2 visits per person

in 1997 to 2.3 visits per person in 2007

(2,3).

Despite the overall decrease in

visits to CAM providers in 2007

compared with 1997, visits to

acupuncturists, a progressively more

regulated and professionalized CAM

provider group, increased over this same

time period, with 17.6 million visits

estimated for 2007 (79.2 visits per 1,000

adults), or three times that observed in

1997 (27.2 visits per 1,000 adults) (3).

The increase for acupuncture may in

part be due to the greater number of

states that license this practice and a

corresponding increase in the number of

licensed practitioners in 2007 compared

with 1997, as well as increased

insurance coverage for these therapies.

Large numbers of articles in the lay

press about the benefits of acupuncture

were published during this period,

increasing awareness in the general

population. Together, greater opportunity

and increased awareness may explain

much of the observed increase in adult

use of acupuncture.

In summary, NHIS data indicate

that the U.S. public makes more than

300 million visits to CAM providers

each year and spends billions of dollars
National Health Statistics Reports

n Number 18n July 30, 2009	 Page5

for these services, as well as for

self-care forms of CAM. These

expenditures, althougha small fraction

of total health-care spending in the

United States, constitutea substantial

part of out-of-pocket health-care costs

and are comparable to out-of-pocket

costs for conventional physician services

and prescription drug use.

References

1.Kaptchuk TJ, Eisenberg DM.

Varieties of healing. 2:A taxonomy

of unconventional healing practices.

Ann Intern Med 135(3):196–204.9.

August 7, 2001.

2.Barnes PM, Bloom B, Nahin RL.

Complementary and alternative

medicine use among adults and

children: United States, 2007.

National health statistics reports; no

12. Hyattsville, MD: National Center

for Health Statistics. 2008.

3.Eisenberg DM, Davis RB, Ettner SL,

Appel S, Wilkey S, et al. Trends in

alternative medicine use in the

United States, 1990–1997: Results of a follow-up national survey. JAMA

280(18):1569–75. November 11,

1998.

4.National Center for Health Statistics.

National Health Interview Survey

(NHIS): 2007 data release [online].

Available from: http://www.cdc.gov/

nchs/nhis/nhis_2007_data_release.

htm.

5.National Center for Health Statistics.

National Health Interview Survey

(NHIS): Public-use data release.

NHIS survey description [online].

Available from: ftp://ftp.cdc.gov/pub/

Health_Statistics/NCHS/Dataset_

Documentation/NHIS/2007/

srvydesc.pdf. 2008.

6.

Research Triangle Institute.

SUDAAN (Release 9.0.1) [computer

software]. Research Triangle Park,

NC: Research Triangle Institute.

2005.

7.Center for Medicare& Medicaid

Services. National Health

Expenditure Projections 1960–2007

[online]. Available from: http://

www.cms.hhs.gov/National

HealthExpendData/01_Overview.

asp#TopOfPage. Accessed December

14, 2008.

8.Nutrition Business Journal.

Supplement Business Report 2006.

p 31. San Diego, CA: Penton Media,

Inc. 2008.

9.Nutrition Business Journal.

Supplement Business Report 2006.p

202. San Diego, CA: Penton Media,

Inc. 2008.

10. Woodwell DA. National Ambulatory

Medical Care Survey: 1997

summary. Advance data from vital

and health statistics; no 305.

Hyattsville, MD: National Center for

Health Statistics. 1999.

11. Cherry DK, Hing E, Woodwell DA,

Rechtsteiner EA. National

Ambulatory Medical Care Survey:

2006 summary. National health

statistics reports; no 3. Hyattsville,

MD: National Center for Health

Statistics. 2008.

12. Willson S, Stussman B, Maitland A,

Nahin RL. The role of self concept

in answering survey questions on

complementary and alternative

medicine: Challenges to and

strategies for improving data quality.

Submitted toa refereed journal.
s of persons aged 18 years and over who saw a practitioner for selected complementary and alternative medicine therapies during the past

er year, and total out-of-pocket costs per year, by type of therapy: United States, 2007

Saw a practitioner

Total out-of-pocket

Total persons1 Total visits per year costs per year (dollars)

Percent Percent Percent

Number (standard Number (standard Number (standard

(thousands) error) (thousands) error) (thousands) error)

........ 38,146 100.0 354,203 100.0 11,938,611 100.0
 

........ 4,965 13.1 (0.72) 27,734 7.8 (0.57) 1,392,508 11.7 (1.10)
 

........ 3,141 8.2 (0.55) 17,629 5.0 (0.44) 827,336 6.9 (0.86)
 

........ 214 *0.6 (0.18) 1,068 † 18,793 *0.2 (0.07) 
 

........ 862 2.3 (0.30) 3,411 1.0 (0.15) 167,416 1.4 (0.30)
 

........ 729 1.9 (0.26) 3,180 0.9 (0.15) 275,863 2.3 (0.44)
 

........ 812 2.1 (0.35) 2,446 0.7 (0.14) 103,100 *0.9 (0.30)
 

........ 1,828 4.8 (0.40) 9,600 2.7 (0.34) 630,479 5.3 (1.11)

........ 111 *0.3 (0.11) 426 *0.1 (0.06) 31,913 *0.3 (0.11)

cts2...... 1,488 3.9 (0.38) 8,273 2.3 (0.33) 566,650 4.7 (1.11)

........ 270 0.7 (0.15) 902 *0.3 (0.08) 31,916 †

........ 33,044 86.7 (0.69) 276,861 78.2 (1.09) 8,629,455 72.3 (2.08)
 

........ 18,740 49.2 (1.07) 151,220 42.7 (1.16) 3,901,894 32.7 (1.81)
 

........ 18,068 47.4 (0.98) 95,296 26.9 (0.86) 4,175,124 35.0 (1.53)
 

........ 3,146 8.3 (0.52) 30,345 8.6 (0.67) 552,438 4.6 (0.87)
 

........ 3,821 10.2 (0.59) 32,806 9.3 (0.79) 864,567 7.2 (1.25)
 

........ 362 1.0 (0.22) 1,991 0.6 (0.15) 83,542 † 
 

........ 3,131 8.3 (0.54) 28,882 8.2 (0.75) 707,175 5.9 (1.16)
 

........ 561 1.5 (0.24) 1,933 0.5 (0.15) 73,850 0.6 (0.16) 
 

........ 1,216 3.2 (0.31) 7,203 2.0 (0.36) 421,602 *3.5 (1.09)
 

tandard error of greater than 30% and less than or equal to 50% and do not meet the standards of reliability or precision.
 

50% are indicated with a dagger, but are not shown.
 

dividual therapies are greater than the total number and 100% because respondents could choose more than one therapy. The totals of the numbers and percentages of the five therapy groups are
 

pondents could choose more than one therapy and would therefore be counted in more than one group.
 

HE PAST 12 MONTHS, how many times did you see a practitioner for {fill in therapy}?’’ and ‘‘On average, how much did you pay out-of-pocket for each visit to a practitioner for {fill in therapy}?’’
 

erbero or Yerbera, Shaman, Botanica, Native American Healer/Medicine Man, and Sobador. Estimates are based on the questions, ‘‘DURING THE PAST 12 MONTHS, how many times did you see a {fill
 

id you pay out-of-pocket for each visit to a {fill in traditional healer}?’’
 

biotic diet, Atkins diet, Pritikin diet, Ornish diet, Zone diet, and South Beach diet.
 

technique, Pilates, and Trager Psychophysical Integration. Estimates are based on the questions, ‘‘DURING THE PAST 12 MONTHS, how many times did you see a practitioner or teacher for {fill in
 

d you pay out-of-pocket for each visit to a practitioner or teacher for {fill in movement therapy}?’’
 

agery, progressive relaxation, and deep-breathing exercises. Estimates are based on the questions, ‘‘DURING THE PAST 12 MONTHS, did you see a practitioner or take a class for {fill in relaxation
 

y out-of-pocket for each visit to a practitioner or to take a class for {fill in relaxation technique}?’’
 

e persons with unknown complementary and alternative medicine information. Estimates are based on household interviews of a sample of the civilian, noninstitutionalized population.

ew Survey, 2007.

Page6 National Health Statistics Reportsn Number 18n July 30, 2009
e intervals) number of visits per person, median out-of-pocket costs per person, and median out-of-pocket costs per visit for persons aged 18
 

er for selected complementary and alternative medicine therapies during the past 12 months, by type of therapy: United States, 2007
 

Saw a practitioner

Out-of-pocket

Number of visits costs per person Out-of-pocket cost

per person (dollars) per visit (dollars)

Median (95% confidence interval)
 

. . . . . . . . . . 3.86 (3.49–4.42) 121.92 (114.69–141.55) 29.37 (29.05–30.76)
 

.......... 2.83 (2.65–3.01) 101.00 ( 86.91–136.03) 39.59 (33.56–48.40)
 

.......... § § § 
 

.......... 2.00 (1.47–2.52) *86.73 ( 36.38–155.81) 32.16 (12.18–39.81)
 

.......... § *28.57 ( 7.37– 48.50) 19.00 ( 5.39–27.27)
 

.......... 2.13 (1.53–2.74) 97.86 ( 65.32–178.40) 29.62 (23.81–45.30)
 

.......... § 224.52 (133.12–315.80) §
 

.......... 2.32 (1.70–2.98) *102.16 ( 67.50–190.39) 32.90 (27.21–46.86)
 

.......... § § § 
 

.......... 3.43 (3.33–3.69) 121.30 (114.38–142.77) 29.45 (29.13–29.77)
 

.......... 3.45 (3.28–3.89) 104.29 ( 88.15–119.45) 21.62 (19.73–24.30)
 

.......... § † 44.06 (20.52–61.31)
 

.......... 2.26 (1.69–2.88) *59.58 (36.22–131.22) 28.47 (14.43–43.72)
 

.......... 2.42 (2.10–2.75) 122.35 (100.10–171.31) 48.25 (38.40–49.50)
 

.......... 1.98 (1.48–2.42) 251.84 (102.11–333.99) 63.25 (45.23–91.69)
 

.......... 2.16 (2.01–2.31) 136.73 (107.17–144.60) 46.65 (45.46–47.82)
 

.......... 4.98 (3.46–6.57) † *4.55 ( 0.36– 8.31)
 

.......... *3.22 (2.67–7.07) § §
 

.......... 2.38 (1.37–3.41) § §
 

.......... 3.47 (2.96–5.89) § §
 

of the data, it was not possible to estimate confidence interval boundaries, and the median is not shown.

tandard error of greater than 30% and less than or equal to 50% and do not meet the standard of reliability or precision.

50% are indicated with a dagger, but are not shown.
 

HE PAST 12 MONTHS, how many times did you see a practitioner for {fill in therapy}?’’ and ‘‘On average, how much did you pay out-of-pocket for each visit to a practitioner for {fill in therapy}?’’
 

erbero or Yerbera, Shaman, Botanica, Native American Healer/Medicine Man, and Sobador. Estimates are based on the questions, ‘‘DURING THE PAST 12 MONTHS, how many times did you see a {fill
 

id you pay out-of-pocket for each visit to a {fill in traditional healer}?’’
 

biotic diet, Atkins diet, Pritikin diet, Ornish diet, Zone diet, and South Beach diet.
 

technique, Pilates, and Trager Psychophysical Integration. Estimates are based on the questions, ‘‘DURING THE PAST 12 MONTHS, how many times did you see a practitioner or teacher for {fill in
 

d you pay out-of-pocket for each visit to a practitioner or teacher for {fill in movement therapy}?’’
 

agery, progressive relaxation, and deep-breathing exercises. Estimates are based on the questions, ‘‘DURING THE PAST 12 MONTHS, did you see a practitioner or take a class for {fill in relaxation
 

y out-of-pocket for each visit to a practitioner or to take a class for {fill in relaxation technique}?’’
 

unknown complementary and alternative medicine information. Estimates are based on household interviews of a sample of the civilian, noninstitutionalized population.

ew Survey, 2007.

National Health Statistics Reportsn Number 18n July 30, 2009 Page7
tandard errors) of average out-of-pocket costs per visit to a practitioner for complementary and alternative medicine therapy, for persons

ractitioner for that type of therapy during the past 12 months, by therapy: United States, 2007

Practitioner costs (dollars)

0–24 25–49 50–74 75–99 100 or more Total

Percent distribution (standard error)

.......... 32.4 ( 3.12) 16.2 (2.23) 25.6 (2.75) 10.9 (2.15) 14.9 ( 2.49) 100.0

.......... *52.4 (15.99) † † † † 100.0

.......... 44.2 ( 6.98) *20.1 (6.75) *10.1 (3.49) *5.7 (2.43) 19.8 ( 5.04) 100.0

.......... 22.9 ( 5.24) *14.8 (4.50) *13.2 (4.51) *11.9 (5.37) 37.2 ( 6.10) 100.0

.......... 57.4 ( 7.03) 15.7 (4.30) *6.8 (3.21) – *20.1 ( 7.45) 100.0

.......... † † † † *51.0 (19.56) 100.0

.......... 35.4 ( 4.63) 21.1 (4.34) 22.3 (4.21) *5.0 (2.41) 16.2 ( 3.70) 100.0

.......... 69.3 (10.56) † † – † 100.0

apies

. . . ....... 50.4 ( 1.39) 34.9 (1.41) 8.4 (0.86) 2.2 (0.42) 4.1 ( 0.53) 100.0

.......... 27.4 ( 1.30) 18.5 (1.20) 31.8 (1.41) 11.0 (0.91) 11.2 ( 0.85) 100.0

.......... 74.4 ( 2.88) 14.9 (2.52) 7.0 (1.64) † *2.7 ( 0.86) 100.0

.......... 58.5 (11.95) † † † *23.1 (11.04) 100.0
 

.......... 71.6 ( 3.29) 9.6 (2.22) *7.2 (2.28) *2.7 (1.14) 8.9 ( 1.79) 100.0
 

.......... 38.9 ( 8.31) *11.9 (5.28) *16.1 (7.59) † 30.6 ( 8.04) 100.0
 

.......... 46.3 ( 4.62) 13.3 (3.42) 15.7 (3.50) *7.6 (2.94) 17.0 ( 3.82) 100.0
 

tandard error of greater than 30% and less than or equal to 50% and do not meet the standards of reliability or precision.

50% are indicated with a dagger, but are not shown.

how much did you pay out-of-pocket for each visit to a practitioner for {fill in therapy}?’’
 

erbero or Yerbera, Shaman, Botanica, Native American Healer/Medicine Man, and Sobador. Estimates are based on the question, ‘‘On average, how much did you pay out-of-pocket for each visit to a {fill
 

biotic diet, Atkins diet, Pritikin diet, Ornish diet, Zone diet, and South Beach diet.
 

technique, Pilates, and Trager Psychophysical Integration. Estimates are based on the question, ‘‘On average, how much did you pay out-of-pocket for each visit to a practitioner or teacher for {fill in
 

agery, progressive relaxation, and deep-breathing exercises. Estimates are based on the question, ‘‘On average, how much did you pay out-of-pocket for each visit to a practitioner or to take a class for
 

de persons with unknown complementary and alternative medicine information. Estimates are based on household interviews of a sample of the civilian, noninstitutionalized population.

ew Survey, 2007.

Page8 National Health Statistics Reportsn Number 18n July 30, 2009
d 18 years and over who purchased selected complementary and alternative medicine therapies or materials, total purchases per year, and

d median (with 95% confidence interval) number of purchases per person, median out-of-pocket costs per person, and median out-of-pocket

y: United States, 2007

Purchases of a therapy or materials

Total

persons

Total

number of

purchases

per year

Total

out-of-pocket

costs per year

(dollars)

Number of

purchases

per person

Out-of-pocket

costs per

person (dollars)

Out-of-pocket

costs per

purchase (dollars)

Number (in thousands) Median (95% confidence interval)

..........

..........

..........

..........

24,905

3,326

5,981

6,442

438,094

69,300

327,207

. . .

14,824,409

2,944,215

4,065,964

187,772

5.41 ( 5.16– 5.65)

1.58 ( 1.20– 1.97)

24.90 (16.94–31.39)

. . .

176.77 (150.52–185.09)

37.99 ( 28.66– 53.08)

*49.43 ( 16.22– 97.16)

18.30 ( 14.89– 18.78)

19.18 (18.12–20.27)

15.28 (14.30–18.92)

4.37 ( 1.39– 5.64)

. . .

tandard error of greater than 30% and less than or equal to 50% and do not meet the standards of reliability or precision.
 

often do you buy herbal supplements?’’ and ‘‘About how much did you spend the last time you bought herbal supplements?’’
 often do you buy homeopathic medicine?’’ and ‘‘About how much did you spend the last time you bought homeopathic medicine?’’
 

HE PAST 12 MONTHS, on average, how often did you take a class or in some way receive formal training for {fill in yoga, tai chi, or qi gong}?’’ and ‘‘On average, how much did you pay out-of-pocket for
 

chi, or qi gong}?’’
 

agery, progressive relaxation, and deep-breathing exercises. Estimates are based on the questions, ‘‘Did you buy a self-help book or other materials to learn about {fill relaxation technique used most}?’’
 

unknown complementary and alternative medicine information. Estimates are based on household interviews of a sample of the civilian, noninstitutionalized population.

ew Survey, 2007.

National Health Statistics Reportsn Number 18n July 30, 2009 Page9
tandard errors) of costs for therapy or materials, for persons aged 18 years and over who purchased that type of therapy or materials, by

Purchased therapy costs (dollars)

Less than 15 15–29 30–59 60–89 90–119 120 or more Total

Percent distribution (standard error)

.......... 26.5 (1.02) 29.4 (1.12) 25.0 (1.02) 9.3 (0.64) 4.4 (0.44) 5.4 (0.52) 100.0

.......... 40.1 (3.58) 30.1 (3.24) 19.8 (2.54) *3.5 (1.14) *3.0 (1.12) *3.4 (1.16) 100.0

.......... 75.2 (2.39) 11.9 (1.64) 8.8 (1.69) *1.3 (0.52) *1.3 (0.47) *1.4 (0.50) 100.0

.......... 36.0 (2.28) 38.8 (2.44) 14.8 (1.79) *2.0 (0.62) 3.7 (0.92) 4.7 (0.98) 100.0

tandard error of greater than 30% and less than or equal to 50% and do not meet the standards of reliability or precision.
 

uch did you spend the last time you bought herbal supplements?’’
 uch did you spend the last time you bought homeopathic medicine?’’
 

how much did you pay out-of-pocket for each class or other formal training for {fill in yoga, tai chi, or qi gong}?’’
 

agery, progressive relaxation, and deep-breathing exercises. Estimates are based on the questions, ‘‘Did you buy a self-help book or other materials to learn about {fill relaxation technique used most}?’’
 

de persons with unknown complementary and alternative medicine information. Estimates are based on household interviews of a sample of the civilian, noninstitutionalized population.

ew Survey, 2007.

Page 10 National Health Statistics Reportsn Number 18n July 30, 2009
National Health Statistics Reports n Number 18 n July 30, 2009 Page 11

Technical Notes

Sample design

The National Health Interview

Survey (NHIS) is a cross-sectional

household interview survey of the U.S.

civilian, noninstitutionalized population.

Data are collected continuously

throughout the year in all 50 states and

the District of Columbia. NHIS uses a

multistage, clustered sample design to

collect data on a variety of health

indicators. Information on basic health

topics is collected for all household

members, if necessary by proxy from

one adult family member. Additional

information is collected from one

randomly selected adult and one

randomly selected child in each family.

Self-response is required for the NHIS

Sample Adult Questionnaire except in

rare cases where sample adults are

physically or mentally incapable of

responding for themselves. Interviews

are conducted in the home using

computer-assisted personal interviews,

or CAPI, with telephone interviewing

permitted for follow-up, if necessary.

Starting in 2006, the sample design

included Asian persons in the NHIS

oversampling of minority populations;

previously, only households with black

and Hispanic persons were oversampled.

The sample adult selection process was

also revised in 2006 so that when black,

Hispanic, or Asian persons aged 65

years or older were present, they had an

increased chance of being selected as

the sample adult.

Response rates

In 2007, NHIS interviews were

completed in 29,266 households, which

yielded 75,764 persons in 29,915

families; the household response rate

was 87.1%. The sample adult

questionnaire was completed by 23,393

persons aged 18 years and over. The

final response rate (which takes into

account household and family

nonresponse) for the 2007 sample adult

file was 67.8%. Procedures used in

calculating response rates are described

in detail in Appendix I of the Survey

Description, NHIS data files (5).

Item nonresponse

For the 2007 complementary and

alternative medicine (CAM) items,

nonresponse ranged from 0.0% to

10.7%, with nonresponse for most items

being less than 5.0%. The denominators

for statistics shown in tables exclude

persons with unknown CAM

information for a given table. Among

the 23,393 interviewed sample adult

respondents in the 2007 NHIS, 610

adults were missing data for all of the

CAM items.

Calculation of estimates

All estimates and associated

standard errors shown in this report

were generated using SUDAAN, a

software package designed to account

for a complex sample design such as

that of NHIS (6). All estimates for

adults were weighted, using the sample

adult record weight, to represent the

U.S. civilian, noninstitutionalized

population aged 18 years and over.

For this analysis, the number of

visits to a CAM provider was calculated

using the midpoint of the interval

containing the number of visits. These

intervals were 2–5 times, 6–10 times,

11–15 times, and 16–20 times. For

response categories of only ‘‘one time’’

and ‘‘more than 20 times,’’ the values of

1 and 21, respectively, were used. To

estimate the out-of-pocket costs per visit

and the costs for purchasing

homeopathic medicine, relaxation

technique materials, and yoga, tai chi,

and qigong classes, the continuous

responses of $0–$499 were retained and

the response of ‘‘$500 or more’’ was

treated as $500. To estimate how often

nonvitamin, nonmineral, natural

products and homeopathic medicine

were purchased, the respondent’s

original answer of times per day, week,

or month was converted into times per

year. The number of times a person took

a yoga, tai chi, or qigong class was

calculated by using the midpoint of the

interval containing the number of times

the person took a class. These intervals

were 2–11 times per year, 2–3 times per

month, 2–3 times per week, and 4–6

times per week. Responses of daily,

times per week, and times per month

were converted into times per year.

Based on prior cognitive testing results

of the Complementary and Alternative

Medicine Supplement of the 2007 NHIS

(12), few respondents report buying

supplements as often as daily. Responses

indicating purchases much more than

365 times per year were therefore

excluded from the analysis as presumed

errors. The question-and-response

categories on which these recodes are

based can be found in the 2007 NHIS

Sample Adult Complementary and

Alternative Medicine Questionnaire at:

ftp://ftp.cdc.gov/pub/Health_Statistics/

NCHS/Survey_Questionnaires/NHIS/

2007/English/qalthealt.pdf. Persons with

unknown CAM information are

excluded from the analysis.

Relative standard error

Estimates with a relative standard

error of more than 30% but less than or

equal to 50% are identified with an

asterisk (*). Estimates with a relative

standard error of greater than 50% are

indicated with a dagger (†) and are not

shown. The relative standard errors are

calculated as:

Relative standard error (as a

percentage) = (SE/Est) 100,

where SE is the standard error of the

estimate and Est is the estimate.

Definition of terms

These definitions were used in the

2007 NHIS and may not reflect existing

scientific evidence on safety, efficacy, or

possible mechanisms of action.

Acupuncture—A family of

procedures involving stimulation of

anatomical points on the body by a

variety of techniques. American

practices of acupuncture incorporate

medical traditions from China, Japan,

Korea, and other countries. The

acupuncture technique that has been

most studied scientifically involves

penetrating the skin with thin, solid,

metallic needles that are manipulated by

the hands or by electrical stimulation.

Alexander technique—A movement

therapy that uses guidance and
Page 12 National Health Statistics Reports n Number 18 n July 30, 2009

education on ways to improve posture

and movement. The intent is to teach a

person how to use muscles more

efficiently to improve the overall

functioning of the body. Examples of

the Alexander technique as CAM are

using it to treat low-back pain and the

symptoms of Parkinson’s disease.

Alternative provider or

practitioner—Someone knowledgeable

about a specific alternative health

practice who provides care or gives

advice about its use, and who usually

receives payment for his or her services.

For some practices, the provider may

have received formalized training and

have been certified by a licensing board

or related professional association. For

example, a practitioner of biofeedback

(biofeedback therapist) usually has

received training in psychology and

physiology, and may be certified by the

Biofeedback Certification Institute of

America.

Atkins diet—A diet emphasizing a

drastic reduction in the daily intake of

carbohydrates (40 grams or less),

countered by an increase in protein and

fat.

Ayurveda—A system of medicine

that originated in India several thousand

years ago. In the United States,

Ayurveda is considered a type of CAM

and a whole medical system. As with

other such systems, it is based on

theories of health and illness and on

ways to prevent, manage, or treat health

problems. Ayurveda aims to integrate

and balance the body, mind, and spirit;

some view it as ‘‘holistic.’’ This balance

is believed to lead to contentment and

health and to help prevent illness.

However, Ayurveda also proposes

treatments for specific health problems,

both physical and mental. A chief aim

of Ayurvedic practices is to cleanse the

body of substances that can cause

disease, in the belief that this helps to

re-establish harmony and balance.

Biofeedback—A method that uses

simple electronic devices to teach clients

how to consciously regulate bodily

functions, such as breathing, heart rate,

and blood pressure, to improve overall

health. Biofeedback is used to reduce

stress, eliminate headaches, recondition

injured muscles, control asthmatic

attacks, and relieve pain.

Botanica—A traditional healer who

supplies healing products, sometimes

associated with spiritual interventions.

CAM practitioner—Someone

knowledgeable about a specific CAM

health therapy who provides care or

gives advice about its use.

Chelation therapy—A chemical

process in which a substance is used to

bind molecules, such as metals or

minerals, and hold them tightly so that

they can be removed from a system,

such as the body. In medicine, chelation

has been scientifically proven to rid the

body of excess or toxic metals. For

example, a person who has lead

poisoning may be given chelation

therapy to bind and remove excess lead

from the body before it can cause

damage.

Chiropractic manipulation—A form

of health care that focuses on the

relationship between the body’s

structure, primarily the spine, and its

function. Doctors of chiropractic, who

are also called chiropractors or

chiropractic physicians, use a type of

hands-on therapy called manipulation

(or adjustment) as their core clinical

procedure.

Complementary and alternative

medicine (CAM)—Therapies not usually

taught in U.S. medical schools or

generally available in U.S. hospitals.

CAM therapies include a broad range of

practices and beliefs such as

acupuncture, chiropractic care,

relaxation techniques, massage therapy,

and herbal remedies. They are defined

by the National Center for

Complementary and Alternative

Medicine as a group of diverse medical

and health care systems, practices, and

products not presently considered to be

part of conventional medicine.

Curandero—A type of traditional

folk healer. Originally found in Latin

America, Curanderos specialize in

treating illness through the use of

supernatural forces, herbal remedies, and

other natural medicines.

Deep-breathing exercises—

Exercises involving slow and deep

inhalation through the nose, usually to a

count of 10, followed by slow and

complete exhalation for a similar count.

The process may be repeated 5 to 10

times, several times a day.

Energy-healing therapy—The

channeling of healing energy through

the hands of a practitioner into the

client’s body to restore a normal energy

balance and, therefore, health. Energy

healing therapy has been used to treat a

wide variety of ailments and health

problems, and is often used in

conjunction with other alternative and

conventional medical treatments.

Espiritista—A traditional healer

who assesses a patient’s condition and

recommends herbs and religious amulets

to improve physical or mental health or

to help overcome a personal problem.

Feldenkrais—A movement therapy

that uses a method of education in

physical coordination and movement.

Practitioners use verbal guidance and

light touch to teach the method through

one-on-one lessons and group classes.

The intent is to help the person become

more aware of how the body moves

through space and to improve physical

functioning.

Guided imagery—A series of

relaxation techniques followed by the

visualization of detailed images, usually

calm and peaceful in nature. When used

in treatment, a person is taught to

visualize his or her body free of the

specific problem or condition. Sessions

are typically 20 to 30 minutes in length

and may be practiced several times a

week.

Hierbero—A traditional healer or

practitioner with knowledge of the

medicinal qualities of plants. Also

known as a yerbera.

Homeopathy—A system of medical

practices based on the theory that any

substance that can produce symptoms of

disease or illness in a healthy person

can cure those symptoms in a sick

person. For example, someone suffering

from insomnia may be given a

homeopathic dose of coffee.

Administered in diluted form,

homeopathic remedies are derived from

many natural sources, including plants,

metals, and minerals.

Hypnosis—An altered state of

consciousness characterized by increased
National Health Statistics Reports n Number 18 n July 30, 2009 Page 13

responsiveness to suggestion. The

hypnotic state is attained by first

relaxing the body, then shifting attention

toward a narrow range of objects or

ideas as suggested by the hypnotist or

hypnotherapist. The procedure is used to

effect positive changes and to treat

numerous health conditions including

ulcers, chronic pain, respiratory

ailments, stress, and headaches.

Macrobiotic diet—A diet low in fat,

emphasizing whole grains and

vegetables and restricting the intake of

fluids. Of particular importance is the

consumption of fresh, nonprocessed

foods.

Massage—Therapy involving the

manipulation of muscle and connective

tissue to enhance function of those

tissues and promote relaxation and

well-being.

Meditation—A group of techniques,

most of which started in Eastern

religious or spiritual traditions, in which

a person learns to focus his or her

attention and suspend the stream of

thoughts that normally occupy the mind.

This practice is believed to result in a

state of greater physical relaxation,

mental calmness, and psychological

balance. Practicing meditation can

change how a person relates to the flow

of emotions and thoughts in the mind.

Native American Healer/Medicine

Man—A traditional healer who uses

information from the ‘‘spirit world’’ in

order to benefit the community. People

see Native American healers for a

variety of reasons, especially to find

relief or a cure from illness or to find

spiritual guidance.

Naturopathy—An alternative

medical system that proposes that a

healing power in the body establishes,

maintains, and restores health.

Practitioners work with the patient with

a goal of supporting this power through

treatments such as nutrition and lifestyle

counseling, dietary supplements,

medicinal plants, exercise, homeopathy,

and treatments from traditional Chinese

medicine.

Nonvitamin, nonmineral, natural

products—Products taken orally that

contain a dietary ingredient intended to

supplement the diet with other than

vitamins and minerals. Examples

include herbs or herbal medicine (as

single herbs or mixtures), other

botanical products such as soy or flax,

and dietary substances such as enzymes

and glandular material. Among the most

popular are echinacea, ginkgo biloba,

ginseng, feverfew, garlic, kava kava, and

saw palmetto. Garlic, for example, has

been used to treat fevers, sore throats,

digestive ailments, hardening of the

arteries, and other health problems and

conditions.

Ornish diet—A high-fiber, low-fat

vegetarian diet that promotes weight

loss and health by controlling what is

eaten, not by restricting the intake of

calories. Fruits, beans, grains, and

vegetables can be eaten at all meals,

while nonfat dairy products such as

skim milk, nonfat cheeses, and egg

whites are to be consumed in

moderation. Products such as oils,

avocados, nuts and seeds, and meats of

all kinds are avoided.

Osteopathic manipulation—A

full-body system of hands-on techniques

to alleviate pain, restore function, and

promote health and well-being.

Pilates—A movement therapy that

uses a method of physical exercise to

strengthen and build control of muscles,

especially those used for posture.

Awareness of breathing and precise

control of movements are integral

components of Pilates. Special

equipment, if available, is often used.

Pritikin diet—A low-fat diet that

allows meat but emphasizes the

consumption of foods with a large

volume of fiber and water, including

many vegetables, fruits, beans, and

natural, unprocessed grains. Also known

as Pritikin Principle.

Progressive relaxation—Techniques

used to relieve tension and stress by

systematically tensing and relaxing

successive muscle groups.

Qigong—An ancient Chinese

discipline combining the use of gentle

physical movements, mental focus, and

deep breathing directed toward specific

parts of the body. Performed in

repetitions, the exercises are normally

performed two or more times a week for

30 minutes at a time.

Self-care therapies—Forms of CAM

that a person can perform alone, even if

training is required. These techniques

can be self-taught with the aid of books

or instructional videos, or learned from

an experienced practitioner. Once the

techniques are learned, a person requires

no additional outside assistance unless

improvement of skills is desired.

Shaman—A traditional healer who

is said to act as a medium between the

invisible spiritual world and the physical

world. Most gain knowledge through

contact with the spiritual world and use

the information to perform tasks such as

divination, influencing natural events,

and healing the sick or injured.

Sobador—A traditional healer who

uses massage and rub techniques in

order to treat patients.

South Beach diet—A diet that

distinguishes between ‘‘good’’ and

‘‘bad’’ carbohydrates and fats. ‘‘Good’’

carbohydrates are those that are digested

relatively slowly, and ‘‘bad’’ fats include

saturated and trans fats. Although the

program does not require a person to

count calories or limit portions, dieters

are encouraged to eat whole-grain foods

and an abundant amount of vegetables.

Tai chi—A mind-body practice that

originated in China as a martial art. A

person doing tai chi moves his or her

body slowly and gently, while breathing

deeply and meditating; the practice is

sometimes called ‘‘moving meditation.’’

Many practitioners believe that tai chi

helps the flow throughout the body of a

proposed vital energy called ‘‘qi.’’ A

person practicing tai chi moves his or

her body in a slow, relaxed, and

graceful series of movements. The

movements, performed alone or in a

group, make up what are called forms,

or routines.

Traditional healer—Someone who

employs any one of a number of ancient

medical practices that are based on

indigenous theories, beliefs, and

experiences handed down from

generation to generation. The methods

employed by each type of traditional

healer have evolved to reflect the

different philosophical backgrounds and

cultural origins of the healer.

Trager Psychophysical

Integration—A movement therapy in

which practitioners apply a series of

gentle, rhythmic rocking movements to
Page 14 National Health Statistics Reports n Number 18 n July 30, 2009

the joints. Practitioners also teach

physical and mental self-care exercises

to reinforce the proper movement of the

body. The intent is to release physical

tension and increase the body’s range of

motion. An example of Trager

Psychophysical Integration as CAM is

using it to treat chronic headaches.

Vegetarian diets—Diets that are

totally devoid of meat, red or white.

However, numerous variations are

followed on the nonmeat theme. For

example, some vegetarian diets are

restricted to plant products only, while

others may include eggs and dairy

products. Another variation limits

consumption to raw fruit, sometimes

supplemented with nuts and vegetables.

Others prohibit alcohol, sugar, caffeine,

or processed foods.

Yerbera—See hierbero.

Yoga—A practice that combines

breathing exercises, physical postures,

and meditation to calm the nervous

system and balance body, mind, and

spirit. Usually performed in classes,

sessions are conducted once a week or

more and roughly last 45 minutes.

Zone diet—A diet in which each

meal consists of a small amount of

low-fat protein, fats, and fiber-rich fruits

and vegetables. Its basic goal is to alter

the body’s metabolism by controlling

the production of key hormones.
Page 16 National Health Statistics Reports n Number 18 n July 30, 2009

Suggested citation

Nahin RL, Barnes PM, Stussman BJ, Bloom

B. Costs of complementary and alternative

medicine (CAM) and frequency of visits to

CAM practitioners: United States, 2007.

National health statistics reports; no 18.

Hyattsville, MD: National Center for Health

Statistics. 2009.

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DHHS Publication No. (PHS) 2009–1250

CS204734-C

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