Complementary and alternative health care industry

Industry Snapshot

GENERAL INDUSTRY: Health Science

CAREER CLUSTER: Health Science

SUBCATEGORY INDUSTRIES: Acupuncturists’ Offices; Chiropractors’ Offices; Herbalists’ Offices; Homeopaths’ Offices; Hypnotherapists’ Offices; Midwives’ Offices; Naturopaths’ Offices

RELATED INDUSTRIES: Health and Fitness Industry; Hospital Care and Services; Medicine and Health Care Industry; Personal Services

ANNUAL DOMESTIC REVENUES: Alternative healthcare providers: $41.9 billion (IBISWorld, 2023; chiropractors: $20.5 billion (IBISWorld, 2023); midwives and doulas: $5.2 billion (IBISWorld, 2023)

NAICS NUMBERS: 62131, 621399

Summary

The complementary and alternative health or medical care (CAM) industry produces and applies a wide range of herbal, vitamin, and food remedies; patient-practiced therapies; and practitioner services. They are not considered part of conventional medical practice, although complementary care may be used along with it. Alternative health care, by contrast, is used in place of conventional medical care and can interfere with it. For example, herbal therapy could interact with conventional medications. Patients often turn to CAM therapies when conventional medical care is not relieving their symptoms, such as chronic pain.

History of the Industry

Some CAM therapies have been in practice since the beginning of human civilization. Herbs have been used to treat and prevent illness for at least as long as the concept of an herb has existed. Midwives, or their ancient equivalent, were most likely the first nonfamily members to assist in the delivery of infants. The ancient Chinese developed a medical system that included acupuncture for the treatment of their health problems.

Early physicians were not interested in delivering infants. As a result, midwives delivered infants until the 1700s. If a mother had complications of delivery, she often died because midwives lacked formal medical skills. In the 1700s, surgeons began to deliver infants for the wealthy. New York City began to require that midwives be licensed. In 1799, doctors Valentine Seaman and William Shippen opened a school to train midwives. In the early 1800s, physicians began to take over the delivery of infants for the middle class. The practice of midwifery declined. Increasingly, mothers delivered their infants in hospitals.

In the 1970s, women clamored for the opportunity to demedicalize childbirth and to deliver their infants at home. Nursing schools began to offer programs in nurse-midwifery. Both nurse-midwives and nonnurse midwives received formal training. Physicians fought to hold onto childbirth, and laws were created to limit the practice of midwifery. Many states required that midwives practice only under the supervision of physicians. Other states licensed nonnurse midwives and permitted them to practice independently.

There is evidence that acupuncture has been practiced for at least eight thousand years. From 650 to 692 BCE., the development and practice of acupuncture increased, and acupuncture schools were established. In 1911, Western medicine was introduced to China, and acupuncture and herbal medicines experienced a decline. In 1950, the Chinese merged Western medicine with acupuncture. Gradually, acupuncture came to the United States. Starting in 1971, acupuncture began to be well known in the United States, and by 1997, it was widely available.

Chiropractic care was recognized as a medical treatment in 1895. It was introduced by Daniel David Palmer. Spinal adjustment is the basis of chiropractic medicine, and it is used to treat a wide variety of conditions. It is thought that spinal adjustment has been practiced since ancient times. Palmer defined the practice of chiropractics and started a training school. In the early 1900s, states began regulating and licensing chiropractors.

Homeopathy was developed by a German physician, Samuel Hahnemann, in 1796. It was introduced to the United States in 1828 by John Franklin Gray. It was quite popular with patients in the early 1900s, in part because conventional medical treatments were often ineffective. Homeopathy is frequently criticized by conventional medicine as being ineffective. Little research has been done to establish its effectiveness.

Naturopathy was introduced to the United States in the late 1800s by Benedict Lust, although it had been practiced in Germany earlier. In the early 1900s, it was widely accepted, but after that it experienced a decline in popularity. Beginning in the 1970s, there has been increased interest in natural treatments such as those proposed by naturopaths.

Hypnosis was originally performed as part of the system of Chinese medicine. It was not studied and practiced until the 1800s. James Braid, a Scottish surgeon, began this exploration. Subsequently, the study of hypnosis became popular in France. One of the students of the French school of hypnosis was Sigmund Freud. Hypnosis was first studied in the United States in 1933 by Clark L. Hull.

The Industry Today

CAM is fairly popular today, in part because conventional medical care is sometimes impersonal and fragmented. Consumers want to be treated as whole people, not just body parts. Stress-related symptoms are common in contemporary society. Some conventional medical treatments do not cure patients or treat their symptoms effectively. CAM practitioners practice holistic medicine, meaning that they base their treatments on the total needs of each individual patient, rather than concentrating only on the particular system or body part that demonstrates symptoms. Patients’ medical and psychological histories, body types, and family histories are all considered when treating them. CAM providers have been successful in treating some health issues that conventional medicine has been unable to cure.

Acupuncture is used to treat a wide variety of conditions, such as depression, chronic pain, and the nausea caused by chemotherapy. An acupuncturist inserts many very fine needles into various locations on the body to assist the flow of chi, or life energy. Acupuncturists work in individual or group practices, and some are employed by hospitals in their integrative therapy clinics. Persons with no medical training must have at least two thousand hours of acupuncture training in order to practice acupuncture. Some physicians, dentists, and other medical practitioners train in the practice of acupuncture. If they use it in their regular practices, they need one to two hundred hours of training. If they plan to devote their practices solely to acupuncture, they require fifteen hundred hours of training. Most states require licensure for acupuncturists.

Most midwives choose to become nurse-midwives to avoid the legal limitations placed upon nonnurse midwives. Nurse-midwives have master’s degrees in nursing with majors in midwifery. They are usually employed by either physician practices or hospitals. In physicians’ offices, nurse-midwives provide pre- and postnatal care, and they also assist in delivery rooms. They perform only normal vaginal deliveries. If there appears to be a complication during childbirth, a physician takes over the delivery. Nurse-midwives do not perform surgery. They are permitted to prescribe medications in some states. Some states permit nurse-midwives and nonnurse midwives to have their own practices and to participate in home childbirth.

Chiropractors practice either alone or with other chiropractors. They can also practice as part of hospital-based integrative medical clinics, but this is not as common. Chiropractors work on the musculoskeletal and nervous systems. Frequently, they use spinal realignment as a treatment to improve nerve conduction. Potential chiropractors must have at least ninety semester hours of undergraduate study, or bachelor’s degrees, before they can enter chiropractic programs. Such programs provide four years of training in the medical sciences and public health, and they grant the degree of doctor of chiropractic (DC). Licensure is required for the practice of chiropractic in all US states and the District of Columbia.

The basis of the practice of homeopathy is the belief that “like cures like” and that the body is able to heal itself of symptoms by confronting similar symptoms. Homeopaths use very dilute solutions of substances that come from plants, minerals, or animals to treat their patients. Homeopathy is often used to treat allergies, rheumatoid arthritis, irritable bowel syndrome, minor injuries, and muscle sprains. Although it is not used to treat persons with severe, acute injuries or serious illnesses such as heart disease or cancer, homeopathy is used to treat the side effects of chemotherapy. Homeopaths may be medical doctors who have taken homeopathy courses, or they may be nonphysicians who have taken four-year courses in homeopathy. Only three states license homeopaths: Arizona, Connecticut, and Nevada. Licensure for homeopathy does not include standards for practice.

Naturopaths believe that an imbalance in one’s life is the cause of illness and that by restoring a natural balance, the illness can be cured. The balance is restored by natural treatments and improvements in lifestyle. Naturopaths do not perform any surgical procedures. They are trained as general practitioners or primary care providers and are able to treat a wide range of conditions. A bachelor’s degree, including completion of premedical courses, is required for admission to a school of naturopathy. Naturopathy students study for four to five years. Often, the fifth year of study is devoted to a specialty such as obstetrics. There are only three or four schools of naturopathy in the United States and Canada. A number of states have licensure requirements and standards for practice. These standards include education and passing the Naturopathic Physicians Licensing Examinations (NPLEX). The areas requiring licensure include Alaska, Arizona, California, Connecticut, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, Washington, the District of Columbia, Puerto Rico, and the US Virgin Islands.

Hypnosis consists of guided relaxation and focused attention that induces a trance-like state in which the subject blocks out external stimuli. It is thought that hypnosis increases suggestibility and helps subjects change their thoughts. Not everyone is susceptible to hypnosis. Hypnosis is used to achieve weight loss and to treat addictions to cigarettes, alcohol, and drugs; insomnia; anxiety; asthma; and irritable bowel syndrome. Hypnosis has been successfully used to alleviate the pain of childbirth. There are no educational requirements for hypnotists in the United States, so consumers must evaluate hypnotists themselves. Some psychologists, counselors, psychiatrists, and dentists are trained in hypnotherapy. Four states—Colorado, Connecticut, Indiana, and Washington—require licensure for hypnotists, and some other states regulate their practice.

An important issue for CAM providers and recipients is health insurance coverage. Many health insurance plans do not cover any CAM therapies. Of the classes of those therapies, chiropractic and acupuncture are the most likely to be covered by health insurance, but insurance plans may limit the number and frequency of treatments for which they will pay. Other plans may contract with specific CAM providers and obtain discounts for their members. Most CAM treatments must be paid for directly by patients.

In the past, some animosity has existed between CAM providers and conventional medical providers. While some research has been done to evaluate CAM practices, it has not been adequate to reach definitive conclusions about many treatments. Moreover, some existing studies do not validate their hypotheses. If a patient chooses a CAM treatment over conventional medical treatment for a serious condition, the patient’s life can be at risk. Some efforts are being made by the National Center for Complementary and Integrative Health (NCCIH) to increase CAM research. Meanwhile, some conventional medical institutions such as hospitals are setting up CAM clinics in order to integrate CAM therapies with conventional medicine, and some conventional medical providers use CAM treatments in their practices.

Industry Outlook

Overview

The global outlook for this industry shows it to be growing. In addition to a growing geriatric population is an increase in the number of patients with neurological disorders and cancer along with government initiatives and activities. Strong transnational connections across healing pathways have been linking global, national, and local movements concerning alternative medicine. A 2017 Pew Research Center survey, the latest year for which information was available, found that 29 percent of American adults had used complementary medicine and another 20 percent had used alternative medicine. Those with chronic medical conditions were more likely to report using CAM as an adjunct to conventional Western medicine. Having a college or postgraduate degree was also linked with CAM usage.

The long-term outlook of the CAM industry is favorable, both in the United States and throughout the world. According to a 2023 Grand View Research report, the global complementary and alternative healthcare market size is expected to reach about $694.22 billion by 2030. Additionally, research into the use of traditional medicines to treat COVID-19 is being conducted as of 2021. The treatment may be particularly effective in treating the symptoms of patients with long-COVID-19 or post-COVID-19 symptoms.

Market analyses may also be distorted by a lack of data on nurse-midwives and nonnurse midwives. Nurse-midwives, who most often work within the realm of traditional medicine, may not be perceived as CAM practitioners. Surveys may also be distorted if they include only participants who are either middle or upper class. Survey respondents may also be reluctant to admit to visiting CAM practitioners as a result of perceived social stigmas against those practitioners in some groups. Nevertheless, it appears that the demand for treatment by CAM providers other than acupuncturists and possibly midwives is not increasing at a dramatic rate.

Employment Advantages

American consumption of acupuncture is increasing, and acupuncture is increasingly being covered by US health insurers as more research is published demonstrating its effectiveness. Acupuncturists require significantly less training and less financial investment than do medical doctors, and they may be able to develop better relationships with their patients than many doctors are able to. Careers in midwifery may appeal to people who wish to support maternity patients who dislike conventional medical techniques for delivery. It can be very exciting to assist women in childbirth and witness one of the major events of life. Nurse-midwives may have significantly greater career options than nonnurse midwives, however, especially given that nonnurses are not allowed to practice midwifery in many states.

While other CAM providers are less in demand, people who are able to succeed in such careers may find them rewarding. CAM providers help people with health problems who cannot or do not wish to seek conventional medical treatment. They often develop close relationships with their patients because they are committed to treating whole persons rather than symptoms.

Annual Earnings

The demand for complementary and alternative care services, with the exception of midwifery, is related to the availability of disposable income, since services must often be paid for in cash, and to the incidence of chronic health problems. Americans, particularly educated Americans, have a fair amount of disposable income. As the US population ages, the demand for CAM services is likely to increase. With combined annual expenditures at nearly $70 billion in the United States, there appears to be a continued demand for CAM providers.

It is difficult to determine the demand for CAM services in the international health care market. There are few data on current expenditures on CAM services. Developing countries are unlikely to increase their use of CAM services. They are also unlikely to report the use of these services. Lack of education and scarcity of conventional medical care make it unlikely that interest in alternative medicine will increase. Countries such as Australia, Great Britain, Japan, and China may demonstrate increased interest in CAM services as their populations increase in wealth, education, and age.

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