Prevalence of the use of herbal products in a low-income population.

Use of alternative therapies in the United States has increased. In the 1990 landmark study by Eisenburg regarding the use of alternative therapies, one in three respondents reported using some form of alternative therapy. In a follow-up study published in 1998, that number had increased to 42.1%. Both studies indicated a higher likelihood of use among those with some college education and with incomes greater than $50,000. The increased likelihood of using herbal products by individuals in those demographic groups was also confirmed by Astin in 1998. These studies, as did a similar study by Elder, included all forms of unconventional therapies, including relaxation, chiropractic, massage, homeopathy, etc. Other studies focusing only on herbal use indicate that one third of Americans use herbs, and they spend more than $3.5 billion annually on herbal products. Eisenburg’s follow-up study indicated that, since 1990, there has been a fourfold increase in the use of herbal products. In fact, whereas herbs ranked 10th in prevalence among alternative therapies in 1990, herbs now rank third, behind self prayer and relaxation techniques. Herbal use deserves more attention, not only because of its increased prevalence, but also because of the potentially more-harmful effects of indiscriminate use, as opposed to other alternative modalities that have no pharmacological effects (eg, prayer, relaxation, and massage). Herbal products are not closely regulated by the Food and Drug Administration like pharmaceuticals are, and there is no requirement to prove safety or medical efficacy prior to marketing. While use of herbs and other alternative modalities is on the rise, there remains a reluctance by patients to report their use to their health care provider. In 1990, 72% of users had not informed their provider that they were using herbal products, and, in 1997, 70% of users had not informed their provider. In Elder’s study involving family practice patients, 47% had not informed their provider. One study indicates that this reluctance may be due to fear of negative response from the provider. However, intuitively, patients may be more willing to disclose use of herbal products, in comparison to other alternative treatments, if specifically asked about them by their provider. Prevalence of the Use of Herbal Products in a Low-income Population