An International Survey of the Use and Attitudes Regarding Alternative Medicine by Patients With Inflammatory Bowel Disease Patricia Rawsthorne, R.N., Fergus Shanahan, M.D., Neil C. Cronin, M.D., Peter A. Anton, M.D., Robert Lo ¨fberg, M.D., Lena Bohman, R.N., and Charles N. Bernstein, M.D. Departments of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; National University of Ireland, Cork, Ireland; University of California, Los Angeles, California; and Karolinska Institute, Stockholm, Sweden OBJECTIVE: There is a perception of increasing and wide- spread use of alternative medicine for inflammatory bowel disease (IBD). We assessed the usage of alternative thera- pies among patients with IBD, whether there were similar or contrasting variables that were predictive of such use, and contrasted the use in four different centers in North America and Europe. METHODS: Patients in four IBD centers completed a self- administered questionnaire regarding alternative medicine. The centers were in Cork, Los Angeles, Stockholm, and Winnipeg. Patient demographics, the use of 18 types of alternative medicine, and attitudes towards alternative and conventional medicine were compared. A multiple logistic regression analysis was used. RESULTS: Fifty-one percent of 289 patients used some form of alternative medicine. The percentages of use by site were Cork = 31%, Los Angeles = 68%, Stockholm = 32%, and Winnipeg = 57%. The six most commonly used therapies in descending order were: exercise (28%), prayer (18%), coun- seling (13%), massage (11%), chiropractic (11%), and re- laxation (10%). Only 7% used acupuncture or homeopathy and 5% used herbal medicine. The highest odds ratios (con- fidence intervals [CIs]) for using any form of alternative medicine were associated with: being single 3.1 (1.7–5.7), Los Angeles patient 4.4 (2.3– 8.3), Winnipeg patient 2.7 (1.3–5.9), and an increase of alternative medicine use of 2.7% for every M.D. visit (CI, 2–11%/visit). The patient age, gender, disease diagnosis, or duration of disease were not predictive of any type of alternative medicine use. Re- garding attitudes, respondents from Cork were most favor- able toward alternative medicine use and least favorable toward conventional medicine. Based on attitudes, subjects were more likely to use alternative medicine if they were not satisfied with conventional therapy, viewed hospitals as dangerous places, thought that alternative medicine practi- tioners should have a role in hospitals, and felt their medical situation was hopeless. CONCLUSIONS: Fifty-one percent of respondents used some form of alternative medicine. The use was greater among the North American patients than the European ones. Respon- dents were more likely to use alternative medicine if they were single, in a higher income bracket, and an urban dweller. (Am J Gastroenterol 1999;94:1298 –1303. © 1999 by Am. Coll. of Gastroenterology) INTRODUCTION There appears to be increasing attention paid to alternative medicine use by patients with chronic illnesses (1–3). A 1995 Consumer Reports article reported that sales of natural herbal remedies alone are growing by an estimated 15%/yr, and now total $1.5 billion, almost half the amount spent on regular vitamins and minerals (4). Inflammatory bowel dis- ease (IBD) is a chronic relapsing illness, which may require invasive investigations, surgery, and loss of time from work, and may have an adverse impact on patients’ personal and professional lives. Conventional therapies can be associated with adverse effects and, at times, may not be successful at achieving disease remission or even lesser treatment goals. Patients may seek alternative medicine for symptomatic relief and as a novel approach when conventional medicine has incompletely satisfied their health care needs or failed to provide them with some sense of control over their illness (5). For some, it may reflect their disgruntlement with their physicians or with conventional medicine in general, as it may be seen as too complex and technologically oriented, impersonal, costly, inconvenient, unavailable, or inaccessi- ble (1, 6). At present, there are wide ranging sources of information regarding alternative medicine available to the consumer through print and electronic media, including the Internet (7, 8). To determine the extent of alternative medicine usage among patients with IBD, we conducted a multicenter sur- vey asking patients from four countries about their use and attitudes toward alternative medicine. In particular, we sought to determine what factors might encourage a patient THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 94, No. 5, 1999 © 1999 by Am. Coll. of Gastroenterology ISSN 0002-9270/99/$20.00 Published by Elsevier Science Inc. PII S0002-9270(99)00136-7