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RESEARCH AND PRACTICE
Knowledge of, Attitudes Toward, and Experience of Complementary and Alternative Medicine in Western Medicine and Oriental MedicineTrained Physicians in Korea
| Sang-Il Lee, MD, PhD, MPH, Young-Ho Khang, MD, PhD, Moo-Song Lee, MD, PhD, and Weechang Kang, PhD
Complementary and alternative medicine CAM, which usually refers to a large range of therapies outside mainstream Western medicine, has grown in worldwide popularity in the past 10 years15 One Korean study found that 29 of adults who perceived themselves as ill sought CAM therapies in 1 year6 In total, 231 different CAM therapies in use were identified, and about half of CAM users indicated that they would recommend CAM to others The study also reported that in Korea, out-of-pocket expenditures for CAM were 40 of those for Western medicine This prevalence of CAM use raised questions about the characteristics of CAM providers in Korea Over the past decade, Western physicians in many non-Asian countries have
provided CAM therapies in an office setting4,717 Office physicians opinions about and behaviors regarding CAM have been examined in several surveys in North America,12,13,18,19 many European countries,4,7,8,1517 Australia,20,21 and Israel9 These studies revealed that physicians show considerable interest in CAM Compared with hospital physicians, office physicians eg, general practitioners may more frequently refer patients for alternative treatment11 In addition, many subgroups of CAM providers eg, chiropractors exist among Western physicians22 Hawk et al23 examined chiropractors use of alternative practices, including spinal manipulation, and found that more than half of US chiropractors were employing acupressure, massage, mineral supplements, and herbs in their practices However, few studies have compared use of CAM among providers who follow Western medical practices with those who follow Oriental practices or have targeted physicians in Asian countries known to have adequate
personnel for CAM Objectives We compared knowledge of, attitudes toward, and experience with complementary and alternative medicine CAM among Western medicinetrained doctors WMDs and Oriental medicinetrained doctors OMDs Methods In Korea, 502 WMDs and 500 OMDs were interviewed with a structured questionnaire Results OMDs held more favorable attitudes toward CAM than did WMDs OMDs possessed a deeper understanding of and greater experience with CAM OMDs more readily endorsed health beliefs congruent with CAM Conclusions In the future, CAM can be more readily used by OMDs than by WMDs Because evidence for the effectiveness of CAM remains sparse, more research is needed for the prudent use of CAM in Korea An education and training system for potential CAM providers remains to be developed Am J Public Health 2002;92:19942000
Korea has 2 different types of doctors: Western medicinetrained doctors WMDs and Oriental medicinetrained doctors OMDs WMDs and OMDs were educated at medical schools
that espouse either Western or Oriental medicine, respectively Division of the 2 groups is not by nationality or country of education, although relatively few Korean doctors were born or educated outside Korea As of 1999, about 11 000 OMDs–about 16 of licensed medical doctors–had graduated from 11 Oriental medical schools24 Physicians in both groups complete 6-year medical school programs and pass a national license examination before starting to practice Most OMDs 85 practice in an office setting,24 providing mainly acupuncture, Chinese herbal medicine, moxibustion applying heat to certain areas of the body using a stickshaped material called moxa-wool, and cupping glass therapy a technique that brings blood to the skin surface with heat and vacuum pressure In addition to Oriental medicine, other alternative therapies exist in Korea, including chiropractic, homeopathic, iridologic, Qi Gong, and taping therapies These alternative therapies are considered neither Western nor
Oriental
medicine and, in contrast to Oriental medicine, are not regulated by any Korean legal system Thus, no laws restrict use of these alternative therapies by either WMDs or OMDs Consequently, physicians opinions and knowledge about alternative medicine may influence patients use of CAM in Korea The purpose of this study was to compare WMDs and OMDs knowledge of, attitudes toward, and practice experience with CAM in an office setting
METHODS
Study Subjects
Study subjects were WMDs and OMDs practicing in Korean cities Rural physicians were excluded because of their low numbers 71 of WMDs, 79 of OMDs25,26 and the impracticality of conducting face-to-face interviews Among WMDs, radiologists, clinical pathologists, and anesthesiologists rarely see patients independently and were excluded as study subjects Study subjects were selected through a proportionate quota and systematic sampling method On the basis of registration data from the Korean Medical Association and the Association of Korean
Oriental Medi-
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cine, a specific number of subjects were allocated to each metropolis and province Thirty of 69 districts in 6 metropolises and 24 of 73 small to medium-sized cities in 8 provinces were randomly selected Names of physicians clinics were then drawn randomly from lists provided by district health authorities Thirty-nine laypersons were recruited as interviewers and trained in a workshop and in 2 pilot interviews After initial phone contact, face-to-face interviews were conducted at the clinics If an interview with a selected subject was rejected or not completed, the next closest clinic was substituted to save time and effort It is believed that this substitution did not create sampling bias, because adjacentlylocated physicians were not expected to have either positive or negative opinions about CAM A total of 1002 of 1679
physicians 597 visited by interviewers–502 of 830 WMDs 605 and 500 of 849 OMDs 589–completed the interview
Data Collection
This study categorized medical practice into 3 groups: Western, Oriental, and CAM For this study, CAM was defined as interventions generally not available in Western or Oriental hospitals and clinics, including folk medicine, chiropractic, Qi Gong, spiritual healing, and aromatherapy In widely accepted definitions,1,27 some therapies, such as acupuncture, Chinese herbal medicine, moxibustion, and cupping glass, could be considered to be types of CAM However, these therapies were not included in the definition of CAM for this study; instead, they were categorized as Oriental medical practice, because they are in the curriculum of Korean Oriental medical schools and are thus practiced by most OMDs Furthermore, acupuncture and cupping glass therapy are covered by National Health Insurance24 Thus, it was appropriate to identify those therapies as Oriental medical
practice distinct from other types of CAM therapies Data were collected with a structured questionnaire finalized after a pilot study Sociodemographic variables included age, sex, location of clinic, religion, and length of practice WMDs were asked if there were any OMDs among their parents, siblings, or spouses, and OMDs were asked if there were any WMDs
in their families Subjects were also asked whether they would be willing to learn CAM and to conduct research on its efficacy if they received research grants In addition, the questionnaire inquired about subjects knowledge, attitudes, and beliefs regarding CAM Subjects indicated knowledge about 10 CAM therapies: Alexander therapy, aromatherapy, Ayurveda, chelation therapy, chiropractic, Gersons diet therapy, high colonic/enema therapy, homeopathy, iridology, and taping therapy Respondents were asked to choose 1 of 3 possible responses for each therapy: 0 never heard of the therapy, 1 heard of the therapy, and 2 knew the
principles Attitudes toward CAM and beliefs in health concepts were assessed on a 4-item scale: 0 strongly disagree, 1 disagree, 2 agree, 3 strongly agree The questionnaire also examined CAM practice and referral patterns Both WMDs and OMDs were asked if they had ever practiced chiropractic, homeopathy, or massage therapy or referred their patients to such a practitioner WMDs were asked about their experience with 3 other Oriental medical practices: acupuncture, Chinese herbal medicine, and herb therapy OMDs were asked about their experience with iridology, Qi Gong, and taping therapy In addition, physicians beliefs in the efficacy of these therapies were assessed on a 4-item scale: 0 not effective at all, 1 rarely effective, 2 moderately effective, and 3 very effective
questionnaire represented a different aspect of health concepts For this studys purposes, we defined a CAM user as one who had experience with at least 1 of 3 therapies: chiropractic, homeopathy, or massage
therapy We calculated overall practice rates of these CAM therapies for both WMDs and OMDs We conducted descriptive analyses to compare WMDs and OMDs on sociodemographic factors and to determine whether any physicians in the other medical domain were in their families We used Chi-square tests to compare both groups as to their willingness to learn CAM and conduct research on CAMs efficacy We also compared knowledge of, attitudes toward, and beliefs about CAM using Student t tests We performed all statistical analyses with SAS, Version 6 P 0528
RESULTS
Characteristics of Study Subjects
We compared demographic characteristics of subjects with each other and with national data Table 1 Both WMDs and OMDs were younger than physicians in the national data The mean age of WMDs was significantly greater than that of OMDs 436 vs 399 years The proportions of male and female physicians among WMDs and OMDs were similar to the proportions in the national data; however, the number of female
practitioners among WMDs was significantly higher than the number of female practitioners among OMDs The proportions of both types of physicians in metropolitan areas were similar to such proportions in the national data The average length of practice of WMDs was significantly greater than that of OMDs 168 vs 125 years In addition, subjects age and length of practice correlated highly among both WMDs and OMDs Pearson correlation coefficients 93 and 84, respectively; P 001 Whereas a significantly higher proportion of Buddhists was found among OMDs, WMDs had a significantly higher proportion of Catholics
ANALYSIS
We computed the overall knowledge score 020 range for both doctors by adding the scores of the 10 CAM items Cronbach coefficients were 083 in WMDs and 081 in OMDs, indicating a high degree of internal reliability We calculated the overall attitudinal score 011 range for WMDs, 012 range for OMDs by adding scores of 4 attitude items after reverse scoring of the first and
second questions Cronbach coefficients were 062 in WMDs and 063 in OMDs High scores represent rich knowledge of and favorable attitudes toward CAM We did not create a summary score about beliefs in health concepts because each item in the
Willingness to Learn and Research CAM
More OMDs 704 than WMDs 359 reported a willingness to learn CAM If awarded research grants, a significantly greater proportion of OMDs 657 than of
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TABLE 1–Demographic Characteristics of Western MedicineTrained Doctors n 502 and Oriental MedicineTrained Doctors n 500 Compared With National Data
WMDs, Characteristics Age, y 39 4049 50 Sex Male Female Location of clinic Metropolis Small to medium-sized city Length of practice after license, y 09 1019 20 Religion Buddhist Protestant Catholic Other None Any doctors of the opposite domain among family membersc Yes
No This Study National Dataa OMDs, This Study National Datab
The Pearson correlation coefficient between overall attitudinal score and age was 07 P 10 for WMDs In OMDs, the overall attitudinal score correlated negatively with age Pearson correlation coefficient 19, P 001
414 360 226 882 118 552 448 156 532 312 106 289 215 06 384 74 926
287 384 329 879 121 539 461
628 218 154 928 72 580 420 472 366 162 252 238 106 30 374 234 766
607 182 211 900 100 585 415
Beliefs About Health Concepts
WMDs and OMDs showed different beliefs in health concepts for all items Table 3 OMDs had stronger beliefs in the natural healing process, healthdisease continuum, and psychological effects on health than did WMDs WMDs showed a greater mean score of belief in a Cartesian view of mind-body dualism
Practice of, Referral to, and Beliefs in Efficacy of CAM
As seen in Table 4, massage therapy was the most recognized and utilized CAM therapy among WMDs OMDs most often used
chiropractic, followed by taping therapy Nearly 70 of OMDs had experience with at least 1 of 3 CAM therapies chiropractic, homeopathy, and massage therapy, compared with only 20 of WMDs Massage and acupuncture therapies were the most common therapies suggested to patients by WMDs, whereas OMDs frequently referred patients to chiropractic, massage therapy, and taping therapy WMDs believed that acupuncture and Chinese herbal medicine, the major therapies in Oriental medicine, were the most effective among 6 therapies OMDs considered chiropractic and massage therapies most effective A greater proportion of OMDs than of WMDs indicated that 3 CAM therapies– chiropractic, homeopathy, and massage therapy–were effective More than 75 of OMDs evaluated the efficacy of chiropractic, massage, and Qi Gong as either very effective or moderately effective
Note WMDs Western medicinetrained doctors; OMDs Oriental medicinetrained doctors a Data from Korean Medical Association25 b Data from
Association of Korean Oriental Medicine26 c WMDs were asked about any OMDs among their parents, siblings, or spouses; OMDs were asked about any WMDs in their families
WMDs 307 reported a willingness to conduct research on CAM efficacy
son correlation coefficients between overall knowledge scores and age were 06 P 16 for WMDs and 35 P 0001 for OMDs
Knowledge of CAM Therapies
As shown in Table 2, OMDs had higher knowledge scores than did WMDs P 001 for the 10 CAM practices, excluding chelation therapy The proportion of WMDs who knew the principles of CAM therapies varied considerably, ranging from 16 for Alexander therapy to 311 for high colonic/enema therapy OMDs had the least knowledge of chelation therapy 26 and the greatest knowledge of chiropractic 786 More than half of the OMDs reported knowing the principles of chiropractic, taping therapy, and aromatherapy OMDs had significantly higher overall knowledge scores than WMDs Pear-
Attitudes Toward CAM
Attitudinal scores showed
statistically significant differences between WMDs and OMDs for all items P 001, as shown in Table 3 Among WMDs, 441 strongly agreed with the statement Scientifically unproven treatments should be discouraged legally; conversely, only 113 of OMDs strongly agreed with this statement OMDs had significantly higher overall attitudinal scores than did WMDs Pearson correlation coefficients between overall knowledge and overall attitudinal scores were 013 P 001 for WMDs and 015 P 001 for OMDs
Doctors Characteristics and Practice Experience
The overall practice rate of WMDs did not differ between those who practiced in small to medium-sized cities and in metropolitan cities However, the overall practice rate of OMDs in small and medium-sized cities was significantly greater than that in metropolises 762 vs 635; P 01 There were no
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TABLE
2–Self-Reported Knowledge of 10 Complementary and Alternative Therapies Among Western MedicineTrained Doctors n 502 and Oriental MedicineTrained Doctors n 500
Knew the Principles of Therapy, Therapy Alexander therapy Aromatherapy Ayurveda Chelation therapy Chiropractic Gersons diet therapy High colonic/enema Homeopathy Iridology Taping therapy Overall knowledge scoreb WMDs 16 157 26 24 285 38 311 54 88 146 OMDs 32 510 78 26 786 54 435 320 498 606 Had Heard of Therapy, WMDs 82 554 120 118 450 178 516 273 323 454 OMDs 148 434 335 150 154 297 511 462 418 286 Had Never Heard of Therapy, WMDs 902 289 854 858 265 784 173 673 589 400 OMDs 820 56 587 824 60 649 54 218 84 108 Mean Percentage SDa WMDs 011 036 087 066 017 044 017 043 102 074 025 052 114 068 038 059 050 065 075 069 535 358 OMDs 021 048 145 060 049 064 020 046 173 057 040 059 138 059 110 073 141 064 150 068 988 366
Note WMDs Western medicinetrained doctors; OMDs Oriental medicinetrained doctors
a Response categories: knew the principles of therapy 2; had heard of therapy 1; had never heard of therapy 0 b The overall knowledge score was computed by summing the scores for the 10 CAM therapy items P 001, 2-tailed t test
TABLE 3–Attitudes Toward Complementary and Alternative Medicine and Health Beliefs Among Western MedicineTrained Doctors n 502 and Oriental MedicineTrained Doctors n 500,
Strongly Agree, WMDs OMDs Agree, WMDs OMDs Disagree, WMDs OMDs Strongly Disagree, WMDs OMDs Mean Percentage SD WMDs OMDs
1 CAM is a threat to public health 2 Scientifically unproven treatments should be discouraged legally 3 CAM could be a supplement to Western medicine 4 Some CAM therapies need to be accepted by Western medicine Overall attitudinal scoreb A Natural healing process B Cartesian view of mindbody dualism C Healthdisease continuum D Psychological effects on health
79 441 28 58 70 16 619 443
22 113 241 266 191 10 764 623
Attitudes toward CAMa 464 277 381 335 300
160 398 525 627 629 444 314
543 407 112 81 175 370 28 20
76 64 130 103 102 351 06 04
158 180 20 24 42 508 02 02
154 075 215 091 132 073 154 076 517 214 146 077 078 069 259 057 238 060
116 071 135 090 209 065 214 065 770 199 193 073 062 072 273 051 260 054
Beliefs in health conceptsc 418 592 410 101 112 532 353 206 22 501 355 52
Note CAM complementary and alternative medicine; WMDs Western medicinetrained doctors; OMDs Oriental medicinetrained doctors a Response categories: strongly agree 3; agree 2; disagree 1; strongly disagree 0 b The overall attitudinal score was calculated by summing the scores of the 4 attitude items after reverse-scoring the first and second questions c Health concept definitions: A Natural healing process: Fatal diseases such as cancers can be cured through natural healing processes B Cartesian view of mindbody dualism: With understanding of the human bodys structure and function, we can cure most diseases, although we
ignore their psychological aspects C Healthdisease continuum: Preventive actions should be reinforced, because health and disease phenomena are not dichotomous but continuous D Psychological effects on health: Attention to psychological factors facilitates disease treatment and health improvement P 001, 2-tailed t test
significant differences by sex in the overall practice rate among both WMDs and OMDs In addition, characteristics of CAM users and nonusers were compared Among
WMDs, no significant difference in age and length of practice was found between CAM users and nonusers Among OMDs, however, CAM users were younger than nonusers 378
vs 443 years; P 0001 The length of practice of CAM users was shorter than that of nonusers among OMDs 107 vs 162 years; P 0001 There was a significant relation-
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TABLE 4–Practice of, Referrals to,
and Belief in Efficacy of 9 Oriental and Complementary Alternative Medical Therapies Among Western MedicineTrained Doctors n 502 and Oriental MedicineTrained Doctors n 500
Oriental Medical Practice, Acupuncture Practice experience with the therapya WMDs OMDs Referrals to the therapyb WMDs OMDs Belief in efficacy of therapyc WMDs OMDs Chinese Herbal Medicine Herbal Therapy Chiropractic Care Complementary and Alternative Medical Therapies, Homeopathy Massage Iridology Qi Gong Taping Therapy
68 269 620
38 219 516
14 54 203
58 568 112 720 347 879
14 90 14 132 116 548
169 390 273 466 486 784
220 240 645
174 328 766
420 452 649
Note WMDs Western medicinetrained doctors; OMDs Oriental medicinetrained doctors a Proportion of WMDs or OMDs who had ever practiced a specific therapy b Proportion of WMDs or OMDs who had ever referred their patients to a specific therapy c Proportion of all positive answers ie, moderately effective or very effective
ship between
religion and experience with CAM therapy among WMDs Subjects in this group who identified as Buddhist or None had more experience with CAM therapies than did those who identified as Catholic or Protestant P 02 In contrast, OMDs overall practice rates did not significantly differ by religion WMDs with 1 or more OMDs in their families tended to have greater experience with CAM therapies than those with no OMDs in their family, whereas having WMDs among family members did not influence use of CAM by OMDs Willingness to learn and conduct research on CAM was also significantly associated with overall practice rates for both WMDs and OMDs Physicians in both groups who expressed a willingness to learn CAM had significantly higher overall practice rates compared with those who did not WMDs who demonstrated a willingness to conduct research on CAMs efficacy had a greater overall practice rate relative to WMDs who did not 273 vs 164; P 01 Similarly, OMDs who were willing to conduct research
on CAMs efficacy had greater overall practice rates than those who did not 771 vs 526; P 0001 Furthermore, knowledge of, attitudes toward, and beliefs about CAM were related to use of CAM CAM users among WMDs had significantly higher overall knowledge scores
74 41 than did nonusers 49 33 Similarly, CAM users among OMDs had higher knowledge scores 109 31 compared with nonusers 76 37 CAM users in both groups had significantly higher attitudinal scores relative to nonusers Among WMDs, CAM users had significantly higher scores in regard to belief scores in the healthdisease continuum than did nonusers, whereas no significant differences were found in the other 3 belief scores Interestingly, among OMDs, CAM users had significantly higher scores for those 3 belief items than did nonusers, whereas the healthdisease continuum item did not reach statistical significance P 07
DISCUSSION
Study results showed that Korean WMDs and OMDs had significant differences in CAM knowledge,
attitudes, beliefs, and practices OMDs had high levels of knowledge about and practice experience with CAM therapies outside the Oriental medical practice, including CAM therapies with origins in Western culture eg, chiropractic Practice and referral rates of 3 CAM therapies chiropractic, homeopathy, and massage therapy of OMDs were higher than median rates reported in a previous study29 However, practice and referral rates among WMDs related to 5 therapies
acupuncture, herb therapy, chiropractic, homeopathy, and massage therapy were lower than median rates previously reported29 Moreover, WMDs showed negative attitudes toward CAM, whereas OMDs were favorable to CAM For instance, nearly half of WMDs strongly agreed that scientifically unproven treatments should be discouraged legally, whereas only 11 of OMDs agreed It is important to examine why these differences between WMDs and OMDs have arisen One explanation may be that WMDs generally consider CAM as a branch of Oriental medicine
rather than an independent domain of medical practice, even though some CAM therapies, such as chiropractic, were developed in Western countries Another reason may be that WMDs do not make significant efforts to incorporate CAM into Western medicine in Korea For example, whereas some US and Japanese medical schools provide courses related to CAM,30,31 none of the 41 Western medical schools in Korea reported including CAM or Oriental medicine courses in their curricula Differences in the socialization process during medical education between WMDs and OMDs may also be a contributing factor International studies of several Far Eastern Asian countries with common cultural backgrounds in traditional medicine could suggest more concrete explanations
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The fact that Oriental medicine is positioned competitively with Western medicine in Korea can
be related to the attitudes of WMDs toward CAM In Korea, Oriental medicine is legally institutionalized and some of its medical services are covered by National Health Insurance24 This competitive position may cause some WMDs to adhere to their own medical domain as a way to differentiate themselves from OMDs, and it may cause them to rigidly exclude CAM One interesting finding was different religious affiliations A greater number of WMDs were Catholics and Protestants, whereas more OMDs were Buddhists The relationship of these different religions to CAM use may be explained as follows Students affiliated with religion originating in Western countries eg, Catholicism and Protestantism may be more likely to choose Western over Oriental medicine, whereas those with Buddhist backgrounds may prefer Oriental medicine Alternatively, students may naturally come to religious beliefs compatible with the beliefs and philosophy on which their medical education is based Future studies should
examine student religious affiliations at the time of admission to medical schools to confirm these explanations Another interesting finding was that younger OMDs had higher CAM practice rates, whereas among WMDs there were no significant age differences between CAM users and nonusers Although Verhoef and Sutherland12 support this finding, other studies have reported no significant effect of age on CAM practice32,33 The greater tendency of young OMDs to use CAM therapies may be attributed to their favorable attitudes toward, and active efforts to incorporate CAM into, Oriental medicine This finding also suggests that in the future more CAM therapies may be used by OMDs rather than by WMDs Particularly, of the 6 CAM therapies surveyed among OMDs, chiropractic had the highest percentage in practice experience, referrals, and beliefs in efficacy This result suggests that chiropractic may become the most popular CAM therapy in the near future In response to increasing CAM use, the public
and OMDs may wish to request that CAM therapies be covered by National Health Insurance In addition, given the negative attitude of WMDs toward CAM, such
an increase might well stir public debate on CAMs efficacy and appropriateness Yet another interesting finding was that WMDs with family members who practiced Oriental medicine were more likely to use CAM therapies The reverse was not true, however, with OMDs This suggests that, whereas OMDs may influence the use of CAM therapies in physicians trained in Western medicine, WMDs have little influence on OMDs This supports the idea that OMDs, as major CAM providers, would lead in the introduction and diffusion of CAM in the future This study highlights knowledge of CAM therapies as an important factor that may influence CAM use in the future About two thirds of OMDs and one third of WMDs reported a willingness to learn CAM therapies In addition, the level of knowledge about CAM was strongly associated with CAM practice experience,
regardless of providers educational backgrounds Berman et al18 also reported that knowledge of CAM was the best predictor of CAM acceptance and usage These findings suggest the need to develop a body of knowledge on CAM and to provide accurate information about it for both WMDs and OMDs This knowledge will be necessary for these doctors to make appropriate clinical decisions and judgments regarding CAM use This study has 2 major limitations In spite of a systematic sampling process, study subjects may not represent the target population One finding was that doctors, particularly WMDs, were younger compared with the average age of doctors in national data One explanation may be that in a practice with more than 1 physician, junior doctors may be appointed to participate in an interview, thus contributing to the samples lower mean age In addition, physicians interested in CAM may be more likely to respond to a survey on CAM34 This effect could bias the results by indicating greater
knowledge of, more favorable attitudes toward, and increased practice experiences with CAM than in fact exist However, no information was collected on physicians who rejected or chose not to participate in the interview process for this study Also, because this was a cross-sectional survey, more attention should be paid to arriving at definitive conclusions regarding cause-andeffect relationships For example, it is unclear
whether a rich knowledge of CAM leads physicians to use these types of therapy or whether chance exposure to CAM practice has influenced the general amount of knowledge18 Further studies with a prospective design may clarify this kind of temporal ambiguity between knowledge, attitudes, beliefs, and practice variables This study was the first Korean attempt to compare WMDs and OMDs in regard to CAM knowledge, attitudes, beliefs, and practice The investigation is meaningful because Korean WMDs and OMDs are licensed medical doctors and thus potential CAM providers CAM
will be more readily used in Korea by OMDs than by WMDs in the office settings Considering the dearth of evidence for CAMs effectiveness, more research is needed for the prudent use of CAM in Korea Also, an education and training system for potential CAM providers needs to be developed
About the Authors
Sang-Il Lee, Young-Ho Khang, and Moo-Song Lee are with the Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea Weechang Kang is with the Department of Information and Statistics, Daejeon University, Daejeon, Korea Requests for reprints should be addressed to Young-Ho Khang, MD, PhD, Department of Preventive Medicine, University of Ulsan College of Medicine, 388-1 Poongnap-Dong Songpa-Gu, Seoul, 138-736 Korea e-mail: youngk@amcseoulkr This article was accepted June 4, 2002
Contributors
S I Lee planned the study, designed the survey, collected the data, reviewed the data analysis, and edited the article Y H Khang participated in the design of the
survey, collected and analyzed the data, and wrote the first draft of this article M S Lee participated in the study design, data interpretation, and analysis W Kang participated in the study design and the statistical analysis, verified the SAS SAS Institute, Inc, Cary, NC programs, and reviewed the data analysis
Acknowledgments
Financial support for this project was provided by the Asan Institute for Life Science, Seoul The authors thank Byung-Mook Lim, OMD, MPH, a researcher at the Korea Institute of Oriental Medicine, for his assistance in developing the questionnaire
Human Participant Protection
This study was approved by the institutional review board of the Asan Medical Center, Seoul
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