PO predicts use of CAM

…and conventional medicine.

Stimulated by Valtonen et al 2023.[1]

PO – political orientation
CAM – complementary and alternative medicine
CM – conventional medicine
Gal-Tan – a political dimension distinguishing Gal voters from Tan voters
Gal – green-alternative-libertarian
Tan – traditional-authoritarian-nationalist

key to acronyms

So, this is a bit different! I was intrigued by the title and assumed that the greens and lefties would be going for CAM if they could afford it, but I was in for a bit of a surprise.

The data in this paper is derived from round 7 of the European Social Survey and included 35 572 people from 19 countries. In case you are wondering, the data was collected pre-Brexit (2014) so the UK is included. Estonia and Israel were excluded due to missing health data and missing political data respectively. At this point in the paper, I thought to myself – I don’t think Israel is in Europe… at least not geographically. Well, it turns out that Israel has essentially been part of the EU since 2000, following an agreement signed in 1995.

Moving on, participants were only included if they had voted – that excluded just over 30%. After a few other exclusions the research team was left with a sample of 20 592. Missing data was not imputed because it was deemed unfeasible to extrapolate voting choices.

A participant was coded as having used CAM if they reported having at least one treatment from the following categories:

1. Acupuncture, acupressure, Chinese medicine (traditional Asian systems)
2. Homeopathy, herbal treatment (alternative medicines that are ingested)
3. Hypnotherapy, spiritual healing (mind-body therapies)

You may be wondering about manual body-based therapies (a fourth category). These were excluded because massage is the single most widely used treatment in all 4 categories and often not considered to be an alternative to conventional treatments.

A participant was coded as having used CM if they answered yes to having discussed health with either a GP or medical specialist within the last 12 months.

PO was determined by voting preference and an expert panel determined the relative PO of each party. The panel rated left–right orientation in general on a zero to 10 scale and did the same for left–right economic, Gal-tan, anti-elite, and anti-corruption.

The study found that 14.2% of respondents had used CAM during the previous 12 months, but only a small minority used CAM alone (1.1%). This is less than the estimate from a previous study using the same data but without such extensive exclusions and with inclusion of the fourth category – manual body-based therapies.[2] In this study the average use in Europe in the previous 12 months was 26%, but the range was from 9.5% in Hungary to 39.5% in Germany.

Now for the really interesting results – PO as a predictor of CM and CAM use. PO did predict both, but not along the traditional left–right axis. Instead, the political-ideological dimension predictive of both CM and CAM use was an anti-corruption orientation, and the correlation was in a different direction for each.

Anti-corruption was the only PO dimension that predicted CM use and it was negatively correlated, meaning that the stronger the PO in favour of anti-corruption the less likely the individual was to use CM. The anti-elite PO was similar but did not quite reach the statistical cut. The association between anti-corruption PO and use (or lack of use) of CM was strongest for those in a good health status. The association disappeared for those with the worst health status. Presumably their PO was not strong enough for them to turn their backs on the use of CM when in serious need – that seems sensible.

Two PO dimensions were predictive of CAM use – anti-corruption and Gal-tan. Anti-corruption PO predicted CAM use but this was only significant in the subgroup of respondents who exclusively used CAM. Gal PO predicted CAM use in both those who used CAM exclusively and in those who used both CM and CAM. The correlation was improved by using a squared term for Gal-tan and further analysis revealed that the association was most pronounced by the Gal pole of the dimension. So, those with a green, alternative, libertarian political leaning were much more likely to use CAM, but for those in the centre or at the tan pole the correlation disappeared ie they were not more or less likely to use CAM.

I will sign off with a quote from the discussion of the paper concerning the association between an anti-corruption political stance and a lack of use of conventional medicine for those who are less in need of care.

Given that such an association exists, it seems self-evident to recommend that the healthcare professions strive for transparency, integrity, and equality in research, practice, and public messaging to avoid exacerbating any concerns about real or perceived corruption. Commercial interests are currently deeply interwoven with conventional biomedicine at practically every level of education, research, and practice. Overdiagnosis and overtreatment are recognized problems in mainstream biomedicine, and their identified primary driver is money.

[1]

This is, is it not, a stark reminder of the pervasive influence of capitalism within healthcare, and it is clearly starting to influence healthcare choices in the population at large.

References

1          Valtonen J, Ilmarinen V-J, Lönnqvist J-E. Political orientation predicts the use of conventional and complementary/alternative medicine: A survey study of 19 European countries. Soc Sci Med 2023;331:116089. doi:10.1016/j.socscimed.2023.116089

2          Kemppainen LM, Kemppainen TT, Reippainen JA, et al. Use of complementary and alternative medicine in Europe: Health-related and sociodemographic determinants. Scand J Public Health 2018;46:448–55. doi:10.1177/1403494817733869

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Declaration of interests MC