Many physicians (particularly, family physicians and orthopaedists) working in private practice in Germany use CAM therapies frequently and believe in their efficacy. Professional views and the specific working situation seem to influence use and believe strongly.

The Use of Complementary and Alternative Therapies in Germany - a Systematic Review of Nationwide Surveys. Ziel der vorliegenden systematischen Übersichtsarbeit war es, Daten zur Inanspruchnahme von Naturheilverfahren, komplementärer und alternativer Medizin (NHV/CAM) durch die deutsche Bevölkerung und zur Verwendung durch Ärzte und Heilpraktiker zusammenzustellen. Bundesweite Repräsentativbefragungen der letzten 20 Jahre (echte Zufallsstichproben, Stichprobenziehung über Paneloder Quotenverfahren), die in der Bevölkerung oder unter Ärzten durchgeführt worden waren, wurden mittels Pub-Med, Google Scholar und Google sowie Durchsicht von Literaturverzeichnissen und Expertenkontakten identifiziert. Zusätzlich wurden Daten aus behördlichen Statistiken und Markterhebungen berücksichtigt. 16 Befragungen von Stichproben der erwachsenen Bevölkerung und 4 Arztbefragungen konnten eingeschlossen werden. Der Bevölkerungsanteil, der in den vergangenen Jahren mindestens eine NHV/CAM-Methode in Anspruch genommen hatte, schwankte zwischen 40 und 62%. Im Vergleich zu anderen Arztgruppen scheinen Hausärzte und Orthopäden NHV/CAM in besonders breitem Umfang anzuwenden. Phytotherapie und Chirotherapie werden dabei besonders häufig eingesetzt. Untersuchungen zur Verwendung durch Heilpraktiker liegen nicht vor. Die vorliegenden Erhebungen belegen eine breite Verwendung von NHV/CAM durch die Bevölkerung und niedergelassene Ärzte. In den letzten Jahren scheint die Inanspruchnahme jedoch nicht weiter gestiegen zu sein; bei einzelnen Verfahren (insbesondere der Phytotherapie) ist ein Rückgang zu beobachten.

We aimed to investigate the use of placebos (e.g. saline injections) and non-specific treatments (e.g. vitamin supplements in individuals without a relevant deficiency) among physicians working in private practices in Germany, and how such use is associated with the belief in and the use of complementary and alternative treatments, and basic professional attitudes. A four-page questionnaire was sent to nationwide random samples of general practitioners (GP), internists and orthopaedists working in private practices. The response rate was 46% (935 of 2018). 24% of GPs, 44% of internists and 57% of orthopaedists had neither used pure placebos nor non-specific therapies in the previous 12 months. 11% percent of GPs, 12% of internists and 7% of orthopaedists had exclusively used pure placebos; 30%, 33% and 26%, respectively, had exclusively used non-specific therapies; 35%, 12% and 9% had used both. Age, sex and agreement to the statement that physicians should harness placebo effects were not significantly associated with any pattern of use. Exclusive use of pure placebos was associated with being a GP, being an internist, and having unorthodox professional views. In addition to these three factors, a lower use of CAM therapies and a wish for having more time was associated with the exclusive use of non-specific therapies. Among physicians using both pure placebo and non-specific therapies, heterodox views were also somewhat more pronounced. However, associations were particularly strong for being a GP (Odds ratio 11.6 (95%CI 6.41; 21.3)) and having orthodox views (Odds ratio 0.10 (95%CI 0.06; 0.18)) among this group. In conclusion, the use of placebos and non-specific treatments varies strongly between medical specialties and is associated with basic professional attitudes. The findings support the view that the use of placebos and, in particular, of non-specific therapies is primarily a coping behaviour for difficult and uncertain situations.

Background: We are performing a nationwide survey in a random sample of German general practitioners (GPs), orthopedists, and internists on the use of placebos and nonspecific as well as complementary treatments and their association with basic professional attitudes. In this article we explain the theoretical considerations behind the study approach and the development of the questionnaire. Methods: Based on a systematic review of published surveys, own surveys on the topic, and on theoretical considerations we developed a preliminary version of a 4-page questionnaire that was tested for feasibility in a convenience sample of 80 participants of a general medical education event. We also performed cognitive interviews with 8 physicians to investigate whether the questions were understood adequately. Results: The questions on typical placebos and complementary treatments were well understood and easy to answer for participants. Discussions about the phrasing of questions on nonspecific treatments during interview reflected the vagueness of this concept; but this did not seem to create major problems when answering the related questions. The original questions regarding basic professional attitudes partly were not understood in the manner intended. The relevant questions were modified but the interviews suggest that these issues are difficult to grasp in a quantitative survey. Conclusion: Our testing procedures suggest that our questionnaire is well-suited to investigate our questions with some limitations regarding the issue of basic professional attitudes.