The silent revolution in the use of complementary and alternative therapies continues unabated in the United States. A recent national survey on trends in the use of alternatives document not only widespread use but also a dramatic increase in visits to alternative practitioners, which now exceeds 40% of visits to primary care physicians. 1 Alternative therapies included in the survey were relaxation techniques, herbal medicine, massage, chiropractic, spiritual healing by others, megavitamins, self-help groups, imagery, commercial diet, folk remedies, lifestyle diet, energy healing, homeopathy, hypnosis, biofeedback, and acupuncture. Some of the more dramatic findings of the survey include:

* In 1997 an estimated 4 in 10 Americans used at least one alternative therapy compared with 3 in 10 in 1990. Usage was especially high among adults ages 35 to 49, from 1990 to 1997. Prevalence of use increased by 25% and total visits to alternative practitioners rose by 47% over 1990.

* Less than 10% of the visits reported were associated with the more mainstream alternatives such as techniques that elicit the relaxation response, diet, and vitamin therapy. Ninety percent of the visits were associated with the less mainstream alternatives.

* There was a 380% increase in the use of herbal remedies and a 130% increase in vitamin use.

* In 1997 42% of alternatives were used to treat or enhance the treatment of existing illness, and 58% were used to prevent future illness or maintain health.

* Approximately 60% of those seeing alternative practitioners paid for services out of pocket. Expenditures on alternatives rose from an estimated $14.6 billion in 1990 to 22.6 billion in 1997.

* Use of alternatives is higher among women (48.9%) than men (37.8%) and higher among those with a college education and less common among African Americans than members of other racial groups.

* Less than 40% of those who used alternatives disclosed this fact to their physician.

This data suggests the existence of a familiar dynamic in the evolution of treatment and care. It is similar to the rise in the use of alternatives in the 1830s when, in reaction to the extreme invasiveness of technological treatments of the time, people turned to more natural, palliative, and self-directed interventions. It is also suggestive of the propensity of individuals to take charge of their own health maintenance and treatment even in the face of the authoritative medical delivery system.

Alternative approaches, validated by science, will continue to be absorbed into the mainstream of care and new alternatives born of intuition and faith will emerge. In an increasingly technological age, alternatives will continue to proliferate so that cure is balanced with care. The goals of alternative therapies are to help individuals achieve harmony both internally and with the environment, to mobilize natural defenses, to elicit care, to gain empathy and respect from healer to person, and to motivate persons to heal themselves. These goals complement the medical system's quest to eradicate disease and pain.

Nurses have a strong history of involvement in what might best be called complementary therapies. Assisting patients with relaxation during difficult procedures or illness experiences, promoting exercise and diet as health maintenance and using methods like healing touch and spiritual healing is natural to nurses' therapeutic repertoire. Whatever interventions are applied in the prevention and treatment of illness, individuals need respect and care. They need to feel in control of their health and to avoid objectification. The authors of this issue offer outstanding examples of the use of complementary therapies in the achievement of these goals.

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