Disparities in Complementary and Alternative Medical Therapy Recommendations for Children in Two Different Socioeconomic Communities

Objective: To compare the content, quality, and cost of recommendations for children made by complementary and alternative medicine (CAM) retailers within 2 New York City neighborhoods of divergent socioeconomic status (SES). Methods: Posing as consumers, researchers sought recommendations from CAM retailers for 2 clinical scenarios: 1) a febrile 6-week-old and 2) a 4-year-old with an upper respiratory infection (URI). All retailers selling CAM therapies outside the direction of a licensed provider within East Harlem (EH) and the Upper East Side (UES) were eligible and mapped. The febrile infant scenario was posed at sites in business in March (n = 23) and the URI scenario at sites that remained in business in April (n = 20) of 2004. Results: In response to the febrile infant scenario, 33% of UES retailers referred to a MD, 0% to the emergency department, and 47% made other recommendations-of which 43% were not indicated. In EH, 50% referred to a MD, 5% to the emergency department, and 37% made other recommendations. The mean price of UES recommendations was $9.66, whereas EH was $2.33 (P = .04). In response to the URI scenario, 93% of UES and 83% of EH retailers made recommendations. The mean price of UES recommendations was $10.55 while EH was $4.26 (P = .002). Conclusions: Complementary and alternative medicine retailers made numerous recommendations for children, including some that were contraindicated for age. East Harlem retailers tended to refer an infant with a potentially serious condition to the emergency department or to an MD and made less expensive recommendations than their UES counterparts.