Germany has long been a leading force in herb and phytomedicine research and regulation. One reflection of this is the relatively high use of herbs and other natural products by German consumers. Since 1970, the Allensbach Institute for Public Opinion Research (Institut für Demoskopie Allensbach , IfD: http://www.ifd-allensbach.de/ ) has been monitoring public attitudes towards the use of natural medicines in Germany. In January 2002, a trend analysis1 was conducted on behalf of the German Non-prescription Drug Manufacturer’s Association (Bundesverband der Arzneimittel-Hersteller , BAH: http://www.bah-bonn.de/ ), along with technical support from the German Society for Phytotherapy (Gesellschaft für Phytotherapie , GPT: http://www.phytotherapy.org ). The report included supplemental data obtained from recent surveys concerning physicians’ prescriptions of natural medicines, i.e., those that are reimbursable under existing insurance plans as well as those paid for out-of-pocket. Although the term “natural medicines” is used throughout this study, to a large extent this category is comprised of non-prescription phytomedicines.
Between January 5th and 15th in 2002, a representative sample population of 2,172 people over the age of 16, from both the former East and West German states were personally selected for the survey by Allensbach interviewers.
According to this survey, in 1970, 52% of the population in the former West Germany used natural medicines, and in 2002, 73% of the population (79% of women and 66% of men interviewed) used natural medicines, indicating an increase of 40.4% in the 32 year period. Where there were once significant differences in age- and education-levels for users of natural medicines, these have mostly disappeared in the last decade. The survey shows that in 2002, 57% of those interviewed between the ages of 16 and 29 regularly or occasionally use natural medicines. Also, people in all social strata or types of employment in Germany use natural medicines in comparably high percentages. There are slight differences in the subpopulation analysis between the former West Germany and the former East Germany. In former West Germany, 73% of those interviewed used natural medicines, but only 64% of those interviewed in the former East Germany did. The rate of growth for use of natural medicines in the former East German states has also been lower in recent years.
|Condition||Population Responding—1970||Population Responding—2002|
|Indigestion, intestinal troubles||24%||24%|
|Exhaustion or fatigue||8%||15%|
Source: Natural Medicine 2002: Most Important Findings of the Allensbach Trend Study1
Although the study does not provide an explanation for the variance between former East and West German populations, one possible reason for the different “traditions” in the use of conventional versus natural medicines is the number and variety of preparations available in the market. The diversity of natural medicines was lower in the former Eastern part because the manufacture and availability was controlled by the former Communist government to a relatively high degree. Consumer attitudes and purchasing patterns might still be affected by this former situation, even 14 years after reunification.
Comparing the data from 1970 and 2002 shows that the intensity of natural medicine use has also increased; that is, the number of people who employed natural medicines increased within the same time periods measured. For example, the number of Germans who had taken natural medicines during the 3 month period before the interview more than doubled between 1970 and 2002, from 14% up to 35%.To clarify, of the 52% in 1970 who used natural medicines, 14% had used them within the previous 3 months, 8% within the previous 6 months, 8% within the previous year, and 22% before the previous year (total 52%). Of the 73% in 2002 who used natural medicines, 35% said they used them in the previous 3 months, 11% within the previous 6 months, 10% within the previous year, and 16% before the previous year (total 72%).
The 2002 survey also showed that the German population expects a continued increase in the usage of natural medicines. When asked the question, “Do you think that in 50 years from now, Germans will use more natural medicines than today, less than today, or about the same?” 47% responded that in 50 years Germans will be using more natural medicines than today, 24% believe that the usage level will be about the same, 21% were not sure, and 8% believed that usage would decline in 50 years.
The trend towards self-medication with natural medicines for minor discomforts and ailments is also increasing, and the former tendency to first consult with a doctor is declining. When asked the question, “Have you recently taken a natural medicine that was prescribed by a doctor, or did you purchase it on your own for self-treatment?” 60% of those surveyed said that they had recently taken self-purchased natural medicines, 22% took natural medicines prescribed by a physician, and 17% had taken some that were prescribed as well as some that were self-purchased. Of the 66% who had recently self-purchased a natural medicine (the 60% group plus part of the 22% group), a follow-up question was asked, “Was the natural medicine that you self-purchased “recommended by a doctor or by a pharmacist?” In response, 9% of respondents had made purchases based on a doctor’s recommendation, 14% based on a pharmacist’s recommendation, but a significant 43% had made the purchase on their own initiative.
One explanation for the growing popularity of natural medicines in Germany is based on the fear of possible side effects of conventional medicinal products (i.e., synthetic drug products). On a scale of 0 (very low) to 10 (very high), participants were asked to rate their opinion of the risk of side effects from conventional medicines compared to that of natural medicines. The mean rating for conventional drugs in this survey was 6.7 (high risk) and for natural medicines 2.3 (low risk). The subgroup of those who identified themselves as “believers” in natural medicines placed the level of risk for conventional drugs higher at 7.3 (high risk) and also lower for natural medicines, at 2.0 (very low).
When asked the question “Do you sometimes take a medicine as a preventative measure, so that you will be less susceptible to an illness? If so, what do you take?” 33% of respondents stated that they do take medications for prevention, of which 38% use natural medicines exclusively, 41% use natural medicines among other types of medications, 16% do not use natural medicines for prevention, and 5% did not know.
This survey also found that natural medicines are increasingly serving as co-medications along with conventional drugs: 62% of respondents would take a natural medicine as a co-medication for (more serious) diseases, but only 4% would take natural medicines exclusively for diseases.
The study found that the primary indications for which Germans take natural medicines are cold and flu conditions, but also for insomnia, indigestion, other stomach and intestinal problems, headaches, and nervousness. Table 1 compares the percentage of the German population using natural medicines for various indications between 1970 and 2002.
The Allensbach study also found that the German population attaches importance to the physician’s knowledge and experience in the testing of the efficacy of natural medicines. Although the 2002 survey found that Germans believe it is important that natural medicines remain prescribable and reimbursable, in the meantime, most non-prescription medicines in Germany, which includes most phytomedicines, are no longer reimbursable under the natural healthcare system as of January 1st 2004, due to political pressure to reform the healthcare system and reduce costs.
Finally, the study found that 61% of the German population believes that natural medicine users pay more attention to their health. They are more likely to eat healthier and/or strengthen their resistance to disease, e.g., by self-medication with natural medicines in order to prevent serious diseases; 79% of natural medicine believers hold this viewpoint, but even 34% of those who are disinterested in natural medicines believe this is true. The study concludes that given the strong willingness of natural medicine users to self medicate, their contribution towards lowering the costs of the National Health Service should not be underestimated.
1. Institut für Demoskopie Allensbach. Naturheilmittel 2002: Wichtigste Erkenntnisse aus Allensbacher Trendstudien . [Natural Medicine 2002: Most Important Findings of the Allensbach Trend Study]. Allensbach, Germany: Institut für Demoskopie Allensbach. 2002. Available at: http://www.bah-bonn.de/news/Naturheilmittel.pdf .