Individualism and differences in the practice of traditional medicine make it difficult to evaluate outcomes.  Users of traditional medicine are less concerned with questions of efficacy because they believe traditional medicine works.

Two recent articles highlight the prevalence and uses of traditional American Indian medicine.

1.  In 1997, Kim et al interviewed a Navajo HIS tribal hospital in order to determine the prevalence of native healer use, the reasons for use, cost of use, and the nature of any conflict with conventional medicine.

The study found high rates of alternative medicine use in the Navajo population. Most patients interviewed had used native healers at some point and almost 40% used native healers on a regular basis.  Patients consulted both native healers and medical providers for a wide range of health problems. Common conditions among the Navajo such as diabetes mellitus, arthritis, and depression or anxiety were common reasons for consulting both the medical provider and the native healer. However, certain diseases such as upper respiratory tract infections and allergies were recognized as the exclusive domain of the medical provider and other problems such as bad luck, blessings, and family difficulties were recognized as the exclusive domain of the native healer.  For diseases such as diabetes, native healer care was viewed as an adjunct rather than a substitute for medical provider care. The patients using native healers consulted native healers for depression or anxiety a greater proportion of the time than patients only using medical providers consulted medical providers for depression or anxiety. As one patient stated, "The doctors give me pills for my body, the medicine man gives me songs for my spirit."

Patients in this study do not perceive conflict between different health system beliefs and may use remedies prescribed by several practitioners for a single health care problem; they may perceive such an approach as more effective than using a single system. This may be rooted in the belief that disease is multifaceted, and different health care systems treat different facets effectively. As one patient succinctly stated, "It is better to stand on two legs than on one." Therefore, inquiring about patients' use of native healers can significantly enhance understanding of the patients' health.  Even though use of native healers can be a religious and private issue, patients are willing to discuss their use of native healers if asked in a sensitive manner. Increased understanding of this deeply rooted system can improve communications between providers and patients and, therefore, can help medical providers improve the quality of care provided.

2.  In 2004,   Novins et al attempted to describe the use of biomedical services and traditional healing options among a reservation-based sample of American Indians from 2 culturally distinct tribes.  

American Indian tribes have a rich history of traditional healing through consultation with medicine people and ceremonies designed to intervene in the spiritual world to affect healing. Traditional systems of healing are active in both of the tribes studied, although the organization of traditional healing is quite different in each. The Northern Plains tribe features a network of traditional healers that is informally organized and whose practices center on a set of core ceremonies, any 1 of which could be indicated for multiple forms of distress. In contrast, the Southwest tribe features a formally organized network of traditional healers who perform carefully scripted ceremonies that often have very specific indications based on the determination of a specific spiritual cause of an individual’s distress. Although specialization is certainly a part of the Northern Plains system of traditional healing, it is much less elaborated than in the Southwest, where practitioners specialize in specific diagnostic practices and ceremonies.

The study found that use of traditional healing was prevalent in both tribes—a much higher prevalence than that reported for the use of complementary and alternative medicine among non-American Indian samples.  Clearly, traditional healing is an important and independent source of care for American Indians from these 2 tribes.

Additionally, although the use of traditional healing was prevalent in both tribes, we identified a number of differences in the prevalence of the use of traditional healing and its use in combination with, or independent of, biomedical services. These tribal differences could be the result of the differing healing traditions of these 2 tribes.  For example, it is possible that, because of its specificity, traditional healing in the Southwest could be viewed as helpful for a greater variety of physical health and psychiatric difficulties than in the Northern Plains, and thus used more frequently. Also, the more formal organization of traditional healing in the Southwest could facilitate the use of such practices.

Third, use of biomedical and traditional services varied by problem type with traditional healing providing a greater proportion of care for psychiatric than for physical health problems. This is consistent with the literature regarding non-American Indian populations that suggests that complementary and alternative medicine is often used for mental health problems. Traditional healing could be viewed as particularly helpful for psychiatric problems, resulting in their greater use for these difficulties. Alternatively, the stigma of psychiatric problems and biomedical services for these problems could drive American Indians with these difficulties to explore traditional healing options first before consulting with a biomedical clinician.

These findings have important implications for clinicians and researchers. For clinicians, use of traditional healing is likely to be common among American Indians, particularly those with psychiatric problems. Clinicians should include questions about traditional healing in their assessments and consider with their patients the need for coordinating their services.