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Mistrust centered on healthcare professionals and the healthcare system as a whole is a social epidemic in rural healthcare communities. Rural mistrust of the healthcare system and physicians stems from a long, systemic assault on the integrity of rural communities and divestment from rural healthcare services [4]. These conditions beg the question, why would these rural community members trust a system that has repeatedly left them out? Members of these communities usually cope with this mistrust through a myriad of comparative and alternative (CAM) and homeopathic medicines and treatments. These methods through which to treat disease are typically spread from generation to generation and by word of mouth; they are nuanced as sometimes they serve as the only source of care for members of rural communities, but, for the sake of this essay, we will be focusing on the harmful effects. They can be considered harmful as they pull the user away from scientifically backed medicines that have been researched, tested, and employed for decades. It is essential to evaluate the use of these alternative medicines in these communities to garner a deeper understanding of greater sociocultural barriers in a rural community. 

A common pattern in rural communities

Rural mistrust in healthcare and public health initiatives is real and abundant in rural communities; this lack of trust impacts both the patient and the physician. There is a pathway to the use of homeopathic treatments and alternative medicines, this pathway begins with rural mistrust, then avoidance of modern medicine initiatives, and, finally, the use of alternative medicines. The establishment of rural mistrust can be perfectly built on by the avoidance of opioid use disorder treatment and COVID-19 vaccinations. Lister and Jourdey’s “Rural Mistrust of Public Health Interventions in the United States: A Call for Taking the Long View to Improve Adoption[4], explains that opioid-use disorder treatment and COVID-19 vaccination are noticeably lower in rural communities than in urban ones. As these public health initiatives are centered around improving the health of all rural community members, without their compliance, these issues perpetuate further. 

Jeffrey Balfrey details this pathway personally in his oral interview through the SOHP [3]. Balfrey details his initial mistrust, “I do believe, like, there is too much of all the advertising on TV,…sounds like you’re going to die of this stuff.” For supposed modern medical cures, it speaks volumes that Balfrey is essentially equating pills to poison. When mistrust leads to infrequent hospital visits and one’s understanding of treatment options is tainted by an extraordinarily long list of side effects, it perpetuates mistrust further. Balfrey goes on to explain, “…one of the things that—sodium lauryl sulfate was one of the prime ingredients in all toothpaste…actually, the last month or two, I’ve been using coconut oil and baking soda.” As evidenced in Balfrey’s explanation, this mistrust ends up leading to avoidance, Balfrey stopped using toothpaste and then switched to an alternative use to cure his disease. Mistrust began the eventual use of alternative medicines for Balfrey, highlighting the pivotal role that decades of built-up mistrust has on the patient. 

Harmful effects of CAM use

Alternative medicine use is harmful because of the neutral or negative effects it can bring on the patient—eventually leading to worse health outcomes. There are two negatives to taking alternative medicines, either they fail to alleviate symptoms or they inflict more harm than doing nothing would—both are extremely harmful for the user. In a review of the myriad effects of alternative medicine use, Niggemann and Grüber’s “Side-effects of complementary and alternative medicine” highlights the potentially carcinogenic properties of these medicines stating that patients who took a Chinese herb for renal disease had a higher risk of urothelial carcinoma [5]. In their research, patients were directly negatively affected by engaging in CAM use, emphasizing the importance of spreading awareness on this topic to particularly rural communities. As Janet Sasser Ross [6] explains, her aunt and grandmother were diagnosed with uterine cancer and skin cancer, respectively, and had differing experiences with homeopathic, alternative medicines. Ross’ aunt tried these medicines and died shortly after diagnosis, while her grandmother utilized an apple cider vinegar method that, according to their family, rid her body of cancer. As these are oral histories and come directly from the family members involved it’s important to recognize the uncertainty that should be accounted for in this storytelling. Ross’ story is one that, superficially, sounds miraculous, but there’s no medical backing to her grandmother going into remission due to her homeopathic treatment. Regardless, Ross’ description is a development of the idea that alternative medicine use is nuanced and isn’t just inherently negative. 

Patient mistrust in CAM disclosure

Patient mistrust toward physicians isn’t only harmful to the patient-provider relationship; it creates a hostile environment that doesn’t allow them to share pertinent patient history, such as CAM use, freely. Akeeb et. al.’s “Communication Between Cancer Patients and Physicians About Complementary and Alternative Medicine: A Systematic Review”, found that nondisclosure about CAM use was based on a variety of factors, with physician-patient relationships and patient beliefs and attitudes about their provider included. This study also found that up to 70% of cancer patients do not disclose their CAM use for the myriad of reasons listed above [1]. These statistics are concerning as they emphasize the negative effect that long-standing physician distrust can inevitably have on patient health outcomes, in a new context. In “Traditional, complementary, and alternative medicine in cancer care: Challenges and opportunities” researched by Ashrafizadeh and Rassouli, they found evidence that the use of CAM in conjunction with allopathic treatment of cancer may lead to severe side effects and reduced quality of life [2]. This further underlines the point that physicians must have empathy to treat patients carefully and correctly which all starts with accepting them at face value. 

Referencing the Ross interview, her aunt’s death can aid in further understanding the direct negative effects of CAM use. Throughout the interview, Ross develops a pattern of physician mistrust; growing up in rural communities alongside continuous healthcare mistreatment, Ross and her relatives developed great physician mistrust.  As Aunt Judy was diagnosed with uterine cancer and died six months after her diagnosis, it’s unclear whether CAM use just distracted her from allopathic treatment attempts or if they exacerbated her symptoms. This physician mistrust most likely led to the nondisclosure of CAM use in Aunt Judy’s cancer treatment which would eventually lead to her death. If physicians lack cultural competency around patient struggle and the prevalence of CAM use, then they’re subconsciously shutting down a patient before they even get their full story. 


Alternative medicine use is problematic for physicians, patients, and the general public. It can have good and bad effects, its causes aren’t concrete, and its ability to diffuse in rural communities is powerful; physician mistrust in healthcare also plays an integral role in all aspects of this complicated method of healthcare. This essay isn’t written as a means to dispel the use of alternative medicines in healthcare, it is meant to draw awareness to how they can potentially be harmful. However, harm reduction in rural communities can specifically be utilized to mitigate the risks of CAM use in neutral and negative ways. Solving the issue of CAM use needs to begin with physician recognition that it isn’t an inherent negative issue and patients need to be met at their individual healthcare preferences and needs.


[1] Akeeb, Ameenat A. et al. “Communication Between Cancer Patients and Physicians About Complementary and Alternative Medicine: A Systematic Review.” Journal of integrative and complementary medicine vol. 29,2 (2023): 80-98. doi:10.1089/jicm.2022.0516

[2] Ashrafizadeh, Hadis, and Maryam Rassouli. “Traditional, complementary, and alternative medicine in cancer care: Challenges and opportunities.” Asia-Pacific Journal of Oncology Nursing vol. 11,1 100321. 19 Oct. 2023, doi:10.1016/j.apjon.2023.100321

[3] Balfrey, Jeffrey. “Y-0004 Interview with Jeffrey Balfrey.” By Caroline Efrid, 2018-06-24. Southern Oral History Program, Accessed 24 April 2024. 

[4] Lister, Jamey J, and Paul J Joudrey. “Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption.” The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association vol. 39,1 (2023): 18-20.

[5] Niggemann, B. and Grüber, C. (2003), Side-effects of complementary and alternative medicine. Allergy, 58: 707-716.

[6] Ross, Janet Sasser. “Y-0045 Interview with Janet Sasser Ross.” By Caroline Efrid, 2018-06-15. Southern Oral History Program, Accessed 24 April 2024.

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