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As genetic models are increasingly incorporated in medicine, health service users seem to accept these models to varying degrees. To appreciate these differences, this paper examines how health service users' genetic beliefs of health are associated with their use of traditional, complementary, and alternative medicine (TCAM) via responses from 31 countries in the 2011 ISSP survey. It finds an interesting contrast between East Asian countries and other countries in the world. The negative association between genetic beliefs and TCAM use is strong in the latter, whereas it is weak in the former. More intriguingly, the analysis demonstrates significant cross-national differences within East Asian countries. Chinese and Koreans reveal a negative relationship between genetic beliefs and TCAM use, while Japanese show a positive relationship. The paper provides an explanation to these cross-national differences by drawing on comparative studies of medical systems. When TCAM is institutionalized as valid and distinct medical resources, and when TCAM is practically available to everyday use, health service users who subscribe to genetic beliefs are likely to use TCAM as well. These findings contribute to revealing the pragmatic nature of health-seeking action and the institutional context in which geneticization and medical pluralism are conditioned to form. • This study examines the association of people's beliefs in genetic attribution and TCAM use. • The negative association of genetic beliefs and TCAM use is weak in China and Korea. • Genetic beliefs and TCAM use are positively associated in Japan. • Geneticization and medical pluralism are conditioned by institutionalization of TCAM. [ABSTRACT FROM AUTHOR]