It now seems safe to say that alternative medicine is no longer on the fringe of health care.
A visit to your neighborhood drug store tells the story. There, you'll find shelves stacked with about as many brands and types of vitamins as over-the-counter cold remedies.
The trend reflects the fact that Americans spend more than $30 billion of their own money on complementary and alternative therapies each year, according to a 1997 study published in the Journal of the American Medical Association.
They also made 628 million visits to alternative health-care practitioners, 243 million more than visits to all primary-care physicians. Nearly half of those visits were to chiropractors and massage therapists.
Alternative Medicine Defined
Dr. David Eisenberg is the author of that landmark study and director of the Center for Alternative Medicine and Research and Education at Beth Israel Deaconess and assistant professor of medicine at Harvard Medical School, both in Boston.
His definition of alternative medicine is any form of therapy not taught widely in medical schools or generally available in hospitals. The term "integrative" or "complementary" medicine refers to the weaving together of alternative options and allopathic or conventional science-based medicine.
The list of alternative therapies changes frequently as more practices are proven safe and effective, but generally falls into five areas: traditional systems (Chinese, Ayurvedic), mind-body interventions, hands-on body work, biological-based therapies (vitamins, herbs) and energy therapies.
A key concept, according to Dr. David Edelberg, founder and former chairman of the integrated medicine clinic, WholeHealth in Chicago, is that most users of alternative medicine don't want to give up their conventional health care. "When we opened our center, we found people weren't giving up their family doctors, they simply wanted physician-supervised alternative medicine....They wanted a center that had two toolboxes," says Edelberg.
Why All the Hype?
What's Driving the Demand for Alternative Medicine?
Consumers, particularly those between 30 and 55, are powering the growth of alternative medicine. According to Eisenberg's 1997 testimony before the U.S. Senate, one out of every two boomers uses non-conventional therapies. What boomers seem to favor is the safe, noninvasive nature of alternative treatments. Furthermore, many alternative remedies hold the promise of slowing the aging process.
Another motivation is the increasing cost of health care — without an increase in the quality of the care, says Dr. Roger Jahnke, doctor of acupuncture and traditional Chinese medicine, chairperson of both the Qigong Department at the Santa Barbara (Calif.) College of Oriental Medicine and the National Qigong Association, and author of "The Healer Within."
A third driver, says Edelberg, is that conventional doctors are coming around to accepting alternative therapies: "More papers are appearing on alternative medicine in conventional medicine journals; there's a National Institutes of Health division on it; and they themselves are experiencing it.
We regularly have doctors coming into our clinic for chiropractic or acupuncture or sending their patients over...Cardiologists are taking antioxidants and vitamins, and psychiatrists are beginning to realize that St. John's wort actually works."
Choosing Safe and Effective Alternative Therapies
Edelberg says attitudes toward alternative medicine still vary greatly by region, but that chiropractic is relatively common as is acupuncture. Usually, the more studies that have confirmed the efficacy of a particular therapy, the greater its acceptance.
For instance a number of controlled studies have proven the effectiveness of acupuncture for treating a variety of conditions, from osteoarthritis to migraine headaches. Other studies have shown positive results in pain management and drug addiction — two areas where conventional medicine is limited.
But as with anything else, it pays to be a careful consumer when it comes to alternative medicine. According to the Food and Drug Administration, the Centers for Disease Control and Prevention, harmful alternative treatments include DMSO, laetrile, snake venom, coffee enemas, ozone generators, and ephedra (also known as ma huang).
Studies have also shown some remedies to be harmless — but not necessarily effective. These include dong quai and wild yam. The latest research on using garlic to reduce blood pressure indicates the effect only lasts several months.
Getting Coverage for Alternative Medicince
Insurance Coverage for Alternative Medicine
Though popular with the masses, alternative medicine has yet to be embraced by health insurers. In his 1987 testimony to the U.S. Senate, Dr. David Eisenberg described a patient who defined it as "therapies I have had to pay for out of pocket."
That statement still sums up how often alternative medicine users are reimbursed by their insurance companies.
"It goes round and round," says Jahnke. "As an acupuncturist back in the '80s, probably 60 percent of my charges were reimbursed by insurance companies. But by the end of the '80s it was down again...And now there are what they call discount networks that are being contracted by insurance companies to provide, not reimbursed services, but discounted services."
Dr. Vasant Lad is director of the Ayurveda Institute in Albuquerque, NM. Although he says Ayurvedic services are as popular as "hot cakes," insurance companies do not reimburse for them.
John Weeks is editor and publisher of the newsletter, The Integrator for the Business of Alternative Medicine. He says, "From a consumer perspective, despite the increased interest, most payments are cash out of pocket."
He added that there's been a trend over the past three years toward discounted access, in which the consumer pays a reduced rate and has the reassurance that the provider has met the insurance company's criteria. The modalities most often covered are chiropractic, massage, acupuncture and naturopathy.
Power to the Patient
The real news about the growth of alternative medicine in the West is a shifting of responsibility from the doctor to the patient, says Jahnke. He says the key is "the revelation that 'Oh, you mean I can do something? And I can do it at home for free?'...The real breakthrough that's happening in health care right now is that we're realizing the client, the customer, the patient can also do something.
"In fact, if you do something in a timely way, you might not need to be a patient."