Used by more than a third of Americans, alternative medicine is slowly becoming accepted by the healthcare establishment.
A growing number of health insurers are recognizing this $30 billion industry, mostly by offering discounts for acupuncture, nutritional counseling, mind-body practices like biofeedback and other complementary or alternative forms of care.
The latest is Hollywood-based Vista Healthplan, which earlier this month announced a discount program for its members of up to 30 percent for 30 alternative programs, including yoga, tai chi and nutrition therapy.
Vista’s Medicare seniors can get a $25 voucher to try alternative care. ”Most of them don’t know about these things. Basically, we’re encouraging them to step over the line,” says Steve Russell, a Vista vice president. “To increase their mobility, their flexibility, to get out and try new things.”
”Complementary medicine is going mainstream quickly,” says Santiago Leon, a Miami health insurance broker who has studied the field extensively. “Part of the impulse is therapeutic. Part of it is economic.”
Studies show some treatments — particularly acupuncture and some mind-body therapies — work as well or better than traditional medicine, and they are frequently much cheaper.
Chiropractic, once considered alternative, is now considered mainstream, or nearly so. A chiropractor’s adjustment of a back, or a few minutes of message therapy, costs a fraction of what back surgery does.
Eighty-seven percent of firms offering health insurance now have benefits for chiropractic, according to the Kaiser Family Foundation. Almost 50 percent cover acupuncture for some cases.
In 1990, virtually no plans covered these services. ”That is quite an amazing change,” says Brian Berman, a physician who founded in 1991 the University of Maryland Center for Integrative Medicine, which studies alternative and complementary care. “I have seen an openness that just wasn’t there when I started this.”
Berman recently conducted a study of 570 persons with arthritic knees, with one group getting acupuncture and the other a sham treatment in which needles were taped to the skin but didn’t penetrate. The conclusion: The ancient Chinese needle treatment can help reduce pain significantly and increase mobility.
Another recent study, reported in the Jan. 26 issue of the American Journal of Hypertension, put 150 men and women with high blood pressure into Transcendental Meditation, muscle relaxation therapy and health education classes. The conclusion: TM did the best job of lowering blood pressure.
Berman was on the committee of the Institute of Medicine that released a report earlier this month saying that both conventional and complementary-alternative medical treatments should be held to the same standards of clinical effectiveness.
That conclusion was viewed with suspicion by many working in the field. Robert Fishman, a 70-year-old Hollywood pharmacist who counsels patients on nutritional alternatives and female hormonal therapy, says: “That sounds good, but who’s going to pay for the studies? Big drug companies will spend the money to prove their drugs work, but who pays to study natural ingredients you can’t patent?”
One treatment he recommends: a combination of vitamins and supplements that he says does a good job of lowering cholesterol. It’s much cheaper that the statin drugs and has none of the side effects, but operating a small pharmacy doesn’t give him the funds to do full-scale scientific studies.
The federally funded National Institutes of Health have put $120 million into the National Center for Complementary and Alternative Medicine to study what works and what doesn’t. At least 27 universities, including Harvard, are in a consortium studying alternatives.
The problem is that there are a lot of alternatives — from flower petals to horse urine. Then there’s naturopathy (treating disease by using food, exercise and heat to assist the natural healing process) and homeopathy (treating disease with small amounts of remedies that produce similar disease symptoms in healthy people when large amounts of the remedies are used).
With herbal remedies and other supplements, experts worry that no regulations exist standardizing their potency or purity, and some herbs imported from China have even turned out to be dangerous.
”If you don’t do that research, it’s like buyerbeware,” says Berman, “and I don’t think that’s a good policy.”
While scientists conduct studies, some physicians are moving ahead into alternative treatments. One is Eric Rydland, a Miami-Dade pediatrician who was once part of a group working on holistic treatments, with a nutritionist, acupuncturist and other alternative therapists.
That arrangement didn’t work out, but he firmly believes that “this is a concept that is going to happen. We need a holistic approach — with practitioners of homeopathy, oriental medicine, message therapy, chiropractic, ayurvedic (Indian) therapies, nutritionists.
”Our healthcare system is such a mess,” says Rydland, “We’re putting drugs into people like putting a Band-Aid on them. They take anti-hypertensives [blood pressure medication] and then go out and have a triple cheeseburger.”
Who should decide whether a patient should be treated with vitamins, acupuncture, homeopathy or traditional medicine? ”To be perfectly honest, the person who decides is the patient. I make recommendations to people, and they are paying for my expertise, but it’s their choice,” says Rydland.
Many consumers would like more choices. Jerry Buechler, a Miami Beach firefighter, has been urging alternatives for his union’s self-funded health plan. Buechler persuaded the plan to cover acupuncture, and he’s now asking it to provide a set dollar amount that could be used for nutraceuticals or herbs.
”If we’re going to control costs, we need to have greater treatment choices,” says Buechler. ”I exercise a lot. I bike 100 miles a week, but I still have a cholesterol of 240. My doctor says maybe I should go to the statins,” drugs like Lipitor that can cost $100 a month.
Buechler says he went instead to the Life Extension Foundation in Fort Lauderdale, which recommended a combination of fish oils and sesame lignan that brought his cholesterol into the normal range. “That’s a lot cheaper, $20, compared to $30 just for the co-pay of the statins.”
Experts who favor alternatives warn consumers . ”I think you need to be very careful with these things,” says Rydland, the pediatrician. “People need to get information.”
Jan. 30, 2005