ALTERNATIVE MEDICINE
Following Congressional hearings, the U.S. Congress mandated the National Institutes of Health (NIH) to open the Office of Alternative Medicine (OAT) in 1993 and begin funding the most promising therapies, including macrobiotics, Native American medicine, homeopathy, music therapy, acupuncture, and other modalities. In 1998, the office was renamed the National Center for Complementary and Alternative Medicine, and Congress increased the annual budget from $20 million to $50 million.
Several medical schools, colleges, and universities have opened alternative medical centers. By 1998, 62 percent of medical schools in the U.S.—nearly two in every three—offered courses in alternative and complementary medicine.
The first public natural health clinic opened in Seattle in 1996. The clinic offers low cost natural therapies, including acupuncture, nutritional counseling, biofeedback, Chinese herbal medicine, and other alternative treatments to the public, especially low-income patients. The estimated cost of the pilot program, funded by the government, is $3 million.
Meanwhile, insurance companies are beginning to reimburse and encourage alternative medical practices. Oxford Health Plans became the first large medical insurer to offer alternative medicine coverage in 1997. No physician referral is required. The company cited a survey of its 1.5 million members showing that 33 percent had used some form of alternative medicine in the last five years. On the West Coast, Kaiser Permanente, the nation’s largest HMO, offers reimbursement for acupuncture and other alternative medical services in California. Blue Cross/Blue Shield are experimenting with similar coverage in the Pacific Northwest.
In a widely publicized survey, the New England Journal of Medicine reported in 1993 that one in every three Americans used alternative medicine.
By 1998, the figure had risen to 42 percent, and the number of visits to alternative practitioners exceeded those to primary care physicians. See Acupressure, Asthma, Fibroymyalgia, Five Transformations, Multiple Sclerosis, Native American Diet, Pregnancy, Skin Problems, Yin and Yang.
Sources: D. M. Eisenberg et al., “Unconventional Medicine in the United States,” New England Journal of Medicine 328:246-52, 1997; M. S. Wetzel et al., “Courses Involving Complementary and Alternative Medicine at U.S. Medical Schools,” Journal of the American Medical Association 280:784-87, 1999; David M. Eisenberg et al, “Trends in Alternative Medicine Use in the U.S., 1990-1997,” Journal of the American Medical Association 280:1569-1575, 1998.
• Clinical Guidelines in Complementary and Alternative Medicine (CAM) - In 1995, the Office of Alternative Medicine convened an expert panel to propose guidelines for clinical practice. Noting that estimated office visits to CAM providers (425 million a year) exceeded the number of visits to primary care physicians (388 million) and that Americans spent $10 billion annually on alternative therapies, the panel stated that it was important that the public be informed about the advantages and disadvantages of CAM.
While professional standards and practices need to be standardized, the panel questioned the assumption that recommendations for CAM must await clinical trial evidence. “Some would argue that the need for CAM to collect evidence in a format acceptable to conventional Western medicine (e.g., randomized trials) is itself a false premise. Reliance on empirical data from controlled experiments to infer effectiveness is a reductionist Western epistemology that is not shared by many of the cultures from which some CAM practices originate.” The report mentioned, for example, that acupuncture has been practiced for more than 3000 years, outspanning “the entire life of newtonian science by several millennia.” Organ-specific results are commonly less important than overall patient well-being, respecting the pa-tient’s personal experience, and dynamic relational issues. Conventional diagnostic models have little relevance, the panel noted, to traditional models of disease origin and development, especially those involving energy balance.
Like psychiatric and mental health therapies, CAM approaches are often not reproducible, because they are highly individualized or recognize an association between the dynamics of the clinician-patient relationship.
“In the long-term, a worthwhile goal is to develop holistic, cross-cutting practice guidelines that specify, for a patient with a given health problem (e.g., cancer), the full range of treatment options available in all areas of conventional medicine and CAM, the benefits and harms that can be expected from each choice, and the nature of the supporting evidence,” the panel concluded.
Source: “Clinical Practice Guidelines in Complementary and Alternative Medicine: An Analysis of Opportunities and Obstacles,” Archives of Family Medicine 6:149-54, 1997.