How Far Has Alternative Health Care Come Since January 1993?

By Patti Frattarola, Editor, FCER
Since the article "Unconventional Medicine in the United States" was published in the New England Journal of Medicine on January 28, 1993, a lot has changed. David Eisenberg, MD, primary investigator of the study managed to set the worlds of mainstream medicine, alternative medicine, third-party payers, and medical schools on their collective ears.

Dr. Eisenberg, et al., said that the "frequency of use of unconventional therapy in the United States is far higher than previously reported." They advised medical doctors to "ask about their patients' use of unconventional therapy whenever they obtain a medical history," because one in three Americans use unconventional therapy, and 72 percent of these people do not inform their medical doctor that they do so.

This study was just the tip of the unconventional medicine (now commonly known as alternative medicine) iceberg. Americans make an estimated 425 million visits per year to providers of alternative health care, amounting to approximately $13.7 billion, three-quarters of which is paid out-of-pocket! Even medical schools are incorporating alternative care into their curriculum. Currently 32 now offer or are developing courses on alternative care, including Columbia University College of Physicians and Surgeons, Harvard Medical School, and Johns Hopkins School of Medicine.

Five months after "Unconventional Medicine in the United States" was published, the Office of Alternative Medicine (OAM) was "codified" as a permanent entity after nearly two years as an interim, special-purpose office within the National Institutes of Health. On June 14, 1993 President Clinton signed into law the National Institutes of Health Revitalization Act of 1993. Congress permanently "established within the Office of the Director of NIH an office to be known as the Office of Alternative Medicine." Also written into the law was the purpose of OAM, "to facilitate the evaluation of alternative medical treatment modalities, including ... physical manipulation therapies."

The OAM works with several government agencies including the Health Care Financing Agency, the Food and Drug Administration, and the Agency for Health Care Policy and Research (the agency that gave us the guideline on acute low-back pain in adults). The budget for OAM was $2 million each year in fiscal year 1992 and 1993. In fiscal year 1994 it was increased to $3.5 million and then to $5.4 million for fiscal year 1995.

As alternative medicine is infiltrating the mainstream, new scientific journals are springing up. In addition to publications such as New Age Journal and Natural Health which cover topics that were once considered taboo, a new crop of alternative journals seem to be catching the attention of doctors, patients, and advertisers. Among the new publications: the Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy; Alternative Therapies in Health and Medicine; and Alternative Health Practitioner: the Journal of Complementary and Natural Care.

The presentation of the recently released report, "Alternative Medicine: Expanding Medical Horizons," to Alan Trachtenberg, then acting director of OAM, grew out of a meeting of unconventional healers summoned to give scientists the lowdown on alternative medicine. The 420-page report is referred to as a "map drawn for us by many of the dedicated natives of the territory." For the first time, most of the meeting's participants were being taken seriously by the medical establishment, and they had a lot to say. The report contains referenced details on a variety of approaches to healing, including diet, chiropractic manipulation, and meditation.

Insurance companies are also jumping on the alternative care bandwagon. A number of reasons may account for the interest taken by third-party payers, including cost-effectiveness, positive results from research, and patient demand. Currently 41 states require private health insurers to cover chiropractic care and seven require coverage for acupuncture. According to Group Health Association of America, the number of HMOs offering chiropractic care jumped from 28.4 percentage in 1992 to 46.6 percentage in 1993.

For the American Medical Association, alternative medicine is still shunned, although there may be some speck of light at the end of the tunnel. Jerome McAndrews, DC, vice president for professional affairs for the American Chiropractic Association, was invited to speak on a conference panel sponsored by the National Association of Independent Insurers, along with a representative of the AMA. According to Dr. McAndrews this is a first. The audience consisted of 200 insurance executives, and the topics included auto insurance.

George B. McClelland, DC, president of FCER's board of trustees, was invited to speak at the Ninth Annual Stanford Health Policy Forum on April 22, 1995. The Stanford Health Policy Reform is an annual conference exploring policy issues integral to medicine and health care. The topic for this year's conference was "Assessing the Value of Unconventional Therapies in America's Health." Dr. McClelland discussed the current research pertaining to chiropractic care.

For Dr. Eisenberg, things have come full circle. On April 1, 1995 Beth Israel Hospital in Boston, Massachusetts began a fund-raising drive to set up the Center of Alternative Medicine Research. The center will be directed by Dr. Eisenberg, and will conduct the kind of rigorous research that has often been lacking in alternative care. The fact the Beth Israel (one of Harvard University's teaching hospitals) is embracing this once taboo subject is a strong indication of the strides being made by alternative medicine.

FCER has always been committed to high levels of research, and is working hand in hand with people like Dr. Eisenberg to raise the quality of research in all areas of alternative health care.

Patti Frattarola Editor, FCER's Advance and The Week in Chiropractic Arlington, Virginia

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