An about-face at the AMA - the American Medical Association revises its stand on alternative medicine

IT'S HARD TO ARGUE anymore that alternative medicine is a trend anymore. Studies show that one-third of Americans use alternative or complementary medicine every year; other estimates indicate that 1 million people have tried homeopathy. Some insurance carriers reimburse policy holders for alternative treatments because they are cost effective, and often work where conventional methods fail. And research on alternative therapies is even being conducted by a wing of the National Institutes of Health.

But the American Medical Association (AMA) has reacted to all this in a decidedly Archie Bunker-like way. In the past, the Chicago-based trade organization has grumbled to the press about herbal remedies, mocked acupuncture and chiropractic, and denounced studies showing that vegetarians have lower health-care costs. But this stodgy attitude hasn't stemmed the tide of interest in alternative medicine, and now the AMA is changing its tune.

The AMA's House of Delegates has adopted a four-point position paper exhorting its members to get up to speed on alternative medical practices, and to encourage the Office of Alternative Medicine to continue evaluating them. Is this the first step toward enlightenment, or is the AMA just trying to head off criticism that their members are quick to condemn what they don't understand?

"I look at this as a wonderful thing, and it really doesn't matter why they're doing it," says Richard Sarnat, M.D., a Chicago-area AMA member and author of Physician Heal Thyself (Herbal Free Press, 1996). Sarnat says the alternative movement in this country is spreading from grass-roots populations to the mainstream and on up to the most senior levels of orthodox medicine. So it's no surprise that the AMA, with its staunch, conservative leadership, is the last to recognize its significance. He adds that doctors who don't know about alternative practices are noticing an attrition of patients from their practice, and the industry is "afraid they're losing ground financially."

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M. Roy Schwarz, M.D., AMA vice president for scientific, educational and practice standards, denies that his organization's move was motivated by economics. But he does acknowledge that physicians with no familiarity with alternative practices are at a disadvantage. "In some cases if you're taking herbs there could be an interaction [with prescription drugs] that is puzzling. Physicians have to be aware enough to at least know what the patient is taking."

Although the AMA's directive to members probably won't make an immediate difference to patients, the coming year will likely be a watershed for alternative medicine. Besides the 12 major insurers that reimburse for alternative medical practices, Sarnat says the world's first alternative HMO is in the works (Vegetarian Times will cover this story when it happens). And according to Schwarz, the AMA is currently working on an in-depth position paper on alternative medicine to give practitioners one central source to learn more about alternative medical practices and their economic ramifications. But no matter what happens, the AMA will always be skeptical toward any method that can't be measured by a double-blind clinical trial (in which people receiving treatment are compared with similar subjects receiving no treatment or a placebo, and where neither the experimenter nor those being tested know which group is which). This method may be the gold standard for testing the efficacy of a prescription drug, but it has yet to explain why or how some alternative practices heal.

"At some point you have to beat them or join them," Sarnat says. "And I don't think alternative medicine is going to be beaten."