21st century ushers in integrative medicine: but many questions remain about how the health care system will react - Integrative Medicine

Physician Executive, July-August, 2003 by Marc S. Micozzi

For example, the American WholeHealth Network, based upon a successful model in Chicago to provide integrated medical services under physician supervision, was unable to receive adequate physician patient referrals and had to embark on costly direct-to-consumer marketing.

The late William Fair, a leader in integrated care, developed one response to the referral problem. He proposed that a facility for complementary care should not be supervised by a physician. This concept, initially developed as Synergy Health, was first tested in New York City under the name Haelth.

Cost-effectiveness

Thanks to an alternative/complementary medicine research program at the National Institutes of Health, a database is being developed that provides abundant and credible data on the effectiveness of alternative healing.

Utilization research of alternative/complementary care is required to better understand:

* Patient motivation and satisfaction

* Willingness to pay for care

* Preference of one type of care over another

* Willingness to substitute care

* Multidisciplinary guidelines for best practices in disease management

The Agency for Health Care Quality, working with a limited budget, is providing important analyses on effectiveness and cost-effectiveness of various treatments for low back pain including pharmaceuticals, surgery, spinal manual therapy, acupuncture, massage, and other therapies If improved effectiveness and cost savings are to be realized by consumers, the health system and third-party payers, it is incumbent upon integrative medicine to determine what kinds of therapeutic options can be provided to which patients for cost-effective disease management.

Integrative medicine products

Appropriate use of nutrients and herbs is a critical component of many integrative medical practices.

Presently in the U.S., these natural products are widely available, classified and regulated as dietary supplements. As such, they are regulated by the Food and Drug Administration for identity, purity and safety, but not for efficacy.

However, unlike pharmaceuticals, information about the health effects cannot be provided on the product label or with the product. Due to the increasing availability of credible, third-party research on the efficacy of herbal and nutritional ingredients, it is important for practitioners of integrative medicine to maintain a medical standard of information and practice about herbal and nutritional ingredients.

The importance of dietary supplementation for optimal health and for the prevention and management of many medical conditions is also recognized by the medical profession. (1) Part of this requirement is to develop and maintain an appropriate clinic- or hospital-based formulary of high quality sources of herbs and nutrients.

Adding to this quixotic regulatory environment are problems such as:

* The natural products industry does not adhere to medical and scientific standards.

* Many irresponsible marketing claims are made about natural products.

* Medical and scientific professionals are not knowledgeable about the science behind herbal and nutritional medicine.