Considering the alternatives - Complementary and Alternative Medicine - What's alternative?

Physician Executive, Nov-Dec, 1998 by David O. Weber

But many employers, insurers, and managed care organizations aren't waiting for the law to tell them to lengthen the therapeutic menu. So strong is the tide to inclusion of alternative therapies among benefits (almost always for a higher premium, of course) that the most authoritative assessment of HMO practices, conducted annually by Interstudy of Bloomington, Minnesota, will this year for the first time report on the prevalence of coverage for CAM modalities from acupuncture to yoga. (Chiropractic has long since become a standard treatment benefit for indemnity plan enrollees, as well as for members of at least half the nation's HMOs.)

And acceptance of unorthodox modalities is snowballing among orthodox physicians like Sheff, whose fledgling company, CommonWell, operates an "integrative medicine program" under contract to clients like the 420,000 members of a New England PPO called HealthCare VALUE Management. CommonWell offers a "Natural Connection" informational telephone line and a credentialed panel of naturopathy, homeopathy, acupuncture, massage, physical therapy, meditation, and chiropractic providers. Its major value-added function is to coax the PPO's patients to consider alternatives to expensive elective coronary artery bypass, laminectomy, and carpal tunnel release surgery.

"I've become convinced that there are opportunities for integrating the best of the best," Sheff says. "It's like the image of the blind man and the elephant. Conventional medicine has a piece of the truth, but not all of it. And the same can be said of complementary approaches. The question is how to tease out the most effective aspects of each and apply them to individual patients and populations."

That's the aim as well of the flamboyantly bearded CAM popularizer Andrew Well, MD. ("More dangerous than a radical quack," says Sampson, "because people believe in him. And he's wrong so much of the time. He's the shoe-horn onto the slippery slope.") At the University of Arizona Health Sciences Center in Tucson, Well heads a Program in Integrative Medicine designed to seed U.S. medical schools with physician-teachers grounded in the amalgamation of far-in and far-out therapies. In Brighton, Colorado, the Kaiser Institute has launched a similar nine-month fellowship program in integrative medicine for physicians and managers who want to set up centers in their own institutions.

"Our assessment is that the time is right," says Kaiser. "There's enough recognition that this is what the consumer wants, and it has some merit."

Three out of four U.S. medical schools already include alternative/ complementary medicine in the curriculum, at least as part of an elective course, according to the AMA. Programs like the Midwest Center for Health and Healing, under the aegis of the Swedish American Health System, in Rockford, Illinois, and the John S. Marten Center for Complementary Medicine and Pain Management, at St. Vincent's Hospital and Health System in Indianapolis, are popping up in the staidest of places. Often they are funded by legacies from philanthropists like Marten, Nathan Cummings, John Templeton, and John Fetzer, all of whom conceived a keen interest in the relationship between spirituality and health.