BOSTON — Long considered quackery by America's medical profession, the herbal remedies, needle treatments, and mind-body healing methods practiced for centuries by ancient cultures are gaining respectability in the public's eyes and in doctors' offices nationwide.
News that a major US health-care provider will offer coverage for people who use yoga, massage, acupuncture, and other nontraditional treatments has added fuel to the debate over the merits of so-called alternative medicine.
Supporters of alternative medicine include several health maintenance organizations (HMOs) that insist their patients want equal footing for alternative care. To many in the medical establishment, though, the move by HMOs to cover less-expensive alternative treatments is simply a way to put profit above patient care.
Oxford Health Plans Inc. announced this month that it would become the first HMO to offer a program of comprehensive coverage for alternative medical treatments. While some HMOs and health-insurance companies have begun pilot projects or research clinics, it is the first to allow patients to see practitioners of naturopathy, yoga, and acupuncture as their primary caregivers, rather than requiring them to receive alternative treatment only on the advice of a medical doctor. Finally, Norwalk, Conn.-based Oxford has expanded the availability of alternative medicine - which is more established on the West Coast - to the Eastern Seaboard.
'Customers have asked for it'
Oxford's announcement comes at a time when HMOs are increasingly powerful in determining the direction of America's health-care system. While alternative medicine is usually much less expensive than conventional medicine, most of it has not been scientifically tested.
But to alternative-medicine practitioners, Oxford's plan signals a long-overdue recognition that a growing number of Americans want - and have been willing to pay for out of their own pockets - a different approach to health care.
"Oxford has always been very focused on its customers and what its customers want," says Hassan Rifaat, Oxford's alternative medicine director. "We have done this because our customers have asked for it. We want the members to make their own choices."
But HMOs are not alone in their efforts to cover the use of alternative treatments. Lawmakers in the US House and Senate proposed bills this year to make alternative medicine more accessible to the public. Washington State last January voted to require health-insurance companies to make available providers from a wide variety of treatment methods, including naturopathy, massage, and acupuncture. And HMOs such as Kaiser Permanente, a leading provider in California, have established alternative-medicine health clinics to provide meditation, nutrition counseling, and deep-breathing exercises for its customers.
Over the past five years, public interest in alternative medicine has ballooned. A Harvard University study published in 1993 in the New England Journal of Medicine documented for the first time what many in alternative health care had long suspected: A third of respondents said they had used at least one "unconventional therapy" during the previous year. Other research shows that Americans spent $13.7 billion on alternative medicine in 1990.
Alternative medicine is even breaking into the staid culture of traditional medicine. Acupuncture, behavioral science, and holistic treatment methods are making their way into medical textbooks. Top medical schools such as those at Harvard and Columbia Universities have established alternative-medicine research centers. At Bastyr University in Seattle, the only accredited natural medicine university in the country, enrollment has grown sevenfold since it opened 18 years ago.
"There's been so much public interest because it makes sense," Joseph Pizzorno, president of Bastyr University and a well-known naturopathic physician, says of alternative medicine.
Medical and alternative-medicine practitioners also attribute alternative medicine's recent jump in popularity to a growing interest in the environment and international cultures, the increasing cost of conventional medicine, the research strides made by alternative-medicine practitioners, and the dominance of HMOs in the health-care system.
Alternative medicine is an umbrella term that encompasses everything from chiropractic to quartz crystals. Gaining most in popularity and acceptability are the disciplines of natural medicine and behavioral science, health-care systems based on teaching patients to care for themselves and "treating people, not disease," says Dr. Pizzorno. Natural medicine uses herbs in place of medicine, acupuncture or massage in place of surgery, and more preventive measures than does conventional medicine.
The premise of behavioral science is that the cause of much disease is stress; therefore to treat disease, a patient needs to emphasize stress reduction.
Quality control a concern
The problem with insurance companies providing coverage for alternative treatments, say medical doctors, is quality control. Without a standard definition of "alternative" or "natural" or even "herbs," says Yank Coble, a doctor and a member of the American Medical Association, how can patients know what they are subscribing to when they turn to alternative medicine? How, he asks, can practitioners be trained or even licensed?
Dr. Coble says his concern is that HMOs, by covering alternative medicine, are seizing an untapped market rather than seeking new ways to provide the best care for patients. "One has to be a little worried that it's a way of offering something cheaper for the same premium."
But Oxford's Dr. Rifaat says that is not a fair claim. So little information is available on the cost of alternative treatments that no one knows if these treatments will save the company money. "We're pioneering," he says. "We're putting out models to measure the health, satisfaction, and cost" of the plans.