`Complementary' Medicine: Is It Good For What Ails You?Naomi Freundlich
Lynn Mirabito, a New York filmmaker, suffered from debilitating lower-back pain off and on for a year and a half. When she finally sought help, she chose a sports-medicine doctor who is also a licensed acupuncturist. He didn't cure the problem, but his use of acupuncture and laser treatments offered her welcome relief from the constant pain.
Mirabito's experience is no longer novel. Americans have proven themselves ardent consumers of alternative medicine, and more M.D.s are expanding their arsenals--practicing techniques not usually taught in medical school. In venues as varied as a family doctor's office or the operating room of a cardiac surgeon, physicians are turning to acupuncture, herbs, massage, or meditation to treat common woes.
Some call it alternative medicine, but the term gaining favor these days is complementary medicine, which suggests that these techniques can be used to complement standard practices--and in some cases, fill gaps where conventional treatment is found lacking. For patients drawn to alternative therapies but fearful of entrusting their care to practitioners without medical training, the M.D. degree provides a greater level of comfort. And since the doctor practices both conventional and alternative therapies, "you increase your treatment options," says Dr. Brian Berman, director of the division of complementary medicine at the University of Maryland School of Medicine.
But while many doctors believe alternative medicine shows promise, others are troubled by the lack of good studies to measure the outcome and cost-effectiveness of these practices. And they worry about practitioners' using alternative techniques for serious diseases that could progress if not treated with conventional drugs or therapies. "Physicians have a commitment to take care of patients based on scientific principles," says Dr. Yank Coble Jr., a Jacksonville (Fla.) endocrinologist who is on the board of the American Medical Assn. "The concern is that the treatment offered is truly of value and that patients are informed of potential risks and benefits."
There are no figures on how many doctors practice complementary medicine. But a survey conducted by Berman found that 70% of family physicians in the Chesapeake Bay area expressed interest in receiving training in multiple areas of alternative medicine. At least 26 medical schools in 13 states, including Harvard, Columbia, and Stanford, are offering courses in alternative medicine. The idea is not necessarily to train students but to educate them about treatments their patients may be using outside their care.
It is knowledge they clearly will need. In 1993, Dr. David Eisenberg, director of the Alternative Medicine Research Center at Beth Israel Hospital in Boston, published a study in The New England Journal of Medicine that found one in three Americans used alternative therapies to treat serious problems such as cancer or arthritis. Since insurers don't pay for most alternative care, that amounted to an estimated $10.3 billion that consumers spent out of pocket.
The doctors most likely to practice complementary medicine are those who treat chronic problems--such as back pain, headache, or immune-system deficiencies--that often don't respond to conventional therapies. Dr. Peter Bower, a family doctor in Charlottesville, Va., began studying osteopathic manipulation and other alternative techniques after meeting a patient with persistent pain from whiplash. The man had seen 10 doctors who all told him they couldn't find anything wrong. "Conventional medicine is excellent for many things, but for chronic pain or stress, we don't have all the answers," Bower says.
STRONGER BUGS. Alternative medicine also is gaining a foothold in areas where conventional medical care is suspect. There's a growing fear, for example, that the overuse of antibiotics will lead to more drug-resistant diseases. For years, doctors have treated ear infections in children with a regimen of antibiotics. But pediatricians also know that if left untreated, most ear infections will clear up in a week or so anyway. So, today, some physicians are trying homeopathic remedies such as belladonna, actinite, and pulsatilla instead of antibiotics.
One basic tenet of complementary medicine has studies to back it up: the idea that the mind is an important player in determining health. That's especially true with back pain, fatigue, or other nonspecific ills, says Berman.
For Dr. Leonid Gordin, a general practitioner at the Marino Health Center in Cambridge, Mass., the mind-body connection is particularly important. He received his medical training in Russia, where he learned acupuncture and herbal remedies. His approach to a person with back pain is to look at where the pain is physically and then talk about the "emotional and intellectual aspects of the problem." Treatment options include visits with a psychologist, biofeedback, or low-level electric currents that he says block the pain. But a cornerstone of care at the Marino clinic is that patients must actively work to help themselves, including altering diet, quitting smoking, and getting more exercise.
Most doctors would agree that a practitioner who emphasizes stress reduction, healthy eating, and exercise is on the right track. But William Jarvis, president of the National Council Against Health Fraud in Loma Linda, Calif., bridles at physicians who go a step further and promote unproven remedies. That view illustrates the inherent controversy in complementary medicine--how far does one go?
When choosing an alternative m.d., the answer might be to find one who will do a complete diagnostic exam to rule out any serious problem first. Berman suggests asking doctors how extensive their complementary training is and whether they're licensed to practice disciplines such as acupuncture or homeopathy.
At the moment, no definitive studies can prove that complementary medicine is cost-effective--or even provides a better quality of life. For this reason, insurance companies and other third-party payers are very selective about the types of alternative therapies they cover. Bower says that some 80% of his patients are covered for their care, but much of it is within the realm of conventional medicine--massage therapy or osteopathic techniques. More insurers are approving acupuncture claims, too. But patients of Gordin--who shuns all conventional medicines except antibiotics--receive no compensation.
TESTING, TESTING. Eisenberg's Alternative Medicine Research Center at Beth Israel is at the forefront of the quest for answers. The National Institutes of Health just awarded it $900,000 to come up with scientific studies to determine the safety, efficacy, and cost-effectiveness of alternative therapies. Nine other academic groups--including Berman's--also got grants to conduct research on alternative medicine's role in such areas as pain, stroke, cancer, and aging. Eisenberg says hundreds of millions more in funding will be needed to conduct large-scale clinical studies. He hopes managed-care companies or large employers will foot the bill.
For now, it's up to consumers to make educated choices about alternative care. Says Coble: "If it sounds too good to be true, it probably is." But if a physician can successfully use an alternative technique where a conventional method fails, then the patient clearly has something to gain.
A Different Approach to Common Ailments
ARTHRITIS & OTHER PAINS
For muscle and joint pain, alternative M.D.s might try acupuncture, massage, or manipulation, along with stress reduction. Homeopathic preparations for musculoskeletal injuries include arnica, rhustox, and ruta.
CHILD'S EAR INFECTION
In place of antibiotics, doctors might use herbal remedies such as echinacea or bifidus to strengthen the immune system. Homeopathic medicines include belladonna for pain and chamimilla for infection.
CHRONIC BACK PAIN
Acupuncture and massage therapy are standard. Some providers use osteopathic manipulation, low-level lasers, or electric currents. Most include stress-reduction techniques, such as meditation or biofeedback.
Treatments include acupuncture and Chinese herbs, as well as biofeedback and other relaxation techniques. Homeopathic medicines include silica, belladonna, and iris bersicolor.
IMMUNE SYSTEM ILLS
Vitamin C and selenium are often used to boost immunity. Herbal remedies include echinacea, peppermint oil, and turmeric. Some practitioners believe ginger has antibiotic-like properties.
DATA: BUSINESS WEEK
What to Ask An Alternative M.D.
-- What kind of training do you have in alternative practices? Have you completed a proven course of study in acupuncture, massage, homeopathy, or whatever--and are you licensed to practice these techniques?
-- Will you do a physical exam to rule out standard treatment options before resorting to complementary medicine?
-- Are you comfortable using both conventional and alternative medications?
-- Can you supply any data to show that a particular alternative treatment is effective for my condition? How does the treatment work? How long will I need it?
-- Have your patients generally been successful in getting health insurers to pay for your therapies?