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The United States spends about $1.5 trillion
on health care each year -- a higher share of GDP than any
other country. But are we happy with the behemoth we've built?
About one-fifth of Americans believe the health system needs
some remodeling, according to a recent survey by the Commonwealth
Fund. Virtually everyone else favors over-hauling it completely.
Nearly half of U.S. adults now go outside the health system
for some of their care. We make more visits to non-conventional
healers (some 600 million a year) than we do to MDs, and we
spend more of our own money for the privilege--about $30 billion
a year by recent estimates. Complementary and alternative
medicine, or CAM, is not a single, unified tradition. And
because few of these therapies have been thoroughly evaluated
in controlled studies, their effectiveness is still widely
debated. But no one now disputes the significance of alternative
treatments. Senior Editor Geoff Cowley joined us for a live
discussion on the increasing use and appeal of alternative
medicine.
Senior Editor Geoffrey Cowley
has led NEWSWEEK's medical coverage for more than a decade,
working with other editors to produce special sections and
issues and writing ground-breaking articles on topics ranging
from brain science to global health. His stories have won
numerous awards and several have prompted government action.
Cowley has chronicled all of the recent trends in American
medicine, from the advent of Prozac and the sequencing of
the genome to health-care costs and the boom in complementary
and alternative medicine. Cowley has also written extensively
about epidemics and global health. Besides tracking the impact
of diseases such as tuberculosis, malaria and hepatitis C,
he has profiled global health crusaders such as Bill Gates
and Dr. Seth Berkley. At the same time, he has covered all
aspects of the AIDS pandemic, from laboratory science to social
policy. The honors he has received for his AIDS coverage include
a Clarion Award (Best Magazine Article), a Certificate of
Merit from the American Academy of Nursing, and a Unity Award
for Public Affairs/Social Issues Reporting from Lincoln University
of Missouri.
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Geoffrey Cowley: Hello everyone, Geoff Cowley
here, ready to take your questions.
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Tucson, AZ: Is it possible to study Chinese medicine or acupuncture
or other alternative therapies at traditional medical schools?
It seems like there is still a stigma attached to any pracititioner
who doesn't have an MD after his or her name.
Geoffrey Cowley: Western medical schools
aren't set up to certify practitioners in traditional Chinese
medicine, but they no longer ignore the existence of other
healing traditions. As I mentioned in the piece, the majority
of U.S. medical schools now offer courses in complementary
and alternative medicine (henceforth, CAM), and a dozen leading
leading schools have established permanent CAM programs or
institutes.
My sense is that very few CAM practitioners
now see themselves competing with MDs. Most readily admit
that while they can sometimes help with problems that elude
conventional medicine (fibromyalgia, irritable bowel, insomnia,
etc.), the reverse is also true. I've yet to meet anyone who
considers herbs or acupuncture a sufficient technique for
treating burns, trauma or a life-threatening bacterial infection.
As for stigma, what most impresses me is how rapidly it's
breaking down. True, insurance coverage is still overwhelmingly
biased in favor of conventional, Western interventions. But
many enlightened MDs now refer their patients to CAM practitioners,
and vice versa. At integrative clinics such as the Marino
Center in Massachusetts (http://marinocenter.org/), MDs actually
work side-by-side with healers from other other traditions.
We're a long way from having a fully integrated health care
system, but it seems to me we're moving in the right direction.
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Santa Fe, NM: If half of all Americans are going outside traditional
medicine to treat themselves, doesn't it seem like we might
have a problem with our 'traditional' health system that needs
to be addressed? Why aren't we including more alternative
therapies in traditional treatment??
Geoffrey Cowley: I think everyone agrees
that the mainstream health care system is broken. It has al
but abandoned humane care in favor of an overzealous quest
for "cures." As you point out, the growth of CAM
provides compelling evidence that consumers are looking for
something more. Here's how I described the dilemma in an earlier
draft of my article:
If high-tech tools were the measure of a medical system, Americans
would have plenty to gloat about. The United States spends
about $1.5 trillion on health care each year--a higher share
of GDP than any other country--and leads the world in technological
prowess. But are we happy with the behemoth we’ve built?
Roughly a fifth of Americans believe the health system needs
some remodeling, according to a recent survey by the Commonwealth
Fund. Virtually everyone else favors overhauling completely.
As summed up recently by the Institute of Medicine, the consensus
view of U.S. health care goes roughly like this: “The
chassis is broken, and the wheels are coming off.”
It’s not that Americans have
soured on technology--we’ll march in the street to demand
more of it when threatened by a scourge like AIDS or breast
cancer. But after a century of pill-and-scalpel medicine and
a decade of managed care, we’ve discovered that waging
war on disease is one thing, restoring people’s health
quite another. As the World Health Organization has long recognized,
health is not merely the “absence of disease or infirmity”
but “a state of complete physical, mental and social
well-being.” Our harried specialists may excel at excising
tumors and bypassing blocked arteries. But when we need hope,
insight, compassion or a sense of personal efficacy--well,
there’s always the neighborhood herbalist.
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Chicago, IL: Do you think so-called alternative and complementary
treatments may one day become mainstream treatments?
Geoffrey Cowley: I don't think there's any
question about it. As Drs. Ted Kaptchuk and David Eisenberg
wrote last year in the Annals of Internal Medicine (vol 135:
pp 196-204), "the boundary demarcating conventional and
irregular medicine has always been porous and flexible."
They note that nitroglycerine and digitalis were once alternative
remedies, and that corn flakes and graham crackers were once
regarded as weirdo health foods. All are now about as mainstream
as you can get. As science reveals more about the risks and
benefits of today's alternative remedies, those showing the
greatest promise will surely become part mainstream care.
Even today, it's hard to find a major cancer center that doesn't
offer complementary care as well surgery and chemo. One study
found that 69 percent of the patients at Houston's MD Anderson
Cancer Center were receiving complementary as well conventional
treatment.
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Denton, TX: Why hasn't more research been done about alternative
treatments if so many Americans are already using them?
Geoffrey Cowley: The research community may
have been slow to recognize the significance of CAM, but as
I explain in this week's article, the research is now exploding.
The National Center for Complementary and Alternative Medicine
(http://nccam.nih.gov/) now spends $105 million a year on
CAM-related research. Those funds are now supporting large
clinical trials of several popular remedies, as well as lab
studies aimed at clarifying the physiological effects of everything
from acupuncture to music therapy. Here are some examples
of resent research findings (not all of them the result of
NCCAM grants):
Dr. Dean Ornish has used CT scans to show that dietary interventions
can increase the diameter of heart patients’ arteries.
Dr. Helen Mayberg has used brain scans to show that placebo
response alters glucose metabolism in the brain.
Janice Kiecolt-Glaser at Ohio State University has shown that
relaxation techniques can alter immune function.
Tiffany Field in Florida has shown that infant massage improves
the outcome for premature babies, allowing them to leave the
hospital 6 days earlier and save as much as $10,000 in medical
costs per child.
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Boulder, CO: Do you think that serious adverse events get
more public attention if they are related to alternative treatments
vs. FDA approved treatments? If so, why do you think this
happens?
Geoffrey Cowley: That's a good observation.
More than 100,000 Americans die each year from complications
caused by prescription drugs being used as intended. That
number got some attention when it came out in a 1998 JAMA
study, but it has never really created an air of crisis. If
a few college kids kill themselves by overdosing on ephedra-based
simulants, we act as though the sky is falling. I wouldn't
deny for a minute that prescription drugs do enormous good,
or that natural remedies can cause harm, but we do tend to
judge them by different standards. I can't tell you why it's
so, except to say that we're all inclined toward chauvinism.
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MSNBC.Com chatroom: Homeopathic remedies are not benign, many
people think that if they're natural they are inherently safe.
This is a common misconception.
Geoffrey Cowley: My impression is that homeopathic
remedies are completely benign--unless they're used in place
of effective therapy. Homeopathy is based on the ideas that
toxic substances taken at virtually nonexistent concentrations
have therapeutic effects. The concentrations are, by any plausible
definition, too low to do any good -- or to cause any harm.
People do get better while taking homeopathic remedies, but
most researchers believe the credit should go to the placebo
effect.
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Philadelphia, PA: I have used St John’s Wort (Latin
- Hypericum, German - Johanniskraut)in the past to treat
mild depression, and I truly thought I noticed an improvement
in my mood. But I stopped taking it after I heard that it
might have dangerous side effects. How conclusive are these
studies? Should I err on the side of caution, even if I felt
like it was an effective treatment? (I am very wary of taking
Prozac or another precription anti-depressant that might have
more severe side effects). Thanks.
Geoffrey Cowley: I'm not aware of any research
suggesting that St. Johns Wort is inherently risky, but there
are some precautions to keep in mind. The herb can reduce
the effectiveness of drugs used to treat HIV and colon cancer
and may interact badly with anesthesia. If you're not at risk
for any of those complications, I'm not aware of any reason
to avoid it altogether. The challenge is to find a supplement
that contains exactly what the label promises. Look for a
brand that carries a USP (United States Pharmacopia) seal.
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MSNBC.Com chatroom: : Do you think that Dr. Weil is the bridge
between traditional medicine and alternatives?
Geoffrey Cowley: I have enormous respect
for him and the work he has done to bridge different healing
traditions. He founded one of the nation's first and most
ambitious programs in integrative medicine (see http://integrativemedicine.arizona.edu/)
and is fluent in conventional as well as complementary health
care.
But do I think he is /the/ bridge between conventional medicine
and alternatives? Not at all. I think he is one of a huge
and growing number of smart, idealistic clinicians and researchers
who share the same vision.
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Palo Alto, CA: If there are no conclusive studies then how
do you determine the risks associated with using herbal remedies
or other alternative treatments? Should you depend on your
doctor? Is there another source?
Geoffrey Cowley: For definitive assessments
of specific remedies, the best source I've seen is a Web-based
library called the Natural Standard (http://www.naturalstandard.com/).
It's loaded with authoritative monographs. Though the available
research is not always definitive, you'll come away with a
good sense of whether something is worth trying. There is
a catch, though. Access is restricted to subscribers, and
subscriptions are not cheap. You'll pay $100 for a year's
access. The NCCAM site is a good place to start if you don't
have $100 to spend. You'll also find lots of useful and reliable
information at Intellihealth (http://www.intelihealth.com/).
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Sarasota, FL: If people are recovering by combining conventional
and alternative therapies, when can we expect insurance carriers
to include coverage for more than mainstream practitioners?
Geoffrey Cowley: There has been a lot of
progress already. Some 70 percent of U.S. health plans now
offer some coverage for chiropractic. Seventeen percent cover
acupuncture and 12 percent cover massage. Dr. Dean Ornish
has persuaded more than a score of big insurers (including
Mutual of Omaha) to cover his lifestyle-based heart disease
program, and federal government is now evaluating as a possible
Medicare benefit. So while progress has been slow, it has
also been steady in recent years.
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MSNBC.Com chatroom: Doesn't the AMA have a conflict of interest
in coding CAM, since the AMA is a physician membership organization
and some CAM interventions may compete directly with conventional
approaches to care?
Geoffrey Cowley: I don't think so. CPT codes
are simply definitions that clinicans use to define and distinguish
different treatments. By expanding the CPT roster to include
more complementary therapies, the AMA isn't endorsing or condemning
them. It is simply providing a mechanism that will make it
easier for CAM practitioners to track the popularity and cost-effectiveness
of different procedures.
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MSNBC.Com chatroom: What portion of the money being allocated
for alternative medicine research is going to large phamaceutical
companies as opposed to smaller and potentially less political
research groups?
Geoffrey Cowley: I'm not aware of any large
grants from NCCAM to pharmaceutical companies. Big pharma
funds its own research in the hope of profiting. NCCAM is
generally funding academic research that the drug companies
have no incentive to pursue or pay for.
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MSNBC.Com chatroom: Geoff, if the NNCAM research you mention
proves successful, how can the public get access to quality
products in this relatively unregulated industry?
Geoffrey Cowley: Where supplements are concerned,
I urge you to look at the work that U.S. Pharmacopia is doing.
It recently launched a Dietary Supplements Verification Program
(DSVP) that enables good manufactures to have their products
independently tested and certified. The American Botanical
Council has some useful resources as well. And though the
supplement makers vary widely in their commitments to quality,
I've been consistently impressed with Pharmavite. I'll attach
links some links here, and sign off for this week. Thanks
very much for tuning in. |
