The struggle for freedom of medical choice is THE political issue of the new millenium. Therefore, it is extremely important that consumers, healthcare professionals, and legislators be both educated to, and aware of, the current progress & obstacles regarding the growing global acceptance of alternative medical therapy, and its ability to compliment allopathic medicine. This web page will provide a small portion of this type of information, featuring "Alternative Medicine in the Spotlight".
with Information on Legal & Regulatory Issues
Pertinent to Alternative & Complementary Medicine:
International Bibliographic Information on Dietary Supplements
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Please take the time to educate yourself on
this legislation, and please email your congressman and senators
with your views of this important Act.
The United States leads the world in
exceptional medical care, and the Food and Drug Administration
(FDA) plays an essential role in evaluating the safety and
efficacy of medical treatments to protect our citizens. The
current health care delivery system, however, effectively
excludes the development and utilization of non-harmful
alternative medical treatments that may help patients, contain
costs, and generate new approaches to treating illness and
chronic conditions. In a free market system, it makes good sense
to open up the health care delivery system to alternative
treatments, under carefully-circumscribed conditions.
The FDA approval process discourages
innovation. The time and expense currently required to gain FDA
approval of a treatment (an average of 10 years and $300
million) works to limit participation in this system to only
large pharmaceutical companies and to only those products that
can eventually be patented. It effectively precludes the
innovative contributions of individual practitioners, scientists,
and smaller companies that do not have the financial resources or
expertise to complete the arduous FDA approval process. It also
prevents many low-cost, natural and holistic treatments from
gaining access to the market.
Current medical approaches are not making
sufficient progress toward combating degenerative and chronic
diseases. Pharmaceutical drugs and high tech approaches have
proven quite effective in treating many infectious, communicable
diseases such as pneumonia, meningitis, and smallpox, in
responding to medical emergencies. They have not been nearly as
effective in treating degenerative diseases such as arthritis,
Alzheimer's, heart disease, diabetes or cancer. Greater attention
should be devoted to the growing need to develop new and more
effective ways to treat these chronic conditions that plague
millions of Americans.
This legislation would allow consumers
to be treated by any health care practitioner who is legally
authorized to provide professional health services in their
state, with any method of medical treatment the individual
desires, so long as:
- the treatment causes no harm more serious that reactions experienced with routinely used medical treatments for the same condition;
- the patient is fully informed about the treatment and its possible side effects;
- the patient is fully informed that the treatment has not been approved by the FDA; and
- there is no advertising or marketing of the product or treatment.
FDA's role remains the same. The Access to Medical
Treatment Act would not dismantle the FDA nor allow
pharmaceutical companies to circumvent the agency. The FDA would
attempt to open up a closed system to the utilization of
alternative and complementary treatments. The strict claims
restriction in the bill is designed to ensure that no incentive
exists for major marketing efforts of non-FDA approved
treatments, and should address the legitimate concern that this
legislation merely establishes a "bypass" for the FDA
approval process. In addition , the Federal Trade Commission Act
prevents pharmaceutical companies from marketing and advertising
non-FDA approved drugs.
This is a freedom of choice issue. Freedom of
choice is one of the bedrock principles upon which our nation
rests. Permitting the use of alternative medial treatments,
provided that individual are not misled or misinformed , extends
freedom of choice to American consumers, ensures their access to
the full range of therapies, increases their heath care options, may
significantly lower health care costs, and increases market
competition. This legislation stems from the conviction that an
individual suffering from a life-threatening or otherwise serious
disease, for which conventional medicine offers limited hope or
unacceptable side-effects, should not be denied access to a
non-conventional treatment, it there is no evidence that it is
harmful and every expectation that if could be efficacious.
Not all Representatives nor Senators have email addresses, but here is a link to a good listing of those that do:
http://www.webslingerz.com/jhoffman/congress-email.html
For specific information from the major proponent of this legislation:
Oregon Rep. Peter Defazio: pdefazio@hr.house.gov
Support the newly introduced Access to Medical Treatment Act bill now under discussion in the U.S. House of Representatives (HR 746) and the Senate (S578) by writing your U.S. Representatives and expressing your desire to have this bill passed into law. This bill will allow an individual to be treated by any licensed or legally authorized health care practitioner of any treatment method desired.
Codex Alimentarius Commission -
Global Plot to Suppress Herbs?
The future availability and legal status of
herbs in the U.S. may be determined by the standards set by a 146
member nation committee called the Codex Alimentarius Commission
operating in conjunction with the United Nations and the World
Health Organization (WHO). According to critics, under the guise
of protecting public safety by standardizing food and botanical
codes, the Commission may be a tool of the international
pharmaceutical industry that is intent on making herbs available
by prescription only.
The Commission was established in 1962 to set
international standards and codes for foods. Since then, it has
published 237 food standards, 41 hygienic codes, and safety
regulations for food additives and pesticides. In 1995, the
Commission's German delegation introduced a set of proposed draft
guidelines for dietary supplements to the Codex Committee on
Nutrition and Food for Special Dietary Uses.
These codes were based on how things work in
Germany where the major drug companies have managed to make a
great number of supplements available only by prescription. If
passed, the German regulations could block the use of supplements
for preventive or therapeutic purposes, severely hamper consumer
access by stipulating acceptable potencies and dosage levels, and
become the International Reference Standard for the U.S. through
its preexisting trade treaties such as NAFTA and GATT. All new
dietary supplements would be automatically banned unless they
passed the Codex approval process, potentially as burdensome and
expensive as that of the FDA for new drugs. In effect, the Codex
regulations would reposition supplements as drugs.
The standards would probably be more
restrictive than anything the FDA has yet proposed, states Frank
Cuny of California Citizens for Health in Oroville, California.
"It will limit our freedom of choice here in America and in
other free nations. It would be a disaster to the health food
stores and the health food industry." That view is shared by
John Hammell, political coordinator for the Life Extension
Foundation in Hollywood, Florida, which distributes supplements
and a health magazine. "The German proposal threatens to
destroy the dietary supplement industry, enabling the
pharmaceutical industry to take over all natural products as
expensive, patented drug analogs," says Hammell.
According to Hammell, although U.S.
representatives to the Commission (including FDA officials)
have opposed the German guidelines, the U.S. has only one vote on
the Commission. In October 1996, the Canadian delegate, Mary
Cheney, M.D., of that government's Health Protection Branch,
proposed creating a list of herbs from which the public needs
protection; this proposal was supported by Elizabeth Yetley,
M.D., of the FDA.
In Hammell's view, this represents the early stage of "a con
job on a global scale, a shell game" in which the
international drug cartel would shift the regulation of herbs and
supplements away from the Commission (which would regulate
them as "foods") to WHO jurisdiction (which
would see them as "drugs").
The German and Canadian proposals, if passed,
would constitute an effective end run by the drug companies
around the medical rights of Americans. "They wouldn't dare
do in the U.S. what they are attempting to do here because there
would be such a public uproar it wouldn't go through,"
observes Mark Davidson, D.O., of the Circle of Life Health Center
in Asheville, North Carolina.
The drug companies are planning a "global
takeover of the vitamin-herb industry" in the next few years
by regulating access and pushing competitors out of the field,
says Dr. Davidson. "They are planning to do it quietly and
carefully through GATT and the Codex Commission and they will
succeed if they are not exposed and their plan given national
headlines."
SOURCES: Life Extension Foundation, P.O. Box 229120, Hollywood, FL 33022-9120; tel: 800-841-5433 or 954-766-8433; fax: 954-761-9199; website: http://www.lef.org. California Citizens for Health, P.O. Box 2260, Boulder, CO 80306; tel: 800-357-2211 or 303-417-0772; fax: 303-417-9378; e-mail: cfh@ares.csd.net.
Express your
dissatisfaction with developments at the Codex Alimentarius
Commission by writing the U.S. and Canadian representatives.
Elizabeth Yetley, M.D., Director, Office of Special Nutritionals,
HFS-45, U.S. Food and Drug Administration, 200C St. S.W.,
Washington, DC 20204; tel: 202-205-4168; fax: 202-205-5295. Mary
Cheney, M.D., Chief, Nutrition Evaluation Division, Food
Directorate, Health Protection Branch, Tunney's Pasture, Postal
Locator 2203A, Ottawa, Ontario K1A 0L2 Canada; tel: 613-957-0352;
fax: 613-941-6636.
124% Growth in Alternative
Medicine Predicted
A new study published in Health Affairs
estimates that the per capita supply of alternative physicians
will increase by 124% between 1994 and 2010 compared to a growth
rate of only 16% for conventional doctors. The study, conducted
by the Health Policy Institute at the Medical College of
Wisconsin in Milwaukee, examined trends in three alternative
modalities that are currently licensed and regulated in the U.S.,
namely, chiropractic, acupuncture, and naturopathy. A 230% growth
rate is predicted for the supply of classical acupuncturists
(excluding those who are M.D.s) by the year 2010, while the
number of chiropractors will double, and that of naturopaths will
triple.
"As a result, the supply of alternative
medicine clinicians will increase from 11% of physician supply to
17% in 2010, "stated Richard A. Cooper, M.D., co-author of
the report. Dr. Cooper reports that currently (1994 data)
there are 59,000 alternative medicine clinicians in the fields of
chiropractic, acupuncture, and naturopathy in the U.S.,
equivalent to 10% of the total number of patient-care physicians.
This means there are almost 23 alternative practitioners per
100,000 people (there are 212 conventional physicians/100,000),
a number predicted to almost double to 43/100,000 by the year
2010.
The researchers observed that the number of
alternative practitioners and their acceptance by the public
already make the field "a force to be reckoned with"
and that medical planners had better start accommodating this
"shift in clinical focus" in all their forecasts.
SOURCE: Richard A. Cooper, M.D., and Sandi Stoflet, "Trends in the Education and Practice of Alternative Medicine Clinicians," Health Affairs 15:3 (Fall 1996), 226-238.
Sales Of Alternative Medicine Soar
A new survey reveals that the U.S. natural
products industry, including natural foods and medicines, grew by
22.6% since 1994, an all-time high of $9.17 billion, as
represented by 6600 retail outlets. Similarly, sales for 1994
were 22.7% higher than the previous year.
Specifically, 1995 sales in natural/health food
stores grew by 20.3%, health food chains by 25.4%, and mass
market outlets by 22%. Sales of vitamins accounted for
$1.15-$1.26 billion, natural medicines took in $270-298 million,
and herbs netted $520-560 million.
Why such phenomenal growth? According to
Natural Foods Merchandiser, which released the report, consumers
are searching for natural, safe, effective health care solutions,
"for more personal control over health care and for ways to
prevent illness." In fact, by one estimate, 90% of people
making their first visit to a natural products outlet do so
because of a health crisis. "Natural medicines are in the
news, and the stores that sell them are ever more visible,"
reported the Merchandiser.
SOURCE: Monica Emerich,
"Industry Growth: 22.6%," Natural Foods Merchandiser,
Vol. XVII, No. 6, June 1996, pp. 1, 22-39. Available from New
Hope Communications, 1301 Spruce Street, Boulder, CO 80302; tel:
303-939-8440; fax: 303-939-9559.
59% Of Canadians Use Alternative
Medicine
According to a poll of 2,629 residents,
conducted in June 1996 by the Richmond Regional Health Board in
Richmond, British Columbia (Canada), 59.4% said they have
tried "complementary" or alternative health therapies,
including chiropractic, acupuncture, massage, and aromatherapy.
The majority of the respondents (59%) were aged 31-50; 75% were
women.
Even more impressive, 86.3% say they are in
favor of having alternative therapies at least partially funded
by Canada's Medical Services Plan, while 88.6% of Richmond
residents want to see a "Complementary Health Therapies
Center" established in their community. Among Chinese
residents, 46.1% have used complementary therapies, as have 44.7%
of hospital workers and 61% of employees of the Workers'
Compensation Board.
Of those individuals dissatisfied with Canadian
Medicare services, 78% had used alternative therapies. Among
modalities, the category of vitamins and supplements was the most
often used, by 37% of respondents; 30% had used chiropractic; 29%
massage, 17% naturopathy, and 14% acupuncture.
For those who had not accessed an alternative therapy, lack of
knowledge of the therapy's benefits followed by cost
considerations were the main reasons, the Richmond poll revealed.
Among hospital workers, however, 24% (compared to only 8.8%
among all 2,629 respondents) gave as a prime reason their
lack of belief in the benefits of the therapies.
"This finding is consistent with the
literature," the Richmond Health Board "Information
Report" summary stated. "Those involved in the
provision of [conventional] medical services are less likely to
explore alternative health therapies."
The Information Report also summarized data on
alternative medicine from other studies. A 1996 survey found that
41% of Canadians aged 55-64 and 43% of those aged 65 and older
were "ready to consider" an alternative therapy. Of
Ontario general practitioners, an estimated 55% to 71% regard one
or more alternative therapies as "useful," but in
Alberta it is 77% and in Quebec, 83%; 44% of Alberta physicians,
52% of Ontario doctors, and 77% of those in Quebec referred
patients for complementary health-care services.
Another survey of British Columbia residents
conducted in 1995 by the Angus Reid Group indicated that 72% of
those polled said they were "interested" in alternative
medicine. Of these, young- to middle-aged women of lower to
middle income represented the majority. The survey also found
that 89% would patronize an alternative medicine clinic.
SOURCE:
Jennifer Larsen, Chair, The Complementary Health Therapies Task
Group of the Health Plan Committee, Richmond Health Board, Use of
and Interest in Complementary Health Therapies in the Richmond
Community, June 3, 1996 (tel: 604-244-5540).
Botanicals Are Big! - Sales of
Natural Herbal Products Climb
The new annual survey of natural herbal
products sales by Whole Foods magazine shows "strong
growth" for herbs. For the average store, with yearly sales
of about $800,000, herbal products represent 27% while herbal
body care and cosmetics pull in 6%.
Retailers responding to Whole Foods' survey
said their 1996 overall herbal products sales were up 32% over
the previous year, while sales of herbal supplements alone have
grown by 7.8%. Among the biggest selling herbs are Echinacea (representing
9.6% of all herbal sales), garlic (7.2%), followed by
ginseng, Ginkgo biloba, and Goldenseal; together these 5 account
for 33% of all herbal supplement sales. In sixth place is
Ma-Huang (ephedra), followed by Siberian ginseng,
psyllium, saw palmetto, and Cascara sagrada; these 5 represent
16.7% of dollars spent on herbal products. The top 10 herbs
captured 49.7% of U.S. herbal sales, says Whole Foods.
Regarding how Americans are using their herbs,
Whole Foods reports that 50% take them in capsules, 18% as
tablets, 11% as teas, 13% as extracts or tinctures, but only 5.4%
as bulk herbs. When asked what obstacles were preventing even
stronger herb sales, 41% of U.S. herbal products retailers
attribute it to lack of consumer education; for 23%, it is
government restrictions on consumer information; and for 18%, it
is "scare stories" about herbs in the mainstream media.
In other words, direct political interference
by official opponents of herbal products accounts for 41% of the
public's resistance to herbs. Only 2% said price was a factor and
only 10% considered lack of product standardization or
manufacturer promotions to be factors.
SOURCE: Alan
Richman and James P. Witkowski, "A Wonderful Year for
Herbs," Whole Foods 19:11 (October 1996), 52-60. Available
from: Whole Foods, 3000 Hadley Road, South Plainfield, NJ 07080;
tel: 908-769-1160; fax: 908-769-1171; 13 issues/$50.
Profiling The Natural Products
Consumer - Educated and Looking for Better Health
According to a new survey of the natural
products consumer in the U.S., 76% are women with an average age
of 47, although 30% are older than 55, and 73% have a college
education. Of these, 26% graduated and 15% received postgraduate
degrees. Regarding family life, 58% are single, 31% live in small
cities, 41% live in a 2-person household, 34% have a gross family
income between $21,000-$40,000, and 32% say they are vegetarians.
For 61%, their primary reason for shopping in a
natural products store is personal health improvement. Regarding
purchases of alternative medicine products, the study revealed
that 45% of shoppers have bought garlic for medicinal purposes at
least once during the last year, 44% Echinacea and ginseng, 35%
Gingko biloba, 31% chamomile, and 30% aloe vera.
In the supplement department, 52% have
purchased a multivitamin, 46% vitamin C, 43% vitamin E, 41%
calcium, 39% garlic supplement, 38% vitamin B complex, 33%
acidophilus and chromium, 30% antioxidant formula and beta
carotene, and 19% have bought aromatherapy products.
SOURCE: Alan Richman and
James P. Witkowski, "Whole Foods ’96 Consumer
Survey," Whole Foods, Vol. 19, No. 9, August 1996, pp.
38-45. Available from: Whole Foods, 3000 Hadley Road, South
Plainfield, NJ 07080; tel: 908-769-1160; fax: 908-769-1171; 13
issues/$50.
Cancer Treatment - Interest in
Alternative Approaches Is Rising
Confidence in the efficacy of alternative
medicine as a treatment option for cancer is growing
impressively. The American Cancer Society estimated in 1993 that
9% of U.S. cancer patients use complementary therapies, although
other researchers placed the figures higher - at 10% to 60%.
A study undertaken at New York Hospital in 1994
revealed that about 30% of breast cancer patients polled said
they had consulted an alternative practitioner while 25% were
currently receiving some form of "unconventional"
therapy such as shark cartilage, medicinal mushrooms, Chinese
herbs, or vitamin injections.
Yet another study in Cancer (1991) estimated
that anywhere from 10% to 50% of cancer patients try some form of
alternative or complementary care; the same study reported that
5% of cancer patients abandon conventional treatment in favor of
alternative approaches. The U.S. government estimates that in
1992 the public spent $2 billion on alternative cancer
treatments.
Based on the most conservative estimate that
10% of U.S. cancer patients consult alternative practitioners
every year, this means that at least 100,000 cancer patients are
under alternative care or using alternative substances as part of
a cancer treatment program.
The trend toward incorporating more alternative
practices in cancer care is growing worldwide. A 1994 survey (published
in the British Medical Journal) of 415 cancer patients in 2
London hospitals indicated that 16% had used alternative
therapies for cancer. Among the most popular modalities used were
relaxation, visualization, diet, homeopathy, vitamins, and herbs.
The average user of these alternative therapies was 50, married,
and female; 82% were either "satisfied" or "very
satisfied" with the therapies, describing the benefits as
both physical and psychological.
A 1994 study at the Women's and Children's
Hospital in South Australia (published in The Medical Journal
of Australia) showed that about 46% of children, aged 4-16,
with cancer had received at least one alternative treatment and
that fewer than 50% of the children's parents discussed their use
of alternative methods with their conventional doctors. Among the
preferred modalities were positive imagery (17%), hypnotherapy
(15%), relaxation exercises (10%), diet (8%), and multivitamins
(8%). Of the children's parents, 83% stated that there were no
side effects.
According to the European Journal of Oncology
(October 1995), of 630 cancer patients in Norway, 20% had been or
were currently users of alternative therapies (called
"non-proven therapies" in the survey) for their
cancer. Among the most popular methods were therapeutic touch,
herbs, vitamins, diet, and Iscador (an injectable remedy from
mistletoe). Up to 40% of these patients had used alternative
therapies for other illnesses prior to developing cancer.
In the Netherlands, of 949 oncology outpatients
polled at several hospitals, 9% said they were presently using
alternative medicine in addition to conventional approaches. Of
the patients with lymphatic cancer at the Center of Oncology in
Krakow, Poland, 25% had received alternative therapies prior to
admission. In Germany, out of 160 cancer patients, 53% said they
had used alternative medicine at some point in their medical
history.
SOURCE: Data
compiled by John Boik, Cancer & Natural Medicine: A Textbook
of Basic Science and Clinical Research (1995), Oregon Medical
Press, 315 10th Avenue North, Princeton, Minnesota 55371; tel:
612-389-0768.
Sales Of Dietary Supplements
Grow - Consumers Want Natural Medicines
A new survey by Whole Foods magazine indicates
that 1995 sales of vitamins, dietary supplements, herbs, and
homeopathic products grew by 19.6% over 1994 for nearly 70% of
U.S. retailers. These four categories represent, on average, 64%
of a natural retailer’s sales. Among vitamins, multiple
vitamin and mineral formulas represent 30% of sales, single
vitamins 20%, led by vitamin C (33%), followed by vitamin E
(20%), and B complex (18%), reports Whole Foods.
Among the most promising of new supplements
expected to soar in sales were Melatonin, antioxidants, shark
cartilage, and green foods. Pycnogenol, cat’s claw, and
glucosamine sulfate, tied with vitamin E. Product categories that
showed the most sales growth in 1995 over 1994 included
homeopathic remedies (85%), specialty supplements and herbs
(44%), single vitamins (28%), sports nutrition formulas (25%),
and single minerals (19%). Specialty supplements include
antioxidants, stress formulas, weight-loss aids, green
concentrates (e.g., spirulina, chlorella, wheat grass),
and probiotics ("friendly" bacteria for the
intestines).
SOURCE: Alan Richman and James P.
Witkowski, "Supplement Survey. Research Reveals Strong
Supplement Sales," Whole Foods, June 1996, pp. 42-48.
Available from Whole Foods, 3000 Hadley Road, South Plainfield,
NJ 07034; tel; 908-769-1160; fax: 908-769-1171; $50/13 issues.
Successful Outcomes Make The Best
Case - Patients Want Alternative Medicine
When researchers L. Terry Chappell, M.D., and
John P. Stahl, Ph.D., reviewed the results of 19 studies
evaluating the effectiveness of EDTA chelation therapy (a
method of draining toxins and metabolic wastes from the body
while increasing blood flow) on 22,765 patients, they found
that 87% registered clinical improvement according to objective
tests. In one study, 58 out of 65 bypass surgery candidates and
24 of 27 people scheduled for limb amputation were able to cancel
their surgery. The analysis provides "very strong evidence
that EDTA is effective in the treatment of cardiovascular
disease," state Chappell and Stahl in Questions from the
Heart (Hampton Roads Publishing, 1996).
A review of 16 published studies involving 320
asthma patients revealed that 91% who used acupuncture were able
to reduce the amount they needed of their conventional
medications, reports Kim Jobst, M.D., an acupuncturist and
researcher in the Department of Pharmacology at Oxford University
in England, in Medical Tribune (July 18, 1996). The
analysis also showed that acupuncture may reduce the severity of
asthma attacks.
Insurers To Cover Alternative
Medicine - Cost Savings and Consumer Demand Show Insurers Why
With annual revenues of $3 billion, Oxford
Health Plans of Norwalk, Connecticut, has set up a
1,000-practitioner provider network for alternative therapies,
enabling its premium holders to consult with and be reimbursed
for visits to alternative providers. The program started on a
trial basis for policy holders in New York, Connecticut, and New
Jersey.
For an additional 3% added on to their
premiums, those holding policies with Oxford may now be
reimbursed for visits to chiropractors, acupuncturists,
naturopaths, massage therapists, and yoga instructors, provided
they are on Oxford's list of 1,000. Oxford plans to expand
coverage soon to include reflexology, Thai chi, hypnotherapy,
meditation, and other body energy approaches.
According to Oxford's senior vice president,
David B. Snow, a survey by the company of its 1.4 million members
revealed that 33% had used alternative health care in 1995.
"This is not fad stuff we're talking about."
Stephen Wiggins, chairman, chief executive of Oxford, and a
personal enthusiast of holistic medicine, says that strong
consumer demand (as indicated by Oxford's survey) and
unarguable cost savings (most alternative therapies cost less
than conventional treatments) are compelling reasons to try
this new approach.
In fact, Wiggins believes that if an insurance company ignores
consumer demand, it does so at its peril. Oxford's decision to go
with alternative care reimbursement was "a recognition of
the obvious trend: the demand by consumers to seek an alternative
to conventional Western medical solutions."
This makes Oxford the first U.S. insurance
company to form a network of alternative practitioners which,
incidentally, mirrors its existing network of 33,000 conventional
physicians. While other insurers - American Western Life, Kaiser
Permanente, Blue Cross/Blue Shield, Mutual of Omaha, Prudential -
offer limited coverage of some alternative specialties, they have
not established a formal holistic provider network such as
Oxford's.
Why are more insurers willing to pick up the
tab for alternative medicine? According to Alan Kittner of
Complementary HealthCare, a consulting firm in San Francisco,
California, "Insurers are beginning to cover alternative
treatments in order to differentiate themselves from their
competitors and appeal to this public demand."
When alternative therapies are allowed to
compete openly and fairly in the health-care marketplace, their
ability to satisfy public demand and provide huge cost savings
alone will establish them as the predominant approach to
medicine.
SOURCE: Karen
Hube, "More Insurers Pick up the Tab for Alternative
Medicine," Money, October 1996, 25; "Oxford Health
Plans to Cover Alternative Care," The New York Times,
October 9, 1996; Lucette Lagnado, "Oxford to Create
Alternative Medicine Network," The Wall Street Journal,
October 7, 1996.
Patients Criticize Health Care
System - It's Confusing, Unreliable, Impersonal & Expensive
A survey of 37,000 hospital patients at 120
different hospitals, clinics, or doctor's offices revealed a high
degree of dissatisfaction with services. The study, conducted by
the Picker Institute of Boston, Massachusetts, in conjunction
with the American Hospital Association, showed that about
one-third of hospital patients felt poorly prepared to return
home, experienced trouble getting basic medical questions
answered, and felt they had too little input in decisions
affecting their treatment.
Specifically, 26% of patients faulted hospitals
for not providing emotional support; 30% of patients were not
told about danger signals to watch for related to their
condition; 31% were not told about side effects of their
prescription drugs; 34% were unable to get care providers to
listen to their concerns; 36% felt they didn't have enough say in
their treatment; and 37% were not told when they could resume
normal activities. Among patients at doctor's offices, 28% did
not get enough information from their physicians while 21% said
they were insufficiently involved in determining their
treatments.
The conclusions of a Picker Institute
300-member focus group were highly critical of conventional
medicine. Only a few people perceived a "planned"
system of health care operating on their behalf. "Instead,
they see a confusing, expensive, unreliable, and often impersonal
disassembly of medical professionals and institutions," the
Picker Institute report said. "If a system is in operation
at all, it is seen as one designed to block access, reduce
quality, and limit spending for care at the expense of
patients." The focus group criticized insurance companies
for controlling decisions about health care that ought to be in
the hands of patients and their physicians.
SOURCE: Eye
on Patients (1996), The Picker Institute, 1295 Boylston Street,
Suite 100, Boston, MA 02215; tel: 617-667-2388; fax:
617-667-8488; website: www.amhpi.com.
America’s Vast Sick-Care Economy
- Chronic Illness Affects 100 Million in U.S.
A new study conducted by the University of
California at San Francisco shows that 100 million Americans have
chronic illnesses or disabilities accounting for $425 billion in
direct health-care costs (doctors, hospitals, medications)
and $659 billion when indirect costs (lost work days from
disability or death) are included. Of those affected, only a
small number (1.5 million) are in nursing or personal care
homes. The study was based on 1990 data then updated with new
estimations in 1995.
The chronically ill account for 83% of
prescription drug use, 80% of hospitalizations, 66% of physician
visits, 55% of emergency room visits, and 96% of professional
home care, based on 1987 and 1990 data and a patient base of
35,000. The study also revealed that 25% of those under age 18
have at least one chronic ailment, while it is 33% for those aged
18-44, and 66% for those aged 45-64. The elderly only account for
25% of people with chronic ailments, while those aged 18-64 (working-age
adults) represent a surprising 60%. Nearly every family in
the U.S. is believed to be affected by chronic illness.
One of the study's co-authors was involved in a
similar study in 1966 and found that chronic ailments accounted
for 59% of all direct health related costs; today that number has
grown to 70%.
Figures such as these help one to understand
why in 1993 the World Health Organization (WHO) ranked the U.S.
as 18th among developed countries for its level of "good
health." One would expect that with an annual expenditure of
$1 trillion for "health care" the U.S. would have a
higher level of health.
According to WHO, a prime factor for why other
industrialized nations outrank the U.S. is that they maintain a
pluralistic approach to health-care delivery. This means many
modalities and alternatives are allowed to thrive and openly
compete in the medical marketplace, as distinct from the U.S., in
which the government essentially supports a medical monopoly by a
single modality - conventional medicine.
What is shameful, even inexcusable, here is that in most cases conventional medicine is unsuccessful in resolving chronic illness, while this is alternative medicine's strongest suit.
SOURCES:
Catherine Hoffman, Sc.D., Dorothy Rice, Hai-Yen Sung, Ph.D.,
"Persons with Chronic Conditions," The Journal of the
American Medical Association 276 (November 13, 1996), 1473-1479.
Sabin Russell, "Chronic Sickness Epidemic," San
Francisco Chronicle (November 13, 1996). Naturopathic Medicine:
Contributions to Health Care Reform, Submission to the Task Force
on National Health Reform, American Association of Naturopathic
Physicians (1993), 20.
31% Of Americans Left Out In The
Cold - Despite $1 Trillion for U.S. Health Care
With the annual cost of U.S. health care
topping $1 trillion, 31% of Americans are still either uninsured
or have difficulty in paying for medical services. In a nation
that spends this much money on health care, leaving 31% of our
population out in the cold is absurd, shameful, and inexcusable.
Harvard University researchers polled 3,993
Americans by telephone in 1995 and found that 17 million insured
and 17 million uninsured Americans alike have financial problems
in receiving needed medical care; about 30 million report they
have difficulty in paying their medical bills; and 45% of the
uninsured and 11% of those with health insurance said they had
trouble in the previous year getting the medical attention they
needed.
Some 70% of the uninsured rated their medical
symptoms as either "somewhat serious" or "very
serious" at the time when they were unable to afford
adequate medical care. Of those uninsured who had problems
receiving medical care, 75% rated their health status as
"poor."
The researchers found that only 37% of those
uninsured were able to receive medical care for free, at a
reduced charge, or as part of charity care. This data shattered
the common assumption that the sick and indigent could always get
free medical care somehow, stated study director Karen Donelan of
Harvard's School of Public Health. "The sickest people
surveyed are most likely to have problems getting the medical
care they need."
The majority (53%) of uninsured adults have
difficulty in obtaining or paying for proper health care, she
added. In fact, more people (44%) received calls from collection
agencies over unpaid bills than received free care (37%). Among
the uninsured are 9.8 million children, or about 13.8% of all
U.S. children. That is the national average, but in 7 states that
number exceeds 20%.
The main reason (55%) given for the uninsured
not having health insurance is that it is simply too expensive,
the study said. One of the prime reasons for this excessive
expense, in the Digest's opinion, is the government-enforced
virtual monopoly of U.S. health care by conventional medicine and
its rigid emphasis on expensive drugs, surgery, and high-
technology interventions.
Perhaps this is why in 1993 the World Health
Organization (WHO) ranked the U.S. 18th among developed nations
in terms of "good health." WHO noted that one of the
prime reasons for this superior showing by other countries (all
of whom spend less per capita for health care) is their
"pluralistic approach" to health-care delivery, meaning
their willingness to allow conventional and alternative therapies
to thrive (and compete openly) side by side in the medical
marketplace.
SOURCE:
Robert Pear, "Health Costs Pose Problems for Millions, a
Study Finds," The New York Times, October 23, 1996; Ron
Winslow, "Study of Access to Medical Care Finds Outlook
Remains Grim for Uninsured," The Wall Street Journal,
October 23, 1996; American Association of Naturopathic
Physicians, Naturopathic Medicine: Contributions to Health Care
Reform, Submission to the Task Force on National Health Reform,
1993, 20; Robert Pear, "New Approach to Overhauling Health
Insurance: Step by Step," The New York Times, November 11,
1996.
Talking To Patients = Fewer
Malpractice Suits
Communication with patients clearly
"pays" for physicians seeking to avoid malpractice
claims. In a review of the number of malpractice claims filed
against 124 physicians in Oregon and Colorado, researchers found
that primary-care physicians with the lowest number of
malpractice claims spent more time educating their patients about
procedures and outcomes, encouraged their patients to express
their views, listened attentively to their statements, and
laughed and used humor more often. The data showed that
primary-care physicians who practiced these communication skills
were 57% less likely to have their patients file malpractice
suits against them.
In addition, these same physicians spent more
time per patient (an average of 18.3 minutes) compared to
physicians with many claims (an average of 15 minutes), a
difference the researchers regarded as highly predictive of
malpractice claims. In a related study conducted by researchers
at Loma Linda University Medical Center in Loma Linda,
California, 149 individuals were polled about their likelihood of
suing their doctor if mistakes in practice were discovered. The
survey showed that 98% of patients expected doctor acknowledgment
of even minor errors, that 76% would sue their physicians if they
discovered severe mistakes on their own, and 60% would sue if
their doctor revealed having made a serious mistake. The study
highlights the value of open and honest communication between
doctors and patients.
When the patient's needs are respected and their views solicited, not only is the risk of malpractice claims seriously reduced, but the likelihood of therapeutic success is greatly enhanced. Treating the whole person - the hallmark of alternative medicine - begins with actually giving the individual patient enough attention during the office visit to allow them to come into view. Alternative practitioners know this because their modalities require detailed case-taking; conventional doctors may come to know this because they cannot afford the malpractice claims that result from ignoring it.
SOURCE: Wendy Levinson, M.D., et al. "The Relationship
with Malpractice Claims among Primary Care Physicians and
Surgeons," The Journal of the American Medical Association
277 (February 19, 1997), 553-559; Amy B. Witman, M.D., et al.,
"How Do Patients Want Physicians to Handle Mistakes? A
Survey of Internal Medicine Patients in an Academic
Setting," Archives of Internal Medicine 156:22 (December
9-23, 1996), 2565-2569.
Science in the Interests of
Profit
The next time you read a "scientific"
article in one of the major conventional medical magazines, it
might be prudent to bear in mind that the authors may have a
vested financial interest in the substance or therapy described.
According to Sheldon Krimsky, Ph.D., of the
Department of Urban and Environmental Policy at Tufts University
in Medford, Massachusetts, in up to 34% of medical journals
surveyed at least one author of an article published in the
journal had a financial interest in the subject matter of that
article.
Dr. Krimsky analyzed 1,105 university-based
authors (in Massachusetts) and 789 articles published in
1992 in 14 scientific and medical journals, including The New
England Journal of Medicine and Science. He found that 15.3% of
the 1,105 authors had at least one financial interest in their
published articles.
In addition, Dr. Krimsky reports that 10% of
journal authors were inventors or held patent applications
related to their article's subject matter; 6.2% were members of
the scientific advisory boards for biotechnology companies
associated with the article; and 1.4% were major shareholders or
officers in such companies.
Viewed from another perspective, 34% of the
articles had at least one lead author with a financial interest
in the subject. Specifically, 20% of the 789 articles had a lead
author with a biotechnology affiliation specifically germane to
the article's subject matter; 7% had lead authors who were major
shareholders in a company with financial interests in the
article's subject; and 22% had lead authors who were inventors or
patent application holders for the specific substance or
procedure discussed.
For 1992, the rate of published voluntary
disclosures of financial interest by scientists in 14 leading
journals based in Massachusetts was "virtually zero,"
states Dr. Krimsky. He notes that it "seems increasingly
evident" that the goal of objective, financially
un-entangled research is "challenged by the perception that
someone...stands to benefit from the research in a way that could
bias the manuscript or its finding."
Some peer-reviewed science journals are starting to require
financial disclosure statements from article authors. However,
Dr. Krimsky suggests the trend of the future may be towards a
somewhat jaded public recognition that unless stated otherwise,
readers should assume that the authors of medical and scientific
articles have vested interests in the subject of their
"objective" reporting.
SOURCE:
Sheldon Krimsky, Ph.D., et al. "Financial Interests of
Authors in Scientific Journals: A Pilot Study of 14
Publications," Science and Engineering Ethics 2:4 (1996),
395-410.
Mainstreaming Alternative
Medicine
For many advocates of alternative medicine, a report in last year's New England Journal of Medicine confirmed what they had long suspected. Researchers found that one in three Americans turn to "unconventional therapies" (often called alternative medicine) to alleviate a variety of problems ranging from back pain to anxiety, a statistic that would seem to set the word "alternative" on its ear. The same study also found that the number of visits to alternative practitioners exceeded the number of visits to primary care practitioners and that Americans spent a staggering $10.3 billion dollars on alternative care - dollars that came out of their own pocket, by-and-large, since alternative medicine therapies are not covered by most insurance companies.
Fortunately, that is changing, although not fast enough for the millions of consumers who pay out-of-pocket while waiting for alternative medicine to be officially declared mainstream. While more and more insurance companies are testing programs in which alternative therapies are covered, the bulk of them are still not included in the list of covered benefits issued from most insurance plans.
The term alternative medicine has been used as a catch-all phrase to describe a broad spectrum of treatment. Common therapies that fall under the alternative medicine umbrella include acupuncture, acupressure, homeopathy, yoga therapy, meditation, biofeedback, herbal and vitamin remedies. In the past, many in conventional medicine shunned alternative treatment as an area reserved for quacks, claiming that the effectiveness of many techniques could not be substantiated.
The growth in acceptance of the alternative medicine market has been fueled by a variety of factors. Consumer frustration with the limitations of traditional medicine, a growing body of scientific literature that links disease to nutritional and emotional factors, and a greater awareness of the medical practices of other cultures have all contributed. The market has also been affected by baby boomers and their buying habits, who are increasingly influencing the health care system to look at new ways of treating old problems. Seventy six million strong, the baby boom generation is markedly different than any other generation to hit the system in several, key ways: a desire for and expectation of wellness, aggressive consumerism and a healthy disregard for authority and conformity. In fact, the New England Journal of Medicine's article pointed out that the biggest consumers of alternative medicine were what we would typically think of when describing the baby boomers: comparatively well-off, well-educated people in the 25 to 49 year old age bracket.
With these factors in place, it was only a matter of time before conventional medicine adopted a "if you can't beat 'em, join 'em," mentality, as evidenced by the recent collaborative efforts by alternative practitioners and mainstream systems. In fact, the National Institutes of Health has recently established an Office of Alternative Medicine, which is funding research projects ranging from the impact of biofeedback on chronic pain to the value of acupuncture on the attention deficit in hyperactive children. Yet, the insurance industry lags behind, even with the current focus on cost containment.
The one small exception is the field of acupuncture. In 1985, the California state Senate Bill 2179 required all group insurance plans to offer acupuncture as a benefit and in 1989 Senate Bill 840 was passed, which required Workers' Compensation insurance to cover acupuncture in California. While this is a good start, the same sort of progress needs to be realized in the other areas which enjoy wide public support. The pressures of cost containment may hasten this process.
When compared to conventional medical treatments, virtually all alternative therapies pose a significantly reduced potential for side effects, which can contribute to cost savings. It is sometimes argued that alternative therapies can delay the application of conventional medical treatments, thus leading to reduced health status and increased medical expenditures. However, there are no studies which substantiate this argument. In the previously-referenced New England Journal of Medicine article, more than 50 percent of those patients who reported that they sought treatment from alternative medicine practitioners were concurrently under the care of a conventional physician. Because many alternative medicine practitioners (particularly acupuncturists) have had training in conventional Western medicine, they are aware of situations when conventional care is indicated and often refer patients to mainstream physicians.
In summary, patients should not be faced with
an "either/or" situation when it comes to seeking
conventional and alternative treatments. The growing awareness of
mind-body medicine and the advantages that each field has to
offer should make collaboration a natural state for providers of
both types, and will result in the best return on the dollar for
patients and the payers of health care.
SOURCE: Jack
Miller, L. Ac., President, Pacific College of Oriental Medicine;
editorial published by the San Diego Business Journal.
On December 14-16, 1994, in Washington DC, there was a symposium on Botanical Medicine sponsored by the National Institute of Health (NIH), the office of Alternative Medicine (OAM), and the Food and Drug Administration (FDA). The purpose of the meeting was to better define how herbs can be integrated into conventional healthcare.
The main discussion revolved around a couple of very important issues, namely establishing the safety and efficacy of herbs, how to regulate herbal medicine, and whether herbs need to be classified as drugs. Devra Lee Davis, who is the senior advisor to the assistant secretary of health, emphasized that the government would like to forge ahead with a scientific agenda to establish the credibility of herbal medicine. She pointed out that cancer therapy has not changed much in the last 30 years and that herbal medicine contains great promise for that and other diseases.
Many of the discussions that followed pointed out that herbs are useful for treating many diseases but they are also dangerous if improperly used or if there is no quality control employed in their manufacture.
Current U.S. regulations require the proper documentation of research to show the validity of effect and the safety of the product. If one wishes to label an herbal product as being effective to treat a medical condition it would fall into the category of a drug and would have to show valid research. The FDA explained that according to the new Dietary Supplement Bill that passed Congress in 1994, herbs are in the Category of "dietary supplements" and can be marketed freely as long as there is no medicinal claim made on the label. If there is a claim then it is illegal to market the product unless it has been approved as either an Over the Counter or Prescription drug. The FDA urged people to do responsible research and validate their claims. They also expressed the same desire as the herbal medicine industry to find new medicines that are safe and relatively free of side effects.
The main example of herbal medicine that was debated was garlic. Proponents of herbs argued that if garlic is useful to lower cholesterol then it would suddenly become a drug. The FDA countered by saying that was true, but only if the garlic was available in bottles with labels that claimed that it was effective for lowering the cholesterol. In the absence of claims on the label, the FDA indicated that they have no jurisdiction.
There will be a presidential commission to research the subject and hopefully this was the beginning of establishing a meaningful dialogue.
Clearly the key to integrating herbs into the healthcare system of American will be research done using the double blind randomized trials. In the absence of research, health claims will not be able to be made. For Chinese herbs that come in bottles, the label will not be allowed to include indications.
The FDA assured the acupuncture community that they do not regulate medical practitioners and they have no problem with acupuncturists giving herbs to their patients, however, they stated that they would urge caution in using all herbal medicines from China as they feel there is no quality control and some products contain drugs or toxic ingredients that have been shown to be dangerous or even fatal.
For the next two years, Chinese herbs will be
classified as "Dietary Supplements" and will be
regulated as such.
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