Integrating alternatives into Western medicine

Filed under: News |

Alternative medicine isn’t really “alternative” any more — in fact, the medical community isn’t even using that term.
Now it’s “integrated” medicine, and after years of being considered a fringe practice, treatments such as massage and acupuncture have found their way into mainstream medicine.
So why the name change?
“Years ago it was called alternative because it was Eastern vs. Western medicine and they knocked against each other often,” said Theresa O’Toole, associate administrator of rehabilitative services at Memorial Health System. “They use integrated because it’s part of the total treatment, not an alternative, but in tandem with other, more Western treatments.”


Lisa Pearson massages Leslie Pillmore’s back. Peasrson is a massage therapist at Toccare.

More than 60 percent of adults say they’ve tried some kind of integrated medicine, according to studies. And the number reaches 70 percent when surveying people who are 60 and older.
What is integrated medicine? According to the National Center for Complementary and Alternative Medicine, one of the National Institutes of Health sites, it’s everything from acupuncture to vitamin regimens to prayer.
The center released a study in 2004 that showed that as many as 62 percent of U.S. residents have used some sort of integrated medical treatment — with most saying that they include megavitamin therapy and prayer as part of their health programs.

Federal Funding for National Center for Complementary and Alternative Medicine
2007: $121.4 million
2006: $122.7 million
2005: $123.1 million
2004: $117.7 million
2003: $114.1 million
2002: $104.6 million
2001: $89.2 million
2000: $68.7 million
1999: $50 million

Changing attitudes

Doctors used to frown on acupuncture, massage, yoga, meditation and tai chi, but more frequently these practices are being included in overall health plans.
Memorial has included acupuncture and massage in its patient plan for 15 years, O’Toole said. The treatments are paid for mostly by patients, but some commercial health insurers will pay for at least part of the care. Medicare, Medicaid and Tricare do not pay for integrated medicine, but most workers’ compensation insurance companies will pay for part of the treatments.
“I think people with discretionary income, who are tired of the acute care practices, or don’t like the Western-style system are pushing this trend,” said Paul Rosser, health care administration professor at Regis University. “They get tired of fighting the insurance companies for care, and they relate better to the complementary practices.”


Diane McCarty is a licensed acupuncturist for Memorial Health System.

And people are using their dollars to bring integrated medicine to mainstream medical practices.
Reports say that Americans spend between $36 billion and $47 billion annually for alternative treatments. A total of $19.6 billion was paid out-of-pocket to massage therapists, chiropractors and acupuncturists. A small amount, compared to overall health care costs, but significant because most insurers won’t pay for the treatment, Rosser said.
But some insurers are paying attention to the trends.
In Colorado, Kaiser Permanente has offered riders on its policies for customers who want to use acupuncture or massage, said C.J. Moore, spokeswoman for Kaiser in Colorado Springs.
“We were one of the first to approve it,” Moore said. “Now other people are getting on board. We believe that things like acupuncture and massage are good for people; but we also think yoga and aromatherapy are great stress relievers. And if you can reduce stress, that definitely helps the physical aspects of a particular condition.”
Moore said she is going to receive acupuncture treatments for a chronic knee condition that doctors deemed not “quite ready” for surgical procedures.
She also said the treatments approved by Kaiser have shown “medical efficacy.”
“We think they should be used in tandem with other treatments, not merely by themselves,” Moore said. “But the treatments — like yoga, acupuncture or massage — can definitely help in conjunction with other, more traditional treatments.”
And who is using the integrated treatments? Women, more frequently than men; the higher educated, those who have been recently hospitalized and former smokers.
Americans are more likely to use integrated medicine for back, neck, head or joint pain. They also use them for colds, anxiety, depression, gastrointestinal disorders and sleeping problems.
At Memorial, the most of the integrated medicine treatments — other than those used in the rehabilitation program — are for cancer patients. Treatments such as music or aromatherapy, art therapy and yoga are offered in the cancer center by volunteers, said hospital spokesman Chris Valentine.

10 most common therapies:
Prayer for one’s own health
Natural products
Deep breathing exercise
Prayer groups
Meditation
Chiropractic care
Yoga
Massage
Diet-based therapy

(Source: National Center for Complementary and Alternative Medicine)

Cancer patients aren’t charged for those programs.
Other treatments are used for rehabilitation purposes, and about half of patients pay out-of-pocket for acupuncture or massage, O’Toole said.
“Until recently, most of our clients were self-pay,” she said. “And most of them used acupuncture as a last resort for their pain. People tend to try a lot of different treatments before they turn to acupuncture. But as we become more and more conscious of our health, more people use it. People want to feel good, and that’s what this kind of treatment is about.”

Acupuncture and massage

Acupuncturists and massage therapists are licensed by the state. Acupuncturists must have a master’s level education before they can be licensed, O’Toole said. Massage therapists need 120 hours of study.
Diane McCarty has been an acupuncturist for eight years, and is a graduate of the Southwest Acupuncture College of Santa Fe, N.M.
“I’ve been amazed at how accepted it is here,” McCarty said. “I’m very surprised at the number of doctors who are prescribing acupuncture.”
McCarty works at Memorial, but she also has her own private acupuncture classes. She is licensed, and formerly practiced in Alaska.
Chiropractors are the practitioners most frequently sending clients for massage, said Nancy Bowers, a massage therapist at Toccare in northern Colorado Springs. She specializes in muscle release massage, a therapy for a number of repetitive-injury problems.
“This works by stretching the muscle,” she said. “And it works very well for things like carpal tunnel syndrome or golfer’s elbow. Things that don’t respond to drugs or surgery will respond to this treatment.”

Not mainstream yet

But acupuncture and massage will only become mainstream treatments when research shows that they are effective methods of treating disease, Rosser said.
“There’s no real proof for the use of these procedures,” he said. “And until insurance companies know for sure that they work, it doesn’t make sense to pay for the treatment. It’s not cost-effective.”
Doctors are frequently opposed to methods that use Eastern philosophy instead of Western science, he said. Practices such as Tai Chi or Reiki are still far from being used as a mainstream medical treatment. The bureaucracy of health insurers is another reason.
“Many of these treatments don’t have national codes, so it’s impossible to get reimbursed for them,” Rosser said. “The codes are standard across the country, so if they don’t have codes, you don’t get reimbursed. But there is pressure from consumers to start to cover more of these procedures.”
Integrated medicine will only become mainstream when its procedures are recognized by Medicare and Medicaid, Rosser said.
“That’s the key,” he said. “Medicare sets the tone for the commercial insurance industry, once Medicare approves it, the states will follow suit. Pressure from consumers, followed by research showing them to be efficacious will also help.”
Amy.Gillentine@csbj.com