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Alternative medicine not quite mainstream in health care

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Alternative, by definition, means not of the mainstream. And although alternative health therapies have certainly made their way out of the fringe in usage and awareness -- from yoga's use by high school football teams to Deepak Chopra's increased prominence -- these practices are still largely secondary to traditional medicine in the health care arena.

A bevy of treatments falls under the alternative medicine umbrella, from the popular chiropractics and herbal supplements to the less familiar biofeedback and qigong. A few sister labels describe such practices as well, such as complementary, integrative and holistic medicine. In 2002, half of the U.S. adult population reported it had used some form of complementary and alternative medicine, abbreviated CAM, according to the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. And if consumer demand is an indicator, CAM usage statistics are continuing to grow.

A pharmacy based out of Berkeley, Calif., is linking customers with the alternative therapies they are starting to request by providing a host of alternative remedies in addition to traditional prescriptions. With a motto of "the pharmacy that prescribes yoga," Elephant Pharmacy's mission is to be a hub where other forms of health care meet conventional medicine. Yet individual demand for -- and practice of -- CAM is ahead of the current overarching health care system that could support it. While one in five companies now offer health benefits for alternative treatments, according to the International Society of Certified Employee Benefit Specialists, coverage is still far from matching that of conventional medicine.

"What drives services in hospital settings is reimbursement," said Susan Instone, APN, director of USD's Hahn School of Nursing. "And right now our health care is really driven by insurance companies and the government, to some extent. So I just think it takes time not just to have evidence, but to present that evidence to people who are essentially paying the bills -- and convincing them that this is in fact beneficial to patients."

Along with insurance companies, medical schools also still lack complementary care inclusion. Universities across the country have been offering classes in alternative medicine for years. Sixty percent of standard medical schools (among them Harvard, Yale and Duke) and 85 percent of nursing schools teach some form of CAM classes. Yet few offer courses as part of the core curriculum. That often makes it difficult for those students interested in alternative medicine to actually take classes, as the number of electives allowed is limited, according to Instone.

Facing a similar challenge, neonatologist and Chopra Center guest speaker Dr. Jamie Jones started a program called Holistic and Alternative Medicine, or HI-Med, in conjunction with UCSD as a knowledge-sharing support group for students wanting to learn more than the traditional curriculum was teaching. Even with courses offered at medical schools, however, a true intersection of holistic and traditional disciplines is still rare.

"I've been to conferences in Europe where a German doctor trained in traditional medicine was also an acupuncturist, but I don't see that very commonly in the states," Dr. Jones says.

Additionally, even if complementary medicine is further integrated into med school curriculums and practitioners are trained in both sides of the field, there is still the significant challenge of how -- and if -- to bring alternative medicine into the traditional hospital setting. Scripps Center for Integrative Medicine is one local example. Yet while many health care facilities have attempted this, few have succeeded.

"It seems like an interesting vision," Dr. Jones states, "but places I've seen try, I haven't seen work. I've seen integrative clinics and spas start up and not work out. I think it is because, for instance, an acupuncturist often works out of the house and feels nurturing, but put in the current medical system they almost turn out more like the American doctors that see a patient every 15 minutes. "

On the other hand, it may be possible to bring parts of alternative medicine into traditional health care facilities as one component of care. As Dr. Jones noted, France uses aromatherapy to calm babies instead of medicine, and lavender is often used to help the elderly sleep in hospice. He sees those two areas -- birth and dying -- as being very potent for a shift in paradigm from "intensive care to caring intensively about a person."

Overall, the infiltration of alternative therapies into more mainstream health care may be as much about changing philosophies as changing practices. According to Dr. Jones, people in traditional medicine are often defensive around alternative practitioners, and vice versa. He attributes it more to a lack of understanding than an assumed lack of mutual respect.

Several years ago, Dr. Jones brought together a group of practioners from various conventional and complementary disciplines so each could learn from the others' approaches.

"I put together a case study of a pregnant woman with high blood pressure that all were to speak about from their field," Dr. Jones recalls. "The acupuncturist said, 'I can't talk about this case from a piece of paper like this. I have to touch them; I can't talk about them in abstraction.' Then I thought, how do these two worlds come together? I don't know if they can because there are so many different ways of looking at it."

Indeed, it has been difficult to find a common language for the two worlds, and as many in the medical profession agree, the perception is still that much of alternative medicine may not be scientific enough. Yet the Scripps Center for Integrative Medicine's mission to "take a whole-person approach to well-being" sounds like an alternative the mainstream on all sides might embrace.

Blackford is a San Diego-based freelance writer.

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