Supreme Court Rules In Favor of States In a move that restricts Congress’ ability to enforce the Americans With Disabilities Act of 1990 (ADA), the Supreme Court handed down a 5-4 decision in University of Alabama vs Garrett that state employees cannot sue their employer over possible ADA violations. The February 21 ruling could leave the ADA vulnerable to further encroachments if the conservative-leaning court continues to support state immunity claims in cases involving the ADA and other civil rights issues. Chief Justice William H. Rehnquist wrote the majority opinion. He was joined by Justices O’Connor, Scalia, Kennedy, and Thomas. Justices Stevens, Souter, and Ginsburg signed Justice Stephen G. Breyer’s dissenting opinion. The split falls along the same lines as other cases dealing with state immunity issues, including last year’s similar decision barring state workers from suing their employers in federal court under the Age Discrimination in Employment Act. Many advocates for the disabled community expressed dismay about the decision. Kathleen Curtis, PhD, PT, professor at the College of Health and Human Services, California State University, Fresno, comments, “It has serious implications for persons with disabilities. On a larger scale, it is one more example of the present Supreme Court’s trend to overlook federal civil rights protection in favor of states’ rights.” White House Commission Discusses Alternative Medicine On December 4-5, 2000, in Washington, DC, the White House Commission on Complementary and Alternative Medicine (CAM) Policy met with several health care practitioners and representatives from insurance companies to discuss utilization of CAM services, patient perspectives on the use of CAM services, public and private sector delivery systems, and novel systems of CAM services delivery. Commission chairman Jim Gordon, MD, cited recent surveys establishing that approximately 40% of Americans use a form of complementary and alternative medicine. “One of the charges of the Commission is to address the needs of those people and to understand the importance of the contributions that those people make to our health care system, as well as the needs that they have from our health care system,” he said. Gordon noted that comparisons between recent and earlier surveys show a dramatic rise in the use of certain forms of CAM, particularly megavitamins, herbal treatments, and homeopathic remedies. According to recent studies, most people do not turn their backs on traditional medicine but use CAM to supplement conventional treatments. The studies show that conventional physicians’ interest in and referrals to CAM are relatively high, and that CAM usage is high among those facing chronic and life-threatening conditions. The majority of medical schools in the United States now offer elective courses in CAM therapies. Commissioners discussed the relationship between limited health insurance resources and CAM usage and whether the rise in the use of certain CAM therapies was related to increased marketing of those therapies. The consensus was that decreased access to health insurance did lead to increased use of CAM, but was not the only explanation. James Dillard, MD, said that in the mid-1990s, he was asked by Oxford Health Plans, Trumbull, Conn, to help build a comprehensive CAM program inside the insurance company. To date, the program has credentialed almost 3,000 CAM providers in six areas. In terms of integration, “there are a number of barriers, including resistance on the part of the physicians, resistance on the part of the CAM practitioners, and resistance on the part of patients.” He said that many patients simply do not want their primary care physician to know that they are seeing a CAM practitioner and, thus, often are resistant to having their records shared by both their traditional physicians and CAM practitioners. Overall, he said, it is appropriate to create access to the therapies that are considered safe. Commissioner Buford Rolin said that the Commission needs to focus on those that are not being served, such as Native American tribes living on reservations, because “those are areas where CAM can make vast improvements within the communities.” Commissioner Conchita Paz added that as culture in the United States becomes more and more diverse, it will be necessary to continually expand the list of potential CAM therapies. Commissioner George Bernier said the time is ripe to take a major step in integrating CAM. Nevertheless, there remain a number of issues, including guaranteeing the safety and efficacy of treatments of all types. One of the problems, he said, is that the term “CAM” means so many different things, and many CAM disciplines are not eager to be integrated with conventional medicine. Chairman Gordon suggested that the Commission should begin to dialogue more with the conventional medicine community, particularly the American Medical Association and the American Association of Medical Colleges. The White House Commission on Complementary and Alternative Medicine Policy was established by former President Bill Clinton on March 7, 2000, in response to the growing number of Americans using complementary and alternative approaches to health promotion and medical treatment. Its mission is to provide a report through the Secretary of the Department of Health and Human Services on legislative and administrative recommendations for assuring that public policy maximizes the benefits of CAM.
