By Tammy Richmond, MS, OTR, and Dave Powers, MA, MBA, PT
Incorporating the Alternative The doctor of the future will give no medicine, but will increase his patients in the care of the human frame, in diet, and in the cause and prevention of disease.” –Thomas Edison The aging of America has brought a significant increase in chronic medical conditions and a growing number of people who are dissatisfied with traditional treatment methods and their expensive price tags. In an attempt to prevent or treat their ailments, more than 80 million Americans are spending approximately $32 billion in visits to alternative practitioners—more than half is paid out-of-pocket.1 In 1997, 629 million visits were made to complementary and alternative medicine providers compared to 326 million visits made to physicians in the same year.1 A more recent survey showed that two-thirds of Americans have tried at least one form of alternative therapy or treatment.2 The most common and effective treatments reported were massage, yoga, herbal medicines, chiropractic, and acupuncture services. The Internet poll conducted by Intersurvey reported that 28% of 1,148 adults said they tried alternative therapies because traditional treatments were not working.2 More surprising is that 22% said that they tried alternative treatments on the recommendation of a physician.2 On the other hand, critics continue to emphasize caution when using alternative medicine until evidence-based research is completed. Alternative medicine is defined as a health science that blends body, mind, science, and experience with traditional and cross-cultural avenues of disease and treatment, with emphasis on prevention and wellness. There are four main categories:. alternative therapies that address structural imbalances within the body such as chiropractic, osteopathy, and craniosacral; herbal medicines, nutritional supplements, diet, and enzyme therapies that maintain proper cellular function by focusing on the body’s biochemical balance of hormones and nutrients; therapies that seek to restore mental and emotional balance such as mind/body techniques, biofeedback, meditation, guided imagery, and neurolinguistic programming; and those that address the energetic levels of the body such as acupuncture, homeopathy, and magnetic field therapy.3 Basically, health care practitioners using procedures that are not generally accepted or used by conventional physicians or therapists and are most often performed alone are considered alternative. On the other hand, clinicians utilizing alternative therapies in conjunction with generally accepted methodological techniques are considered complementary. The term integrative implies the blending of both conventional and nonconventional treatment methods and having them available within the same clinical setting. Leading the way in integrative medicine programming are facilities such as Beth Israel Medical Center, New York, and University of California, Los Angeles, Medical Center, which now offer patients the option of complementing their conventional care with procedures that include aromatherapy, biofeedback, meditation, acupuncture, and naturopathy. However, even as supporters boast improved quality of life and lower health care costs, critics of alternative therapies feel the necessary clinical evidence needed in order to take the integrative plunge is not there. In response to the growing demand for scientific evidence by health care providers and for insurance coverage by consumers, Congress mandated the creation of the Federal Office of Alternative Medicine under the National Institutes of Health in 1992, now called the National Center of Complementary and Alternative Medicine (NCCAM). The organization’s purpose is to protect and educate the public on complementary and alternative treatments. In 1999, Congress appropriated $50 million to explore the efficacy of alternative therapies through clinical research. Currently, there are 15 centers created by NCCAM to explore “complementary and alternative medicine practices in the context of rigorous science and disseminate authoritative information.”4 Presently concluded studies on tai chi7,8 and acupuncture9 clearly support their beneficial effects in certain populations and with specific medical conditions. By 1997, a few third-party payors began providing coverage for some alternative medicine treatments. Plan members paid an increased premium for co-pay and out-of-pocket discounts with alternative practitioners. Today, several major health plans typically cover chiropractic and acupuncture services. According to recent surveys, 90% of employer-paid plans cover chiropractic services and about 30% cover acupuncture.5 National Trends in Managed Care Plan Benefits Coverage reported 46.9% of plans cover chiropractic visits and 43.4% cover wellness.6 Several other insurers have established affinity programs that provide discounts to affiliated alternative care practitioners. Rehabilitation practitioners should not ignore the opportunity to develop treatment programs and services that synthesize the best of modern scientific rehab with the best of alternative techniques. To develop and implement alternative therapies into a rehab program, therapists need to keep these guidelines in mind:
