CAMLAW: Complementary and Alternative Medicine Law Blog

Senate considering expanding mandatory insurance coverage for alternative therapies

Proposed federal legislation could require expanded insurance coverage for alternative and complementary therapies.

The bill is raising a lot of controversy:

Acupuncturists, dietary-supplement makers and other alternative health practitioners, some of whose treatments are considered unproven by the medical establishment, would be brought more squarely into the mainstream of American medicine under the health legislation now before the Senate.

The legislation would allow doctors to incorporate alternative health providers in some treatment plans. It also includes language that some believe could require insurance companies to expand their coverage for alternative therapies, on which Americans now spend $34 billion a year.

Insurers and some scientific watchdogs say the measure would undermine one of the central principles of the healthcare overhaul: that the system cut costs by eliminating medical treatments that aren't proven effective.

"These provisions are anti-science and anti-consumer," said Dr. Steven Novella, a professor of neurology at Yale School of Medicine, who is mobilizing opposition to the Senate bill.

The leading champion of these measures is Sen. Tom Harkin (D-Iowa), chairman of the Senate Health Committee, who credits bee-pollen pills with curing his seasonal allergies. He is also the leading recipient in Congress of campaign donations from chiropractors and dietary-supplement makers.

Harkin's staff says he supports healthcare that has shown itself to be effective....

Oncology nurses should know more about CAM:

Many patients are reluctant to talk to oncologists about their complementary and alternative medicine (CAM) use, and for good reason: they may have raised it with a physician in the past and been ignored or told it was irrelevant. To overcome this reluctance, nurses must be familiar with the various CAM modalities and comfortable with eliciting information from patients about their use and advising on their pros and cons.

Several presenters from the CAM special interest group emphasized these points at a workshop that explored complementary and alternative medicine at the Canadian Association of Nurses in Oncology/l' Association Canadienne des infermieres en oncology's (CANO/ ACIO) 2009 Annual Conference .

“Nurses can play a key role in communication and collaboration surrounding CAM, including encouraging patients to inform all of their healthcare providers about their CAM use, and assisting patients in finding timely, accurate and evidence-based CAM information,” said Lynda Balneaves, RN, PhD, associate professor and Canadian Institute for Health Research New Investigator, University of British Columbia School of Nursing, Vancouver.

She and several others have formed a special interest group on CAM within CANO to help make all oncology nurses in Canada conversant with CAM. Ms Balneaves and also is involved in an initiative called CAMEO (see Sidebar).

Up to 80% of Canadians with cancer use CAM during their illness, noted Dr Balneaves. However, a 2007 survey of cancer patients in British Columbia showed that only 53% felt comfortable talking with healthcare providers about CAM. And other research has confirmed that patients, families, and oncology professionals struggle with making safe and informed decisions about CAM.

Nurses can best serve patients by, first, knowing the position of their college or associations with respect nurses' scope of practice related to CAM, explained Dr Balneaves. Furthermore, before they provide a particular intervention, nurses should determine whether providing it falls within the nurses' role at their particular institution. They should also ascertain whether there is a robust evidence base for its use in the indication being considered.

"CAM is just dangerous! Especially because Oprah endorses it!"  Or something like that:

Alternative medicine consists of products or treatments used for health benefits, but is not always evidence-based. It is often based on cultural and traditional health practices or more recent disproved theories that have remained popular within certain fringe groups. Common types include homeopathy, acupuncture, herbalism and bio-identical hormone therapy.

Generally speaking, complimentary medicine is less regulated, or self-regulated, and should be required to meet the same standards as conventional medicine. Despite little evidence for alternative medicine, public support is growing.

According to a study released by the U.S. Center for Disease Control and Prevention in 2002, use of complementary and alternative medicine increased substantially during the 1990s. The study estimated that the U.S. public spent between $36 billion and $47 billion on alternative therapies in 1997. To put that in perspective, that's more than the U.S. public paid out-of-pocket  for all hospitalizations and about half that paid for physician services that year.

Why is the use of alternative medicine growing? Few studies have looked into the social parameters of alternative therapy; however, growing wait times for Canadian medical treatments and financial barriers to care in the U.S. may be a possibility. Also, people are increasingly trusting doctors and pharmaceutical companies less ­- possibly a paradoxical result of the advent of evidence-based medicine. Most people aren't concerned with the fatality of minor bacterial infections, the devastation of epidemics like measles or polio or the agony of surgery without anesthesia thanks to advances in conventional medicine. Instead, people are now faced with occasional complications from treatments and drugs.

Furthermore, there are a number of popular personalities endorsing alternate treatments. Oprah, one of the more influential celebrities, often supports uncommon treatments on her talk show and invites personalities to discuss dissenting views of conventional medicine. Susanne Somers, an endorser of bio-identical hormones whose personal health regimen has included injecting high doses of estrogen into her vagina for several years now, and Jenny McCarthy, a playmate turned-anti-vaccination advocate, are two of the most infamous. However, other mainstream media and international organizations have actively criticized alternative medicine and those who advocate it...

And, Bangalore, India is to become an alternative medicine hub:

In a quantum leap in integrated medicine, Bangalore could become the hub for a combination of traditional and modern systems for doctors from all over the world. Driving this initiative is Prince Charles’s
tie-up with Bangalore-based Soukya Foundation led by Dr Issac Mathai.

The foundation will ink a pact soon with the proposed Royal College of Integrated Medicine, London, of which Prince Charles is the founder, to provide clinical training in Bangalore to European and Western doctors in ayurveda and homoeopathy and traditional forms of medicine to integrate them in their practice.

“The second campus of the Royal College will be in Bangalore. We have already proposed the setting up of an All India Institute of Integrated Medicine to the Union health ministry. At a meeting in London last week with Prince Charles, we finalized the project which will kick off in July 2010,’’ Dr Mathai told STOI.

At the meeting, Prince Charles observed that integrating Western and Eastern medicine is the future of modern healthcare. He felt that integrative medicine will be cost effective with least side-effects.

Medical schools are teaching CAM more widely now:

Additional tax money has been spent to recruit and train young doctors to do research in this field, launching some into careers as alternative medicine providers.

Doctors need to know about popular remedies so they can discuss them nonjudgmentally and give competent advice, the government says, and many universities and medical groups agree.

"Patients are using these things" whether doctors think they should or not, and safety is a big concern, said Dr. Victor Sierpina, an acupuncturist at the University of Texas Medical Branch in Galveston who heads a group of academics who favor such training.

But to critics, it's like teaching Harry Potter medicine. Students are being asked to close their eyes to science principles that guide the rest of their training in order to keep an open mind about pseudoscience, they say.

"I'm concerned about the teaching of illogical thinking to medical students" and lending credence to biologically implausible theories such as distance healing and energy fields, said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a Web site on medical scams.

Teaching about alternative medicine implies acceptance of it and "potentially creates more gullibility and less critical, objective thinking," said Dr. Wallace Sampson, editor of the journal Scientific Review of Alternative Medicine. "This will be felt in many indirect ways," he said, including judgment errors, misguiding people with severe diseases.

The real issue is not whether alternative medicine should be taught, but how, said Dr. Joseph Jacobs, former head of the federal Office of Alternative Medicine. "If the topic is taught objectively, to help students communicate with patients, it's a good idea," Jacobs said. "If it's being taught as part of an advocacy, for acceptance among physicians, I think that's a little bit bogus."

Learn to deep-breathe on your iphone:

A Reston-based alternative medicine practice is launching ancient spiritual concepts into the frenetic world of iPhone apps, in yet another sign of technology’s steady march into pretty much every fiber of our existence.

Dr. Darshan Khalsa and his wife, Carol O’Donnell Khalsa, went live this month with their first app, “Long Deep Breathing.” It’s a stress relief technique that is part of the Kundalini yoga that Darshan Khalsa has practiced since the early 1970s.

The Khalsas’ collaborative project hints at the limitless opportunity behind smart phones and the app craze, a no-barriers-to-entry industry that has made millionaires out of entrepreneurs peddling everything from flatulent noisemakers to imaginary farms that sell imaginary seeds for genuine money.

If expelling air can make big bucks, there has to be a market for inhaling.

“Apps,” or applications, are tiny software programs that give smart phones the power to find a restaurant, hail a cab and identify the song playing on the cab’s radio.

Khalsa, a quiet Sikh convert whose gentle hazel eyes and impossible stillness of being inspire healing in his 1,500 or so patients at Khalsa Integrative Medicine, is an unlikely prophet for technology and social media. He rises at 4 a.m. to do yoga and pray for world peace, then tends to 10 or 12 patients a day.

If Khalsa were left to his own devices, “I’d have just four or five patients — she’s the one who brings in the patients,” he said in his Reston office, surrounded by Chinese herbs, maps of the body’s energy meridians and dozens of certificates affirming his training in alternative and Oriental medicine.

Michael H CohenMichael H Cohen
The Los Angeles / San Francisco / Bay Area-based Michael H Cohen Law Group provides healthcare legal and FDA legal & regulatory counsel to health & wellness practices and ventures, including health technology companies (medical devices to wearable health and nanotech), healthcare facilities (from medical centers to medical spas), and healthcare service providers (from physicians to psychologists).Our legal team offers expertise in corporate & transactional, healthcare regulatory & compliance, and healthcare litigation and dispute resolution, in cutting-edge areas such as anti-aging and functional medicine, telemedicine and m-health, and concierge medicine.Our Founder, attorney Michael H. Cohen, is an author, speaker on healthcare law and FDA law, and internationally-recognized thought leader in the trillion-dollar health & wellness industry.


Trackbacks (0) Links to blogs that reference this article Trackback URL
Comments (0) Read through and enter the discussion with the form at the end

Michael H. Cohen, Esq.; 468 North Camden Dr. | Beverly Hills, California 90210 | 310-844-3173