From Acupuncture to Yoga, Alternative Healing Gains Ground : Medicine: Americans spend $13.7 billion in unorthodox forms of treatment, a study says.

TIMES STAFF WRITER

Americans willing to try unorthodox remedies to relieve asthma, back pain, insomnia and other ailments are gradually pulling the practice of alternative medicine into the mainstream.

With one prominent study showing that one in three Americans turn to alternative treatments each year--spending $13.7 billion in the process--health insurers and doctors are taking a harder look at the benefits of acupuncture, biofeedback, naturopathy and the like.

A major force driving this change in attitude is cost. Practitioners of alternative therapies contend that their methods, which stress preventive care, are far less costly than conventional treatments.

Their argument strikes a chord as President Clinton campaigns for sweeping health care reform aimed at reining in medical costs and ensuring coverage for all Americans. The presidential task force drawing up the reform agenda--led by First Lady Hillary Rodham Clinton--has enlisted the help of advisers from the chiropractic, acupuncture and naturopathic professions, among many others.

Harry Swope, a Santa Monica naturopath--a practitioner who treats patients with such drug-free remedies as herbs, nutrition and massage--asserts that alternative therapies "really work, are really cost effective and are really a better answer."

Many consumers would agree.

Of the $13.7 billion Americans spent on alternative care in 1990, a whopping $10.3 billion was paid out of pocket without reimbursement by insurance plans, according to a study published in January in the New England Journal of Medicine.

By comparison, $12.8 billion was spent out of pocket in 1990 for all hospitalizations in the United States.

The study, by Harvard Medical School's Dr. David M. Eisenberg and colleagues, defined unconventional alternative therapies to include chiropractic, massage therapy, homeopathy, relaxation techniques, acupuncture, herbal medicine, megavitamin therapy and spiritual healing, among others.

Eisenberg found that most people used unconventional therapies for chronic--but not life-threatening--illnesses, and that 83% had also sought treatment for the same condition from a medical doctor.

The use of alternative medicine was not confined to any specific segment of the population, but was significantly more common among those aged 25 to 49, those with some college education and those with annual incomes above $35,000. Not surprisingly, the use of alternative therapies was most common in the western United States, where 44% of the respondents reported using one or more.

B.J. Coburn, a Los Angeles medical photographer who has undergone three kidney transplant operations, is fairly typical of those who have turned to alternative therapies.

A few years ago, Coburn began suffering from severe headaches and stomach pain, chronic fatigue and weight loss.

Her doctor performed laboratory tests, then told her that he could find nothing wrong. Desperate to find relief for her pain, she visited an acupuncturist, who prescribed dietary changes and treated her with Chinese herbal remedies and acupuncture therapy.

"The first time after I went in there I had more energy," said Coburn, 40, of her initial visit to acupuncturist Lisa Berger. "She cares for the whole body and not just one specific area. She's concerned about you in general, and it makes you feel really good."

Eisenberg's study--which provided the first statistical evidence to support alternative practitioners' claims that many Americans were benefiting from their services--also caught the attention of many insurers.

In what observers say is probably the first insurance policy of its kind in the nation, American Western Life Insurance Co., based in Foster City, Calif., recently began offering coverage for alternative medical treatment.

The plan offers a network of about 300 providers in California, Arizona, Colorado, New Mexico and Utah specializing in acupuncture, aromatherapy, biofeedback, chiropractic, herbal medicine, massage, naturopathy, reflexology and yoga, among other therapies.

Over the long term, American Western expects that its plan--which encourages people to take responsibility for improving their health--will save money.

"A lot of (alternative practitioners) have been very effective in treating people for less dollars," said Lisa WolfKlain, vice president of wellness and human resources. The natural herbs used in alternative medicine, for example, "tend to be cheaper than pharmaceutical drugs and have fewer side effects. A lot of our hospitalizations last year were due to drug interactions."

Initially, she acknowledged, American Western's "wellness health plan" will actually cost the company more than standard policies do. WolfKlain said that this is because the initial stages of some alternative therapies require frequent patient visits as practitioners offer counseling on diet, stress reduction or other "lifestyle adjustments."

There are other signs that unconventional therapies are gaining acceptance among insurers.

Mutual of Omaha Insurance Co.--a large insurer with a reputation for conservatism--announced last month that it would reimburse the costs of a non-surgical therapy for heart disease.

The therapy, which includes a vegetarian diet, meditation and exercise to reverse the disease, was developed by Dr. Dean Ornish, an internist and director of the Preventive Medicine Research Institute in Sausalito.

Harvie E. Raymond, director of insurance products for the Health Insurance Assn. of America, a Washington-based trade group, said the Nebraska firm's announcement "will probably capture the attention of other insurers."

But Betsy Reece, a spokeswoman for Mutual of Omaha, said the company's decision was not an endorsement of all alternative medicine--just approval of the program designed by Ornish. "Other non-traditional medicines and treatments can't compare to what he's done as far as proving effectiveness," she said.

According to Raymond, many insurance carriers have demonstrated a reluctance "to be the first to reimburse for alternative treatment unless it was mandated by state law."

Most states require reimbursement for chiropractic care, a result of the industry's effective lobbying efforts and a growing body of statistical evidence about the benefits of spinal manipulation. Some health-maintenance organizations now include chiropractors in their preferred provider networks. And a growing number of insurers are paying for acupuncture to treat acute pain or as an alternative anesthetic.

When it comes to most other unconventional therapies, however, insurers remain largely unconvinced. "The industry tends to want to see hard statistical data," Raymond said.

To address the lack of scientific studies, the National Institutes of Health's Office of Alternative Medicine plans to fund 20 preliminary research studies of unorthodox cures, including the use of shark cartilage to treat cancer and the effectiveness of bee pollen in treating allergies.

Some alternative practitioners contend, in the meantime, that the insurance industry's reluctance to pay for unconventional therapies stems, in part, from medical doctors' biases.

"Most insurance companies are heavily influenced by doctors," said one Santa Monica naturopath. "Anything that isn't straight out of the American Medical Assn. cookbook tends not to be paid for."

To be sure, not all medical doctors dismiss alternative medicine out of hand. Some practitioners say they occasionally get referrals from medical doctors. Indeed, one study by a Santa Monica physician found a growing acceptance by medical doctors of alternative forms of medicine.

Dr. Oscar Janiger and Los Angeles writer Philip Goldberg interviewed more than 250 doctors nationally about their experiences with and attitudes toward unconventional therapies. The findings were included in their recently published book, "A Different Kind of Healing."

"What we found was a majority of (medical doctors) were using some form of alternative medicine themselves or were willing to suggest it to their patients," said Janiger, an associate clinical professor of psychology and human behavior at UC Irvine's California College of Medicine.

Gradually, he said, doctors will become more accepting of the complementary role that alternative therapy can play with traditional Western medicine.

Dr. Richard H. Helfant, former director of cardiology at Cedars-Sinai Medical Center, also believes that alternative therapies will "seep into" mainstream medicine over time.

Helfant, 55, is a convert of sorts.

A leading figure in cardiovascular research and education, he now faults traditional medicine for failing to adequately explore preventive treatments for heart disease. In October, he plans to open a Marina del Rey center for heart patients that will focus on attitudinal change, lifestyle, exercise and diet, along with traditional medical concepts.

"We have swung off totally to science and high-tech as the be-all" in health care, Helfant said. "But it isn't a substitute for the power of the mind."

Alternative therapies are popular treatments...

The most common treatments were relaxation techniques (such as meditation), chiropractic care and massage.

Type of Therapy % who used in the last 12 months Relaxation techniques 13% Chiropractic 10 Massage 7 Imagery 4 Spiritual healing 4 Commercial weight-loss program 4 Lifestyle diets 4 (e.g. macrobiotic) Herbal medicine 3 Megavitamin therapy 2 Self-help groups 2 Energy healing 1 Biofeedback 1 Hypnosis 1 Homeopathy less than 1 Acupuncture less than 1

Total using some form of unconventional therapy: 34%*

* Figure does not include respondents who used exercise and prayer.

Patients increasingly are turning to unconventional therapies to seek relief from some of the most common, chronic medical complaints.

Condition: Back problems

% reporting condition: 20%

of those, % who used unconventional therapy in last 12 months: 36%

*

Condition: Allergies

% reporting condition: 16

of those, % who used unconventional therapy in last 12 months: 9

*

Condition: Arthritis

% reporting condition: 16

of those, % who used unconventional therapy in last 12 months: 18

*

Condition: Insomnia

% reporting condition: 14

of those, % who used unconventional therapy in last 12 months: 20

*

Condition: Sprains or strains

% reporting condition: 13

of those, % who used unconventional therapy in last 12 months: 22

*

Condition: Headache

% reporting condition: 13

of those, % who used unconventional therapy in last 12 months: 27

*

Condition: High blood pressure

% reporting condition: 11

of those, % who used unconventional therapy in last 12 months: 11

*

Condition: Digestive problems

% reporting condition: 10

of those, % who used unconventional therapy in last 12 months: 13

*

Condition: Anxiety

% reporting condition: 10

of those, % who used unconventional therapy in last 12 months: 28

*

Condition: Depression

% reporting condition: 8

of those, % who used unconventional therapy in last 12 months: 20

Americans spent an estimated $13.7 billion for unconventional therapies in 1990--most of which they paid for out-of-pocket.

Unreimbursed by third-party payer: 55%

Partially reimbursed by third-party payer: 31%

Fully reimbursed by third-party payer: 14%

Source: The New England Journal of Medicine. Based on 1991 study of 1,539 U.S. adults by Dr. David M. Eisenberg, of Harvard Medical School, and colleagues.

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