ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, October 7, 1996 TAG: 9610070097
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
DATELINE: NEW YORK
SOURCE: STEVE SAKSON THE ASSOCIATED PRESS
NOTE: Above
ALTERNATIVE MEDICINE is catching on with health maintenance organizations. But medical experts say some of the treatments amount to quackery.
They won't pay for shark cartilage pills and coffee enemas yet, but leading HMOs are experimenting with the demi-science called alternative medicine, hoping to cure ills when regular medicine fails.
It's a startling trend. Many doctors still view some alternative methods with great skepticism - the word ``quackery'' is bandied about - and health maintenance organizations have a reputation for shunning all but the most reliable treatments.
While most HMOs already offer chiropractic coverage, a number are adding acupuncturists and massage therapists, along with practitioners called naturopaths, who use herbal remedies, relaxation therapies, yoga and more. The health plans are offering to cover this care just as they do for cardiologists and pediatricians.
The picture will broaden Tuesday when Oxford Health Plans Inc., a highly profitable HMO in the Northeast with a reputation for marketing innovation, jumps into the field with the most extensive program to date.
One big reason is that patients want it, even though hardly any of the alternative techniques have undergone rigorous, scientifically controlled studies.
A landmark survey, published in 1993 by Harvard Medical School, showed that one in three Americans used nontraditional treatments, spending a total of $14 billion a year compared with just under $1 trillion spent on traditional health care.
``Consumers are already voting with their out-of-pocket expenditures that these services work,'' said Alan Kittner, a California-based consultant who helps HMOs set up networks of alternative providers.
``Quite often these things can be less expensive than traditional health care, especially if you can avoid hospitalizations,'' said Randall Huyser, an HMO industry analyst with the securities firm Furman Selz in San Francisco. ``Secondly, there is a tendency for people that like holistic cures to generally be healthier people, so they are more attractive patients for HMOs.''
More importantly, public health authorities are becoming convinced that at least some of these things may really work.
At least 41 state governments now require chiropractic coverage in some form. Six states require acupuncture coverage and nine license naturopaths. Late last year, the Washington state Legislature mandated that all insurers provide alternative medicine.
Until now, leaders in the movement to cover alternative medicine have mostly been small niche companies on the West Coast and upper Midwest. Also involved are some respected nonprofits - such as Seattle's Group Health Cooperative of Puget Sound and Kaiser Permanente of California.
Oxford's program will offer fully insured coverage of chiropractic, acupuncture and naturopathy coverage from a network of prescreened providers for an additional premium cost of 2 percent to 3 percent.
In addition, members will be able to purchase yoga, massage, and nutrition services from an Oxford-endorsed network at a discount. And they will be able to buy herbal remedies, vitamins, and other supplements by mail order, also at a discount.
``Our members said this was important. We responded by creating these programs as a natural extension of what Oxford has done throughout its history,'' said Dr. Hassan Rifaat, the company's alternative medicine director.
Still, respected skeptics abound.
They're particularly worried that desperately ill patients are abandoning traditional methods and are getting sicker.
``One HMO frankly admitted they were referring AIDS patients to this quack clinic where they were giving them dietary supplements,'' said William Jarvis, president of the National Council Against Health Fraud. ``They said it's cheaper than AZT and the patient won't be around as long to collect.''
A 1991 study by psychologist Barrie Cassileth of the University of North Carolina found that coffee enemas given to terminal cancer patients didn't work and the recipients were in greater discomfort than those who took chemotherapy.
Serious kidney damage has resulted from chelation therapy - injections of a substance called EDTA, which normally are used to combat lead poisoning but also are popular as an alternative treatment for heart disease.
HMOs stress that they will only pay for the alternative therapies that have already shown wide acceptance and safety - shark cartilage to ward off cancer is definitely out. All authorized practitioners must carry malpractice insurance, and most of them can only go to work after a referral from a doctor.
Oxford's program requires the nontraditional practitioner to submit a care plan for each member for preapproval by Oxford before extensive treatment begins.
Washington's Group Health limits coverage to specific ailments. Acupuncture, for instance, is covered only for 10 conditions including chronic neck and back pain, migraines, arthritis and cancer-related pain. Group Health doesn't pay for any herbals, vitamins or supplements.
Dr. David Eisenberg, the Harvard doctor who wrote the seminal 1993 alternative medicine study, praised the expanded coverage, saying it will help scientists conduct larger and more authoritative studies to see what really works for broad groups of patients.
``It's conceivable they'll feel better, look better, and it will cost less,'' he said. ``Just the opposite is also possible.''
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