Boston Globe: Senators seek coverage for alternative therapies

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Senators seek coverage for alternative therapies

By Kranish, Globe Staff | July 24, 2009

WASHINGTON - Naturopathic doctors, herbal healers, mind-body specialists,

and acupuncturists often have been scorned by the US medical establishment,

but growing numbers of Americans are seeking such care, and now an

influential group of US senators believes the time has come to embrace an array

of

alternative therapies.

Senator Tom Harkin, an Iowa Democrat who is a longtime supporter of

nontraditional medicine, is at the forefront of the effort to win insurance

coverage for such providers as part of national healthcare legislation.

“It’s time to end the discrimination against alternative healthcare

practices,’’ Harkin said at a congressional hearing.

Harkin is the cosponsor of an amendment that says healthcare plans will not

be allowed to “discriminate’’ against any healthcare provider who has a

license issued by a state, an amendment Senate aides said was designed to

provide coverage for alternative medicine. Backers of the amendment say it

could save tens of billions of dollars in the long run by providing less

expensive and better alternatives to drugs and surgery in a variety of cases.

The amendment was adopted by a Senate committee writing health legislation,

but details are still being negotiated.

With hundreds of disciplines falling under the general category of

alternative medicine, and with a variety of sometimes-conflicting studies about

their effectiveness, there is much disagreement about the value of including

such providers in a national health insurance program.

State by state, there is a wide disparity of coverage of alternative

medicine. For example, Massachusetts licenses acupuncturists, and many health

insurance plans cover the service, but most do so only on a limited basis, by

restricting the number of visits or the dollar amount of coverage.

Forty-four states license acupuncturists. Fifteen states, not including

Massachusetts, license naturopathic physicians, who use natural remedies in

their treatment.

Many practioners of alternative medicine say mainstream caregivers don’t

want the competition.

But the American Medical Association says there is little evidence to

confirm the safety or efficacy of most alternative practices. “Much of the

information currently known about these therapies makes it clear that many have

not been shown to be efficacious,’’ the association said in a policy

statement. The association denies that it is trying to stifle competition and

says it is only trying to ensure that medicine is based on science.

Dr. Harriet Hall, a retired Air Force flight surgeon who examines medical

claims for Skeptic magazine, said she worries that ill-informed members of

Congress will elevate practitioners of alternative medicine to the same

level as medical doctors.

“If it were shown to be truly effective, it would be part of regular

medicine,’’ she said.

Nonetheless, the federal government has become increasingly involved in the

field, funding the National Center for Complementary and Alternative

Medicine at the National Institutes of Health, and states are increasingly

being

lobbied by providers to receive formal approval for the field.

Massachusetts insurance companies recognize the growing consumer demand for

alternative therapies, said Dr. lou Buyse, president of the

Massachusetts Association of Health Plans, which represents groups providing

services

to 2.4 million people. She said coverage varies from one plan to another,

but many plans provide for a limited number of services such as

chiropractic, acupuncture, and massage therapy. She said costs would become

prohibitive if Congress mandated that an unlimited number of visits be covered.

Certain kinds of alternative medicine are considered mainstream in sectors

of the Massachusetts medical field, where they are increasingly called “

integrative’’ to emphasize that they are done in concert with traditional

medicine, not as an alternative. At the Zakim Center for Integrative Therapies

at Dana-Farber Cancer Institute, traditional treatment is complemented by

acupuncture and massage therapy as well as counseling on mind-body

techniques to reduce stress. For example, acupuncture has proved beneficial to

reduce nausea from chemotherapy, according to the center’s co-clinical

director, Dr. Rosenthal.

“We have a tendency to treat drug symptoms with another drug. We are

looking at trying to find nonpharmalogical approaches,’’ Rosenthal said.

The two main sponsors of the Senate amendment were Harkin and Senator

Barbara Mikulski, a land Democrat. Republicans, including the ranking

member

on the Senate health committee, Senator Mike Enzi of Wyoming, also backed

the amendment. The Senate committee on Health, Education, Labor and

Pensions agreed to the measure, but it will be left to the Senate Finance

Committee, which is working on companion legislation, to write crucial language

regarding potential reimbursement, Senate aides said. The matter will then be

debated on the Senate floor, and a similar amendment is expected to be

offered in the House.

Whatever the fate of the amendment, merely the fact that it is pushed by a

number of senators has been greeted as a breakthrough by supporters of

alternative medicine.

“I was shocked and elated that it was even on the table,’’ said Shiva

Barton of Winchester, one of 50 naturopathic doctors who practice in

Massachusetts. Barton is leading an effort to have Massachusetts grant licenses

to

naturopaths, which in turn might enable them to be covered in the national

plan.

Barton said that he mostly sees patients who have not been satisfied with

the results of traditional medicine.

“We are not opposed to conventional medicine, but it has its limits,’’

Barton said. He talks with patients about lifestyle changes, stress reduction

techniques, vitamins, minerals, herbal agents, acupuncture, and homeopathic

remedies. He said that naturopaths and other practitioners of alternative

medicine are discriminated against by a system that is dominated by

well-financed lobbies for medical doctors who don’t want competition.

Acupuncturists are also hoping for relief. Harvey Kaltsas, president

emeritus of the American Association of Acupuncture and Oriental Medicine, said

the country could save billions of dollars by shifting care for a number of

conditions away from pharmaceutical treatment and toward acupuncture.

Kaltsas said the number of licensed practitioners has grown to 20,000 from just

300 in 1971, indicating that many people are sold on the practice’s

effectiveness.

Proponents of alternative medicine say they cannot match the lobbying power

of conventional-medicine groups, but they have been making inroads. Dr.

Mark Hyman, a physician based in Lenox who has authored several books on what

he calls “ultrawellness’’ said he has met with a number of senators, as

well as administration officials, about the need to provide for alternative

therapies in the healthcare legislation. He said he has received a

sympathetic response to his argument that the use of complementary therapies

can

save money.

Proponents of mind-body wellness and related stress-reduction techniques

also want to be included as care providers in the legislation.

Dr. Herbert Benson, the Boston-based author of the popular book The

Relaxation Response, said in an interview that Congress should revise the

healthcare legislation to incorporate his stress-reduction techniques. Educating

the public about the techniques, and hiring more trainers to implement them,

would save billions of dollars, said Benson, director emeritus of the

Benson-Henry Institute for Mind Body Medicine at Massachusetts General

Hospital.

He emphasized that he supports using drugs and surgery when necessary, but

he said it is time to adopt national policies that focus on the need for

stress reduction.

Kranish can be reached at _kranish@..._

(mailto:kranish@...) .

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