This report has covered a broad spectrum of alternative medical therapies and systems of medicine. Some of these medical systems, such as Ayurvedic medicine and traditional oriental medicine, are centuries old and are still in extensive use in other nations and cultures of the world. Others, such as osteopathy and naturopathy, evolved in the United States in the not-too-distant past but were relegated to the fringes of medicine because they differed from conventional biomedicine in the concepts of health and illness they embraced. Still others, such as some of the mind-body and bioelectromagnetic approaches, are on the frontier of scientific knowledge and understanding.
Many alternative practitioners face numerous economic, political, and scientific barriers that block their acceptance by mainstream biomedicine. On the other hand, some alternative medical practitioners do not expect to be brought into the fold. Rather, they just want the opportunity to coexist peacefully with mainstream medical practitioners and to be allowed to offer consumers alternative health care options. Consumers, however, are not waiting for mainstream science to give them a "green light" on many alternative treatments before using them. The fact is that today alternative medicine constitutes a significant and growing portion of the Nation's health care expenditures.
Recent surveys have demonstrated that most people who opt to use alternative treatments or systems of medicine believe that conventional medicine has not adequately addressed their needs, or they want to supplement and thus improve on their conventional treatment. This is especially true of people with chronic, debilitating illnesses such as arthritis, pain, cancer, and AIDS. People often are attracted to alternative medicine practitioners who emphasize the patient's role in the healing process as well as the importance of the patient-practitioner interaction.
Studies also show that individuals who seek out and use alternative medical treatments tend to be the better educated and the more affluent. Thus the stereotype of the alternative medicine consumer as an uneducated, poor person succumbing to the sideshow lures of quacks and charlatans appears to be greatly overblown. The reality is that because patients, in general, are demanding more health care options at a lower cost, a growing number of conventionally trained American physicians have already begun incorporating alternative medical modalities into their everyday medical practices.
The dominant biomedical U.S. health care system has made countless technological discoveries and innovations in the past half century, revolutionizing the way the body, the mind, and the environment are viewed. By all measures, however, it is an extremely expensive system offering limited accessibility. In other words, the patients who have the most money and live nearest the best health care facilities often receive the best care. Increasingly, this situation will dictate that the elderly, the disadvantaged, people with chronic illnesses, and the very young go without adequate health care-the populations that need health care most.
One of the simplest and most effective ways to significantly lower health care costs and thus increase access is through a major focus on preventive medicine. In this clinical arena, many of the alternative health care systems may have much to offer. Homeopathic and naturopathic physicians, for example, strongly advise their patients about diet and other health-promoting lifestyle choices as a matter of routine care. In contrast, many conventional physicians do not routinely give such advice until a patient has already become chronically ill, by which time the patient may need expensive high-tech surgery and face a lifetime of expensive drug therapy.
Another major factor contributing to the skyrocketing health care costs in this country is the amount of time involved in officially certifying a drug or medical intervention as clinically effective and safe. Millions of dollars may be spent, and years may pass, before a potentially lifesaving drug, instrument, or intervention winds its way through the complex Federal approval process. That same process too often ignores or discounts related, potentially valuable Canadian, European, and Asian data that could significantly shorten the assessment process.
In addition, standards of testing drugs and therapies in the United States are inconsistent with standards in many other technologically developed countries. For example, U.S. regulations on testing herbal medicines require a much more circuitous testing process than is required overseas. There, evidence of prior use without adverse side effects may be accepted by medical authorities without data from extensive clinical trials; preliminary clinical trials can therefore focus immediately on the effectiveness of the herbal remedy. In the United States, however, Phase I trials focus solely on safety issues, and effectiveness is not dealt with until much later.
Furthermore, in many European and Asian countries it is completely acceptable to test an herbal extract as a single drug rather than require every potentially active ingredient in the plant to be tested, as is the rule in the United States. Thus in other developed countries significantly less time and cost often are involved in bringing a potentially beneficial herbal or naturally occurring remedy to market.
As U.S. consumers continue to use alternative medicine, the challenge for health care policymakers and Federal regulators is not only to protect the public from unscrupulous medical practitioners but also to ensure the public's access to the most effective treatments available. Certainly, patients should have recourse if it can be shown that their practitioners or the treatments they offer have no clinical or psychological benefit. By the same token, patients with debilitating severe or chronic illnesses should have the right to have access to-as well as insurance to cover-an alternative therapy they believe offers them relief.
Many of the alternative therapies described and discussed in this report-hypnosis, art therapy, music therapy, chiropractic, massage therapy, acupuncture, and many herbal and nutritional supplementations, to name a few-have already received extensive and positive clinical evaluations. However, no critical mass of researchers, clinicians, and policymakers has formed to give them more exposure and recognition. Therefore, many of these therapies should be included in any serious discussions about developing a truly comprehensive health care system. Others, as the report has indicated, need to be quickly and thoroughly evaluated before any judgment can be passed. However, they still may represent a great and largely untapped resource for improving the Nation's health.