Because of the increasing sophistication of the U.S. health care system, its increasing administrative costs, and the exponentially expanding degree of training and specialization required by the health care practitioners who administer it, health care costs in this country have skyrocketed in the past few decades. Indeed, in 1940, health care absorbed $4 billion, a mere 4 percent of the U.S. gross national product (GNP); by 1992, health care costs had ballooned to more than $800 billion, or almost 14 percent of GNP.1 Experts predict these costs will exceed $1 trillion this year.
Despite these expenditures, many Americans currently have little or no access to adequate health care. In fact, 37 million Americans have no health insurance at all; another 22 million have inadequate health care coverage. To increase access to basic health care, individuals and organizations from many sectors of society are now calling for reform of the present health care system. To date, this debate has focused mainly on making the current system less expensive through capping the amount of damages that can be awarded because of medical malpractice, limiting physician and hospital fees, further regulating the pharmaceutical companies, and controlling the misuse of health insurance.
Unfortunately, this debate has failed to take into account the fact that the current health care crisis is primarily a crisis of chronic disease. Today almost 33 million Americans are functionally limited in their daily activities by chronic, debilitating conditions such as arthritis, allergies, pain, hypertension, cancer, depression, cardiovascular disease, and digestive problems. More than 9 million, or almost one-third, of these individuals have limitations so severe that they cannot work, attend school, or maintain a household. The U.S. Public Health Service (PHS) estimates that 70 percent of the current health care budget is spent on the treatment of these individuals; as the population grows older, such conditions will continue to consume an even larger proportion of national health care expenditures. Furthermore, the worldwide pandemic of acquired immunodeficiency syndrome is threatening to completely overwhelm the health care delivery systems in certain areas of the United States.
While the dominant system of health care in the United States—often called "conventional medicine," or biomedicine—is extremely effective for treating infectious diseases and traumatic injuries, it is often ill equipped to handle complex, multifaceted chronic conditions. One reason is that over the years, conventional medicine has increasingly emphasized finding a single "magic bullet" solution for each condition or disease it confronts. The reality is that many chronic conditions are not amenable to such one-dimensional solutions.
Rather, such complex conditions require equally multifaceted treatment approaches. Furthermore, it is far less expensive to prevent them from occurring in the first place than to attempt to treat the symptoms and consequences with surgery and expensive drugs, which often offer only short-term solutions. For example, coronary artery disease affects approximately 7 million Americans and causes about 1.5 million heart attacks and 500,000 deaths a year. Approximately 300,000 coronary artery bypass graft operations are performed in the United States each year at a cost of about $30,000 each, or $9 billion total. Yet coronary artery bypass surgery prevents premature death in only a few patients with the most serious main coronary or multiple-vessel heart disease. On the other hand, heart disease is almost entirely attributable to poor diet (i.e., high fat intake) and unhealthy lifestyle decisions (alcohol consumption and smoking), and thus can be avoided. For those who already have heart disease, an extremely low-fat diet combined with exercise and other therapies may actually start unclogging blocked arteries and significantly extend life.
Thus, for health care reform truly to succeed at reducing costs and increasing access, disease prevention must be the ultimate focus of the primary health care system rather than disease treatment. This change in emphasis can be accomplished only by restructuring the current system so that people learn that they are far better off staying healthy than relying on high technology to rescue them from a lifetime of unhealthy living. In addition, to care adequately and cost-effectively for those who already have chronic illnesses, health care reform must incorporate multifaceted approaches to the treatment of these patients, approaches that control the symptoms while alleviating the underlying causes.
In 1990, PHS recognized the need to completely revamp the current approach to health and illness when it released a 700-page report called Healthy People 2000. This report enumerated the challenges and goals for improving the Nation's collective health by the year 2000 and challenged the Nation to move beyond merely saving lives. It explained that "the health of a people is measured by more than death rates. Good health comes from reducing unnecessary suffering, illness, and disability. It comes from an improved quality of life. Health is thus measured by citizens' sense of well-being. The health of a Nation is measured by the extent to which the gains are accomplished for all the people." To reach this goal, the report called for "mobilizing the considerable energies and creativity of the Nation in the interest of disease prevention and health promotion" as an economic imperative.
This report was developed in the spirit of Healthy People 2000. Its purpose is to investigate which "alternative" health care options might best be mobilized to help in the fight against the major diseases and conditions that are robbing so many Americans of their quality of life. The individuals who helped write it comprised members of systems of medicine and therapies that emphasize improving quality of life, disease prevention, and treatments for conditions for which conventional medicine has few, if any, answers. Therefore, the popular term alternative has been chosen to describe these medical systems and therapies. Another term for these systems and therapies, which is preferred in Europe, is complementary medicine.
This report establishes a baseline of information on alternative medicine, which may be used to direct future research and policy discussions. Specifically, this report will aid OAM in its mandate to establish an information clearinghouse on alternative medicine so that the public, policy-makers, and public health experts can make informed decisions about their health care options. The goal of OAM is to speed the discovery, development, and validation of potent treatments that may be added to the complementary wheel of alternatives currently available to patients and practitioners. Ultimately, it may provide the foundation for the development of a whole new system of medicine, one that incorporates the best of conventional and alternative medicines.
Brian M. Berman, M.D.
David B. Larson, M.D., M.P.H.
Cochairs, Editorial Review Board
1 Most of the statistics cited in this preface can be found in the publication Healthy People 2000: National Health Promotion and Disease Prevention Objectives, U.S. Department of Health and Human Services (DHHS Pub. No. PHS-91-S0212), Washington, DC, 1990. Healthy People 2000 is the latest in a series of reports that have been developed by the U.S. Public Health Service since the early 1970s dealing with issues that affect the health of the Nation.