Prevention - Alternative Medicine Practitioners

Health Care Manager tells us that people visited primary care physicians 386 million times in 1997. Alternative care practitioners received 629 million visits.⁴ The chart shows whom we visit when we seek alternative medical care. Of a total of 159,600 alternative care practitioners at work in 1999, most were osteopaths, chiropractors, and massage therapists.

Comparing the chart to data from the U.S. Bureau of Health Professions, we learn that there has been growth in the number of osteopaths⁵ and chiropractors.⁶ The Bureau does not keep statistics on the other alternative medical practitioners shown on the chart. Government data show 12,600 osteopaths in 1980 and 37,300 in 1996. The chart shows 39,800 osteopaths in 1999, an increase over 1980 of 216%. By way of comparison, there were 701,200 MDs and 154,900 dentists in 1996.

Government data show 25,600 active chiropractors in 1980 and 47,200 active chiropractors in 1996, an increase of 84%. The chart shows 65,300 chiropractors in 1999, only three years later. This figure, from World Almanac and Book of Facts, seems high.

Practitioners of alternative therapies have long been at loggerheads with the scientific medical community. The latter is represented by the 300,000-member American Medical Association (AMA). AMA takes credit for the 20^th-century movement that "led to the acceptance of the biological, disease-oriented models that dominate medicine" and "limited the practice of medicine to graduates of accredited institutions." That acceptance caused alternative medical practices to fall out of favor. Although they are enjoying renewed interest, critics complain that practitioners fall under too little state and federal regulation. The exception is osteopaths.

Osteopathy: Osteopathic training is similar to that for an M.D., and the AMA counts osteopaths among its members. Many would argue that osteopaths do not belong in the category of "alternative" medical practitioners. The Osteopathic Association's web page⁷tells us: "D.O.s practice a "whole person" approach to medicine. Instead of just treating specific symptoms or illnesses, they assess the overall health of their patients including home and work environments. Osteopathic physicians focus on preventive health care." When your primary care physician tells you to lose weight, stop smoking, and eat better, (s)he is using osteopathic philosophy.

Chiropraxis: According to CQ Researcher, "one in 20 Americans now uses the spinal manipulations [performed by chiropractors] to remedy supposed misalignments of verte- brae.… Recent studies by the RAND Corp… and others have found that chiropractors can do more for back pain than traditional medical treatment." This alternative group has the largest number of practitioners. In 1992 the AMA reversed its longstanding opposition to chiropraxis and declared that it was ethical for doctors to refer patients to chiropractors who have "denounced unscientific methods used by many of their colleagues" (for example, promoting manipulation as a cure for disease). The AMA concedes that "manipulation has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints."

Massage therapy: Who doesn't enjoy a relaxing massage? Health Care Manager tells us that in 1997, somewhere between $4 and $6 billion was spent on massage therapy. The chart shows that massage therapists are the third largest group of alternative practitioners. The AMA approves of massage therapy when performed by a licensed practitioner.⁸ Traditional Chinese medicine and acupuncture⁹: These specialists are fourth and fifth on the chart, with 10,500 and 5,500 practitioners respectively. The AMA says "practitioners of traditional Chinese medicine use acupuncture, a host of herbal remedies, and sometimes include substances derived from sources such as the gallbladder of bears, tiger teeth and bones, and rhinoceros horn, increasing the hazards facing these endangered species."

Regarding acupuncture, U.S. News & World Report tells us: "American doctors have tolerated acupuncture practitioners in their midst since the 1930s, mostly with suspicion. According to The Academy of Chinese Culture and Health Sciences, in 1998 there were 50 schools of acupuncture in the United States, 7,000 licensed acupuncturists, hundreds of acupuncturists had been approved by HMOs and PPOs, and after 20 years of debate, the AMA has finally changed its position and accepted acupuncture as an effective medical treatment." Laws governing the administration of acupuncture vary from state to state.¹⁰ Americans made more than 5 million visits to acupuncturists in 1998.

Naturopathy: Number six on the chart with an estimated 2,200 practitioners in 1999 is naturopathy. According to the AMA: "Naturopaths practice various treatments such as manipulation and massage, and use herbs, acupuncture, and traditional Oriental medicine. Its practitioners treat underlying causes of illness by facilitating the body's response to disease through its 'life force' … Naturopaths are licensed in 11 states, but most third- party payors, including Medicare, do not cover their services." In the early 20th century there were about 20 schools of naturopathy. Today there are five North American schools of naturopathy.

Homeopathy: Last on our chart, with 1,700 practitioners, is homeopathy. Based on the theory that "like cures like," homeopathy treats patients with an extremely diluted version of what ails them. During the anthrax scare of 2001, hundreds of web sites offered homeopathic cures for anthrax. The National Center for Complementary and Alternative Medicine (see next panel) warned that it was "unaware of any scientific basis that these or other CAM therapies would be effective in protecting the public from biological or chemical weapons." According to the AMA, in order to "ferret out fraud," a few states have validated certain CAM therapies, including homeopathy.

Sources: "Alternative Medicine." World Almanac and Book of Facts, Annual 2001, p.508; National Center for Complementary and Alternative Medicine. National Institutes of Health, Nutrition Business Journal. Bureau of Health Professions, National Center for Health Workforce Information and Analysis, United States Health Workforce Personnel Factbook. Online. Available: http://bhpr.hrsa.gov/healthworkforce/. May 22, 2002. American Medical Association. "CSA Reports: Report 12 of the Council on Scientific Affairs (A-97) Full Text: Alternative Medicine." Online. Available: http://www.ama-assn.org. June 3, 2002. Jay Greene, "FSMB developing guidelines for complementary care." amednews.com, May 8, 2000. Online. Available: http://www.amaassn.org/sci-pubs/amnews/. June 10, 2002.