Considering the alternatives. (Complementary and Alternative Medicine).

Therapies variously described as alternative, complementary, or unconventional because they lie outside the realm of scientific medicine practiced by graduates of orthodox U.S. medical schools are gaining mainstream respectability despite many questions about their efficacy and safety. Depending on definitions, surveys indicate that fewer than 10 percent to nearly 40 percent of Americans supplement or substitute for conventional health care with alternative systems of medical practice. Spending for complementary and alternative medicine (CAM) nationwide has been estimated at up to $14 billion a year. Establishment of an Office of Alternative Medicine in the National Institutes of Health in 1992 has heartened advocates of CAM, increased interest and government funding for research into unorthodox therapies, and lent credibility to CAM modalities. Embracing marginal therapies may represent an opportunity for physicians and health systems to reduce inappropriate consumption, offer a wider range of choices to pat ients, and profit from a lucrative market.

Key Concepts: Alternative Medicine/Complementary and Alternative Medicine (CAM)/Unconventional, Alternative, or Complementary Therapies/Unorthodox Modalities

BY ALL OUTWARD CREDENTIALS, RICHARD SHEFF, MD, is a physician of the old school. He's an Assistant Professor of Family and Community Medicine at the prestigious Tufts University School of Medicine in Boston, a former Chairman of the research committee of the Massachusetts Academy of Family Practice, and a member of American College of Physician Executives whose resume includes senior administrative positions at a physician-hospital organization, an independent practice association, and a major hospital. Recently, he founded his own innovative disease management company.

"I approach things as a skeptic and a scientist," Sheff asserts. Yet, when the 44-year-old doctor/entrepreneur suffers back and neck pain, he seeks relief from a chiropractor. And when his children developed allergies and asthma, he readily endorsed a therapeutic regimen that included acupuncture and Chinese medicinal herbs.

Sheff, like as many as one in three of his fellow Americans, is convinced that benefits can be derived from what are variously termed "unconventional," "alternative," or 'complementary" therapies. Indeed, according to an influential and endlessly cited survey by David Eisenberg. MD. published in the New England Journal of Medicine in 1993. Americans may be more apt to take their medical problems to practitioners of healing arts not taught in traditional medical schools than they are to bona fide primary care physicians. (1)

Extrapolating from 1,500 telephone interviews, Eisenberg calculated that spinal manipulation, acupuncture, biofeedback, massage, and a dozen other non-textbook treatments accounted for 425 million visits to alternative health care providers nationwide in 1990, as against 388 million visits to primary care doctors. What's more, he reckoned, patients spent almost $14 billion for those unorthodox ministrations, fully $10 billion of it out-of-pocket.

Sheff resembles his fellow consumers of unconventional therapies in several other ways. Studies have shown that they tend to be well educated, not the opposite, and that they embrace alternative modalities not so much because they are dissatisfied with mainstream medicine as because, according to John Astin, PhD, a researcher at the Stanford University School of Medicine, they find non-traditional approaches to healing and wellness "congruent with their own values, beliefs, and [holistic] philosophical orientations toward health and life." (2)

Wallace Sampson, MD, an oncologist who has taught courses on holistic health care to Stanford medical students since 1979 and edits the quarterly journal The Scientific Review a/Alternative Medicine, takes a decidedly jaundiced view. He dismisses consumers of fringe therapies as "the disaffected" who have "abandoned rationality. They've been swept up in a mass delusion."

The establishment is fretting

And just how palpable that mass may be is open to question. Critics of Eisenberg's research charge that he significantly inflated his consumption numbers by including as "unconventional therapies" such pedestrian practices as meditating (use of "relaxation techniques" was the practice reported most often by those in his sample, 13 percent), joining a commercial weight-loss program, trying a "lifestyle" diet, or taking part In a self-help group. When alternative therapies were winnowed to a hard-core four--chiropractic, acupuncture. relaxation techniques, and therapeutic massage--only 10 percent of Americans could be considered the market, according to a recent analysis of the 1994 Robert Wood Johnson Foundation National Access to Care Survey. Still, noted L.C. Paramore, of the Project HOPE Center for Health Affairs in Bethesda, Maryland, in the February 1997 Journal of Pain Symptom Management, that's almost 25 million people. (3)

More than 400 of 1,000 men and women randomly surveyed by Astin had relied on some form of alternative health care during the past year. he reported in the May 20 issue of the Journal of the American Medical Association. They were most often seeking to alleviate such nagging and often nebulous conditions as chronic pain, anxiety, muscle strain, addiction, arthritis, or headache. (2) Interestingly, in another recent study of patients at a primary care clinic, reported in the Journal of the American Board of Family Practice in May, fewer than half of the 28 percent who had gone to alternative practitioners came away satisfied, although 82 percent acknowledged some improvement in their condition. (4)

The burgeoning market for alternatives to the ready prescription from the biotech pharmacopoeia, the syringe, the scalpel, the pocketa-pocketa-queep of the latest stainless-steel-and-silicon-chip medical machinery has not gone unremarked by the establishment for which those have become the sine qua non of practice.

"The public's expensive romance with unconventional medicine is cause for our profession to worry, editorialized Edward Campion, MD, in the New England Journal of Medicine issue in which Eisenberg disclosed his findings. (5)

The profession has been fretting ever since. Last year, physicians who read the Journal of the American Medical Association voted alternative medicine among the seven most important topics for peer-reviewed research coverage and commentary, out of 73 choices. The editors heard. Late this year, they announced the American Medical Association's influential flagship medium and its sister Archives sulispecialty journals will publish coordinated issues dedicated to the single theme of complementary and alternative medicine (often compressed to the acronym (CAM). (6)

Allopathic medicine is the alternative

Proponents of therapeutic methods and systems that had long been excluded from the canon of traditional American medical education are fond of pointing out that for most of the world's population, it is "allopathic" medicine that represents the departure from tradition.

"If you take the whole history of healing," observes holistic health care guru Leland Kaiser, "it is the alternative methodologies that were mainline. Allopathic medicine is the alternative." Even today, the World Health Organization estimates, eight out of 10 human beings on the planet resort primarily to herbal remedies to keep well and cure illness.

The very term allopathic medicine ( now meekly accepted by orthodox physicians, who prescribe and cut to kill pathogens and eradicate symptoms) was invented by practitioners of a contrary approach, homeopathy. Propounded by German physician Samuel Hahnemann, MD, in the 18th Century, before acceptance of the germ theory of disease, homeopathy is based on three counterintuitive (most doctors would say utterly unscientific) principles.

The first is that illness can be cured by dosing patients with animal, herbal, or mineral essences that would induce the symptoms of the illness in a healthy person (or "like cures like," thus the distinctions in the Greek prefixes, homeo- for "same" and allo- for "other"). The second is that a single right medicine is all that's necessary to cure the entire array of physical, mental, and emotional symptoms affecting a patient. And the third is that the potency of a therapeutic substance increases as it is diluted. A patient with a runny nose might receive from a homeopathist a pill containing a few molecules of allium cepa, or red onion; a medical doctor would be more likely to prescribe 60 milligrams of Allegra, an antihistamine.

And members of the latter profession have had to fight hard to establish the preeminence of the discipline for which they proudly bear the honorific appendage MD. By the mid-19th Century, one in seven American doctors was a homeopath. A second challenge arose in 1874, when a Missouri physician named Andrew Taylor Still, MD, gained adherents to his concept that problems in the internal organs are underlain by musculoskeletal defects. Stills system centered on enhancing the patient's physical, mental, and social well-being through "osteopathic therapy" (manual or mechanical adjustment of the spine and joints.)

The authority of homeopathy waned, but today there are more than 200 osteopathic hospitals and 16 schools that confer DO degrees in the United States. And after decades of bitter antagonism, the two disciplines have reached a rapprochement: MDs and DOs, who receive similar training in the use of drugs and surgery and are licensed in all states, now practice side by side with little differentiation except the inclination of the latter to lay on hands under certain circumstances.

Two other offshoots of conventional Western medicine enjoyed burgeoning popularity in the marketplace at the turn of the century. Chiropractic, founded by Iowan David Daniel Palmer in the 1890s, and naturopathy, a contemporaneous coinage by John Scheel, MD, a New York City physician who embraced the vitalist teachings of German hydrotherapist Sebastian Kneipp, excited the active antipathy of the American Medical Association for more than 75 years.

Chiropractors, of whom there are currently about 50,000 in the United States, claim the ability to realign bone and tissue to restore health; unlike osteopaths, however, DCs are not licensed to provide immunizations, treat infectious diseases, or perform surgery. And by 1995, according to one survey, more than 40 percent of U.S. internists said they would willingly refer a patient to a chiropractor. (7)

When the federal Agency for Health Care Policy and Research issued clinical practice guidelines for treatment of low back pain in 1994, spinal manipulation was Included as an option provided only that it be done by a "professional with experience." (8) (North Carolinians with aching backs who went to chiropractors got more satisfaction than those who saw primary care physicians, researchers reported in the October 5, 1995, issue of the New England Journal of Medicine, even though the chiropractors' care was no more effective and twice as expensive. (9)

Naturopathy emphasizes the "healing force of nature," and Is a potpourri of many alternative systems, including botanical medicine, homeopathy, acupuncture, nutrition, and Oriental medicine. At its zenith, naturopathy boasted 20 medical schools throughout the U.S. Today there are only three, and only eight states In which NDs are licensed (though they practice in virtually all).

The birth of the Office of Alternative Medicine

America's multicultural stewpot. moreover, has always bubbled with what the Office of Alternative Medicine of the National Institutes of Health designates "community-based health care practices." Into this broad category fall Native American shamanic healing and purging rituals; Latin American curanderismo, with its own distinctive classes of sickness based on humors (hot, cold, dry, or moist) and remedies; India's traditional Ayurvedic system of lifestyle interventions and natural therapies; Oriental medicine (one place where the non-politically correct adjective adheres) with Its prominent reliance on herbs, needle puncture, and site-specific pressure to correct bodily energy patterns, or qi; as well as weight-loss clinics, midwifery practices, and 12-step programs.

In 1987, Iowa Representative Berkley Bedell medicated a recurrence of prostate cancer with an offbeat drug called 714X. Promoted from Quebec by a man named Gaston Naessens, who had twice been convicted of fraudulent medical practice in France, the substance has been analyzed by Canadian health authorities and found to contain only camphor, ammonium chloride and nitrate, salt, alcohol, and water. They declared the drug worthless, if not dangerous. Nevertheless, Bedell credited 714X with restoring him to health. (He retired from Congress after six terms because of Lyme disease, which he had been self-treating with whey.)

Meanwhile, Bedell's Iowa colleague in the upper chamber, Senator Tom Harkin, who chaired the appropriations committee that oversees the budget of the NIH, had rejected standard prescription and over-the-counter drugs as useless in alleviating his "half-a-box-of-tissues-a-day" allergies. At the suggestion of a friend, he tried bee pollen tablets. They dried up his sniffles, and Harkin too became an enthusiast for unconventional therapy (although clinical literature doesn't lack for cautionary reports of anaphylactic reaction by indiscriminate consumers of bee pollen, a potent allergen).

In 1991, the two legislators teamed up to win federal funding for an Office of Alternative Medicine in the NIH. Nothing has done more to usher therapies once dismissed as quackery into the light of serious medical regard.

Charged with "facilitat[ing] the evaluation of alternative medical treatment modalities to determine their effectiveness," the CAM was given a minuscule budget of $2 million when it opened its doors in 1992. By fiscal year 1997, the budget had increased six-fold. Altogether, according to CAM director Wayne Jonas, MD, the NIH now invests some $40 million a year in CAM-related research, including support for 11 centers where studies are underway on the use of alternative methods to treat specific conditions.

Bastyr University in Seattle, for example, a naturopathic institution, is examining what its methods can accomplish in treating HIV/AIDS; the University of Maryland is looking into the analgesic effects of herbal medicines; Beth Israel Hospital/Harvard Medical School, under Eisenberg, is investigating the incorporation of CAM practices into internal medicine; and the Palmer College of Chiropractic in Davenport, Iowa, has a $500,000 grant to explore the therapeutic applications of its specialty. (For perspective, it should be noted that the entire extramural biomedical research budget of the NIH is $10.5 billion.)

But far out of proportion to its funding, the CAM can confer respectability on alternative modalities that have hovered beyond the threshold of medical acceptance.

In 1996, a consensus panel assembled by the NIH concluded that relaxation techniques, hypnosis, cognitive-behavioral techniques, and biofeedback are sometimes effective in relieving chronic pain. Last November, another CAM-sponsored consensus panel declared that "there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting, nausea of pregnancy, and postoperative dental pain." The statement recommended that acupuncture be used more widely in conventional medicine. (10)

Sampson and his colleagues on the Council for Scientific Medicine, including four Nobel prize-winners, were aghast. They maintain that the most rigorous studies of acupuncture show it to be no better than a placebo. The effects of the needles can be explained (like those of all CAM therapies that rest on concepts opaque to Western scientists and resistant to experimental method, such as qi) as a combination of "expectation, suggestion, counter-irritation, conditioning, and other psychological mechanisms," Sampson says.

When presented with evidence as equivocal as that acupuncture has going for it, Sampson notes, most unbiased scientific review panels recommend against adoption of a method rather than for it. (A recent case in point: mammography screening for breast cancer for women in their 40s, which was rejected by a consensus panel until political pressures tipped the evidentiary scale.) On the contrary, however, the consensus panel on acupuncture went so far as to urge insurance companies, federal and state health insurance programs, including Medicaid and Medicare, and other third party payers to spring for appropriate acupuncture treatments in their coverage.

It was more or less superfluous advice.

Acceptance of unorthodox modalities

"In January 1997, Oxford launched the first Alternative Medicine program in the country, crows the big Connecticut-based managed care company on its Internet Web page. The action, Oxford explains, was spurred by an internal survey in which a third of its 2 million health plan members in New York, New Jersey, Connecticut, and Pennsylvania said they had used alternative medicine in the past two years, and three-quarters wanted those kinds of treatments and services added to their current plan. Better yet, 85 percent of benefits administrators expressed similar interest.

Oxford, which has subsequently been the subject of less happy headlines on the business pages, got good ink when it established a network of acupuncturists, naturopaths, and other state-licensed unconventional practitioners. But a lot of managed care providers had already been quietly undercutting Oxford's claim to primacy.

Blue Cross of Washington and Alaska, for instance, offered Seattle members a pilot supplemental alternative health care benefit in 1994. In 1996, Northern California members of the nation's largest HMC, the Kaiser Foundation Health Plan, could opt for acupuncture, biofeedback training, hypnosis, or Chinese herbs at a physician-run alternative medicine clinic in the system's Vallejo Medical Center.

That year, the state of Washington began requiring all health insurers and managed care plans to allow subscribers to consult licensed alternative providers if they so choose. Cregon voters have passed a similar measure, and a member of its Congressional delegation, Representative Peter DeFazio, has been pushing hard since 1995 for an extension of the mandate nationally. DeFazio's "Access to Medical Treatment Act" (HR. 746, in committee) now has 70 cosponsors.

But many employers, insurers, and managed care organizations aren't waiting for the law to tell them to lengthen the therapeutic menu. So strong is the tide to inclusion of alternative therapies among benefits (almost always for a higher premium, of course) that the most authoritative assessment of HMO practices, conducted annually by Interstudy of Bloomington, Minnesota, will this year for the first time report on the prevalence of coverage for CAM modalities from acupuncture to yoga. (Chiropractic has long since become a standard treatment benefit for indemnity plan enrollees, as well as for members of at least half the nation's HMOs.)

And acceptance of unorthodox modalities is snowballing among orthodox physicians like Sheff, whose fledgling company, CommonWell, operates an "integrative medicine program" under contract to clients like the 420,000 members of a New England PPO called HealthCare VALUE Management. CommonWell offers a "Natural Connection" informational telephone line and a credentialed panel of naturopathy, homeopathy, acupuncture, massage, physical therapy, meditation, and chiropractic providers. Its major value-added function is to coax the PPO's patients to consider alternatives to expensive elective coronary artery bypass, laminectomy, and carpal tunnel release surgery.

"I've become convinced that there are opportunities for integrating the best of the best," Sheff says. "It's like the image of the blind man and the elephant. Conventional medicine has a piece of the truth, but not all of it. And the same can be said of complementary approaches. The question is how to tease out the most effective aspects of each and apply them to individual patients and populations."

That's the aim as well of the flamboyantly bearded CAM popularizer Andrew Well, MD. ("More dangerous than a radical quack," says Sampson, "because people believe in him. And he's wrong so much of the time. He's the shoe-horn onto the slippery slope.") At the University of Arizona Health Sciences Center in Tucson, Well heads a Program in Integrative Medicine designed to seed U.S. medical schools with physician-teachers grounded in the amalgamation of far-in and far-out therapies. In Brighton, Colorado, the Kaiser Institute has launched a similar nine-month fellowship program in integrative medicine for physicians and managers who want to set up centers in their own institutions.

"Our assessment is that the time is right," says Kaiser. "There's enough recognition that this is what the consumer wants, and it has some merit."

Three out of four U.S. medical schools already include alternative/ complementary medicine in the curriculum, at least as part of an elective course, according to the AMA. Programs like the Midwest Center for Health and Healing, under the aegis of the Swedish American Health System, in Rockford, Illinois, and the John S. Marten Center for Complementary Medicine and Pain Management, at St. Vincent's Hospital and Health System in Indianapolis, are popping up in the staidest of places. Often they are funded by legacies from philanthropists like Marten, Nathan Cummings, John Templeton, and John Fetzer, all of whom conceived a keen interest in the relationship between spirituality and health.

"Part of what complementary and alternative medicine offers is hope for people," suggests Wesley Wong, MD, a neurologist trained in acupuncture who heads the Indianapolis program. "There's a spiritual side to healing that I think traditional medicine has lost touch with." Nevertheless, he adds, it's important to subject CAM providers to the same rigorous standards physicians bring to the integrative table. Kaiser agrees.

Physicians are trained to evaluate evidence, to take legal and personal responsibility," Kaiser explains. "It's essential to rule out any kind of allopathic problem first, to get the true diagnostic picture. So I'm comfortable to have a medical doctor heading a center, to have regular chart review, to have case conferences where the staff looks over one another's shoulders. It gives a lot greater safety for the consumer. And it keeps people Out of basement seances."

"Physicians shouldn't feel threatened," he summarizes. "If you're committed to science, you've got to be committed to looking at various paradigms."

Besides, the plain-spoken Kaiser points out, "there's money in it. Cash. It's a whole new bankroll that can be tapped."

References

(1.) Eisenberg, D.M., et al. "Unconventional medicine In the United States. Prevalence, costs, and patterns of use." New England Journal of Medicine, 1993:328:246-52.

(2.) Astin, J.A. Why patients use alternative medicine: results of a national study." Journal of the American Medical Association, 1998 May 20:279[19]:1548-1553.

(3.) Paramore, L.C. "Use of alternative therapies: estimates from the 1994 Robert Wood Johnson Foundation National Access to Care Survey." Journal of Pain Symptom Management. 1997 Feb: 13(2):83-89.

(4.) Drivdahl. C.E., Miser. W.F. "The use of alternative health care by a family practice population." Journal of the American Board of Family Practice. 1998 May; 11(3):193-199.

(5.) Campion, E.W. "Why unconventional medicine?" New England Journal of Medicine. 1993:328:282-283.

(6.) Fontanarosa, P.B., Lundberg, G.D. "Complementary, alternative, unconventional, and integrative medicine.' Journal of the American Medical Association, 1997:278:2111-2112.

(7.) Blumberg, D.L. et al. The physician and unconventional medicine. Alternative Therapy Health Medicine, 1995 Jul: 1[3]:31-35.

(8.) Agency For Health Care Policy and Research Publication #95-0642: Dec 1994.

(9.) Carey, T.S. et al. "The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners. chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project." New England Journal of Medicine, 1995 Oct. 5:333[14]913-917.

(10.) NIH Consensus Statement, 1997 November, 3-5; 15[5] in press, Available online at http://odp.cd.nih.gov/consensus/starements/cdc/107/107_stmt.html.

RELATED ARTICLE: WHAT'S ALTERNATIVE?

"I think the term 'alternative' creates political problems," says Robert Klint, MD, CEO of Swedish American Health System in Rockford, Illinois. His organization's subsidiary Midwest Center for Health and Healing is engaged in research and provision of what he prefers to call "complementary therapies, because that seems to be how people use them."

But not all unorthodox health care practices complement one another, notes Wesley Wong. MD, Medical Director of the John 5, Marten Center for Complementary Medicine and Pain Management at St. Vincent's Hospital and Health System in Indianapolis. A patient who takes the herb St. John's Wort for depression, for instance, is in danger of suffering an adverse reaction if a psychiatrist unknowingly prescribes a standard selective serotonin uptake inhibitor like Zoloft or Prozac too. The herb gingko biloba affects platelets and increases bleeding time. Yoga can be fatal after open heart surgery

'Unconventional' is another misleading term, observes Jonathan Lin, MD, of Columbia University's College of Physicians and Surgeons. "While most allopathic physicians may not recommend the use of energy healing to their ill patients" he says, "they might recommend other practices such as the use of vitamins." Indeed, if allowing a patient go to a weight loss clinic, pray, exercise, or pop a few vitamins is considered the practice of alternative medicine, says CAM critic Wallace Sampson, MD, "count me in."

And alternatives are, in fact, the stock in trade of orthodox physicians, stresses William London, Director of Public Health at the American Council on Science and Health in New York. The rub is that not all alternatives are created equal

A patient with an enlarged prostate, for example, may be counseled on several options, each with advantages and disadvantages: surgery, drug treatment, or watchful waiting. Each of these alternatives has been proved viable by carefully randomized, controlled, double-blind clinical trials. Their benefits, when selected appropriately, have been shown scientifically to outweigh their potential for harm.

A second type of alternative, says London, rests on less solid ground. This is the type of treatment that is still in the experimental stage but is based on a strong, scientifically plausible rationale. A physician, says London, may legitimately provide such an alternative to a patient. but only with the latter's informed consent. The therapy should never be aggressively marketed, he argues; in fact, even charging patients for it is problematic.

Finally, there are alternatives that fail to pass medical muster because they lack for convincing evidence of safety and effectiveness, and their proposed mechanisms are so incongruous according to prevailing standards of scientific merit that research funding cannot be justified. Depending on how these alternatives are marketed, says London, they may be considered "questionable, dubious, or fraudulent."

The Office of Alternative Medicine (CAM) of the National Institutes of Health has developed a classification scheme that groups unconventional therapies into several broad categories. This list, the agency notes, is neither complete nor authoritative (nor, of course, should it be construed as implying endorsement by the government).

OAM CLASSIFICATION SCHEME

"The NIH cautions users not to seek the therapies described... without the consultation of a licensed health care provider," a disclaimer adds.

1. Alternative systems of medical practice

* Acupuncture

* Anthroposophically extended medicine

* Ayurveda

* Community-based health care practices

* Environmental medicine

* Homeopathic medicine

* Latin American rural practices

* Native American practices

* Natural products

* Naturopathic medicine

* Past life therapy

* Shamanism 

* Tibetan medicine

* Traditional Oriental medicine

2. Bioelectromagnetic applications

* Blue light treatment and artificial lighting

* Electroacupuncture

* Electromagnetic fields

* Electrostimulation and neuromagnetic stimulation

* Devices

* Magnetoresonance spectroscopy

3. Diet, nutrition, and lifestyle changes

* Changes in lifestyle

* Diet

* Gerson therapy

* Macrobiotics 

* Megavitamins

* Nutritional supplements

4. Herbal medicine

* Echinacea (purple coneflower)

* Ginger rhizome 

* Ginkgo biloba extract

* Ginseng root

* Wild chrysanthemum flower

* Witch hazel

* Yellowdock

5. Manual healing

* Acupressure 

* Alexander technique

* Biofield therapeutics

* Chiropractic medicine

* Feldenkrais method

* Massage therapy

* Osteopathy 

* Reflexology

* Rolfing

* Therapeutic touch

* Trager method

* Zone therapy

6. Mind/body control

* Art therapy

* Biofeedback

* Counseling

* Dance therapy

* Guided imagery

* Humor therapy

* Hypnotherapy 

* Meditation

* Music therapy

* Prayer therapy

* Psychotherapy

* Relaxation techniques

* Support groups

* Yoga

7. Pharmacological and biological treatments

* Anti-oxidizing agents

* Cell treatment

* Chelation therapy

* Metabolic therapy

* Oxidizing agents (ozone, hydrogen peroxide)

Alternative Resources

What follows is a compilation of Websites, journals, Office of Alternative Medicine research centers, and some high-visibility programs devoted to issues related to complementary and alternative medicine (CAM).

Websites

Acupuncture.com

http://www.acupuncture.com

Alternative Medicine Homepage

(A compilation of Internet resource links maintained by librarian Charles Wessell at the Falk Library of the Health Sciences, University of Pittsburgh)

http://www.pitt.edu/-cbw/altm.html

American Association of Naturopathic Physicians 

http://www.naturopathic.org

American Botanical Council 

http://www.herbalgram.org

American Chiropractic Association 

http://www.amerchiro.org

American Council on Science and Health

http://www.acsh.org

American Holistic Health Association

(Board includes Deepak Chopra, MD, and Bernie Segal, MD)

http://www.ahha.org

American Holistic Medical Association

http://www.ahmaholistic.com

American Naturopathic Medical Association

(This organization and the American Association of Naturopathic Physicians are at bitterly litigious loggerheads).

http://www.anma.com

American Osteopathic Association 

http://www.am-osteo-assn.org

Healthcare Reality Check

http:/www.hcrc.org

Herb Research Foundation

http://www.herbs.org

National Council Against Health Fraud 

http://www.ncahf.org

North American Society of Homeopaths

http://www.homeopathy.org

Office of Alternative Medicine National Institutes of Health

http://altmed.od.nih.gov

Quackwatch

http://www.quackwatch.com

The Fetzer Institute

http://www.fetzer.org

The John Templeton Foundation 

http://www.templeton.org

The Nathan Cummings Foundation 

http://www.ncf.org

Journals and newsletters

Alternative Therapies in Health and Medicine

800/345-8112

Complementary and Alternative Medicine at the NIH

(the DAM's quarterly newsletter). 888/644-6226

http://altmed.od.nih.gov/oam/clearinghouse/

Scientific Review of Alternative Medicine

800/427-0351

http:/www.hcrc.org/sram

Alternative medicine journals currently in MEDLINE 

http://altmed.od.nih.gov/oam/what-iscam/medline.shtml#journals

* Acupuncture and Electra-Therapeutics

* Research Alternative Therapies in Health and Medicine

* American Journal of Chinese

* Medicine Biofeedback and Self Regulation

* Chen Tzu Yen Chui (Acupuncture Research)

* Chinese Medical journalChung-Hua I Hsueh Tsa

* Chih (Chinese Medical Journal) Chung-Kuo

* Chung Hsi I Chieh Ho Tsa ChihChung-Kuo

* Chung Yao Tsa Chih (China Journal of Chinese Materia Medica)

* Journal of Manipulative and Physiological Therapeutics

* Journal of Natural ProductsJournal of Traditional Chinese Medicine 

* Planta Medica 

Office of Alternative Medicine research centers

Bastyr University, Focus: HIV and AIDS, Principal Investigator: Leanna 1, Standish, ND, PhD

Beth Israel Hospital, Harvard Medical School, Focus: Internal Medicine, Principal Investigator: David M. Eisenberg, MD

Columbia University College of Physicians and Surgeons. Focus: Women's Health, Principal Investigator: Fredi Kronenberg, PhD

Kessler Institute for Rehabilitation. Focus: Stroke and Neurorehabilitation, Principal Investigator: Samuel C. Shiflett. PhD

Minneapolis Medical Research Center, Focus: Addictions, Principal Investigator: Thomas J. Kiresuk. PhD

Palmer College of Chiropractic, Focus: Chiropractic, Principal Investigator: William Meeker, DC, MPH

Stanford University, Focus: Aging, Principal Investigator: William L. Haskell, PhD

University of California, Davis, Focus: Asthma and Allergy, Principal Investigator: M. Eric Gershwin, MD

University of Maryland School of Medicine, Focus: Pain, Principal Investigator: Brian M, Berman, MD

University of Texas Health Science Center, Focus: Cancer, Principal Investigator: Guy S. Parcel, PhD

University of Virginia School of Nursing, University of Maryland School of Medicine, Focus: Pain, Principal Investigator: Ann Gill Taylor, RN, EdD, FAAN 

High-visibility programs

CommonWell, Brookline, Massachusetts

617/566-WELL

John S. Marten Center for Complementary Medicine and Pain Management, St. Vincent's Hospital and Health System, Indianapolis, Indiana

317/338-6650

Midwest Center for Health and Healing, Swedish American Health System, Rockford, Illinois

815/391-7118

Mind/Body Medical Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts

617/632-9525

Memorial Hospital Southwest, Houston, Texas

713/776-5020

Morristown Memorial Hospital, Morristown, New Jersey 

201/971-4575

Riverside Methodist Hospital, Columbus, Ohio

614/566-4050

Baptist Hospital, Nashville, Tennessee

800/826-9998

St. Peter's Medical Center, New Brunswick, New Jersey 

908/937-6051

St. Joseph's Medical Center, South Bend, Indiana 

888/237-7360

http://www.med.harvard.edu/programs/mindbody

Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California 

415/502-0285

Program in Integrative Medicine, University of Arizona College of Medicine, Tucson, Arizona

520/626-6102

http.//www.ahsc.arizona.edu/integrative_medicine

The Kaiser Institute, Kaiser & Associates, Brighton, Colorado

303/659-8814

David O. Weber is a prolific journalist based in Berkeley California. He regularly contributes to publications such as The Healthcare Forum Journal and The Healthcare Strategist. He can be reached by calling 5i0/845-3385 or via email at [e-mail].