6/28/98
     People who worry about their health flock to alternative therapies of every conceivable stripe _ and then they want their insurance to pay for it. 
     Insurance companies, being either open-minded or cynical, go along rather than lose patients to more accommodating competitors. 
     And this headlong flight from science and reason is accelerated by cash flowing from the federal government. The Office of Alternative Medicine, part of the National Institutes of Health, offers generous grants for studying unconventional medical practices, and medical schools at major universities have been only too glad to lend their prestige to the enterprise. 
     It's all very embarrassing. 
     Even the OAM sounds just a little bit embarrassed. Its Web page (http://altmed.od.nih.gov/) announces, in bold type, ``The NIH cautions users not to seek the therapies described on these pages without the consultation of a licensed health care provider.'' Inclusion of a therapy ``does not imply endorsement.'' 
     Most of the therapies are not licensed by anybody, at least not yet, but that's the ultimate goal for many practitioners because insurers are more likely to pay for treatments the states legitimize through licensure. 
     The OAM defines alternative and complementary medicine generally by what it is not: ``Those treatments and health care practices not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies.'' 
     Among the best known on OAM's long list are acupuncture, Ayurveda, bioelectromagnetics, chelation, chiropractic, homeopathy, macrobiotics, naturopathy, osteopathy, past life therapy, reflexology, shamanism, therapeutic touch, yoga and zone therapy. 
     People eat this stuff up. The journal New Age and the Naropa Institute in Boulder are offering a weekend conference in Denver July 24-27 featuring Deepak Chopra. Besides writing popular books, he runs the Chopra Center for Well Being in La Jolla, Calif., which offers ``Ayurvedic treatments a la carte'' or as part of a comprehensive program. 
     He'll be joined by self-styled psychic James Van Praagh and miscellaneous ``healers.'' If you register now for all four days, it'll cost you $549 (without lunch or college credit). 
     Conference organizers say many sessions will be sold out, and I don't doubt them for a minute, but why are people so willing to believe? 
     Barry Beyerstein has a long list of reasons. Beyerstein, an associate professor in the Brain Behavior Laboratory at Simon Fraser University in British Columbia, spoke at a conference earlier this month put on by the Rocky Mountain Skeptics in Boulder. 
     ``We all come wired,'' Beyerstein said, ``with a tendency to think that things linked in time and space are causally linked. Mistaking correlation for causation is the basis for most superstition and much support for alternative medicine.'' 
     Many diseases vary in severity, and if you finally go for treatment when you feel the absolute worst, you will get better and give the credit to whatever you tried. 
     Also, he says, people are inclined to rely more on personal experience than large-scale data. 
     ``I tried it, and it worked,'' they say, without asking ``compared to what?'' Doing nothing? Another treatment tested on a scientifically chosen comparison group? 
     People hedge their bets, Beyerstein said, adding an alternative therapy to their standard treatments. 
     The placebo effect is real enough (and medical doctors use it too). Many people are not so much sick as worried well, some have symptoms that were psychosomatic in the first place, some were misdiagnosed, and some diseases do go into spontaneous remission. 
     ``I tried itts. 
     The placebo effect is real enough (and medical doctors use it too). Maeing sick, and their feelings are responsive to psychological factors, such as suggestion and expectation, even though they're no less sick. And when they feel better, they are more likely to do things that help them get better; take their medicines, eat better, exercise more. 
     And finally, he said, people have a bias toward confirming their beliefs; they remember the hits and forget the misses. 
     So there's no lack of testimonials, but the only proof of effectiveness is a properly controlled scientific study. 
     If patients take this stuff seriously, then doctors have to. The Denver Medical Society, according to its newsletter, is presenting a series of sessions on alternative/complementary medicine. Recently they heard from a preceptor of acupuncture who teaches at the University of Colorado School of Medicine, and a homeopathic physician who practices in Denver. 
     Another speaker told the doctors that Americans spent $13 billion on 425 million visits to assorted alternative practit60 percent of HMOs plan to offer coverage for at least some such treatments. who believe it is worthless or downright dangerous. Patients, however misguided, will leave if they don't get what they want. 
     The pressure on doctors increases when insurers begin to go along, but the insurers, too, have an ethical problem. Alternative therapies are often much cheaper than high-tech medicine, and if the patient is happy with a massage and an herbal infusion instead of a CAT scan and a bone-marrow transplant, why argue? After all, even the best science-based medicine is effective statistically, not universally. 
     And down the road, then what? How will insurers decide which practices they'll cover, in the absence of scientific evidence? Will patients sue if they can't get a referral to an alternative therapy they want, or if they're pushed into one they don't want? If a hospital has half-a-dozen different practitioners on its staff, and someone comes in in a coma, who gets to treat him? 
     Scientific medicine is relatively new, and it has plenty of unanswered questions. But they're nothing compared with the questions that will go unanswered if it becomes just one among many alternatives.