Health Reform-White House Commission on Integrated Health Care

DRAFT Proposal for a White House Commission on Integrated Health Care: Developing A National Plan BACKGROUND Widespread and Increasing Use: The New England Journal of Medicine reported that, in 1990 alone, an estimated one in three Americans visited an alternative health care practitioner, constituting nearly 425 million visits, more than to all conventional primary care physicians. It is estimated that 85 million American adults (42% of the population) now use complementary and alternative medical (CAM) products and practices, usually in conjunction with more conventional care. Harvard University reported that the public's out-of-pocket expenses for these CAM products and services is equal to that paid out-of-pocket for physician services and is three times that paid out-of-pocket for hospital expenses. In 1990, those costs equaled more than $14 billion, of which at least $10 billion were not reimbursed to patients by medical insurances. The NIH reports that more than 50% of conventional physicians in the U.S. use or refer patients for alternative treatments, while in Europe and Australia, up to 70% of health care patients make regular use of CAM practices. The groundswell of public demand for CAM therapies has greatly fueled the interest of conventional medical practitioners, with 80% of medical students in the U.S. reporting a desire for more structured training in CAM practices. A Women's Health Issue: Increasingly, women are turning to CAM products and practices for a variety of conditions and illnesses, including breast cancer, fibroids, menstrual- related problems, endometriosis, nerve-related conditions, and pregnancy and labor management. The Journal of the American Medical Association (JAMA) recently reported that the four top treatment categories for CAM users are chiropractic (16%); lifestyle diet (8%); exercise/movement (7%), and relaxation (7%). Nearly 50% of these CAM users are women. Health issues for women are multiple and diverse; most have profound effects on both the mind and the body. Some of these impact all women, regardless of health status, simply through the process of aging. For example, over the next 16 years, each year nearly 1 million American women will turn 50. The average age for menopause is 51. Accordingly, hormone replacement therapies constitute the most prescribed drugs in America today and often are marketed as panaceas for conditions associated with aging such as osteoporosis and heart disease, in addition to the full range of menopausal complaints. Increasingly, older women are seeking out natural products and mind-body treatments as alternatives to synthetic drugs. Yet very little is known about the effectiveness of these products and practices on pre- and menopausal women. Similarly, little is known about alternative treatments for endometriosis, even though up to 20% of American women of childbearing age are diagnosed every year with this painful disease. Current treatment strategies are ineffective in eliminating the disease, which can affect 1