That never happens, MacIntosh says of the quiet. It's never quiet in there. I'm not metaphysical or anything like that. But it's like I'm recharging my battery; I feel energy afterwards. If I miss a day (of acupuncture) I know it. MacIntosh, of Deering, says she thought about acupuncture in the past, but it wasn't until her doctor recommended she try it that the idea had credence. I think maybe because my doctor suggested it, that it was maybe more medically founded than I originally thought, she says.
MacIntosh is part of an increasing number of people turning to alternative medicine to treat everything from depression and migraines to stomach ailments and chronic pain. Four in 10 adults in the United States use some form of alternative health care each year, a category that includes chiropractors, acupuncture, Reiki, naturopathic medicine and massage therapy, according to the American Holistic Medical Association. The use of acupuncture and Chinese medicine increased 50 percent between 2002 and 2007-the last time the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, conducted a national study. Another study will be conducted next year.
Anecdotal evidence suggests alternative medicine is gaining a following among patients. Alternative health care clinics in NH interviewed for this story report increased patient activity, new staff members and increased hours-along with more referrals from doctors. When it comes to insurance, the news is less upbeat. Chiropractic care is now covered by most insurers. And acupuncture can be covered if people purchase a rider, says Andy Wegman, owner of Manchester Acupuncture Studio, where MacIntosh gets her treatments. Most other therapies are not covered, though treatments that include nutrition, physical therapy, craniosacral therapy (the gentle massage of bones in the skull, spine and pelvis) and weight counseling are often covered in part.
The Business of Healing
MacIntosh is part of a growing number seeking a healing touch that includes less medication. That is due in part to personal choice, but also to a landscape where-as was the case with MacIntosh-traditional and alternative health increasingly intersect.
Whole Life Health Care in Newington epitomizes that model. The 11-year-old practice offers an integrative approach to health care that includes traditional primary care services as well as a host of other practices including acupuncture, hypnotherapy, craniosacral therapy and nutrition counseling. Primary care services are provided by nurse practitioners and covered by insurance. Each specialty is an individual business, though shared administrative staff provides appointments and administrative functions, and patients' cases are discussed together at monthly clinical meetings.
Clinic founder and owner Amy Coombs, a nurse practitioner, sees this as a future model for health care. I think we are going to see this becoming more and more popular, she says. I speak with conventional physicians every day to help me with the patients I take care of. We are the center of the wheel. All the people within our building are part of the cogs and all the people outside our building are part of it too.
Coombs sees 7,000 patients a year and has seen steady growth. She added a nurse practitioner in January to meet growing demand and is exploring adding another.
In Manchester, Wegman and his staff of seven provided 15,000 acupuncture treatments last year. He is one of 107 people in NH licensed to provide acupuncture, under a licensing system that started in 1997. In acupuncture, small, solid needles are placed in the skin at certain chakra or energy points on the body. The purpose is to release energy and tension and to promote relaxation and wellbeing.
Wegman says many of his patients come in with chronic pain or arthritis. While treatments won't cure them, Wegman says, it is another way for them to manage the pain. Meanwhile, Wegman works to manage payments. Acupuncture is covered under most insurance, but only if the policyholder purchases a rider for the coverage, Wegman says.
This is one of the many reasons he says he's implemented a community care business model. Depending on the location, a one-on-one acupuncture treatment can cost $200 an hour in a large city and $50 per hour in a modest suburb. At Wegman's studio, his patients sit in recliners, together in a circle as they get their treatments. Unlike the one-on-one model, more people can be treated at a time, which keeps the cost down. He's able to charge on a sliding scale between $15 and $35 for a treatment and no one has to show proof of income or need.
As patient interest in alternative health care has grown, providers have become savvier in helping them navigate insurance. At Holistic Self Care Center in Nashua, owner Barb Tremlett advises patients on how to be reimbursed for procedures through Health Savings Accounts, which allow them to pay for services pretax, or in cases where employers fund the accounts, at no expense. For example, a patient referred to the center by a doctor for migraines could get the code the doctor used in the referral, Tremlett says, and then use that to submit the bill from the center for reimbursement. Often times, it works, at least for partial reimbursement.
Tremlett's practice is similar to Coomb's, consisting of 28 individual businesses that pay an administrative fee to cover appointments, payments, compliance and paperwork. And Tremlett sees more traditional doctors working with her, noting that her practice received six referrals from neurologists in the past six months relating to head pain-some for acupuncture and some for other natural approaches. It's a recognition doctors are seeing a value in what we do, Tremlett says.
From Sidelines to Standards
While alternative health care is increasingly recognized for having a place in the medical community, it still has a way to go to gain a true toehold next to traditional medicine. Another alternative treatment that's gaining in popularity is Reiki, the Japanese practice of no-hands or light touch massage meant to move energy throughout the body. Reiki is provided free to cancer patients at Dartmouth-Hitchcock's Norris Cotton Cancer Center in Lebanon.
Though Reiki has been around for many years at Norris Cotton Cancer Center, it really took off in 2003 when hospital officials decided to place more emphasis on patient services, says Deb Steele, manager of support services programming at Norris Cotton Cancer Center. Steele says that since its inception, the program has grown from only a handful of volunteers to 16 and plenty of patient demand to keep them busy. Between March and May of this year, the most recent numbers available, 600 people received 15- to 20-minute Reiki treatments, she says.
Joseph Carringer, president of the executive board of the New England Holistic Health Association, is glad places like Dartmouth-Hitchcock offer Reiki treatments, but he is troubled by the delivery system and the suggestion the treatment is not as valued, as the hospital does not compensate the Reiki practitioners but instead uses them on a volunteer basis.
Steele understands such concerns but says the decision was an economic one. With a limited budget they had the choice to offer the service one day a week, or to recruit volunteers, each of whom give three to four hours a week as volunteers. The hospital also maintains a list of Reiki providers in the community, which it gives to patients seeking longer treatments.
A Holistic Approach
Alternative medicine providers say the key difference between themselves and traditional providers is their holistic approach to treatment, not just specific symptoms. An initial intake appointment at the NH Natural Health Clinic with naturopathic doctor Bert Mathieson takes two hours and includes an extensive interview, physical exam and lab work.
Becoming a naturopath takes eight years, including a four-year pre-medical bachelor's degree and four years of naturopathic medical school. The difference between us and other practitioners is that from day one in medical school we are trained holistically. We try to help the body get rid of what it doesn't need and give it what it does need, Mathieson says. We learn conventional medicine. We learn everything an MD would learn.
Naturopathic methods focus on natural treatments and include nutrition, spinal manipulation, herbal medicine, acupuncture, counseling and homeopathy among other things.
One of his specialties is the treatment of Lyme disease. He says it is one of the few ailments where he does use antibiotics to treat the patient, but he uses it in conjunction with other therapies such as probiotics and detoxification therapies. So we're basically treating the body by trying to support it, as we also give anti-microbials that kill off the organisms. Where in conventional medicine they would kind of just kill off the organisms, but the body is not supported.
Mathieson, who treats thousands of patients a year, says initial visits cost $250 and follow ups are $90. He is one of 57 naturopaths licensed in NH and one of about 5,000 nationally, according to the NH Economic and Labor Market Information Bureau. To put that in perspective, there are 6,039 doctors licensed by the NH Board of Medicine.
Some of the remedies naturopaths like Mathieson prescribe include nutraceuticals-natural dietary supplements and other herbal remedies that are uniquely created for patients. Called compounding, it refers to medications created by combining different ingredients in unique measurements to meet a specific patient's need.
Bob Lolley, owner and pharmacist of Medicine World in Nashua, is a licensed pharmacist who also compounds at his pharmacy. According to the NH Board of Pharmacists, there is no comprehensive list of pharmacies that specifically compound, because all pharmacies in the state are licensed to do so, though many don't.
Lolley says he caters to people who just want to stay well and age gracefully and who don't want to take a bunch of pills. Compounding can also be used to produce a commercial medication without a dye if there is an allergy. We look at the whole person, he says of his pharmacy, which he refers to as a wellness center. There are so many people who want to get well who don't want to do it by taking the magic pill. They want to change their lives.
Natural medications there include everything from amino acids used in neurotransmitter therapies to dietary supplements. For the most part, nutraceuticals are not covered by insurance. The prices range from $6.50 to about $100 with most falling in the $20 to $30 range.
While patients support the holistic approach-Mathieson alone has doubled his number of patients and his profits from January to July-it is still not yet mainstream. Alternative medicine is their last stop-not their first. What we get a lot of these days is people who've gone everywhere and done everything and are still sick, says Mathieson, who now has 2,000 patients.
That is in large part due to the insurance issue, which Mathieson describes as a rough road to travel. Patients, he says, can get partial reimbursement if they push the issue with insurance and follow up. That, however, is far from ideal, he says.
Insurance companies may still not cover many alternative medicine practices, but doctors are increasingly recommending them, and alternative providers say that brings more patients to their doors.
Gary Sobelson, a family medicine doctor with the Concord Hospital Medical Group, says there has been growing interest among the hospital's patients to offer some forms of alternative health care and officials are responding. Some are seeking it out because of a perception that alternative health care may be less expensive than traditional health care, he says.
Sobelson, who is also a trustee and council member for the NH Medical Society, says the society has not taken a firm stance on alternative medicines, but that most practitioners are comfortable with patients using alternatives in addition to traditional health care-just not in lieu of treatment. They also encourage all patients to work closely with their doctors, he says, and more highly value the alternative practices that attempt to have some science at their core.
That said, as a doctor, he recognizes sometimes one doesn't have to know how something works, just that it does. Frankly, it isn't that much stranger to think about Reiki as it is to think about what is in the pill you just took that makes it work, he says. Truth is, there are aspects of both that we don't understand.
For now, the most frequent alternative treatments are massage, chiropractic and acupuncture, in that order, says Carringer of the New England Holistic Health Association. The ones who are the most profitable are the chiropractors. The business model of how they run their operation is definitely the most profitable and the most accepted by the insurance establishment.
Still, Carringer sees the acceptance of alternative medicine increasing. I think 15, 20 years ago, it was the person who had been diagnosed with cancer. They had gone through all their cancer treatment, the doctors told them, that's it,' and they wanted to try one more thing. And for so many of the cases, and it's really tragic, it was already too late. But (combining alternative and traditional) is what is really becoming the norm.
Associate Editor Erika Cohen contributed to this story.
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