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Alternative Medicine's Roadmap to Mainstream

Published online by Cambridge University Press:  24 February 2021

Kristen J. Josefek
Kristen J. Josefek*
Affiliation:
Boston College, Boston University School of Law
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Extract

Alternative medicine has been rapidly expanding as consumers drive the demand for more cost-effective, accessible and individualized healthcare. A commonly cited survey in the New England Journal of Medicine (NEJM) found that more Americans were consulting alternative care providers than allopathic/conventional physicians. In 1998, David Eisenberg published a follow up to this landmark survey, showing a marked increase in both the use of alternative care and the number of individuals seeking such care. The study revealed that 42.1% of Americans consulted at least 1 of 16 alternative therapies during 1997, an increase from 33.8% in 1990. Total visits to alternative practitioners soared from 427 million in 1990 to 629 million in 1997. This explosion of alternative care in the United States has begun to force prominent medical schools across the country to offer courses in alternative medical techniques. Over seventy-five major medical schools have begun to teach courses in alternative modalities. Moreover, the alternative care industry has established several journals to cover its expanding field.

Type
Notes and Comments
Information
American Journal of Law & Medicine , Volume 26 , Issue 2-3: The Changing Face of Law and Medicine in the New Millennium , 2000 , pp. 295 - 310
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2020

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References

1 See Andrews, Lori B., 77ie Shadow of the Healthcare System, 32 Hous. L. Rev. 1273, 1274-76 (1996)Google Scholar (stating that consumers seek alternative treatments because they provide more accessible care in keeping with the patients' personal preferences and cultural beliefs).

2 See David M. Eisenberg et al., Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use. 328 New Eng. J. Med. 246, 246 (1993). In 1990, Americans made 425 million visits to a range of 16 different alternative care providers, while only 388 million visits were made to primary care physicians. See id. Despite the demand, consumers paid $10.3 billion out-of-pocket for unconventional care. See id.

3 See Eisenberg, David M. et al.. Trends in Alternative Medicine Use in the United States. 1990-1997, 280 Jama 1569, 1575 (1998)Google Scholar.

4 See id. at 1571.

5 See id. at 1572. Herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing and homeopathic therapies increased the most during this seven year span. See id. at 1574.

6 See Michael H. Cohen, Holistic Health Care: Including Alternative and Complementary Medicine in Insurance and Regulatory Schemes, 38 Ariz. L. Rev. 83, 105 (1996). The following list is a sample of the medical schools that teach at least one course in alternative care: Albert Einstein College of Medicine, Columbia University College of Physicians and Surgeons, Harvard Medical School, John Hopkins School of Medicine, Mount Sinai School of Medicine, Penn State College of Medicine, UCLA School of Medicine and Yale School of Medicine. See id. at 105.

7 See Miriam S. Wetzel, Ph.D., et al., Courses Involving Complementary and Alternative Medicine at U.S. Medical Schools. 280 Jama 784, 785 (1998). 117 of the 125 medical schools across the country responded to a mail survey and follow-up telephone study in 1997-98. See id. Of the 117 medical schools that replied, 75 (64%) reportedly offer required or elective courses in complementary and alternative medicine. See id. “Of the 123 courses reported, 84 (68%) were stand alone electives, 38 (31%) were part of required courses, and one (1%) was part of an elective . . . Common topics included chiropractic, acupuncture, homeopathy, herbal therapies, and mind-body techniques.” Id. at 784.

8 See Andrews, supra note 1, at 1275. The author lists some of the journals established, including the following: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy: Alternative Therapies in Health and Medicine: and Alternative Health Practitioner: The Journal of Complementary and Natural Care. See id.

9 See National Institutes of Health Revitalization Act of 1993, Pub. L. No. 103-43 § 209, 107 Stat. 122, 149 (1993) “The purpose of the Office is to facilitate the evaluation of alternative medical treatment modalities, including acupuncture and Oriental Medicine, homeopathic medicine, and physical manipulation therapies.” Id. § 404E(b).

10 See id.

11 See Robin Herman, Therapies Outside the Mainstream, WASH. POST, Aug. 1, 1995 (Magazine), 10, 14; see also Samuel Benjamin et al., Exploring Other Health Care Systems, Patient Care, July 15, 1997, at 135 (listing some of the research that had been funded by the Office of Alternative Medicine (OAM) as of 1995) [hereinafter Patient Care].

12 See <http://nccam.nih.gov/nccam/an/history> (last modified Mar. 1, 2000) (citing Pub. L. No. 105-277, 1 Stat. 2681, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 1999 § 601 for the establishment of National Center for Complementary and Alternative Medicine (NCCAM)).

13 See id. at <http://nccam.nih.gov/nccam/an/general> (last modified Mar. 1, 2000). The Center's purpose is to “facilitate the evaluation of alternative medical treatment modalities” to determine their effectiveness. NCCAM also provides a public information clearinghouse and a research-training program. See id.

14 See Fiscal Year 2001 President's Budget Request for the NCCAM, 106th Cong. (2000) (statement of Stephen E. Straus, M.D., Director, NCCAM), NCCAM has funded 10 Specialty Research Centers to study complementary and alternative treatments for specific health conditions. See id. In its first year, NCCAM has funded several diverse research projects such as: a study on the positive healing effects of the Ginkgo biloba tree, clinical trials for the treatment of osteoarthritis, and a study on the effects of St. John's Wort on depression. See id.

15 Id.

16 See Andrews, supra note I, at I29I-92. The American Medical Association (AMA) has tried to quash alternative practitioners by bringing suits for the unauthorized practice of medicine and lobbying insurance companies to drop coverage of doctors who work with alternative providers. See id.; see also Wilk v. American Med. Ass'n, 719 F.2d 207, 211 (7th Cir. 1983), cert, denied, 467 U.S. 1210 (1984) (federal district court ruled that the AM A had violated the Sherman Antitrust Act when it openly conspired to eliminate chiropractic).

17 See Richard Saltus, Medical Journal Rips Alternative Remedies. Boston Globe, Sept. 17, 1998, at Al.

18 See Carol Gentry, Alternative Medicine Gets Boost. Wall ST. J., Sept. 9, 1998, at NE1, NE4. Harvard Pilgrim Health Care could be pressured to add coverage of alternative treatment as either a standard benefit or a rider that employees can buy. See id.; see also Andrews, supra note 1, at 1279 (stating that third-party payors have begun to experiment with alternative care coverage, reimbursing participants who use these therapies for the prevention of coronary disease, stress management, diet and exercise).

19 See Eisenberg et al., supra note 3, at 1573.

20 See Andrews, supra note 1, at 1274; Cohen, supra note 6, at 86.

21 See Patient Care, supra note 11, at 136.

22 See Cohen, supra note 6, at 101-03.

23 See id. at 103.

24 See Michael H. Cohen, A Fixed Star in Health Care Reform: The Emerging Paradigm of Holistic Healing. 27 Ariz. ST. L.J. 79, 87 (1995). “The medical model . . . views the body as a machine that can be analyzed in terms of its parts. Medicine reduces disease to an outside invader that preys upon a particular part of the body; treatment, accordingly, consists in attacking the invader.” Id. (emphasis added).

25 See Cohen, supra note 6, at 103.

26 See id. at 101.

27 See id. (quoting Stephen Schwartz, Holistic Health: Seeking a Link Between Medicine and Metaphysics, 266 Jama 3064 (1991)).

28 See Andrew Weil, M.D., Health and Healing 128-29 (4th ed. 1998). 2 9 N.C. Gen. Stat. § 90-143(a) (1994).

30 See Weil, supra note 28, at 132.

31 See id. at 131. Chiropractic uses manipulation to correct spinal subluxations or misaligned vertebra. See id. at 129. Most chiropractors combine manipulation, dietary advice, nutritional supplements, and ice and heat. See id. at 133.

32 See id. at 131; fee also Cohen, supra note 6, at 93 (stating that every state legislature allows for the examination and licensure of chiropractic, despite the unscientific definitions used by some states).

33 See generally Wilk v. American Medical Ass'n, 719 F.2d at 207 (1983) (Chiropractors charged defendant medical organizations with violations of the Sherman Act for engaging in activities which allegedly furthered the conspiracy of eliminating chiropractic services.).

34 See Weil, supra note 28, at 131.

35 Complaint at 125, American Chiropractic Ass'n v. Donna Shalala, Secretary of Health and Human Serv., Civ. Act. No. 98-2762 (D.D.C. filed Nov. 1, 1998).

36 See id. at H25.

37 See id. at 1147(B).

38 See Patient Care, supra note 11, at 141.

39 See Cohen, supra note 6, at 95.

40 See Patient Care, supra note 11, at 141.

41 See id.

42 See Cohen, supra note 6, at 96.

43 See Weil, supra note 28, at 149-50 (Acupuncture received front page publicity from a satisfied reporter who told America that needles really do work, setting off a public demand for this treatment).

44 See David M. Sale, Overview of Legislative Developments Concerning Alternative Health Care in The United States 1-4 (Fetzer Institute) (1994). The following states and the District of Columbia have practice acts, in some form or another, for the practice of acupuncture: Alaska, California, Colorado, Dist. of Columbia, Florida, Hawaii, Iowa, Louisiana, Maine, Maryland, Massachusetts, Montana, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington and Wisconsin. See id. at App. 2.

45 See Studdert, David M. et al., Medical Malpractice Implications of Alternative Medicine, 280 Jama 1610, 1614 (1998)Google Scholar (adding Arizona, Arkansas, Connecticut, Illinois, Minnesota, New Hampshire, Tennessee and West Virginia to the states already licensing acupuncture).

46 See id. at 1613, n.16.

47 Cohen, supra note 6, at 93 (citing a number of state statutes, including D.C. Code Ann. § 2-3309.1(b)(1994)).

48 See Sale, supra note 44, at 8.

49 See Studdert, supra note 45, at 1614. The states that have massage practice acts include: Alabama, Alaska, Connecticut, Delaware, Dist. of Columbia, Florida, Hawaii, Iowa, Louisiana, Maine, Maryland, Massachusetts, Nebraska, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia and Washington. See id.; see also Sale, supra note 44, at 8, 10 (stating that in 1994, only 20 jurisdictions recognized massage therapy and only eight had independent regulatory boards).

50 See discussion infra Part II.D and accompanying notes.

51 See Sale, supra note 44, at 12.

52 See id. Some states that regulate on a local level include: Florida, Iowa, Louisiana. Maine, New Hampshire, New Mexico, Texas, Utah and Washington.

53 See Weil, supra note 28, at 135-36.

54 See id. at 136.

55 See Weil, supra note 28, at 138; Patient Care, supra note 11, at 148. The vagueness of the definition displays the incoherence of the therapy itself and its lack of professional standing. See Weil, supra note 28, at 136.

56 See Weil, supra note 28, at 138.

57 See Patient Care, supra note 11, at 148.

58 See Weil, supra note 28, at 139.

59 See Studdert, supra note 45, at 1614. Alaska, Arizona, Connecticut, District of Columbia, Florida, Hawaii, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont and Washington have practice acts permitting the practice of naturopathy. See id.

60 See Weil, supra note 28, at 12.

61 See id. at 12-13.

62 See Patient Care, supra note 11, at 147.

63 See Cohen, supra note 6, at 95 (citing WASH. Rev. Code Ann. § 18.36a.020(9) (West 1989)).

64 See Patient Care, supra note 11, at 147.

65 See Weil, supra note 28, at 17-24.

66 See id. at 22.

67 See Studdert, supra note 45, at 1614 (citing Arizona, Connecticut, Nevada and Washington as the only four states that have licensing statutes for the practice of homeopathy).

68 See Weil, supra note 28, at 24.

69 Ala. Code § 34-24-50 (Michie 1997); Alaska Stat. § 08.64.380 (1998); Ariz. Rev. Stat. Ann. § 32-1401 (West 1992 & Supp. 1993); Ark. Code § 17-93-202 (1995); Cal. Bus. & Prof. Code § 2052 (West 1990 & Supp. 2000); Colo. Rev. Stat. § 12-36-106 (1999); Conn. Gen. Stat. Ann. § 20-9 (West Supp. 1999); Del. Code Ann. tit. 24 § 1703 (Michie 1997); Fla. Stat. Ann. § 458.305 (West 1991 & Supp. 2000); Ga. Code Ann. § 43-34-20 (1999); Haw. Rev. Stat. Ann. § 453-1 (Michie 1998); Idaho Code § 54-1803 (1994 & Supp. 1999); Ill. Ann. Stat. ch. 225, para. 60/1 (West 1998); Ind. Code Ann. § 25-22.5-1-1.1 (1998 & Supp. 1999-2000); Iowa Code Ann. § 148.1 (West 1997 & Supp. 2000); Kan. Stat. Ann. § 65-2869 (1992); Ky. Rev. Stat. Ann. § 311.550 (Baldwin 1994 & Supp. 1998); La. Rev. Stat. Ann. § 37:1262 (West 1998); Me. Rev. Stat. Ann. tit. 32 § 3270 (West 1999 & Supp. 1999-2000); Md. Code Ann. Health Occ. § 14-101 (1994 & Supp. 1999); Mass. Gen. L. ch. 112 § 6 (1998); Mich. Comp. Laws Ann. § 333.17001 (West 1992 & Supp. 2000); Minn. Stat. Ann. § 147.081 (West 1998 & Supp. 2000); Miss. Code Ann. § 73-25-33 (West 1997); Mo. Ann. Stat. § 334.010 (Vernon 1989 & Supp. 2000); Mont. Code Ann. § 37-3-102 (West 1999); Neb. Rev. Stat. § 71-1.102 (1998); Nev. Rev. Stat. § 630.020 (1999); N.H. Rev. Stat. Ann. § 329:1 (1995 & Supp. 1999); N.J. Stat. Ann. § 45:9-5.1 (West 1991 & Supp. 1999); N.M. Stat. Ann. § 61-6-6 (1999); N.Y. Educ. Law § 6521 (McKinney 1994 & Supp. 1999); N.C. Gen. Stat. § 90-18 (West 1997); N.D. Cent. Code § 43-17-01 (1999); Ohio Rev. Code Ann. § 4731.09 (Anderson 1997); Okla. Stat. Ann. tit. 59 § 492 (West 1994 & Supp. 2000); Or. Rev. Stat. § 677.085 (1997); Pa. Stat. Ann. tit. 63 § 422.10 (West 2000); R.I. Gen. Laws § 5-37-1 (1999); S.C. Code Ann. § 40-47-40 (Law Co-op. 1993 & Supp. West 1999); S.D. Codified Laws § 36-4-9 (1999); Tenn. Code Ann. § 63-6-204 (Michie 1997); Tex. Rev. Civ. Stat. Ann. art. 4510a (West 1976 & Supp. 1999); Utah Code §58-12-28 (1998); Vt. Stat. Ann. tit. 26 § 1311 (1992 & Supp. 1998); Va. Code Ann. § 54.1-2900 (Michie 1998); Wash. Rev. Code Ann. § 18.71.011 (West 1999); W. Va. Code § 30-3-4 (1998); Wis. Stat. Ann. § 448.01 (West 1998 & Supp. 1999-2000); Wyo. Stat. § 33-26-102(1999).

70 See Andrews, supra note 1, at 1299.

71 See Cohen, supra note 6, at 143; see also Carl T. Drechsler, J.D., J.U.D., Ph.D., Physicians, Surgeons, and Other Healers, 61 Am. J. Phys. & Surgeons § 36 (1981 & Supp. 1999) (listing examples of cases from numerous states, involving the unlawful practice of medicine by various alternative providers).

72 Alaska Stat. § 08.64.380(6)(A) (1998). (emphasis added).

73 See Andrews, supra note 1, at 1298-99.

74 See In re Guess, 393 S.E.2d 833, 838 (N.C. 1990) (medical doctor's license revoked by the state medical board for practicing homeopathy which was considered to be substandard care despite the fact that the patient was unharmed).

75 See Andrews, supra note 1, at 1299 (stating that at least 20 jurisdictions still use the term “condition” in their statutes, which creates “a wide umbrella category that could conceivably cover any human state”). See also Mehmet C. Oz, Book Review Essay, 20 J. Legal Med. 141, 144-45 (1999) (reviewing Michael H. Cohen, Complementary & Alternative Medicine: Legal Boundaries and Regulatory Perspectives (1998)).

Because the states can regulate all aspects of medical practice, decisions often rest on individual state medical practice acts, which generally define the practice of medicine as the diagnosing, preventing, treating, and curing of disease. This approach has a predictable bias toward biomedicine, leaving precious little room for alternative medicine, especially because states have applied the definition of medical practice quite broadly.

Id. at 144-45.

76 See Cohen, supra note 6, at 85 (noting that state medical boards have the authority to punish departures from “prevailing medical practice”). Michael Cohen notes that alternative practitioners would have to avoid diagnosing disease and limit the scope of their practice to fall within “statutorily defined conduct.” See id.; see also Andrews, supra note 1, at 1306 (noting that local medical societies frequently instigate medical suits against alternative providers even when they are statutorily authorized to provide healthcare services).

77 See Cohen, supra note 6, at 89.

78 See id.

79 See generally Cohen, supra note 6, at 97-98 (noting that legislative efforts to license alternative modalities would broaden opportunities to heal patients since alternative modalities would complement traditional medicine).

80 See generally id. (noting that since the standard of review is very high, such case decisions are rarely published).

81 See Andrews, supra note 1, at 1308 (noting that consumers are deprived of the benefits of alternative medicine when traditional physician groups control alternative providers).

82 See id. at 1311 (noting that state laws that favor traditional physicians should be revisited).

83 See generally Cohen, supra note 6, at 134 (noting that a uniform regulatory scheme would protect public health).

84 See Sale, supra note 44, at 33-37.

85 See Alaska Stat. § 08.64.326(a)(8)(A) (1998).

86 See WASH. Rev. Code Ann. § 18.130.180(4) (Supp. 1999) (stating that “[fjhe use of a nontraditional treatment by itself shall not constitute unprofessional conduct, provided that it does not result in injury to a patient or create an unreasonable risk that a patient may be harmed").

87 Id.

88 Kathleen M. Boozang, Western Medicine Opens the Door to Alternative Medicine, 24 AM. J.L. &MED. 185,211 (1998).

89 N.C. GEN. Stat. § 90-14(a)(6) (1999).

90 See generally Saltus, supra note 17 (citing a New England Journal of Medicine (NEJM) article that discredited alternative modalities, arguing that they are unsafe and inefficacious).

91 Eric Levine, A New Predicament for Physicians: The Concept of Medical Futility, the Physician's Obligation to Render Inappropriate Treatment, and the Interplay of the Medical Standard of Care, 9 J.L. & Health 69, 85 (1994).

92 See Oz, supra note 75, at 147 (predicting that “[a]n interesting paradox will soon occur, I suspect, when a physician dismisses a complementary therapy and is then sued for providing substandard medicine because his patient was not informed of all the treatment options available for the ailment involved, including unconventional ones").

93 See Eisenberg et al., supra note 3, at 1573.

94 Okla. Stat. Ann. tit. 59 § 492 (1999). 95 N.Y. Educ. Law § 6527(4)(e) (McKinney Supp. 1999); see also Cal. Bus. & Prof. Code § 2061 (West 1990 & Supp. 2000) (stating that no provision which defines the practice of medicine “shall be construed as limiting the practice of other persons licensed ... ” under this chapter).

96 610 N.Y.S.2d 334 (N.Y. App. Div. 1994), appeal dismissed, 616 N.Y.S.2d 479 (N.Y. 1994). This case involved a disciplinary action against a homeopathic care provider who was charged with practicing gross negligence, practicing with negligence on more than one occasion, and failing to maintain records. See id. at 355. The New York Supreme Court affirmed the State Board's decision and rejected the practitioner's argument that his conduct should not be judged by conventional/allopathic standards of medicine. See id. at 336.

97 See Cohen, supra note 24, at 86.

98 See Andrews, supra note 1, at 1287.

99 See Boozang, supra note 88, at 211. 100 See id. at 199-200. The author notes that allopathic medicine often denies patients any degree of control over the healthcare services they receive. Id. Alternative medicine gives the patient back that lost control since it is often the patient that seeks out the unconventional provider after determining what type of treatment he or she would like to try. Id.

101 See Boozang, supra note 88, at 205.

102 See Barry R. Furrow Et Al., Health Law: Cases, Materials and Problems 721-27 (3d ed. 1997) (republishing the Congressional Budget Office's (CBO) 1992 publication entitled Economic Implications of Rising Health Care Costs). In this article, the CBO lists several different factors that contribute to the excessive costs of medical care. One reason for this exorbitant bill is because consumers delegate enormous control to their physicians. Id. at 722. “With such power, physicians are in the position of being able to create a demand for their own services.” Id. In addition, when physicians have the incentive to earn higher incomes from providing more care, financial self interest creates a money pit filled with excessive spending. Id.

103 See Studdert et al., supra note 45, at 1612-13.

104 See id. at 1610. The authors conclude that “malpractice concerns alone should not inhibit physicians from referring patients to alternative medical practitioners. . . ." Id. l°5/rf. at 1612.

106 See id.

107 See id.

108 See id. at 1610.

109 See Saltus, supra note 17, at A16 (citing reports critical of alternative therapies that were published in the NEJM). In one case, the author discusses the case of a 15-year-old boy who had Hodgkin's disease and chose to forgo recommendations for radiation and chemotherapy treatments for a compound of herbs and dietary extracts; five months later, the boy's condition had deteriorated and he required intensive chemotherapy. Id.

110 See generally Wilk v. American Medical Ass'n, 719 F.2d at 207 (AMA sought to eliminate chiropractic by engaging in a conspiracy to restrain trade by refusing to deal with chiropractors, calling chiropractic quackery).

111 See Eisenberg et al., supra note 3, at 1575 (citing statistics that show less than 40% of all patients do not inform their primary care physician that they are visiting an alternative practitioner).

112 See id.

113 See generally Boozang, supra note 88, at 185 (discussing the debate over alternative medicine's entrance into western medicine).

114 See, e.g., MASS. Gen. Laws Ann. ch. 13 § 64 (1994).

115 See id.

116 David G. Warren, Book Review, 18 J. Legal Med. 257, 260 (1997) (reviewing Julie Stone & Joan Matthews, Complementary Medicine and the Law (1996)).

117 See Saltus, supra note 17, at A16; see also Fiscal Year 2001 President's Budget Request for the NCCAM, 106th Cong. (2000) (statement of Stephen E. Straus, M.D., Director, NCCAM (stating that NCCAM is going to focus on definitive clinical trials utilizing evidenced-based reviews in order to educate practitioners about effective alternative modalities).

118 See Warren, supra note 116, at 261.

119 Id.

120 See id.

121 See Boozang, supra note 88, at 194-95; see also Michael T. Murray, Battling the Blues with St. John's Wort, Better Nutrition, Feb. 1998, at 15.

122 See Patient Access to Responsible Care Act (Parca), H.R. 1415, 105th Cong. (1997). A companion bill was introduced in the Senate by Senator Alfonse D'Amato. See Parca, S. 644, 105th Cong. (1997).

123 H.R. 1415 § 2772 (b)(1) (emphasis added).

124 See id. § 2773 (c).

125 See discussion supra Parts III—IV and accompanying notes.

126 See H.R. 1415 § 2773 (c).

127 Federal Legislation Relating to Health Care Quality: Hearings on S. 644 and H.R. 1415 Before the Senate Labor and Human Resources Committee, 105th Cong. (1998) (statement of the American Chiropractic Association (ACA)).

128 Id.

129 See id. (noting that Congressional members who oppose PARCA during an election year dismiss public sentiment).

130 See id.

131 See id.

132 See H.R. 2635, 106th Cong. (1999); S. 1955, 106th Cong. (1999). The Access to Medical Treatment Act (AMTA) has been proposed in past congressional sessions. See AMTA, H.R. 746, 105th Cong. (1997); AMTA, S. 578, 105th Cong. (1997). However, the AMTA has yet to be enacted. In each of the years that it was introduced, it was referred to a subcommittee for review and was lost in the process. See AMTA, H.R. 4499, 103rd Cong. (1994); S. 2140, 103rd Cong. (1994).

133 H.R. 2635, 106th Cong. (1999); S. 1955, 106th Cong. (1999).

134 Access to Medical Treatment Act, 1999: Hearings on S. 1955 Before the Senate Comm. On Health, Education, Labor, and Pensions, 106th Cong. (1999) (statement of Sen. Daschle).

135 See id. The AMTA proposes one way to expand “freedom of choice for medical consumers under carefully controlled situations. . . . [Individuals] should have the option of trying an alternative treatment.... This is a choice that is rightly made by the consumer and not dictated by the federal government.” Id.

136 See id.

137 See H.R. 2635, 106th Cong. (1999); S. 1955, 106th Cong. (1999).

138 See H.R. 2635 § 4; S. 1955 § 3.

139 See Cohen, supra note 6, at 147-48.

140 See id. at 148; see also Federal Legislation Relating to Health Care Quality: Hearings on S. 644 and H.R. 1415 Before the Senate Labor and Human Resources Committee, 105th Cong. (1998) (statement of the ACA), supra note 127.

141 Cohen, supra note 6, at 148.

142 991 P.2d 77 (Wash. 2000).

143 See id.

144 See Slate Supreme Court Upholds Interpretation of Alternative Provider Law in Regulations, 9 Health Law Rep. (BNA) No. 3, at 99-100 (Jan. 20, 2000).

145 See id.

146 See id. at 100.

147 See id. at 99.

147 See id.

149 See Andrea Petersen, Home Remedies. WALL ST. J., Oct. 19, 1998, at R4. The following are a sample of internet sites available to consumers to access healthcare information online: <http://www.healthfinder.gov>; <http://www.health-futures.org>; <http://www.altemed.od.nih.gov>; <http://www.nlm.nih.gov>; <http://www.ahcpr.gov>; <http://www.docboard.org>; <http://www.cancercareinc.org>.

150 Id.

151 See Boozang, supra note 88, at 200.

152 See generally Cruzan v. Director, Missouri Dep't of Health, 497 U.S. 261 (1990).

153 See id.

154 See Petersen, supra note 149, at R4.

155 See Cohen, supra note 6, at 140-41.

156 See id.

157 See id.

158 See id.

159 See Studdert, supra note 45, at 1612.

160 See id.

161 See Boyd v. Albert Einstein Medical Center, 377 Pa. Super. 609, 618 (1988).

162 See id.

163 See id.

164 See Saltus, supra note 17, at Al (discussing how physicians in the NEJM were refusing to refer patients to alternative care providers).

165 See Furrow ET AL., supra note 102, at 722 (citing CBO article claiming that competition in the market can reduce the price of medical care).

166 See WEIL, supra note 28, at 25; see also Andrews, supra note 1, at 1288 (stating that the AMA has fought to eliminate the practices of acupuncture, homeopathy, chiropractic, midwifery and naturopathy).

167 See Andrews, supra note 1, at 1278.

168 See id. at 1279 (stating that alternative care can result in cost saving as well because these providers have lower training costs and in turn can charge less for their services).

169 M. at 1278.

170 See discussion supra Part IV.A.2 and accompanying notes.