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Complementary & Alternative Medicine (CAM)

There are several advantages of Complementary and Alternative Medicine, (CAM) especially when combined with Western medical treatment. When you choose to add alternative treatments to a Western treatment plan for a specific health situation, the process is referred to as complementary alternative medicine because the alternative treatments are working in conjunction with the primary health care plan, and the treatments complement each other. It's important to communicate with all health care providers to make sure the treatments work together, but as long as proper communication is established, you may benefit greatly from combining treatments.

The following list provides several reasons to add complementary alternative medical treatments to your primary health care.

Integrative Medicine

Any therapy that is typically excluded by conventional medicine, and that patients use instead of conventional medicine, is known as "alternative medicine." It's a catch-all term that includes hundreds of old and new practices ranging from  acupuncture to homeopathy to iridology. Generally alternative therapies are closer to nature, cheaper and less invasive than conventional therapies, although there are exceptions. Some alternative therapies are scientifically validated, some are not. An alternative medicine practice that is used in conjunction with a conventional one is known as a "complementary" medicine. Example: using ginger syrup to prevent nausea during chemotherapy. Together, complementary and alternative medicines are often referred to by the acronym CAM.

Enter integrative medicine. As defined by the National Center for Complementary and Alternative Medicine at the National Institutes of Health, integrative medicine "combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness."

In other words, integrative medicine "cherry picks" the very best, scientifically validated therapies from both conventional and CAM systems. In his New York Times review of Dr. Weil's latest book, "Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being," Abraham Verghese, M.D., summed up this orientation well, stating that Dr. Weil, "doesn't seem wedded to a particular dogma, Western or Eastern, only to the get-the-patient-better philosophy."

Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.

The principles of integrative medicine:

• A partnership between patient and practitioner in the healing process
• Appropriate use of conventional and alternative methods to facilitate the body's innate healing response
• Consideration of all factors that influence health, wellness and disease, including mind, spirit and community as well as body
• A philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically
• Recognition that good medicine should be based in good science, be inquiry driven, and be open to new paradigms
• Use of natural, effective, less-invasive interventions whenever possible
• Use of the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease
• Training of practitioners to be models of health and healing, committed to the process of self-exploration and self-development

Some Alternative Treatments are Holistic in Nature
Many alternative medical practices are more holistic - meaning all-encompassing - than Western medical treatments. While Western doctors do place some emphasis on preventative medicine, alternative treatments such as Ayurveda and traditional Chinese medicine are much more encompassing, examining your emotional, spiritual and physical health. The health advice you may get from these alternative doctors may reveal some interconnected aspect of your health that was overlooked by a Western doctor.

Many Alternative Treatments Have Been Proven Over Centuries
Several of the more popular alternative treatments-Ayurveda, traditional Chinese medicine, acupuncture-have been in practice for thousands of years. The wisdom of these lengthy practices should not be ignored, since these treatments have proven themselves over time.

Medicine is Not an Exact Science
While we'd all like to believe doctors know the answers to everything, the truth is that science is always changing. Studies may point us in the right direction, but nothing is proven to work all the time for everyone. Alternative treatments may not be considered conventional now, but the very practices that sound a little crazy today may be widely accepted in a decade. While you will want to proceed with caution when trying alternative treatments, you just may be one of the first to experience success with a new treatment that will later become standard.

Complementary Alternative Medicine Often Uses Natural Methods
Most complementary alternative medicine is based off natural methods of restoring health. Many people find the idea of using natural products and stimuli appealing and intuitive, since the idea that the earth provided everything we need to remain healthy is an appealing philosophy. Naturopaths use herbal remedies, massage therapists use therapeutic touch to heal, and yogi use breathing patterns, body poses, and meditation to bring comfort and relief to people. All of these natural remedies can supplement a Western care plan without clashing.

Alternative Treatments Can Reduce the Number of Prescription Drugs You Need
Tired of taking diabetic medications because you don't like the side effects or they don't work? Don't want to manage your pain with drugs? Many alternative treatments offer relief without drugs. Yoga, meditation and lifestyle changes such as dietary changes and exercise can relieve mild depression or pain without the need for drugs. You may want to work together with your Western doctor to see if you can use alternative treatments in place of some of the drugs you have been prescribed.

Because of the increasing popularity of complementary and alternative medicine — nearly 40 percent of U.S. adults report using it — doctors are learning more about these non-conventional approaches. When doctors use the term "alternative medicine," they're referring to practices not typically used in conventional Western medicine. Exactly what's considered alternative medicine changes constantly as more treatments undergo study and move into the mainstream. When an alternative medicine therapy is used in addition to — not instead of — conventional therapy, it's called complementary. And when you use a complementary therapy in addition to a conventional one, it's called integrative medicine.

Examples of Complementary Alternative Medicine

To make sense of the many therapies available, it helps to look at how they are classified by the National Center for Complementary and Alternative Medicine (NCCAM), the lead agency that funds for scientific research on CAM in the United States. The NCCAM categories are:

• Whole medical systems
• Mind-body medicine
• Biologically based practices
• Manipulative and body-based practices
• Energy medicine

Keep in mind, however, that the distinctions between therapies aren't always clear-cut, and some systems use techniques from more than one category.

Whole medical systems
A system isn't just a single practice or remedy — such as massage — but many practices that center on a philosophy, such as the power of nature or the presence of energy in your body. Examples of whole medical systems include:

• Ancient healing systems. These healing systems arose long before conventional Western medicine and include ayurveda from India and traditional Chinese medicine.
• Homeopathy. This approach uses minute doses of a substance that causes symptoms to stimulate the body's self-healing response.
• Naturopathy. This approach focuses on noninvasive treatments to help your body do its own healing and uses a variety of practices, such as massage, acupuncture, herbal remedies, exercise and lifestyle counseling.

Mind-body medicine
Mind-body techniques strengthen the communication between your mind and your body. Complementary and alternative medicine practitioners say these two systems must be in harmony for you to stay healthy. Examples of mind-body connection techniques include meditation, prayer, and relaxation and art therapies.

Biologically based practices
Examples include dietary supplements and herbal remedies. These treatments use ingredients found in nature. Examples of herbs include ginseng, ginkgo and echinacea, while examples of other dietary supplements include selenium, glucosamine sulfate and SAMe. Herbs and supplements can be taken as teas, oils, syrups, powders, tablets or capsules.

Manipulation and body-based practices
These methods use human touch to move or manipulate a specific part of your body. They include chiropractic and osteopathic manipulation and massage.

Energy medicine
Some complementary and alternative medicine practitioners believe an invisible energy force flows through your body, and when this energy flow is blocked or unbalanced you can become sick. Different traditions call this energy by different names, such as chi, prana and life force. The goal of these therapies is to unblock or re-balance your energy force. Energy therapies include qi gong, therapeutic touch, reiki and magnet therapy.

Why are some doctors hesitant about complementary and alternative medicine?

Many conventional doctors practicing today did not receive training in CAM therapies, so they may not feel comfortable making recommendations or addressing questions in this area. However, as the evidence for certain therapies increases, doctors are increasingly open to complementary and alternative medicine.

At the same time, conventional doctors also have good reason to be cautious when it comes to complementary and alternative medicine. Conventional medicine values therapies that have been demonstrated through research and testing to be safe and effective. While scientific evidence exists for some CAM therapies, for many there are key questions that are yet to be answered. In addition, some practitioners of complementary and alternative medicine make exaggerated claims about curing diseases, and some ask you to forgo treatment from your conventional doctor. For these reasons, many doctors are conservative about recommending CAM therapies.

Lack of evidence about complementary and alternative treatments

One reason for the lack of research in complementary and alternative treatments is that large, carefully controlled medical studies are costly. Trials for conventional medications or procedures are often directly or indirectly funded by the government or drug companies, giving conventional treatments more resources to do studies. CAM trials are more difficult to fund, since pharmaceutical companies don't want the competition, and, so there are fewer trials. Nonetheless, a number of studies are under way on CAM treatments ranging from herbs to yoga. The National Center for Complementary and Alternative Medicine is the lead U.S. agency that supports research into complementary and alternative treatments, and it makes research findings available on its Web site.

Risks and Benefits of CAM

Work with your conventional medical doctor to help you make informed decisions regarding complementary and alternative treatments. Even if your doctor can't recommend a specific complementary and alternative treatment, he or she can help you understand possible risks and benefits before you try a treatment.

Though some of these treatments can be helpful, many have side effects and can cause problems with certain medications or health conditions. A final piece of advice: Don't forget to tell your primary care doctor if you're using any alternative therapies. And don't stop or change your conventional treatment — such as your prescription medications — without talking to your doctor first. 

Benefits of Alternative Medicine

Alternative medicine refers to therapeutic practices that are based on natural and traditional methods. The treatment methods are totally different from the allopathic medical practice. In contrast to the conventional medical techniques that only treat diseases, alternative medicine emphasizes in improving the quality of life; be it treatment of diseases or promoting well-being of the individual. Alternative medicine is the form of treatment for practicing holistic health. A holistic health practitioner has a thorough knowledge about the body, mind and spirit of the human system.

In general, the term complementary and alternative medicine (CAM) is used to cover all the practices, other than the standard medical care techniques (or conventional methods). However, the terms complementary and alternative can be used to determine the purpose of following the therapies. If alternative medicine therapies are used in addition to the conventional treatment methods, then they are referred to as complementary. Therapies are called alternative, in case they are used instead of the conventional methods.

Types of  of Alternative Medicine and Their Benefits

Alternative medicine has been used for treatment of many diseases, since the olden days. Alternative medicine encompasses many disciplines such as homeopathy, herbal medicine, acupuncture, naturopathy, nutrition, massage therapy, physical therapy, chiropractic and traditional Chinese medicine (TCM). Though many of these therapies have gained interests worldwide, there are some like humor and radium therapy that are no longer in use. Following are some of the benefits of alternative medicine.

Acupuncture is the method which involves the insertion of needles into different parts of the body and can be used to activate the discharge of natural chemical painkillers. Again, this might be useful for diabetes patients suffering with often painful nerve damage. Acupuncture has proven to help reduce pain in the joints. Acupuncture can also used to treat mental illnesses. The advantage of acupuncture is that it can be conducted in people who have a low immune system. Health problems treated by acupuncture technique include fatigue, stress, headache, tennis elbow and osteoarthritis.

Allopathic treatment: Traditional treatment of diabetes begins with a well balanced diet and moderate exercise. Medications are prescribed only if the patient's blood glucose cannot be controlled by these methods.

Aromatherapy refers to the use of plant essence for treatment of diseases. In recent times, aromatherapy has become a part of massage therapy. Essential oils added to a carrier oil base are used for massaging the body. The skin absorbs the plant essence easily (due to their molecular structure), which then stimulates the circulatory system, lymph flow and helps in natural detoxification process.

Ayurveda is a very ancient form in the East. They also cater to the natural elements and the natural vegetation. They are similar to naturopathy, but the internal constituents are little different. They function on the various seasons and the body type of a person. They involve additional techniques like Aurvedic massages, facials etc along with an Ayurvedic diet.

Biofeedback: Many studies have been performed to test the benefit of adding biofeedback to the diabetic's treatment plan. Relaxation techniques, such as visualization, usually were included. Biofeedback can have significant effects on diabetes including improved glucose tolerance and decreased blood glucose levels. In addition, biofeedback can be used to treat diabetic complications and improve quality of life.

Chiropractic is a popular technique for treatment of ailments related to muscle, bone and joints (neuro-musculoskeletal system). The basic principle behind chiropractic is that the body system has the ability to heal by itself. It gives more emphasis in treatment of spine problems, as spine is the primary center for many health related problems.

Guided Imagery helps relaxing the mind and body and develops consciousness of, and an ability to deal with, the body's reaction to pain using peaceful images. This can be predominantly helpful for diabetes suffering with nerve damage.

Herbal medicines (use of herbs) are used for treatment of varied health problems like insomnia, diabetes, bad breath, respiratory disease, heart disease, circulatory problem, skin and allergy problems. Some known herbs like aloe vera and garlic can be used for detoxification process. Various herbs are also identified that help to lose weight naturally.

Holistic Medicine is an alternative medicine approach to treatment and natural healing of the 'whole being' (body, spirit and mind), considering mental well-being is as important as physical and that they are closely interconnected. Holistic health care focuses on natural health, mind, emotional dimensions, mental aspects and spiritual awareness along with nutritional, environmental and lifestyle factors.

Homeopathy is a form of alternative medicine system based on the theory that certain diseases can be treated with minute doses of a natural substance that can produce symptoms similar to those of the illness; effectively stimulating the body's own defenses against the illness resulting in a healthier balance of internal chemistry.  Here individuals are presented with various forms of liquid medications in a diluted form that seems to be similar to their problems. It also involves using of various sugar pills with various medicative liquids. This form of healing also involves a complete mind body spirit healing. Everything is treated holistically.

Nutrition therapy has proven to be very effective for nutrient-deficient diseases such as diabetes, heart disease, and chronic fatigue. In many ways, Type 2 diabetes is one of the easiest diseases for people in alternative medicine to "prove" that it works -- because of blood glucose testing and monitoring technology, which allows the patient to measure and verify that his blood glucose is returning to the normal range.

Massage therapy helps in instant relaxing and recuperating from fatigue and tiredness.

Naturopathy refers to nature cure. The plants, herbs, flowers  and vegetables are used in combination with the nature’s laws and elements for a self purification process. It comes from a philosophy that states that if one part of the body is affected the entire system will be affected. Hence the cure also needs to be holistic and separate for any particular body part.

Tibetan medicine is yet another eastern way of healing. This works on assessing the body nerves and the vibration a person is giving out. Depending on the same, several herbs, flowers, metallic powders etc that would compliment to restore the original configuration is suggested.

Traditional Chinese Medicine (TCM) refers to an array of traditional medical practices developed in China. Herbal medicine, dietary therapy, acupuncture and so on is included in TCM. Non-insulin dependent diabetics who practiced daily qigong for one year had decreases in fasting blood glucose and blood insulin levels.

Yoga therapy: Studies of diabetics have shown that practicing yoga leads to decreases in blood glucose, increased glucose tolerance, decreased need for diabetes medications, and improved insulin processes. Yoga also enhances the sense of well-being.

Meditation and Acupressure are some of the other widely used types of alternative medicine.

The benefits of the above therapies are very clear. They all work to restore the human mind body spirit combination. They all function on the energy system called the ‘chakra’ system and the meridians. There are various practices given to restore the configuration of a particular ‘chakra’.

Another popular medicine is the laughter therapy and hypnosis. They are meant to restore the emotional well-being, which in turn keeps you healthy and fit physically as well as spiritually.There are many options for an alternative medicine. It is advised that all the practices be done under supervision and from a certified practitioner.

In addition to these benefits, alternative medicine does not have side effects, provided the therapies are conducted properly by a licensed practitioner. Alternative medicine is more cost-effective as compared to medical treatments. Since the therapeutic practices of alternative medicine often lack biomedical proof, a number of researches are ongoing to study the effects of alternative medicine on the human body. 

Complementary and Alternative Medicine for Diabetes

The National Center for Complementary and Alternative Medicine (NCCAM) defines complementary and alternative medicine (CAM) as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine" (NCCAM, 2002). Three key terms in the CAM literature need clarification. The term complementary implies that these types of therapies are used in conjunction with conventional medicine, whereas the term alternative implies that the therapy is used in lieu of conventional medicine. Integrative medicine, on the other hand, is a combination of mainstream medical treatment and CAM therapies that are offered to patients.

History of CAM in the United States

Data suggest that an increasing number of people in the United States use one or more CAM remedies, and these remedies appear to be used most frequently to treat chronic medical conditions (Eisenberg et al., 1993). Although CAM therapies appear to be used predominantly as complements to conventional treatments, people who use both CAM and conventional treatments tend to have significantly more outpatient physician visits (Druss and Rosenheck, 1999). The costs associated with CAM use in the United States increased by approximately 45% between 1990 and 1997 (Eisenberg et al., 1998). Approximately $21.2 billion was spent on CAM in 1997, of which $12.2 billion was attributed to out-of-pocket expenses. Certain types of patients appear more likely to use CAM remedies: whites, more educated individuals (higher than high school education) and people living in the western United States (McFarland et al., 2002).

CAM for the Treatment of Diabetes

A tremendous number of CAM treatments are recommended for diabetes, and most of these agents are touted as having hypoglycemic effects. For instance, chromium picolinate (Fox and Sabovic, 1998), stress management with biofeedback (McGrady et al., 1991) and relaxation training (Lane et al., 1993), acupuncture (Chen, 1987; Chen et al., 1994), and traditional Chinese remedies (Zhang and Teng, 1986) have been reported to possibly be of benefit to people with diabetes. 

A major concern is that people with diabetes may use these CAM agents in place of clinically proven conventional diabetes treatments. Another concern is the potential for drug interactions when these agents are used as complements to conventional treatments. Finally, there is concern that some of these agents may worsen glycemic control or even create additional complications for people with diabetes.

Leg ulcers have been reported with the use of the traditional Chinese remedy of moxibustion (Ewins et al., 1993), and lead poisoning has been reported due to traditional Indian remedies for diabetes (Keen et al., 1994). Other therapeutic approaches such as prayer, faith healing, unusual diets, and supplements of vitamins and trace elements have resulted in life-threatening ketoacidosis (Gill et al., 1994). Additionally, a review of a host of natural products concluded that claims about their hypoglycemic effects lacked scientific merit and that they could be harmful if used in place of conventional diabetes treatments (Gori and Campbell, 1998). As a result of these concerns, the American Diabetes Association (ADA) continues to caution people with diabetes about using unproven treatments in its annual clinical practice recommendations (ADA, 2003).

Unfortunately, the diabetic drugs recommended by traditional medicine are not working ...

The ADA defines a safe and efficacious therapeutic modality as one approved by the U.S. Food and Drug Administration, but the FDA is funded by the pharmaceutical companies! In fact, some of the people in the FDA come from the pharmaceutical companies! 

Some recent research indicates that some CAM agents may have promise as therapeutic adjuncts in the treatment of diabetes, especially raw food therapy and wholefood supplements.

Biofeedback is effective for stress reduction (Lane et al., 1993; McGrady et al., 1991), and acupuncture delivered by experienced practitioners is effective for controlling the chronic pain of peripheral neuropathy associated with diabetes (Abuaisha et al., 1998). Chromium (Althuis et al., 2002), vanadium (Evans and Krentz, 1999; Goldfine et al., 2000) and magnesium (Kao et al., 1999; Lima Mde et al., 1998) are promising agents when used with a superior nutrition program.

Meditation; prayer; massage therapy; yoga; and art, music and dance therapies may benefit some individuals with diabetes (Andrews, 2002; Rice, 2001) as long as they are used in conjunction with conventional treatments.

However, additional evidence from large, well-designed clinical trials on their efficacy are needed before they can be recommended for use in routine clinical practice.

CAM Use in Individuals With Diabetes

Only two nationally representative surveys have examined the patterns of CAM use in people with diabetes. The estimates of CAM use ranged from 8% in one study (Egede et al., 2002) to 57% in the other study (Yeh et al., 2002). Clearly, these estimates are broad and likely reflect the manner in which CAM was defined and whether or not the definition of CAM use was associated with a provider visit. When CAM use was linked to a CAM provider visit, only 8% of people with diabetes reported using some form of CAM (Egede et al., 2002), whereas 35% to 57% reported CAM use when it was not linked to a CAM provider visit (Yeh et al., 2002).

Of the reported CAM therapies used among individuals with diabetes, nutritional advice from a non-health care provider was the most frequently used. Among those who reported using CAM for diabetes, the therapies were used to complement conventional diabetes treatments rather than to replace them, and most users informed their physicians about CAM use. The clergy and spiritualists were the most frequently visited CAM providers. On average, CAM users with diabetes made nine visits per year to CAM providers and spent over $400 per year on CAM remedies.

Factors Associated With CAM Use for Diabetes

Among people with diabetes, the factors that predicted CAM use were similar to predictive factors for the general population. Older individuals (greater than or equal to 65 years) and more educated people (more than high school education) seemed more likely to visit CAM providers and use CAM remedies than other individuals with diabetes (Egede et al., 2002). It is unclear why there is a higher likelihood of CAM use in these groups of patients. It may be that older age and higher educational attainment are surrogates for higher earning power, which is needed to pay for the out-of-pocket expenses associated with CAM use.

Approaches to CAM Use in Clinical Practice

Based on evidence suggesting high use of CAM by people with chronic medical conditions, it is clear that physicians will increasingly be inundated with requests for advice on CAM use, referral to CAM providers and questions about combining CAM treatments with conventional diabetes treatments. It will be important for physicians and other health care providers to realize that individuals with diabetes mostly use CAM as a complement to conventional treatment. As a result, health care providers should acquaint themselves with common CAM treatments for diabetes, their mechanisms of action and their likely side effects.

It is also essential that health care providers adopt an open and non-judgmental approach to these discussions. Patients should be routinely asked about the use of CAM, and they should be given ample opportunity to discuss why they use CAM remedies, how often they use them and their beliefs about the role of CAM in diabetes management. In addition, patients should be encouraged to read reliable information on CAM treatments such as those available from the NCCAM Web site at <www.nccam.nih.gov>.

Such candid discussions in many cases may prompt patients to discontinue unproven therapies. However, there needs to be willingness on the part of the health care provider to respect and concede to the wishes of the patient if there are no apparent adverse effects of the specific CAM remedy. For instance, it may be appropriate for a health care provider to compromise on the use of meditation, prayer, yoga, dance or music therapies, which have no overt adverse effects, and discourage the use of unproven herbal medicines. In general, discussions about CAM use should be guided by mutual trust and candor.

Key Point: Don't assume that just because a healthcare professional is involved in alternative medicine that they can help you with your diabetes! Most of the following alternative healthcare professionals are ill-equipped to help you with your diabetes: dietitians, nutritionists, diabetes educators, chiropractors, herbalists, wellness consultants, holistic practitioners,  acupuncturists, naturopathic doctors, etc. Ensure that the person has the science background in diabetes pathology and nutrition by interviewing the person before you give up any of your money! Be wary if they offer a guarantee but require full payment!

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Complementary Alternative Medicine and Insurance

Despite the lack of insurance coverage, many people in the United States are increasingly utilizing the various forms of alternative medicine or CAM (Complementary and Alternative Medicine). CAM is a group of health related therapies and practices that are presently not recognized as part of traditional medicine.

These therapies include such treatments as acupuncture, manipulative body therapies (chiropractic and massage therapies), health coaching, biologic therapies (herbal), energy healing, mind and body mediations (hypnosis, biofeedback and meditation), prayer and spiritual healing, etc.

Alternative medicine, holistic wellness and homeopathic remedies are becoming more and more commonplace. The increased awareness about the benefits of living a healthy lifestyle has resulted in a greater awareness about holistic wellness and a renewed interest in alternative medicine. Health providers that specialize in alternative medicine therapies aren’t a new concept; for centuries people have been relying on homeopathic and natural or alternative cures to their ailments.

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Doctors & Drugs: Conflict of Interest?
Visit any doctor's office and you'll see drug reps giving doctors samples to promote their products. Drug companies are known to lobby doctors and health care providers but until now there was no way to find out how much money doctors were being paid by pharmaceutical companies.

Doctor Kickbacks: Getting Paid by the Drug Companies
Most people have gotten a doctor's prescription at some point in their lives for a medicine they have needed. Some people need prescription medication on a regular basis due to their medical problems. The question is, to what degree can you trust that your doctor writes a prescription based only on your best interests as a patient?

The Truth About the Drug Companies

Every day Americans are subjected to a barrage of advertising by the pharmaceutical industry, especially on TV. Mixed in with the pitches for a particular drug—usually featuring beautiful people enjoying themselves in the great outdoors—is a more general message. Boiled down to its essentials, it is this: “Yes, prescription drugs are expensive, but that shows how valuable they are. Besides, our research and development costs are enormous, and we need to cover them somehow. As ‘research-based’ companies, we turn out a steady stream of innovative medicines that lengthen life, enhance its quality, and avert more expensive medical care. You are the beneficiaries of this ongoing achievement of the American free enterprise system, so be grateful, quit whining, and pay up.”

Is any of this true? Well, the first part certainly is. Prescription drug costs are indeed high—and rising fast. Americans now spend a staggering $200 billion a year on prescription drugs, and that figure is growing at a rate of about 12 percent a year (down from a high of 18 percent in 1999).  Drugs are the fastest-growing part of the health care bill — which itself is rising at an alarming rate. The increase in drug spending reflects, in almost equal parts, the facts that people are taking a lot more drugs than they used to, that those drugs are more likely to be expensive new ones instead of older, cheaper ones, and that the prices of the most heavily prescribed drugs are routinely jacked up, sometimes several times a year.

Paying for prescription drugs is no longer a problem just for poor people. As the economy continues to struggle, health insurance is shrinking. Employers are requiring workers to pay more of the costs themselves, and many businesses are dropping health benefits altogether. Since prescription drug costs are rising so fast, payers are particularly eager to get out from under them by shifting costs to individuals. The result is that more people have to pay a greater fraction of their drug bills out of pocket.

Many of them simply can’t do it. They trade off drugs against home heating or food. Some people try to string out their drugs by taking them less often than prescribed, or sharing them with a spouse. Others, too embarrassed to admit that they can’t afford to pay for drugs, leave their doctors’ offices with prescriptions in hand but don’t have them filled. Not only do these patients go without needed treatment but their doctors sometimes wrongly conclude that the drugs they prescribed haven’t worked and prescribe yet others—thus compounding the problem.

The people hurting most are the elderly. When Medicare was enacted in 1965, people took far fewer prescription drugs and they were cheap. For that reason, no one thought it necessary to include an outpatient prescription drug benefit in the program. In those days, senior citizens could generally afford to buy whatever drugs they needed out of pocket. Approximately half to two thirds of the elderly have supplementary insurance that partly covers prescription drugs, but that percentage is dropping as employers and insurers decide it is a losing proposition for them. At the end of 2003, Congress passed a Medicare reform bill that included a prescription drug benefit scheduled to begin in 2006, but as we shall see later, its benefits are inadequate to begin with and will quickly be overtaken by rising prices and administrative costs.

For obvious reasons, the elderly tend to need more prescription drugs than younger people—mainly for chronic conditions like arthritis, diabetes, high blood pressure, and elevated cholesterol. In 2001, nearly one in four seniors reported that they skipped doses or did not fill prescriptions because of the cost. (That fraction is almost certainly higher now.) Sadly, the frailest are the least likely to have supplementary insurance. At an average cost of $1,500 a year for each drug, someone without supplementary insurance who takes six different prescription drugs—and this is not rare—would have to spend $9,000 out of pocket. Not many among the old and frail have such deep pockets.

Furthermore, in one of the more perverse of the pharmaceutical industry’s practices, prices are much higher for precisely the people who most need the drugs and can least afford them. The industry charges Medicare recipients without supplementary insurance much more than it does favored customers, such as large HMOs or the Veterans Affairs (VA) system. Because the latter buy in bulk, they can bargain for steep discounts or rebates. People without insurance have no bargaining power; and so they pay the highest prices.

In the past two years, we have started to see, for the first time, the beginnings of public resistance to rapacious pricing and other dubious practices of the pharmaceutical industry. It is mainly because of this resistance that drug companies are now blanketing us with public relations messages. And the magic words, repeated over and over like an incantation, are research, innovation, and American. Research. Innovation. American. It makes a great story.

But while the rhetoric is stirring, it has very little to do with reality. First, research and development (R&D) is a relatively small part of the budgets of the big drug companies—dwarfed by their vast expenditures on marketing and administration, and smaller even than profits. In fact, year after year, for over two decades, this industry has been far and away the most profitable in the United States. (In 2003, for the first time, the industry lost its first-place position, coming in third, behind “mining, crude oil production,” and “commercial banks.”) The prices drug companies charge have little relationship to the costs of making the drugs and could be cut dramatically without coming anywhere close to threatening R&D.

Second, the pharmaceutical industry is not especially innovative. As hard as it is to believe, only a handful of truly important drugs have been brought to market in recent years, and they were mostly based on taxpayer-funded research at academic institutions, small biotechnology companies, or the National Institutes of Health (NIH). The great majority of “new” drugs are not new at all but merely variations of older drugs already on the market. These are called “me-too” drugs. The idea is to grab a share of an established, lucrative market by producing something very similar to a top-selling drug. For instance, we now have six statins (Mevacor, Lipitor, Zocor, Pravachol, Lescol, and the newest, Crestor) on the market to lower cholesterol, all variants of the first. As Dr. Sharon Levine, associate executive director of the Kaiser Permanente Medical Group, put it,

Third, the industry is hardly a model of American free enterprise. To be sure, it is free to decide which drugs to develop (me-too drugs instead of innovative ones, for instance), and it is free to price them as high as the traffic will bear, but it is utterly dependent on government-granted monopolies—in the form of patents and Food and Drug Administration (FDA)–approved exclusive marketing rights. If it is not particularly innovative in discovering new drugs, it is highly innovative—and aggressive—in dreaming up ways to extend its monopoly rights.

And there is nothing peculiarly American about this industry. It is the very essence of a global enterprise. Roughly half of the largest drug companies are based in Europe. (The exact count shifts because of mergers.) In 2002, the top ten were the American companies Pfizer, Merck, Johnson & Johnson, Bristol-Myers Squibb, and Wyeth (formerly American Home Products); the British companies GlaxoSmithKline and AstraZeneca; the Swiss companies Novartis and Roche; and the French company Aventis (which in 2004 merged with another French company, Sanafi Synthelabo, putting it in third place). All are much alike in their operations. All price their drugs much higher here than in other markets.

Since the United States is the major profit center, it is simply good public relations for drug companies to pass themselves off as American, whether they are or not. It is true, however, that some of the European companies are now locating their R&D operations in the United States. They claim the reason for this is that we don’t regulate prices, as does much of the rest of the world. But more likely it is that they want to feed on the unparalleled research output of American universities and the NIH. In other words, it’s not private enterprise that draws them here but the very opposite—our publicly sponsored research enterprise.

Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself. (Most of its marketing efforts are focused on influencing doctors, since they must write the prescriptions.)

If prescription drugs were like ordinary consumer goods, all this might not matter very much. But drugs are different. People depend on them for their health and even their lives. In the words of Senator Debbie Stabenow (D-Mich.), “It’s not like buying a car or tennis shoes or peanut butter.” People need to know that there are some checks and balances on this industry, so that its quest for profits doesn’t push every other consideration aside. But there aren’t such checks and balances.