The Native American tribes of the Southwest have brought their sick to Sedona for centuries. It's said the red-and-cream-streaked pinnacle rocks that dot this portion of the Northern Arizona desert contain mystical healing powers. At night, when the pinnacles are backlit by a thick froth of stars and strobed by flashes of faraway lightning, the notion becomes difficult to dismiss.
In fact, it's getting harder to dismiss the merits of alternative medicine, both in this picturesque corner of the Southwest and elsewhere.
Once vilified by much of the medical establishment, alternative treatments have caught the eyes of aging baby boomers with open minds and large wallets. According to a 1993 New England Journal of Medicine study, an estimated $13.7 billion was spent on alternative care in 1990. More recent spending data are not available.
Several major health plans have responded by offering coverage. And with legitimate research now entering the picture, it made sense for the Bonita, Calif.-based Gerson Institute, which uses organic foodstuffs to treat cancer, arthritis and other ailments, to open an inpatient facility last February just outside Sedona.
Despite its reputation for rock-ribbed conservatism, Arizona has among the most liberal licensing laws in the nation for practicing alternative medicine. And the Gerson staff saw an opportunity to go mainstream.
While the organization is headquartered in California, its only clinic had been one it has operated in Tijuana, Mexico, for the past 20 years.
"Mexico is still Mexico. By having a clinic in the U.S., this is a chance to lend greater credibility to our research," says Chip White, Gerson Sedona's vice president of client services.
On the face of it, the Gerson treatment seems odd. Patients-the majority of whom have terminal cancer-pay $4,500 a week for a regimen of virtually no-fat food, 13 daily servings of fruit and vegetable juices, coffee enemas, vitamin supplements and other treatments. They typically stay for three weeks, then continue the treatment after returning home.
Little formal research has been conducted to date, but a 1995 study published in the journal Alternative Therapies shows a five-year survival rate 21% to 43% higher among Gerson patients with either local or metastasized melanomas than those receiving chemotherapy and other traditional treatments.
That may be among the reasons the 10-bed Gerson Center at Sedona-which shares space with an 18-bed assisted-living center for the elderly-has been running at around 80% occupancy since it opened. It expects to treat 150 to 220 patients in its first year of operation. The institute is in negotiations to take over the adjoining assisted-living facility and may use it for long-term care, which would provide greater controls for research, White says.
Together, the Sedona and Tijuana facilities expect to treat about 500 patients this year. Gerson has treated roughly 6,000 patients over the past 20 years and has annual revenues from treatments, product sales and donations of about $1 million.
Although they receive a relatively eager reception now, it wasn't long ago when alternative treatments such as the Gerson plan fought tooth and nail simply to exist.
Physician Max Gerson created the regimen to treat the migraine headaches he suffered while a medical student in Germany early in the century. But even though his methodologies were published in peer-reviewed journals in the late 1920s and Albert Schweitzer was a champion of his work, Gerson was treated as a virtual outcast by the New York medical establishment after he immigrated in the 1930s.
According to Charlotte Gerson, who founded the institute on her father's behalf, hospitals routinely denied him practice privileges. His state medical license was challenged five times during his career-unsuccessfully. Suspicious colleagues told potential patients of Gerson's that he charged $2,000 per office visit, when he actually charged $25. Near the end of his life, he could not obtain malpractice insurance.
"We were always stunned and thunderstruck that he would be treated this way," reminisces Charlotte Gerson, who sips several cups of clinic-approved carrot juice during an interview.
Although it has taken the more than four decades since Dr. Gerson's death in 1959, the public's attitude toward alternative medicine has changed dramatically.
In 1991, the National Institutes of Health established the Office of Alternative Medicine, which has since funded several small research projects to study the efficacy of such treatments as hypnosis, acupuncture and tai chi.
The 1993 NEJM study indicated 34% of respondents in a national survey said they had used at least one alternative therapy in the past year. "Studies based on samples in limited geographic areas suggest that the use of unconventional therapy is widespread," the researchers conclude.
The study's conclusions "were a big surprise," says James Dillard, M.D., a member of the faculty at Columbia University and director of alternative medicine for Norwalk, Conn.-based Oxford Health Plans. Dillard, a trained acupuncturist and chiropractor, confirms that before the establishment of the OAM and the NEJM study, alternative medicine had always been viewed by the medical community as an extreme outlier.
"Medical practices in general tend to be fairly inertial, to which there are advantages and disadvantages," Dillard says. "The good thing about that is that doctors are not immediately swayed by any new, faddish treatment. The downside is that they are slow to change as a profession."
Many experts believe, however, that the open-mindedness and perhaps self-absorption of the baby-boom generation, combined with disenchantment with the sometimes assembly-linish culture of managed care, has given patients a desire for something new.
"Americans are interested in quick fixes. They have a romance with pills, procedure and medicine in general. It relieves them of the responsibility of eating less tiramisu," says Jesse Gruman, executive director of the Center for the Advancement of Health, a Washington-based think tank that advocates healthier lifestyles.
While Gruman generally supports the idea that alternative medicine can be beneficial, the attitude she observes in the population suggests its rising stature reflects an obsessive quest for well-being. "People don't think much about their health until they're sick, and they have no patience after that. They'll do anything they need to do to get their lives back in order," she says.
That observation may be borne out in part by the patients at the Gerson Institute. Three-quarters of the cases seen are late-stage cancers, with most having already sought traditional treatments. Many-such as pancreatic cancer patients who already have undergone chemotherapy-normally will not respond to the Gerson regimen and are turned away.
"We're the last stop. People beg and plead, and it can be very hard emotionally to say, `Go home,"' says Gerson Sedona's White.
The rise of managed care also is seen as an alternative medicine catalyst.
"For years, medicine has been focused on acute crisis management; now we are moving more to the outpatient side. With the increasing limitations on the crisis-intervention model, I think there has been a paradigm shift," says Kakit Hui, M.D., director of the Center for East-West Medicine at University of California, Los Angeles.
"Until recently, doctors have always approached medicine as a healing practice. They used to tell patients to get fresh air, with a spiritual approach being the norm," says Stephen Bickel, M.D., director of New Age guru Deepak Chopra's Center for Well Being in La Jolla, a suburb of San Diego.
"It's a strange phenomenon we've seen in the 20th century, where people equate medicine with technology," Bickel says. "There's been a dislodgment of the spiritual part, and I think it's left a void for a lot of people. Managed care has only served to accelerate that."
Whether that's true, the years following the NEJM study have ushered in even more dramatic changes: payers willing to provide alternative care and education in alternative techniques becoming available for more doctors.
This year alone, Oxford and Bedford, N.H.-based Matthew Thornton Health Plan began paying for alternative therapies; 38 other providers now pay for some form of alternative care, according to a recent issue of the New Age Journal.
Shadyside Hospital in Pittsburgh has opened a clinic boasting alternative-care procedures. Daniel Freeman Marina Hospital near Los Angeles announced earlier this month a residency program in conjunction with the Emperor's College of Traditional Oriental Medicine in Santa Monica. And the University of Arizona at Tucson will begin a similar medical residency program this fall.
Hui and Bickel agree that providers offer alternative-care options primarily to please consumers. "People always vote with their pocketbooks," Bickel says. And health plans such as Oxford cash in by charging enrollees extra to access their networks of alternative-care providers.
As for alternative therapies being introduced into traditional medical training, experts agree that some seem to work well but to a scientifically unknown extent.
The Center for the Advancement of Health's Gruman admits practices like biofeedback have shown great success in managing stress and anger, thereby reducing risk of hypertension and heart attack.
"This middle ground is very fertile," Gruman says.
"There is a fairly open-minded, nonprejudiced group of doctors who tend to stay that way, while there is a significant minority who will say these treatments are absolute poppycock," agrees Oxford's Dillard. "Which means a majority are stuck in the middle. They don't know a lot about the techniques, but they wouldn't mind seeing more proof."
Most practitioners agree research will be the key to making alternative medicine more than just the latest baby-boomer fad.
"The only way for alternative medicine to really proliferate in a responsible way is to identify the evidence base for it in order to really find out and know what works," Gruman says. "Penicillin will cure my small pox or pneumonia because a dose-response relationship has been formulated, with realizable general outcomes. We don't have that for many alternative practices."
To that end, Oxford last month announced a collaborative effort with Boston's Beth Israel Deaconess Medical Center and Harvard Medical School to conduct research based on the outcomes of Oxford enrollees using the alternative medicine network. The first results are expected to be published in two years.
"It would have been a mistake to enter this assuming we will find positive results everywhere. We're willing to accept some responsibility if some things are not cost-effective," Dillard says. "We need to know what works and what doesn't and what's helping our membership. If we do find something that's not working out, we're going to have to modify our program."