The following article is excerpted from a presentation given by Nancy M. Childs, Ph.D., Department of Food Marketing, St. Joseph's University, Philadelphia, PA at Nutracon '98, which took place July 20-22 in San Antonio, TX and was sponsored by Global Business Research, New York, NY.

At the recent Nutracon '98 conference, Dr. Childs reported, "Alternative care approaches in today's market are divided into two approaches-alternative care providers and alternative care products, which include herbs, nutritionals, nutraceuticals and diet protocols.

There has also been a push to change the term 'alternative care' to 'complementary medicine,' since 'alternative care' does not accurately represent the cross utilization of products. The perception should be on integrated care within the spectrum of ongoing medical protocols. "Two dramatic shifts have been occurring in this area," said Dr. Childs. "The first is the move from acute treatment to preventive medicine, moving toward predictive medicine. Related to this is the blurring and shifting of the food/drug boundary.

"The second shift is in the area of customer perceptions," said Dr. Childs. "Consumers need 'metrics' to help control health. For example, today there are consumer tests for cholesterol, which has been the biggest boost for fat free foods, creating more awareness among consumers of alternative choices. These metrics provide readily quantifiable measurement of an aspect of one's health." She continued, "Current biomarkers and genetic tests are lagging behind nutritional knowledge and this is creating a significant opportunity to create and fill health needs through diagnostic and food products."

There is dissatisfaction with the current health care industry, said Dr. Childs. "Estimates of 30-40% of the U.S. population, particularly women, want more autonomy in controlling their health and they are taking it, particularly through eating habits."

Dr. Childs shared the results of a sample study of 17,000 people-from Consumer Health Science, Princeton, NJ-which looked at certain diseases and what treatment protocols people were using. "The results were interesting," she said. "Of the Alzheimer's patients surveyed, 35% use vitamin E therapy, 25% use anti-inflammatory drugs, 14% use ginkgo and 9% use herbal medicines. For those concerned with their cholesterol-97% had documented high cholesterol-only half took drugs. Diet was the largest area of change, but alternative products are moving in."

"HMO's will pay attention to this and may start integrating these types of products into their formularies," stated Dr. Childs. "The focus on preventive care and cost may not be what drives consumers, but it is what will drive HMO's. What will happen when HMO doctors begin providing specific dietary suggestions for their patients? HMO's will likely try to capture value in providing health food solutions for patients to control costs."

"The question," said Dr. Childs, "is how much are alternative products being used? In a 1998 poll of 400 pharmacists (with a 45% response rate), 94% said they believe in complementary medicine, but two thirds said more research is needed. Pharmacists consider themselves the least informed on new nutraceuticals, but the most informed on herbals. Pharmacists are willing to learn, however, and 50% cited continuing education as the method of choice for educating themselves about nutraceuticals. Magazines/journals and reading/research were next, with 32% and 30% respectively.

"There are also concerns at the pharmacy level about dosages, drug interaction, adverse reactions, adulteration and standardization. There are safeguards needed, such as counseling, education and computer profiles and software; right now the majority of pharmacists-72%-do provide patient counseling," commented Dr. Childs.

"Physicians are a separate channel and definitely a new opportunity," she said. "This is a way to deal with the captured market and here is where the HMO can play a role. The future may be in new patient partnerships, with a health management team approach, or a 'super doc,' who knows herbals too. Disease management (i.e. preventive) will be the approach of the future."

Today, more than 30% of medical schools have curriculum dealing with complementary medicine and more than 50% of conventional doctors report that they use or recommend complementary medicine, said Dr. Childs.

She then discussed an interesting experiment where American Western Life insurance company, San Mateo, CA, introduced a Wellness Plan in 1994 that promotes "health insurance" rather than "sick insurance." The company covers both standard prescription drugs and naturopathic remedies and has a mail order service to provide natural remedies to consumers to guarantee the quality and capture the profits.

Dr. Childs also discussed another insurer, Oxford Health Care, Norwalk, CT, which discovered that more than one third of its membership used alternative therapies within the past two years. Coverage now includes more than 1000 alternative providers and Oxford markets its own herbs and nutritionals, books and tapes. The company determined that there was interest in this program from 75% of its members and 85% of benefits administrators.

The main hurdle for manufacturers, said Dr. Childs, is how best to convince carriers about the benefits of complementary medicine. "First," she recommended, "focus on the personal/lifestyle aspects of the regimen and the fact that it encourages consumer responsibility for his or her own health. Also, there is the advantage of non-invasive treatments and no side effects, as well as an emphasis on vitality, not absence of disease. Complementary medicine also promotes a healthier workforce and increases productivity. It often benefits chronic ailments and can be used as 'last resort' treatments for chronic pain and illness.

"The perception of the 'best' choice-not an 'either/or' alternative-should be stressed," she went on. "Also, HMO's should know that there is state mandated coverage and state licensing and registration practices. Top medical schools are also investigating this area.

"The advantages for the HMO include top line growth, developing a point of differentiation from competitors, a niche market response, real time data evaluation, potential cost control and quality control and consistency," she said.

For the consumer, the advantages are a shift in perception to self care and more personalized answers. Additionally, consumers feel like they have a choice. It provides a preventive halo over people and medical/drug necessity issues. Complementary medicine makes nutrition inroads and offers the potential of disease management. Solutions can include biometrics, genome assuagement or controlled meals.

In conclusion, Dr. Childs stated, "there is definite activity now. HMO's continue to demand credible products with the research to back it up in the complementary medicine field. In turn, HMO's will help accelerate market growth for these products."