Aetna considers alternative medicine interventions medically necessary if they are supported by adequate evidence of safety and effectiveness in the peer reviewed published medical literature.  The following are some of the alternative medicine interventions that Aetna considers medically necessary for properly selected members, subject to applicable benefit plan limitations and exclusions.  

• Acupuncture - see CPB 135 - Acupuncture  
• Biofeedback - see CPB 132 - Biofeedback  
• Electrical stimulation - see CPB 011 - Electrical Stimulation for Pain  
• Chiropractic Services - see CPB 107 - Chiropractic Services.  

Aetna considers the following alternative medicine interventions experimental and investigational, because there is inadequate evidence in the peer-reviewed published medical literature of their effectiveness:

"Alternative medicine" is a term used for a broad range of treatments and practices that have not gained wide acceptance in the traditional medical community and so are not considered standard medical treatment.  Other terms used to describe such procedures include "holistic", "unconventional", and "complementary."

Alternative therapies are based on no common or consistent ideology, therapy of illness, or treatment.  They derive from a variety of sources: ethnic and folk traditions, mainstream medical practices, established religions or semi-religious cults, philosophies or metaphysical movements, and health-and-wellness groups.  The National Institutes of Health's Office of Alternative Medicine classified alternative therapies into the following seven categories:

• Diet and nutrition - use of specific foods, vitamins, and minerals to prevent illness and to treat disease  
• Alternative systems of medical practice - use of medicine from another culture (e.g., Ayurvedia, Chinese medicine)  
• Herbal medicine - use of plants as medicine  
• Mind-body interventions - use of the mind to enhance health (e.g., hypnosis, meditation, yoga)  
• Manual healing methods - use of the hands to promote healing (e.g., massage, chiropractic and osteopathic manipulation)  
• Pharmacologic and biologic treatments - use of various substances (e.g., drugs, serums) to treat specific medical problems 
• Bioelectromagnetic therapies - use of electrical currents or magnetic fields to promote healing (e.g., bone repair, electroacupuncture)  

The efficacy of various alternative medicine regimens is generally unproven, and some alternative therapies have been shown to be ineffective or even harmful. 

Active release technique (ART) is a patented soft tissue system that treats problems with muscles, tendons, ligaments, fascia and nerves (e.g., headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow).  These conditions have one important commonality -- they often result from injury to over-used muscles.  Each ART session is a combination of examination and treatment.  The ART provider uses his/her hands to evaluate the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves.  Abnormal tissues are treated by combining precisely directed tension with very specific patient movements.  These treatment protocols - over 500 specific moves - are unique to ART.  They supposedly allow providers to identify and correct the specific problems that are affecting each individual patient.  Active release technique is similar to some massage techniques, albeit more aggressive.

While ART may be utilized by some chiropractors, it is different from conventional chiropractic manipulation.  Furthermore, Drover, et al. (2004) reported that ART protocols did not reduce inhibition or increase strength in the quadriceps muscles of athletes with anterior knee pain.  Further study is required.

Bioidentical hormones (e.g., estrogen, testosterone, dehydroepiandrosterone [DHEA}, etc.) are manufactured to have the same molecular structure as the hormones made by one's own body, and have been used in conjunction with laboratory tests of salivary hormone levels.  These preparations can be custom-made for patients according to a physician's specifications.  Based on test results, providers prescribe dosages of bioidentical hormones that are compounded at a pharmacy.  Proponents of bioidentical hormones state that they are better than synthetic hormones in that they are "natural" and that they are more easily metabolized by the body, minimizing side effects.  They state that synthetic hormones are stronger than bioidentical hormones and often produce intolerable side effects.

According to a committee opinion by the American College of Obstetricians and Gynecologists (ACOG, 2005), there is no scientific evidence to support claims of increased safety or effectiveness for individualized estrogen or progesterone regimens prepared by compounding pharmacies.  Furthermore, hormone therapy does not belong to a class of drugs with an indication for individualized dosing.  The opinion by ACOG also pointed out that salivary hormone level testing used by proponents to 'tailor' this therapy isn't meaningful because salivary hormone levels vary within each woman depending on her diet, the time of day, the specific hormone being tested, and other variables.

According to ACOG, most compounded products, including bioidentical hormones, have not undergone rigorous clinical testing for either safety or efficacy.  Also, there are concerns regarding the purity, potency, and quality of compounded products.  In 2001, the United States Food and Drug Administration (FDA) analyzed a variety of 29 product samples from 12 compounding pharmacies and found that 34% of them failed one or more standard quality tests.  Additionally, 9 of the 10 failing products failed assay or potency tests, with all containing less of the active ingredient than expected.  In contrast, the testing failure rate for FDA-approved drug therapies is less than 2%.  The FDA requires manufacturers of FDA-approved products that contain estrogen and progestogen to include a black box warning that reflects the findings of the Women's Health Initiative.  However, compounded products, including bioidentical hormones, are not approved by the FDA and therefore, compounding pharmacies are exempt from including warnings and contraindications required by the FDA in class labeling for hormone therapy.

Given the lack of well-designed and well-conducted clinical trials of these compounded hormones, ACOG recommended that all of them should be considered to have the same safety issues as those hormone products that are approved by the FDA and may also have additional risks unique to the compounding process.

In a position statement, the Endocrine Society (2006) stated that it is concerned that patients are receiving potentially misleading or false information about the benefits and risks of bioidentical hormones.  It stated that the efficacy of bioidentical hormone therapy is unproven.

There are few, if any, carefully designed studies on the use of hypnotherapy in the treatment of mental health problems (Fromm and Shor, 2006; Kirsch et al, 1995; Mamtani and Cimino, 2002). Based on the current research literature, there is insufficient evidence to support the use of hypnosis in the treatment of psychiatric and psychological disorders, such as depression and anxiety.  Furthermore, there also has been no experimental validation of the effectiveness of hypnosis in controlling the symptoms of attention deficit disorder (Baumgartel, 1999).

Proponents of neural therapy believe that (i) the nervous system influences all bodily functions, (ii) energy flows freely through the body of a healthy person, and (iii) illness and chronic pain disrupt this flow of energy.  It involves the  injection of anesthetics into various places of the body to eliminate pain and cure illness.  This method is not to be confused with nerve blocks and local anesthesia used in conventional medicine.  In neural therapy, anesthetics such as lidocaine and procaine, are injected into areas of the body that may be located far from the pain source. These injections are meant to eliminate "interference fields" and restore the body's natural energy flow. The injections may be given into nerves, acupuncture points, glands, scars, and trigger points.  A course of treatment may involve one or more injections spread over several weeks.  A few practitioners use electrical current and lasers instead of injected drugs.  Research into neural therapy has been done mainly in Germany where it is widely used; however, there is insufficient evidence on the effectiveness of neural therapy for pain management or for any other health problems (American Cancer Society, 2007).