Missouri employers select doctors in worker’s compensation cases. Employers nearly always refer injured workers to the usual suspects who practice conventional medicine instead of those specialists who practice complementary and alternative medicine.

Many employees still pursue CAM remedies on their own or go to CAM specialists, whether such treatment is authorized or not. CAM bills are often contentious if treatment sounds wacky or appears not to discernibly cure or relieve anything. The true CAM believers will often second-guess opinions of conventional doctors, no matter which side retains them, which makes it harder to make them find MMI and move on.

Complementary and alternative medicine includes many things: traditional Chinese medicine, acupuncture, chiropractic, therapeutic touch, macrobiotic, and ayuverdic. Some broad definitions of CAM include healing by prayer. Some practices claim they can detect many different types of pulses at the wrist. Some practices claim they can cure disease from energy released from fingertips.¹ Some practices stress purification techniques with colonic cleansing.

Missouri compensation law authorizes some complementary and alternative medicine to treat injured workers. Section 287.140 specifically allows for chiropractic care. Section 287.140.9 provides an employee may be treated for injuries by prayer and spiritual means.²

Missouri citizens outside the compensation system have embraced complementary and alternative medicine for years. Missouri’s Division of Professional Registration lists the state with 2061 chiropractors and 70 acupuncturists. Logan Chiropractic, the second largest chiropractic school in the country, has been in St. Louis for 70 years and has over 1000 students. Kansas City has its share of CAM schools with places like the Core Star Energy Healing School where students can cleanse their auras or the Midwest Institute of Body Works where students can balance their energy.

The National Center for Complementary and Alternative Medicine claims about 1 in 3 Americans practice some form of CAM. More interesting, about half the people who practice never consult an expert in the field.³ This has onerous implications for people who misuse herbs or mix them with other medications which may produce toxic combinations.

The popularity of New Age medicine has been explained as a distaste for technology, a fascination with Eastern mysticism, a belief in mind over matter cures, or a belief that proper nutrition can restore balance to the natural forces.⁴

Some CAM reports successes in yoga and low level lasers to treat certain forms of carpal tunnel, and herbs to alleviate the effects of spinal arthritis. Chiropractors who manipulate the spine to fix carpal tunnel have not been effective proving such claims.⁵ (David Palmer, the father of chiropractic, claimed he cured deafness by fixing a bump on the spine).

The absence of CAM experts in reported decisions may be due to tight Frye standards that required theories must be widely accepted in the medical community. Section 490.065, however, indicates an expert may testify to treatment if the facts or data can be reasonably relied upon. Different CAM practices may or may not satisfy this test. Daubert, similarly, applies “general acceptance” as one of several criteria whether such testimony is admissible.

Most attorneys who encounter the CAM padawan or expert find themselves sometimes speaking a Bizarro language, a weird lexicon of long-established Eastern Chinese practices, Internet chic, folk religion, and traveling show magic potions. The University of Pittsburgh⁶ has an informative research page linking to various CAM databases within the field. Good Internet resource tools include MedBioworld’s link to CAM journals, Medline, Quackwatch, and the Metaphysical Dictionary (Black’s, for the New Age). CAM followers swear by anecdotal successes and site medical studies that support their positions. Millions of Chinese can’t be wrong. Many followers are convinced the truth is out there; as traditional medicine has produced more than its share of failed surgeries, and addicted workers who will never punch a clock again. Critics claim the movement is creepy and kooky, no more effective than placebos, and site to medical studies to support their positions. It is important to talk the talk, to understand what seems to work from the nonsense. Rolling one’s eyes and sighing loudly goes only so far as a meaningful defense.

The growth of CAM in the general community will affect attorneys dealing with medical issues of damages and liability in workers’ compensation. Employer’s insurance companies, who often direct care, may be last to convert without clear record that such treatments work, and can deliver results more efficiently than conventional methods. This may represent a growing rift between employers who acquiesce to employees’ choice of personal physicians and insurance carriers not wanting to chart new waters.

A basic understanding of CAM is important for several reasons.

1.Intake for claimants. Plaintiff attorneys who decide they want to take a case might inquire about CAM practices to determine how this may impact their relationship with the new client and their own chi.

2. Damages. Large CAM bills may be harder to recover if the judge thinks the CAM expert is worth less respect than somewhere wearing a cheese head.

3. Discovery. Attorneys who don’t ask about CAM may miss the elephant in the room. CAM schools have their own accreditation boards, too, such as the ACAOM.

4. Treatment. Drug-herbal reactions can impair other medications, produce side effects or kill patients. Medical histories at hospitals do not always inquire about such practices. Studies have shown Kava and xanax can cause a coma, ginsberg with phenelzine can product mania and St. John’s wort and Zoloft can cause bleeding and delirium.⁷ Some herbal “medicines” have been linked to recreational drug use.

5. Negotiations. True believers in CAM may disregard conclusions of MMI from traditional medical providers.

The CAM movement is out there. Any compensation attorney who deals with injured workers needs to know how to talk the talk to understand the claimant and medical choices, and whether CAM can more efficiently resolve symptoms or create its own Pandora effect.

ABOUT THE AUTHOR
Martin Klug is a partner and workers’ compensation practice group leader at Wagenfeld Levine, 211 N. Broadway Suite 2400, St. Louis, MO 63102. He can be reached at mklug@wagenfeldlevine.com.

ENDNOTES
1.Barrett, Miniglossary of Alternative Methods, http://www.quackwatch.org/01QuackeryRelatedTopics/altmini.html. This is the claim of Quingong masters. cf. Qui-Gon, who claims to bring balance to the Force in a popular George Lucas movie. Reynolds, Star Wars Episode I p. 12 (1999).