special report: Integrative Medicine in the Marketplace
Marketplace Dynamics: Implications for Integrative Providers
Stephen Bolles, DC
W
hile recent headlines trumpet health care reform for
focusing on revising elements of the delivery and com-
pensation systems, in fact, the transactional part of
our health system already had been undergoing substantial evolu-
tion. New health care products have dramatically altered insur-
ance coverage models, and health plan subscribers are being
thrust into a new role—one resembling that of retail consumers.
Providers, however, have not been adequately prepared for
this shift, and, although some nonmedical professions have grown
and become established outside of health-plan coverage, there still
is a need for an ongoing conversation about how the retail health
care marketplace will affect integrative practitioners.
Health Care Marketplace Dynamics and the
Taxonomy of Dominance
Viewed from the perspective of retail marketplace dynam-
ics, the American health care system is a curious animal.
Although in most retail markets supply and demand are in a
state of constant and interdependent tension in which demand
encourages and supports supply-side innovation, health care has
historically inverted that dynamic. In contrast to retail markets,
health care in America developed with the supply side able to
dictate to the demand side what was available, with no practical
competitive pressures to force innovation and efficiency.
Hence, until recently, consumers have been protected from
needing—or even being able—to make discriminating choices,
so the kind of information retail consumers would generally
expect has not been available. It is only now that information
about price and quality, along with decision-support tools to
compare and contrast options, is slowly beginning to make its
way into the market for consumers to use.
Up to this point, the validity, wisdom, and effectiveness of
this medical variation to retail marketplace design has essen-
tially gone unchallenged. Due to the cultural dominance and
politics of mainstream medicine, no profession or organization
has been able to amass the required evidence or achieve suffi-
cient public visibility to challenge medicine’s supply-side domi-
nance, even in the face of often compelling clinical research that
clearly shows some medical community practices to be wrong,
ineffective, or even dangerous.1(p514)
This situation has been possible for at least 2 reasons. The
first is because medical education has had the ability to deeply
inculcate its own cultural values through the training of its prac-
titioners. Until the late 1980s, when the chiropractic profession
won a landmark antitrust lawsuit against the American Medical
Association, there was no way to effectively challenge the biased
information being taught in medical schools and reinforced by
the medical culture in practice.
20 Integrative Medicine • Vol. 9, No. 5 • Oct/Nov 2010
Second, until recently, the demand side (consumers) has
not had any real marketplace power. Further, consumers have
not exhibited any real awareness of the consequences of medical
utilization or values, such as outcomes per unit of service and
delivery cost. The supply side (providers) has been able to essen-
tially establish, in market terms, an exclusive set of products
with no competition.
Cracks in the Armor of Health Care Provision
One of the more arresting aspects of David Eisenberg’s
original 1993 study on complementary and alternative medi-
cine (CAM) use2 was the finding that suggested more than half
of respondents using alternative medicine were not telling
their physicians what they were doing. When reexamined
some years later,3 this behavior was intact. No evidence shows
the behavior has changed since, though it has arguably become
an even more pervasive position that patients—as consumers
of health care services and information—take with providers.
This position is especially evident when considering the pro-
found shift in older Americans’ behavior in this respect.
Whereas this population used to be the most reliable reporters
of their health practices to physicians, a 2007 survey showed
they have shifted to being a population least likely to be volun-
tary reporters, withholding significant information from their
doctors unless specifically asked.4
Another phenomenon that has contributed to health care’s
changing marketplace has to do with the shifts in health insur-
ance products. Health care benefits that health plans develop,
promote, sell, and manage, for example, began to change in
character about 10 years ago when it became clear that managed
care had not been able to deliver on its promise to control esca-
lating costs. Early changes included shifting some aspects of
financial responsibility and decision making onto consumers,
with never-before-experienced options among deductibles,
choices between provider networks, and variable copay levels.
This menu of options has continued to increase, with pro-
viders handing off the responsibilities of choice to consumers. In
contrast to the former, paternalistic system, these increased
options may feel to the consumer like an abdication of guidance
and support. This is especially true when consumers chose high-
deductible health plans in which they have much more responsi-
bility for managing health expenses; health plans have made
these products available with very little in the way of decision-
support tools for how to most effectively choose health care ser-
vices across the wide spectrum of cost and quality.
Originally heralded by the imposition of copay responsi-
bilities when health costs began to escalate rapidly in the 1980s,
the bliss of benign disengagement that consumers had been able
Bolles—Integrative Medicine in the Marketplace
to enjoy began to dissipate. Since then, the sense of protection
and safety that consumers feel continues to evaporate, with
shrinking benefit sets, increasing deductibles, higher copays,
and an overall greater proportionate amount of patient fiscal
sponsorship and responsibility. Based on the degree of market
penetration these benefits products have accomplished in a
short time, this is an inexorable trend, a response to uncon-
trolled rising costs and an inability on employers’ parts to con-
tinue to absorb these costs on behalf of their employees. Save for
the few individuals who still enjoy highly compensated benefits
packages, most consumers can no longer maintain any sense of
detachment from health care finances.
New Products, New Roles
The New Consumer
The current product version of this trend is the euphemisti-
cally termed consumer-directed health plans, or CDHPs. At
heart, these are revised transactional processes in which con-
sumers have a model of insurance protection that is an inverted
form of what was customary for more than 50 years. In the old
model, consumers paid a deductible amount on the front end
then had costs covered in such a way that they rarely knew—or
had to care—about health expenses after that. Instead of the
deductible being used first, these newer plans initially provide
the contract benefit, covering a set amount of health expenses.
Once the benefit is exhausted, the consumers move into paying
their deductibles, placing them on the hook for claims costs
until a defined threshold is reached. If expenses exceed that
deductible, insurance kicks back in, based on “stop loss” cover-
age for “catastrophic events.”
In the new world, rather than seeing a deductible as some-
thing to “get through” to the point where coverage kicks in—at
that point enjoying the sense of safety that this arrangement
conveys—consumers in these plans are now protected initially,
then exposed to the substantial uncertainty of health care costs
after their employer-sponsored “budget’ (the services covered as
the “benefit” provided for employees) has been exhausted. As an
example, an older insurance plan might have offered a $2000
deductible that a family could budget for and amortize over a
calendar year. When their expenses satisfied the deductible, the
benefits of the health plan would kick in, and the family would
essentially never need to see another bill for the year, a relatively
seamless process. In many CDHPs, the benefit now commonly
comes first and then the deductible; a much higher dollar figure
($5000 to $10 000) is not uncommon. Coverage still exists after
that deductible is satisfied, but the financial bar for most fami-
lies is much, much higher than before.
This change in benefit design has had 2 principal effects.
The first is financial. CDHP deductible amounts are larger than
the “front end” deductibles that older insurance plans provided,
so family budgets have to absorb greater amounts of costs—
commonly, many more thousands of dollars per year, straining
and breaking family finances. The second is emotional. The
sense of protection many used to feel with older insurance plans
in which patients were inured to the costs of care has been
replaced with a sense of being threatened by the lack of any clear
sense of control in purchasing decisions.
Tools such as health savings accounts (HSAs) support this
type of product. Examples of other health plan product tools are
shown in the Table. In an HSA, employers can either fund a pretax

Table. Health Care Product Definitions

Health Care Product
Consumer-directed health plans (CDHPs)
Fee for service
Flexible spending account (FSA), also called
125 plans (their designation with the
Internal Revenue Service) or Flex Plans
Health maintenance organizations (HMOs)
Health savings account (HSA)
High-deductible health plan (HDHP)
Preferred provider organizations (PPOs)
Definitions are adapted from Wikipedia. Available at: http://en.wikipedia.org. Accessed July 30, 2010.
Characteristics
A class of benefits products that have an orientation toward consumer choice, normally paired
with high-deductible health plans (HDHPs).
In the health insurance and the health care industry, fee for service involves doctors and other
health care providers receiving a fee for each action provided, such as an office visit, test, pro-
cedure, or other health care service.
An FSA is 1 of a number of tax-advantaged financial accounts that can be set up through a caf-
eteria plan of an employer in the United States. An FSA allows an employee to contribute to a
pre-tax account that can be used to pay for certain IRS-approved medical expenses. This is a
“use-or-lose” account where any money not spent by the end of the plan year will be forfeited.
An HMO is a prepaid type of fee for service where care costs are capped or budgeted.
An HSA is a tax-advantaged medical savings account available to employees who are enrolled in
an HDHP. Unlike an FSA, HSAs are owned by the individual and funds roll over and accumulate
year to year if not spent. The funds contributed to the account can be either pretax or posttax,
but interest on the account is not subject to federal income tax. Withdrawals for nonmedical
expenses are treated very similarly to those in an individual retirement account in that they may
provide tax advantages if taken after retirement age and they incur penalties if taken earlier.
An HDHP is a health insurance plan with lower premiums and higher deductibles than a tra-
ditional health plan.
PPOs are normally networks of those who provide services at contractually-defined discounts
from “list” fees.

Bolles—Integrative Medicine in the Marketplace Integrative Medicine • Vol. 9, No. 5 • Oct/Nov 2010 21
 amount that can be added to by employees, with unspent balances
frequently rolled over to retirement account contributions, or, in
an alternate scenario less expensive to the company, only
employees make pretax contributions. Another version is health
reimbursement accounts (HRAs; also called 125 Flexible
Spending Plans, FSAs), which are also pretax contributions to
accounts that employees can draw on to pay for certain Internal
Revenue Service–approved health care expenses.
The Captive Provider
From the providers’ standpoint, the market that most are
used to is not really one of insurance per se, but in reality a dis-
counted health care service plan made possible by the ability of
insurers to control access to certain providers who have agreed
to contractually negotiated price discounts. Providers have his-
torically felt captive to agreements of this type because of the
ability of insurers to control the flow of patients. What formerly
was bonafide insurance has evolved into capped utilization
models at prices that are often discounted to a point below pro-
viders’ ability to deliver the services.
New Rules for Employers
Codified into these new products, the advantage of CDHPs
for employers (purchasers) is mainly that their exposure (costs)
is capped because of the limits on first-dollar coverage (due to a
benefit that is based on utilization management). From their
point of view, employment health benefits are a more predict-
able, controlled, and thus known amount of money. If and when
employees’ health expenses exceed that amount, they are on the
hook for the substantial middle ground of health care costs. This
is a huge advantage for employers who used to be forced to
absorb these costs, with tremendous uncertainty about what the
final responsibility would be.
The Result
If one goes by the marketing language, the goal behind this
direction in new products seems to be conceptually sound:
Make consumers more cost-conscious by putting them in a
clearer position of buying health care. The challenge in practice
has been that information and retail decision-making tools have
lagged in development, and as yet really do not match in rich-
ness the profundity of change in benefit design. While difficult
to quantify, consumer awareness of this need can at least be
appreciated indirectly by the explosive growth in information-
seeking behaviors on the internet. According to the Center for
Studying Health System Change, researchers found that, in
2007, 56% of American adults had sought information about a
personal health concern from a source other than their doctor.5
This figure had risen from 38% in 2001. Those using the internet
for this purpose had doubled in number in 6 years, from 16% in
2001 to 32% in 2007. Figures from Pew Research in 2007 quanti-
fied overall health information–seeking behavior and reported
that 74% of American adults use the internet, 75% of those have
searched for health information at least once, and 10% of inter-
net users search daily for such content.6
The result of this trajectory is a profound change in the
22 Integrative Medicine • Vol. 9, No. 5 • Oct/Nov 2010
supply-demand dynamic, leading to what some have called the
emerging retail health care marketplace. Consumers are begin-
ning to have access to more information about the goods and
services they consume from health care providers and plans;
they are using budgets such as HSAs to pay for them; and com-
parison shopping tools are coming on the market that help
people make choices on the same basis they make other retail
choices—a sense of value, defined as satisfaction of consump-
tion needs and desires.
Unprepared Providers
So where have providers been during these changes?
Judging by the lack of visible professional and interprofessional
dialogues on this subject, appearances suggest that they are
unengaged and unprepared.
The lack of engagement can perhaps be understood, and
providers can perhaps be forgiven for thinking they were the
permanent beneficiaries of a broadened awareness of their use-
fulness on the part of the American public. Eisenberg’s initial
study data2 created something of a consolidation of public
awareness on the use of CAM, creating a political opportunity.
In response to grass-roots and professional action, during
the late 1990s and into the early 2000s health plans were forced
to broaden coverage for CAM services. These changes were
driven less by policy and more by political leverage—a force that
is often migratory, exhausting to maintain, and blunt in its
application. Despite the use of what was presumed to be intrinsi-
cally appealing, cost effectiveness–based arguments, these man-
dates have rarely become core benefits, ie, covered services that
are embedded into all health plan products. Rather, they have
commonly ended as riders to benefit sets, additional buy-up
expenses for employers who, in many cases, now find them-
selves in such precarious financial positions that they are being
forced to stop paying for such services. Current economic trou-
bles are accelerating this type of decision.
The effects of this scenario are still playing out. In the early
days of CDHP product use, consumers initially spent freely (for
CAM services as well), draining HSAs early and often. Then
things began to change. There is evidence that consumers start-
ed to resist spending money. The reasons and implications are
not clear. Canopy Financial, the platform for HSAs for many of
the larger banks and plans in the United States, reported in its
fourth quarter 2008 report that the average HSA balance for
individuals was $1429, and, for families, it was $1600.7 The US
Government Accountability Office reported in 2006 that the
average employer contribution was $1064.8 Why is this signifi-
cant? With average balances greater than annual contributions,
consumers are not spending money on services that were previ-
ously being consumed. No one understands quite yet what this
means. Canopy further reported in January 2009 that individual
and family HSA balances in the third quarter of 2008 had
dropped by only 2% and 4%, respectively.9
A New Relationship With Consumers
Some implications for providers—and perhaps especially
for nonconventional medical providers—may be coming into
Bolles—Integrative Medicine in the Marketplace
focus, particularly when they are outside health plan coverage.
Consumers are more often in a position of spending money that
they see as their own instead of their health plans’, meaning
that decisions about that spending will potentially be very dif-
ferent. If a consumer needs something that is available from
several retail sources, what do they do? They compare prices
and value. Value is a complex calculus in consumers’ minds, but
at its heart is a very personal definition that factors quality in
with quantity and price when decisions are made (along with
additional factors such as time, access, etc). Consumers in
many cases pay more for a sense of enhanced quality simply
because it makes them feel good.a
There are signs on the supply side that this new position for
consumers is being recognized. Experiments in price-point com-
parison and bundling of services into new consumer-facing
products such as web portals that present costs of care and
options are being conducted (see Carol.com for 1 example), with
uneven results. Additionally, social technologies employed to
rate doctors and the quality of patients’ experiences are emerg-
ing on the internet (eg, ratemds.com, HealthGrades.com), but
these are usually independent of clinical outcomes and often
evoke dismay and anger in the rated physicians because it is easy
for a single disgruntled patient to hurt someone’s reputation by
making unfounded charges or claims.
As well, health plans are developing customized health
plan products aimed at more precise life-circumstance demo-
graphic segments such as young adults with very few health care
needs, older adults with Medicare gap coverage needs, etc.
Information management—perhaps the truest currency of
health care in practice—is shifting substantially to include or
focus on consumers. Personal health record products are emerg-
ing, and, despite low national adoption figures, access to elec-
tronic medical records is becoming a benchmark for hospitals
and clinics. A marketing message of information ownership is
becoming evident across many of these efforts, a concept that is
challenging both the existing health care system and consumers:
Managing personal health information is a locus of control that
may someday redefine important aspects of health care.
What Does All This Mean for Integrative Health
Care Providers?
With this fundamental reordering of the legacy health care
marketplace and the demand side’s increasing influence on what
the supply side offers up, the slow broadening of product and
a The Natural Marketing Institute, formed to examine the marketing segment known as LOHAS
(Lifestyles of Health and Sustainability) identified that, for some 30 million or more Americans,
a price-point premium of 10% to 20% can be expected to be paid because of the intrinsic values
of a product, ie, earth-friendly, spiritual, socially-conscious, etc. Consumers do this both because
of the perception of quality and because of a halo effect, “elevation by association.”
b The taxonomy of patient vs consumer is important to consider because providers and patients
often hold different assumptions about the terms. Many argue passionately that the term
patient (someone who suffers, is a victim, or who bears the burden of a health challenge) forces a
necessary focus of attention, caring, empathy, etc, on the one who needs healing. Whether con-
sumers think of themselves in this light is not clear, however, and needs to be explored. To think
of someone as a consumer is not necessarily to demean their suffering but, perhaps, more clearly
acknowledges that becoming a patient is really an agreement to a social contract that it may be
important to explicitly acknowledge as a way of transitioning into someone’s care.
Bolles—Integrative Medicine in the Marketplace
service availability is beginning to resemble normal retail dynam-
ics, and decisions about health care service consumption are
beginning to reflect these as well. Patients are now consumers,b
and while they seek services because of clinical needs or inter-
ests, they are framing their decisions in very different terms—
terms that parallel retail considerations. Consumers look for
value, are accustomed to making comparative price-point deci-
sions, discuss finds and deals with friends and family, and are
finding that providers rarely think in similar terms. For integra-
tive health care providers, this emerging retail health care mar-
ketplace offers some compelling opportunities, as well as some
potentially painful disruption. If what is required is to begin to
think in new terms about all this, what can or should we do?
Consider Separating Information From Care
Providers have historically been the source of both services
and information, and the two have been woven into 1 product.
Consumers now are asking by their behaviors to unwind these 2
elements and to make decisions about services based on infor-
mation digested before a health care service purchase is made.
Frequently, consumer-patients come into a doctor’s office with
recent internet research in hand, and providers can no longer
assume a given patient is uninformed and compliant without
some measure of autonomy in decision making. If we can guide
without selling, we create trust with consumers.
Think of Clinical Outcomes as Retail Outcomes
Providers and consumers think in terms of outcomes but
framed in different ways. Providers look for the quantitative
changes in clinical findings, whereas retail consumers consis-
tently look for qualitative changes in their lives. The quantitative
changes produce the qualitative changes, but, in a retail health
care marketplace, integrative providers need to be aware of the
perception of difference. Consumers see purchases of services as
a means to an end, and how providers define that end will ulti-
mately make a big difference to consumers. The clinical equiva-
lent of going above and beyond expectations in customer service
is likely to come into play with uncertain consequences.
Consumers will buy from retailers that meet their minimum
expectations but will prefer to return to those that exceed these
expectations. What will be our clinical equivalent?
Identify Your Customers and How You Position Your Services
Retailers intentionally segment their markets, products,
messages, and positioning all the time. For example, some con-
sumers shop at Wal-Mart, some shop at Target, and some shop
at Neiman-Marcus—3 retailers on a price-point continuum who
have adopted very different brand management and pricing
strategies. Commonly, there is little consumer overlap; consum-
ers will normally shop at an adjacent 2 of the 3, but rarely skip
Target, for example, to shop at both Wal-Mart and Neiman-
Marcus. The factors that influence these behaviors and decisions
include price, but they also include perceptions of the quality of
goods and experiences and how being associated with that
retailer makes them feel.
What will become visible in health care that influences
Integrative Medicine • Vol. 9, No. 5 • Oct/Nov 2010 23
 how value is defined to consumers? As integrative health care
providers find it necessary to appeal directly to consumers who
make purchase decisions that are influenced by entirely new
sets of considerations, values, and perspectives, how will pro-
viders and professions respond?
Useful Prospective Concepts
A set of prospective concepts may help set the stage for a
more wide-ranging and organized discussion that will become
more important as this retail health care marketplace takes
shape. These concepts are presented in a proposed ordinal
ranking because they build on one another.
Concept 1: The Consumer is King—and Queen
This concept is not meant to assume that the consumer is
automatically prepared to make critical decisions about care for
themselves and their loved ones—far from it. Rather, it is
meant to suggest that providers, like retailers, need to begin to
listen to consumers about their interests, needs, and prefer-
ences and to rethink how they present themselves, their servic-
es, and the gestalt of the consumer-patient experience. Those
who do this are more likely to thrive in a retail health care mar-
ketplace than those who do not.
Two important representations of this mindset were pre-
sented at the Institute of Medicine’s Summit on Integrative
Medicine and the Health of the Public in 2009.c One was a
quote from Art Berarducci: “Every patient is the only patient.”
The other was a summary of consumer guidance that came
from Diane Pampling: “Nothing about me without me.” Retail
businesses orient their thinking toward the satisfaction of the
consumer. What will be the corollary in health care delivery?
Concept 2: Information Ownership Resides With the Consumer
Providers and vertically-integrated systems are used to a
mindset that ownership of clinical information is their exclusive
province. It’s really an extension of the paternalistic and often
condescending position providers have taken with patients
over the years. Consumers don’t agree, if data about informa-
tion-withholding behaviors cited earlier are accurate. Consumers
are coming to see their personal health information as just that,
and as more tools come online where they can actively partici-
pate in reviewing, adding to, and controlling some aspects of
this content, it is very likely that tensions will arise when this is
not viewed as a collaborative effort.
Providers who effectively engage consumers in a sense of
shared ownership and responsible distribution of this informa-
tion will tend to thrive in this marketplace more than those who
do not. Shared responsibilities and collaboration in generating,
documenting, agreeing on, and acting on personal health infor-
mation is likely to be the basis for a new social contract between
providers and consumer-patients.
c For more information on the summit, see Schultz AM, Chao SM, McGinnis JM; Institute
of Medicine. Integrative Medicine and the Health of the Public: A Summary of the February
2009 Summit. Washington, DC: National Academies Press; 2009.
24 Integrative Medicine • Vol. 9, No. 5 • Oct/Nov 2010
Concept 3: Providers Are Resources and Guides, Not Gods
Hubris has often been a characteristic of the position pro-
viders have adopted in relation to patients, and, as indicated in
its origins in Greek mythology, those with hubris often are
humbled as those with real power assert themselves. For provid-
ers, this lack of hubris can be as simple as just listening to con-
sumer-patients from a perspective of humility, receptivity, and
openness (see Concept 1). Consumer-patients come in with their
own agenda; how often are providers guilty of imposing their
own agenda on them? Once they have choices, will consumers
tolerate this behavior? Will we even know when, and why, they
go away? Retailers track this all the time.
Concept 4: Value Matters—And It Must Be Communicated
Consumers who are spending money on products and ser-
vices want to know what they are getting for their money. By
extension, they also want to know what happens when they
don’t get what they expect. In the retail health care marketplace,
providers and other resources must figure out how to tell their
messages of value that essentially promise something in return
for what consumers spend. In the past, providers have been
spared the consequence of having financial exposure to failed
clinical outcomes; in fact, they’ve been rewarded for failure in
many ways, as patients return for more and more services in
their own personal N-of-1 clinical trials.
Retail products have service warranties. In a retail health
care marketplace, a consumer can’t return a failed or ineffective
service, but providers who think through how they will address
unmet expectations are, again, more likely to thrive than those
who do not.
Concept 5: It Takes a Village
Health care is local, as many have previously observed. The
people we surround ourselves with and their healthy lifestyle prac-
tices are the greatest determinants of our own. Healing may be the
province of the individual, but health is a collective effort that is
heavily dependent on the health of the community we live in.
Consumers see their lives as ecosystems and make deci-
sions about what they do and how they do it in the context of an
often complex set of dynamics, considerations, priorities, and
trade-offs. Many consumers have effectively created their own
integrative care teams—members of the team just don’t always
know it. If we are to effectively engage people in their own
health, we must present solutions that are seen as relevant
within the context of their lives. If we fail to understand that
context, we are likely to be replaced by someone who does.
Conclusion
It will be interesting to watch what transpires in health
care marketplace dynamics over the next several years. Health
care reform efforts have created new opportunities for integra-
tive providers to offer services and fulfill roles that have been
largely unavailable until now. Expectations for a broadened
paradigm of health and healing that focuses more on health
promotion than disease management are high, but it remains
to be seen what this means in operation. Despite the best intent
Bolles—Integrative Medicine in the Marketplace
and concentrated efforts, a significant gap between policy mak-
ing and the marketplace may still exist. Individuals who focus
on entrepreneurial efforts may be more significantly rewarded
than those who expect systemic change to provide greater
N ATURAL SOLUTIONS MAGAZINE’S
DEFINITIVE GUIDE TO CANCER
assurance of economic viability.
The speed of change is placing great pressure on all provid- IS NOW AVAILABLE!
ers to prepare to respond with foresight, business nimbleness,
and a reshaping of their own sense of place than has ever been
required. The economic survivors of this transition—and the
reasons for their survival—may more profoundly change health
care than any other dynamic. No matter what form the new
health care legislation finally produces, the fundamental dynam-
ic between provider and patient has shifted. Integrative health
care practitioners, because of our historically strong relation-
ships with consumers, are positioned well to benefit from these
evolving dynamics—if we pay attention.

Stephen Bolles, DC, has been in health care for more than 25 years, first as a
provider; then as a nonprofit institutional executive, a consumer product devel- ONLY
oper and manager for UnitedHealth Group; a vice president for Institutional $39.95
Advancement at Northwestern Health Sciences University in Bloomington, plus shipping
and handling
Minnesota; and now as a consultant and entrepreneur. His work focuses on
strategic effectiveness, linking vision and infrastructure, and developing strate-
gies to encourage and facilitate effective and humanistic corporate community
and cultural integration.

References
1. Fisher El, Goodman D, Skinner J, Bronner K; Dartmouth Institute for Health Policy
and Clinical Practice. Health Care Spending, Quality, and Outcomes: More Isn’t Always
Better. February 27, 2009. Available at: www.dartmouthatlas.org/downloads/
reports/Spending_Brief_022709.pdf. Accessed August 20, 2010.  
2. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL.
Unconventional medicine in the United States. Prevalence, costs, and patterns of
use. N Engl J Med. 1993;328(4):246-452.
3. Kessler RC, Davis RB, Foster DF, et al. Long-term trends in the use of complementa-
ry and alternative medical therapies in the United States. Ann Intern Med.
Regain an Active Lifestyle!
2001;135(4):262-268. The first layperson’s guide to using natural nutritional
4. No authors listed. Older Americans not discussing complementary and alternative
medicine use with doctors. National Center for Complementary and Alternative supplements to support conventional cancer therapy,
Medicine. Available at: http://nccam.nih.gov/news/2007/011807.htm. Accessed the 768-page Definitive Guide to Cancer encourages
August 20, 2010.
5. Tu HT, Cohen GR. Striking jump in consumers seeking health care information.
an integrative approach that embraces both alternative
Track Rep. 2008 Aug;(20):1-8. and conventional therapies in the battle against cancer.
6. No authors listed. Internet activities. Pew Internet. Available at: http://www.pewin-
Naturopathic physician Lise Alschuler and medical
ternet.org/Static-Pages/Data-Tools/Download-Data/~/media/Infographics/
Trend%20Data/January%202009%20updates/Internet%20Activities%20-%20all%20 journalist Karolyn A. Gazella present in-depth discussions
-%201%206%2009.jpg. Accessed August 4, 2010. of twenty specific cancers, how to incorporate natural
7. No authors listed. HSA Market Report Q4-2008. Available at: www.crnstone.com/news-
letters/HSA%20Market%20Report%20Q4-canopy08.pdf. Accessed August 20, 2010. therapies, empowering stories from cancer patients
8. United States Government Accountability Office. Report to the Ranking Minority and much more!
Member, Committee on Finance, U.S. Senate: Consumer-Directed Health Plans; Early
Enrollee Experiences with Health Savings Accounts and Eligible Health Plans. GAO 06
798. August 2006. Available at: http://www.gao.gov/new.items/d06798.pdf.
Accessed August 20, 2010.
9. No authors listed. Average health savings account balances show modest declines in
wake of U.S. financial crisis, according to Canopy’s Q3. Reuters. January 26, 2009.
Available at: http://www.reuters.com/article/pressRelease/idUS135540+26-Jan-
2009+MW20090126. Accessed August 4, 2010. To order this and other great health books, visit
naturalsolutionsmag.com/go/shop or call
800-841-2665 or visit your local bookseller.

Distributed by
CELESTIAL ARTS/TEN SPEED PRESS

Bolles—Integrative Medicine in the Marketplace Integrative Medicine • Vol. 9, No. 5 • Oct/Nov 2010 25