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In this issue of To Your Health:

• A Prescription for Disaster
• Study Finds Limited Risk from Making Massage a Covered Insurance Benefit
• Answers to Your Massage Questions: Highlights From This Month's "Ask a Massage Therapist" Online Forum

A recent study has found that MDs often prescribe drugs for unproven and unapproved uses. A new analysis of prescription drug use has found that the number of prescriptions written for off-label use is even higher than a November 2003 study previously indicated. Published in the May 8 issue of the Archives of Internal Medicine, the analysis shows more than one in five prescriptions written in the U.S. - as many as 173 million each year - are for unapproved or unproven uses, and as many as one in seven drug prescriptions are written for reasons that have "little or no scientific support."

Off-label prescribing is the term for a drug prescribed for a use other than the drugs approved use on its FDA label. For example, a doctor might prescribe a drug approved by the FDA to treat one condition, such as cancer, for another condition, such as hypertension. Changing a drugs approved dosage or duration of treatment, or prescribing a drug approved by the FDA for adults and giving it to a child, are other examples of off-label prescribing.

Once a drug has received approval from the FDA to be marketed for the treatment of at least one specific ailment, it legally can be prescribed to treat other ailments. The FDA does not require drug manufacturers to obtain approval for all conditions for which a particular drug might have value. In addition, while medical doctors normally are required to obtain informed consent from their patients before providing prescribed treatments, no law in any state specifically requires a doctor to inform his or her patient a drug is being prescribed for off-label use.

Off-label prescriptions were most common among two classes of drugs: cardiac medications (such as antianginals, antiarrhythmatics and anticoagulants) and anticonvulsants. For both classes of drugs, 46 percent of all prescriptions for these drugs were considered off-label prescriptions. In terms of sheer numbers, the most off-label prescriptions were written for antimicrobials (35.5 million) and drugs for "psychiatric therapies" such as antidepressants, anxiolytics and antipsychotics (17 million). Combined, these two classes accounted for more than one third of all off-label prescriptions in the analysis.

For more information about the details of the study, the financial implications or other drugs tested, visit www.realcities.com/mld/krwashington/news/special_packages/riskyrx.

A recent study by William E. Lafferty, MD, et al., published in The American Journal of Managed Care, offers a glimpse into what the future health care landscape might look like, particularly in terms of CAM availability and affordability. The study, "Insurance Coverage and Subsequent Utilization of Complementary and Alternative Medicine Providers," used Washington state as the "laboratory" from which to determine what, if any, financial risks are involved when third-party payers decide to cover specific types of CAM providers. According to the study authors, "The number of people using covered CAM insurance benefits was substantial; the effect on insurance expenditures was modest."

The study analyzed three different health care plans with a total of 600,000 enrollees. According to the study, "Data for calendar year 2002 were included for all individuals 18 to 64 years of age who were continuously enrolled for 12 months in a single, private health insurance plan." Among the 600,000 enrollees, 13.7 percent made CAM claims. Of those, 2.4 percent were for massage. The study treated massage "like a rehabilitation benefit, with visit limits and primary care provider referral requirements."

According to the Washington study, "The use of CAM was greater among women and among persons 31 to 50 years of age." The Washington study also found that musculoskeletal pain was the most common condition attended to at a CAM visit, accounting for 92.7 percent of visits to massage therapists. Headaches and neurologic problems accounted for 8.7 percent of massage therapy visits. Median per-visit expenditures were $39 for CAM care versus nearly $75 for conventional outpatient care; total expenditures per enrollee were $2,589, of which $75 was spent on CAM. The study also found that "requiring a gatekeepers recommendation as opposed to self-referral may be the biggest disincentive to insurance-financed CAM use."

The authors suggest that "future studies should evaluate the trajectory of CAM expenditures and the role of CAM in the health care marketplace, especially whether CAM therapies actually substitute for more expensive conventional care. Only then can the total impact of CAM integration on health care utilization be measured. As the number of CAM providers and the visibility of CAM services increase, the pressure on third-party payers to cover these services grows."

Question: I have a lot of people that come to me with knee pain and most of them are 60 years old or older. I was wondering if when massaging them should I spend more time working the quads than working on the knee itself?

Answer: Its quite common for older folks to suffer with degenerative joint conditions such as osteoarthritis in their knees. Pay a fair amount of attention by working with the knee joint itself. The cartilage and joint capsule can be affected so work that maintains range of motion will be important. Drainage techniques can help a great deal. You are correct that the quadriceps muscles will need work too. Any muscles that cross an affected knee joint can be hypertonic. Facial work to IT Band may be necessary. Check hamstring muscles as they probably will be compensating.

Wendy Turpin, RMT
New Brunswick, Canada

Note: Information provided in this Q&A section is drawn from the "Ask a Massage Therapist" online forum, in which massage therapists field questions relative to the massage profession. Readers are encouraged to post their questions at www.massagetoday.com/ask/. Answers should not be misconstrued as a diagnosis, prognosis or treatment recommendation and do not in any way constitute the practice of massage therapy or any other health care profession. Readers should consult their own health care providers for medical advice.

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