Next Issue: Religion and Politics?

We know that this may be the most inflammatory issue that we have ever produced, between “alternative” medicine on the one hand and physician unions on the other. Our purpose is neither to upset nor to coddle you. We just want to keep you informed. Still, as they say, a little knowledge is a dangerous thing.

Our physician readers may be irked by what they may perceive as our endorsement of alternative medicine in the cover story. We don't promote it. Rather, Senior Editor Mike Dalzell points out that health plans have made the decision to cover some of these services, mostly for marketing reasons, and he describes the need to somehow integrate them with traditional Western medicine in a manner that is clinically defensible.

Likewise, we expect some health plan executives and physicians to be appalled by the inflammatory statements of Robert L. Weinmann, M.D., president of the Union of American Physicians and Dentists. Weinmann calls it as he sees it — and he doesn't like what he sees. He is merciless in attacking commercial insurance and managed care and even takes a swing at the American Medical Association.

Still, doctors and HMO executives are going to learn some things about the union movement that they didn't know. They're going to see possibilities that they hadn't seen before. Agree with Weinmann or not, he's sharp and not to be ignored.

Even our medical ethicist, John La Puma, M.D., independently weaved into his own piece some theses that appear elsewhere in the issue: He argues that failure to treat obesity (not just obesity-related disease) is “criminal,” while at the same time seeing a great and expanded role for managed care in “lifestyle” areas that sometimes include alternative therapies such as acupuncture, massage, and chiropractic.

Both unions and “alternative” medicine are issues because of faults in the system. Will they improve it or substitute their own faults?