The dictionary definition is a choice between mutually exclusive possibilities. Jack Raso, R.D., who edits Nutrition Forum newsletter, has catalogued nearly a thousand of these. The best way to minimize confusion is to classify alternatives as genuine, experimental, or questionable. Whether some approaches are valid depends not only on their methods but how they are used and what claims are made for them. Spinal manipulation, for example, can be useful in properly selected cases of low-back pain.
Relaxation techniques have a limited but acceptable role in the treatment of anxiety states.
The program that Dean Ornish, M.D., developed for people with coronary heart disease illustrates how this selection process should work. This program is novel because its dietary fat level is half the lowest level the American Heart Association recommends for people unresponsive to less stringent cholesterol-control measures. His work is sufficiently promising that Mutual of Omaha is testing whether his approach is an economical alternative to bypass surgery or angioplasty in carefully selected patients. Coverage can also be dictated by state or federal laws. A few require coverage for acupuncture, and the state of Washington recently ordered inclusion of naturopathy and massage therapy as well.