David Spiegel showed higher rates of cancer survival for group members. And Dr. Dean Ornish's continuing program for treating heart disease makes extensive use of self-help groups, with surprising results. Over time I began to realize that group support was itself one of the most powerful interventions. It would appear that self-help groups and the health system would be a natural fit. Hand in hand with the proliferation of self-help groups for illness is a veritable revolution in self care.
Studies showing that self-help groups lessen demand on the health system are still in the works.
Despite the promise, successful collaborations between the formal health delivery system and the informal world of self-help members and organizations have been few and far between. There are exceptions, the Puget Sound HMO in Seattle for example, but by and large hospitals and managed care organizations are not aware of the variety of groups available to their patients, do not manage referrals, and are not abreast of the literature on the effectiveness and cost-effectiveness of groups. HMOs may also fear liability for the advice given from one patient to another in a mutual aid setting. And where self-help and formal health care overlap, there has been friction as often as cooperation. When you asked them a question you never got a straight answer.