Pubdate: Sun, 28 Nov 1999 Source: Newsday (NY) Page: A05 Copyright: 1999, Newsday Inc. Contact: (516)843-2986 Website: http://www.newsday.com/ Author: Ridgely Ochs. Staff Writer MAP: Editor's note. While I would normally consider an article on our legal herbs off topic, this one is posted for what it does not mention. A good in depth article, but not a word about the popular herb used as medicine for which sick folks go to jail. A CAPSULE A DAY... We're Usine More Herbs, Vitamins - But Not Telling Docs Half of Queens residents use some form of alternative medicine, a rate higher than seen nationally, and many have not told their doctors, a practice some experts say may put them at risk. These are the central findings of a Newsday-Hofstra University poll that also determined that most people use alternative therapy as preventive medicine, not to cure a chronic ailment, and that herbs are the most popular treatment used in Queens, a finding that differs from national studies. And the percentage may, in fact, be even higher, experts suggest. With the borough's extraordinary ethnic diversity comes "a lot of folklore and traditions, and there are people doing all kinds of things under the guise of medical cures-so many I couldn't even estimate," said Dr. Jeffrey Cole, chairman of the department of physical medicine and rehabilitation at The New York Hospital Medical Center of Queens in Flushing. Many may not even consider these to be "alternative" therapies, Cole and other experts said. Sheila Kushnick 62, of Flushing is typical of many of the 600 borough residents polled who say they use alternative medicines to stay healthy. Kushnick says she will take echinacea when she feels a cold coming on. Her husband, meanwhile, takes saw palmetto for an enlarged prostate as well as vitamin E, vitamin C, selenium and a multivitamin because "he's been having a little problem with his memory." But she said neither has told their doctor. Although she said she "could use a little more information ... I've heard a lot of bad raps about herbal medication and I don't think it's true. Everything has to be done in moderation." Like Kushnick, more than one-half who use herbal medicine said their doctor did not know they use herbs, and half said they had not done any research before they began using them, the poll found. About the same percentage said they began using herbs based on recommendations from family and friends. The finding was similar for those taking megavitamins. In the Newsday poll, 3 in 10 herb and/or megavitamin users said they did not know whether their herbs or vitamins could interact unfavorably with other medicines. Those who had informed their doctor of what they are taking are twice as likely to be aware of potential interactions. The fact that so many people don't tell their doctors what they're taking-and doctors don't ask-mean that doctors are often left not knowing why a patient may be having a problem or is feeling better. Nor do they know whether a drug they are prescribing might interact with the patient's herbs and supplements, a key issue, some experts say. The New York State Society of Anesthesiologists, for instance, said its members are reporting "significant changes in heart rate or blood pressure in some patients who have been taking herbal medications." They warn that patients need to tell their doctors everything they are taking to ensure there are no interactions with the anesthesia. Dr. Carole Agin, an anesthesiologist and director of Long Island Pain Management at John T. Mather Memorial Hospital and St. Charles Hospital and Rehabilitation Center in Port Jefferson, said she is seeing more and more patients "on a tremendous amount of herbs. It's almost scary." And "around the coffee pot," she said, doctors are sharing stories of patients coming into the operating room with erratic blood pressure and excessive bleeding problems that they suspect-but don't know-are caused by supplements. Not only are there concerns about potentially blood-thinning herbs, but there are also worries about psychotherapeutic herbs. St. John's wort can potentially intensify or prolong the effect of narcotics or anesthesia. Indeed, Dr. Brian Hainline, chief of neurology at ProHealth Care Associates in Lake Success, said he had two patients on anti-depressants who became manic: they were also on high doses of St. John's wort, he later discovered. Additionally, experts point out that some laxative herbs, such as senna, can interfere with the body's ability to absorb other drugs or food. But many also point out that most herbs appear to be fairly benign and that the potential for dangerous reactions or interactions seems to remain just that: potential. Dr. Richard Stein, a spokesman for the American Heart Association, called the issue "a worrisome possibility" and Dr. Jerry Cott, a psycho-pharmacologist at the National Institute of Mental Health, said it was "a potential rather than a real problem." Dr. Adriane Fugh-Berman of the George Washington University School of Medicine and Health Sciences in Washington, D.C., recently co-authored an article in the journal Psychosomatic Medicine looking at use of herbs and supplements in treating psychiatric disorders. She agrees "there's not an epidemic of people falling over in the streets, although," she adds, "there are some well-documented interactions you need to be aware of." While the issue of potential side effects and drug interactions is key, according to most experts, Newsday's poll also uncovered ways in which Queens mirrors or may even slightly exceed what is going on nationally with alternative medicine: About 50 percent of Queens residents use some form of alternative therapy. Twenty-eight percent use two or more therapies. This is slightly higher than findings from two national telephone polls done at Harvard Medical School, which are cited as landmark studies on alternative medicine use and served as the model for Newsday's poll. In the most recent Harvard study, published last November, 42 percent used one of 16 alternative therapies surveyed. Moreover, experts point out that a telephone poll done in an ethnically and economically diverse area such as Queens is likely to underestimate actual usage: People without phones would not be surveyed; some surveyed who were not native-born English speakers might feel uncomfortable answering questions (although Spanish-speaking pollsters were available); or cultural differences in what is considered "alternative" medicine might make some discount non-mainstream therapies they grew up with. Herbal medicine is the most popular alternative treatment: About 38 percent of those who use alternative medicine say they have used herbs in the past year. After herbal medicine, relaxation techniques (such as meditation), megavitamins (defined as taking more than a daily multiple vitamin), massage therapy, chiropractic care and spiritual healing by others (prayer) were most popular. By contrast, the most recent Harvard poll found a huge increase in herbal medicine use, but it was not the most widely used alternative treatment. Queens also mirrors national trends. For instance: As with the rest of the country, alternative medicine appears to be a growing phenomenon in Queens. Although there is a sizable percentage who have been using some alternative treatments for 10 years or more, many surveyed are fairly recent users. More than half of herb users and megavitamin users began using them within the past five years. Seventy-eight percent of those using energy healing, such as magnets, have been using them 2 years or less; almost half of those using hypnosis have used it less than a year. The use of alternative therapies cuts across economic, racial, gender and age lines with few exceptions: Those in the workforce are more likely to use alternative medicines than are those who are unemployed; those 55 and older are less likely to use alternative therapies than younger ones. African-Americans are slightly more likely to use an alternative therapy, although they use fewer methods on average than whites, and Hispanics are somewhat less likely to use alternative medicine than whites. There's no difference in usage rates between men and women. Queens residents use most alternative treatments (except for chiropractic, acupuncture, commercial diets, biofeedback and self-help groups) to stay healthy. The number of annual visits to doctors is about the same among those who use one or two alternative therapies as among those who use none. Those who use three or more therapies make far more visits to the doctor. Although 76 percent of Queens residents rated their health as good to excellent, Dr. Lawrence Scherr, chief medical officer and chief academic officer for the North Shore-Long Island Jewish Health System, said he was not surprised by the percentage using some form of alternative medicine. "I don't think it relates to having smarter or dumber doctors. I don't think it relates to biases against conventional medicine. I think we're dealing with a population that is a lot more sophisticated and concerned over maintaining their health," Scherr said. "... I think we're dealing with a select population ... I want to be better; I want to be healthier.' I don't see it as a wholesale rejection or migration away from mainstream medicine." The poll supports Scherr's contention that Queens residents are using alternative treatments as a kind of health insurance. Except for chiropractic, acupuncture, commercial diets, biofeedback and self-help groups-used to treat specific conditions like back pain or weight problems-most people use most alternative therapies to prevent illness or stay healthy. More than 60 percent of herb users and close to 90 percent of megavitamin users, for instance, say they use them for that reason. Yet while there doesn't appear to be a "wholesale rejection" of mainstream medicine, many interviewed conveyed an underlying frustration with or ambivalence about their doctors-which may be in part fueling the recent boom in use of alternative medicine mirrored in the rest of the country. For 10 of the 16 therapies surveyed, half of the users have been using the therapies 5 years or less. Although the poll showed 57 percent considered doctors the most reliable source of health information (followed by 17 percent who cited other health professionals) many interviewed depicted doctors as not supportive or not aware of other approaches. Claude Lewis, 45, of Jamaica said he suffered back problems as a result of a job-related accident-he's a bus driver-but the conventional treatments offered by his doctor didn't help. "These guys hand out muscle relaxants and painkillers but they don't help the pain enough," said Lewis. "I took them for a couple days but I really don't like taking drugs, so I thought I would try something else." Since then, he's been going two times a week on and off for the past year to a chiropractor and "it seems to help." He's also willing to consider other alternative approaches-he's been thinking about trying hypnosis, he said-anything noninvasive or not harsh. "I think the doctors are in league with the pharmaceutical companies and they also do operations that are unnecessary. I want to try a gentler approach," he said. Like Lewis, John Pullows, 21, a student and freelance stagehand who lives in Flushing, said he almost has a "fear or phobia of prescription drugs," preferring instead a "holistic approach" that stresses mind-body treatments. Calling himself a "struggling Buddhist," Pullows says he meditates every day and will occasionally use echinacea and goldenseal to fight off a cold, or ginseng when he needs a tonic. When he's deeply into his martial arts training, Pullows will also "sporadically" use sports supplements, such as DHEA precursors, supplements that turn into or boost production of the so-called anti-aging hormone DHEA. Like other Queens residents interviewed, who are saturated by the media and close to major medical institutions, both Pullows and Lewis consider themselves fairly savvy and will read about or research other treatments. Yet about half of those polled said they get much of their initial information about various alternative treatments from friends and relatives, not from their doctors. Interestingly, only 7 percent of all those polled in Queens said they used the Internet to seek information about their health. While both said the doctor was aware of their alternative approaches, it was clear the doctor's approval was not necessary. Speaking of his parents, Pullows said, "they go to a mainstream doctor and they seek the approval of society-not the approval of whether it works for them." Others appear to have some regard for their doctors but still don't tell them what other approaches they are using. John Chin, 49, of Flushing, said he is "comfortable with western medications" but he or other family members will occasionally take the Chinese herbs and teas his mother, from mainland China, gives the family "for maintenance of health." He and his wife also regularly go to a chiropractor. He has told his doctor about neither, he said. This apparent disconnect between what people are doing for their health and what they feel comfortable telling their doctors is abundantly apparent in the poll. For eight of the 16 treatments surveyed, less than half had told their doctors they were using the treatment. Among those using herbs, 55 percent had not told their doctors and among those using megavitamins 34 percent said their doctors were not aware. Yet the majority of herb and vitamin users in the poll said their herbs and vitamins helped: About 58 percent said their herbs and vitamins helped somewhat; about 23 percent said they helped more than anything else they had tried. The fact that doctors are apparently so often unaware of what their patients are taking "worries me greatly," said Cole, who works with an acupuncturist also knowledgeable about herbs and has been doing his own study on the use of magnets for back pain. Why don't people tell their doctors? Dr. Shibani Ray-Mazumder, head of research at the State University at Stony Brook's Center for Complementary/Alternative Medicine, said people may not think their "alternative" treatment is so alternative and thus not worth mentioning. Or, rushed in their 15-minute visit with their conventional doctor, they discuss only specific physical symptoms and don't think to bring other aspects associated with their well-being into the exam room. "The focus of conventional medicine has been on the illness and not on the patient, so they leave the rest outside the door"-an occurrence she has often seen in her work with cancer patients, she said. And, she said, often people "will not mention certain things because they don't think they are going to be validated." At least in somes cases, according to interviews, Mazumder is right. Kushnick said she had not told her doctor she and her husband were taking some herbs and supplements. "I don't think he would approve of it," she said. The fact that people believe a doctor will not be supportive explains some of the "schism" in medicine today, said Dr. Samuel Benjamin, director of Stony Brook's Complementary/Alternative Medicine Center. "We have divorced ourselves from understanding our role as servants of the society. I'm not implying that our expertise is not cherished but maybe it needs to be tempered somewhat," Benjamin said. And, he said, from a public health perspective, researchers and health policy makers should be looking at how people like Lewis or Kushnick might be saving money by not resorting to expensive prescription drugs. Benjamin said he was "delighted" by the poll findings that indicated Queens residents are not spending large amounts of money out of pocket for their alternative therapies. Most people spend $60 or less a month out of pocket on the five most expensive treatments: lifestyle diet (such as macrobiotics or vegetarianism), massage therapy, commercial diet (such as Weight Watchers), homeopathy, megavitamins and herbs. The typical megavitamin user and typical herb user each spends $20 a month. People said they paid no money for nine of the 16 alternative therapies surveyed. About three-quarters of those using chiropractic say it is covered by health insurance; half of those using a chiropractor say they spent nothing out of pocket for it. Ravi Chandnani, 36, of Bellerose, who works in advertising, thinks many doctors are opposed to alternative medicine because they "don't want to rock the boat. That's why I pay attention to it-when you see any new phenomenon that has changed the way things are done, it rocked the boat and it went against the grain." Chandnani grew up in an Indian-American household that regularly practiced transcendental meditation. He said he knows little about traditional Indian Ayurvedic medicine but "I would consider it if I thought it would help." And he said he was about to start the high-protein, low carbohydrate Atkins diet. Stella Wilson, 64, of College Point, a retired registered nurse, echoed some of what Chandnani said. Although careful to research anything she takes-she says she will take echinacea and megadoses of vitamin C when she feels she is coming down with a cold and has tried St. John's wort-she said she is open to other ways of healing. In her youth, Wilson said she found the use of imagery helpful "for de-stressing." And in the 1980s, she said, she visited China, where she watched people being successfully treated by acupuncture for asthma in the smoggy cities of Beijing and Hong Kong. Her own doctor, Wilson said, was open to using alternative therapies. But her fellow nurses, she found, were typically more open than many other mainstream doctors she encountered. Not surprisingly, those with chronic problems not easily cured by mainstream medicines appear more willing to try a variety of alternative treatments. For three of the five treatments people used primarily to cure an ailment-chiropractic, acupuncture and biofeedback-back pain is the most often cited ailment. Florinda Archie, 31, a security guard from Far Rockaway, has scoliosis-curvature of the spine-and a related muscle disorder in her neck and back which keeps her in constant pain. Instead of taking prescription medications which left her drowsy and which she feared might be addictive, Archie has been seeing an Orthodox Jewish herbalist who has given her valerian tea to help her sleep and reduce anxiety. He has also given her a megavitamin designed to help build bone and muscle. She meditates and is looking into trying acupuncture and aromatherapy, as well as taking a stress management class. Her neurologist and orthopedic doctor are aware she is seeing the herbalist and don't object, she said. Although experts interviewed said most alternative treatments are fairly benign, many worry that some people will go overboard and lethally mix herbs and drugs or herbs and herbs. Indeed, a former heroin addict now on methadone who has chronic hepatitis C says she spends "a good $100 to $150" a month on a slew of herbs, including a weight loss supplement of "all-natural herbs" that she says increases her metabolism and acts as a diuretic. Her herbs appear to interfere at times with her methadone and she gets the sweats, she said, which she simply ignores. Yet she says that as a former addict she is more afraid of prescription drugs her doctors want to give her, which she said "can kill you worse." On the other hand, a young woman from Queens Village who battles manic depression said she is very careful about what herbs she takes, limiting herself to ginseng and camomile tea, for fear of interfering with her medications. She-like many interviewed-said she wanted to see more studies done on herbs and megavitamins. Benjamin says that while there are far too many people who take herbs and vitamins willy-nilly, most people are sensible-just as most are sensible about taking potentially dangerous over-the-counter medications. Yet, unlike over-the-counter medications, most herbs and vitamins, which are not classifed as drugs, have few warning labels and little information about proper dosage. Scherr also worried that if people rely too much on self-medication and avoid the doctor, serious illnesses may go undiagnosed. "We don't want to be lulled into a false sense of security, because we know that early detection is one of the best forms of ensuring a cure," he said. Regardless, all experts agreed that alternative medicine plays and will continue to play a real role in health care in Queens. "I don't believe it's going away," said Benjamin. "It's not like the Hula Hoop." - --- MAP posted-by: Richard Lake