Pubdate: Wed, 02 Jun 1999 Source: San Diego Union Tribune (CA) Copyright: 1999 Union-Tribune Publishing Co. Contact: http://www.uniontrib.com/ Forum: http://www.uniontrib.com/cgi-bin/WebX ALTERNATIVE MEDICINE, SAFE OR NOT, LURES MORE PEOPLE In a time when mainstream medicine often stands accused of greed, indifference and worse, more and more Americans are putting their faith and health in alternative forms of health care. * In Idaho, for example, people flock to a nonmedical doctor selling a topical lotion alleged to alleviate everything from pain to paralysis. * In Orange County, an orthopedic surgeon exposes patients to electromagnetic beams, contending they help regenerate tissue, melt away scars and cause "dysfunctional limbs to recover function." * And everywhere -- from supermarkets to the Internet -- pills, potions, therapies and lotions are being marketed as remedies, if not cures, for virtually all that ails us. In 1997, more than 40 percent of the adult population in the United States used some form of alternative medicine, spending $21 billion, more than half of that out of pocket. What to do -- or not do -- about the surging popularity of these forms of so-called alternative medicine has become a sort of chronic conundrum for conventional medical doctors and government regulators. Next week, for example, the federal Food and Drug Administration will hold the first of two public hearings on establishing new regulations governing dietary supplements, a comparatively free-wheeling industry whose sales exceed $7 billion annually. "We're looking at new limits on dosages, the labeling of side effects, what is an allowable claim," said an FDA spokeswoman who asked not to be identified. "This is a priority for this year. I can't tell you when exactly we'll have new law, but it's definitely not on the back burner." The FDA has tried before to regulate dietary supplements, but these efforts have largely failed, leading in fact to Congress voting in 1994 to weaken the FDA's ability to control dietary supplements. It is difficult to say what will happen at the FDA's June 8 hearing in Washington, D.C. The FDA representative said the agency believes the dietary supplement industry as a whole will be cooperative, but some industry representatives say they are wary, fearful that the FDA's idea of appropriate regulation will prove unreasonable and overreaching. The science of safety Much of the debate, of course, will revolve around a couple of questions fundamental to any discussion of alternative medical practice: Is it safe? Does it work? For most of this century, medical science has been highlighted by astounding progress. Doctors have learned how to treat and cure a wide range of medical conditions and diseases. What's left, though, seems harder to cure. The frustration of that reality, combined with broad disenchantment over the state of America's health care system, prompts millions of Americans to seek alternative forms of medicine, many of which tout their "natural" origins. But "natural" doesn't necessarily mean "safe," says William Jarvis, founder of the National Council for Reliable Health Information, a watchdog group. "I think the American people are in the dark about this. People assume all of this alternative stuff must be safe because it's out there, that the government or somebody is guarding their interests. But the fact is, we've largely abandoned the idea of broad-based social protections for health and medicine. "Predatory commercial interests now rule. It's buyer beware. If you get hurt by a quack remedy now, it rips you off or causes medical harm, there's very little chance of legal redress because current law says you should've known better." Critics of alternative medicine complain that it is largely unproven, at least by Western scientific standards. "What most sets alternative medicine apart," write Dr. Marcia Angell and Dr. Jerome P. Kassirer in a 1998 editorial in The New England Journal of Medicine, "is that it has not been scientifically tested and its advocates largely deny the need for such testing." To be sure, many conventional medical treatments have not been rigorously tested either, but Angell and Kassirer note that the scientific community recognizes this as something that needs to be addressed. "Many advocates of alternative medicine, in contrast, believe the scientific method is simply not applicable to their remedies. They rely instead on anecdotes and theories." Of course, some alternative medical therapies have been rigorously tested. The millennia-old practice of acupuncture, for example, has been shown in various studies to be therapeutic for behavior modification, addiction and relieving some kinds of pain. Likewise, certain herbal medicines have been proven beneficial. The herbs echinacea and ginkgo biloba, for example, have been shown to improve resistance to respiratory infections and blood flow to the brain, respectively. But full-fledged clinical studies of herbal medicines and other forms of alternative therapy are relatively scarce. The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, has awarded approximately 30 research grants to study alternative medical therapies in the last seven years. Twenty-eight of these studies have resulted in "final reports," but only nine have produced peer-reviewed, published papers -- and five of the nine appeared in two very obscure journals. Untested miracles Without substantial clinical trials or scientifically sound research, skeptics say, there is no way to know with any certainty whether a therapy or medicine is safe, and whether it works as its advocates say or believe. Take magnet therapy. A few reputable studies have shown that exposure to powerful, pulsating electromagnets can spur healing in damaged bone. The problem is that some proponents claim far more expansive achievement, often with little or no scientific substantiation. Dr. David Stokesbary is an orthopedic surgeon who also operates a clinic in Laguna Niguel using electromagnets to allegedly regenerate damaged tissue, eliminate scars and restore function to disabled limbs. Despite his conventional medical training at Stanford University and the University of Southern California, Stokesbary says he is not unduly bothered by the lack of scientific evidence to support his work or, in fact, most forms of alternative medicine. "It takes a lot of money to do research," he said, "and it's often very hard to do. You'll find in alternative medicine that some of us have great faith in results, not process. We don't care how you (the patient) got there as long as you got better. It's very difficult to prove the pathway through which some of these medical miracles occur." The level of government oversight in areas of alternative medicine is surprisingly limited. "You have more protection from economic scams than you do from nutritional scams," said Dr. John Renner, head of the Consumer Health Information Research Institute. "Lie to the Securities and Exchange Commission and you go to prison. Lie to the public and there's rarely any penalty at all." Consider again those rows of herb-based pills and potions sold almost everywhere. Many of these products -- goldenseal, cat's claw, astragalus, dong quai and grape seed extract, to name five of the most popular kinds -- have never been subjected to controlled clinical study. No government health agency monitors their production, quality or marketing. That's because in 1994, at the behest of the dietary supplement industry, Congress exempted these products from FDA regulation, declaring them to be foods rather than drugs. Since then, so-called dietary supplements have flooded the market, "subject only to the scruples of their manufacturers," said Angell and Kassirer in The New England Journal of Medicine. Dietary supplement companies are still prohibited from claiming that a product can treat or cure a specific disease. The result, said Jarvis of the Reliable Health Information group, has been an ongoing game of deceptive wordplay. "For example, it's illegal to claim something can cure arthritis, but it's OK to say it's a `bone and joint rebuilder.' People equate one with the other. They buy the stuff thinking it will help with their arthritis, even if there's no scientific proof." As difficult as regulating dietary supplements might be, it pales compared to the freewheeling market of alternative medicine on the Internet. Here, alternative treatments, remedies and cures are touted with virtual abandon, protected by the relative anonymity and ever- changing nature of the medium. Example: A recent one-day survey of the Internet by health authorities in the United States and Canada turned up more than 400 Web sites marketing suspect medical treatments and products. "The Internet is extolled as the `information highway,' " said Renner, "but just as in the days of stagecoaches, the road seems to be plagued by highwaymen who are out to rob passengers. Even worse may be the harm done by well-meaning people who spread the word about the latest health fad that they have tried with imagined success." Beyond the fringe? Alternative medicine isn't so alternative anymore. Percentage of American adults who used an alternative therapy: 1990 -- 33.8 percent 1997 -- 42.1 percent Estimated visits to alternative medicine practioners: 1990: 427,120,000 1997: 628,825,000 Estimated visits to primary care physicians: 1990: 387,558,000 1997: 385,918,000 Therapies increasing most: * Herbal medicine * Massage * Megavitamins * Self-help groups * Folk remedies * Energy healing * Homeopathy Conditions most often treated: * Back and neck problems * Allergies * Fatigue * Headaches * High blood pressure * Sprains or strains * Insomnia Did you know...? * 39.8 percent of patients inform their physicians that they are pursuing alternative therapies as well * In 1969, there were 15 massage schools. Last year, there were 800. * Estimated $21.2 billion spent on alternative medical services, up 45 percent from 1990, with at least $12.2 billion paid out of pocket. This exceeds the 1997 out-of-pocket expenditures for all hospitalizations in U.S. Top-selling herbs in 1997 (in millions of dollars) Echinacea $310 Ginseng $270 Ginkgo biloba $240 Garlic $200 St. John's wort $200 Goldenseal $160 Saw palmetto $130 - --- MAP posted-by: Derek Rea