AP IMPACT: Alternative medicine goes mainstream
BALTIMORE
– At one of the nation's top trauma hospitals, a nurse circles a
patient's bed, humming and waving her arms as if shooing
evil spirits. Another woman rubs a quartz bowl with a wand, making
tunes that mix with the beeping monitors and hissing respirator
keeping the man alive.
They are doing
Reiki
therapy, which claims to heal through invisible energy fields. The
anesthesia chief, Dr. Richard Dutton, calls it
"mystical mumbo jumbo." Still, he's a fan.
"It's self-hypnosis" that can help patients relax, he said. "If you
tell yourself you have less pain, you actually do have less pain."
Alternative
medicine has become mainstream. It is finding wider
acceptance by doctors, insurers and hospitals like the
shock trauma
center at the
University of Maryland Medical Center.
Consumer spending on it in some cases rivals that of
traditional health care.
People turn to unconventional therapies and
herbal remedies for everything from
hot flashes and trouble sleeping to cancer and heart
disease. They crave more "care" in their health care. They
distrust drug companies and the government. They want natural, safer remedies.
But often, that is not what they get. Government actions
and powerful interest groups have left consumers vulnerable to
flawed products
and misleading marketing.
Dietary supplements do not have to be proved safe or
effective before they can be sold. Some contain natural things you
might not want,
such as lead and arsenic. Some interfere with other things you
may be taking, such as
birth control pills.
"Herbals are medicines," with good and bad effects, said
Bruce Silverglade of the
consumer group
Center for Science in the Public
Interest.
Contrary to their little-guy image, many of these
products are made by big businesses. Ingredients and their
countries of origin are a
mystery to consumers. They are marketed in ways that manipulate
emotions, just like ads for hot cars and cool clothes. Some make
claims that average people can't parse as proof of effectiveness or
blather, like "restores cell-to-cell communication."
Even therapies that may help certain conditions, such as
acupuncture, are being touted for uses beyond their
evidence.
An Associated Press review of dozens of studies and
interviews with more than 100 sources found an underground medical system
operating in plain sight, with a different standard than the rest
of medical care, and millions of people using it on blind faith.
How did things get this way?
Fifteen years ago, Congress decided to allow dietary and
herbal supplements to be sold without
federal Food and Drug Administration
approval. The number of products soared, from about
4,000 then to well over 40,000 now.
Ten years ago, Congress created a new federal agency to
study supplements and unconventional therapies. But more than $2.5 billion of
tax-financed research has not found any cures or major
treatment advances, aside from certain uses for acupuncture and ginger for
chemotherapy-related nausea. If anything, evidence has mounted
that many of these pills and therapies lack value.
Yet they are finding ever-wider use:
_Big hospitals and clinics increasingly offer alternative
therapies. Many just offer
stress reducers
like meditation,
yoga and massage. But
some offer treatments with little or no scientific basis, to
patients who are emotionally vulnerable and gravely ill. The Baltimore hospital, for
example, is not charging for
Reiki but
wants to if it can be shown to help. Other hospitals earn fees
from treatments such as acupuncture,
which insurance does not always cover if
the purpose is not sufficiently proven. The giant HMO Kaiser Permanente
pays for members to
go to a Portland, Ore., doctor who prescribes ayurvedics —
traditional herbal remedies from
India.
_Some medical schools are teaching future doctors about
alternative
medicine, sometimes with
federal grants.
The goal is educating them
about what patients are using so they can give
evidence-based, nonjudgmental care. But some schools have ties to
alternative medicine
practitioners and advocates. A
University of
Minnesota program lets students study nontraditional
healing methods at a center in
Hawaii
supported by a philanthropist fan of such care,
though students pay their own travel and
living expenses. A private foundation that wants
wider inclusion of
nontraditional methods sponsors fellowships for hands-on experience at the
University of Arizona's Program in
Integrative Medicine, headed by well-known advocate
Dr. Andrew Weil.
_Health
insurers are cutting deals to let
alternative
medicine providers market supplements and services directly
to members. At least one
insurer promotes these to members with a discount, perhaps
leaving an incorrect impression they are covered services and medically
sound. Some insurers steer patients to Internet sellers of
supplements, even though patients must pay for these out of pocket. There are
networks of alternative medicine providers that
contract with big employers, just like HMOs.
A few herbal supplements can directly threaten health. A
surprising number do not supply what their labels claim, contain potentially
harmful substances like lead, or are laced with hidden
versions of prescription drugs.
"In testing, one out of four supplements has a problem,"
said Dr. Tod Cooperman, president of
ConsumerLab.com,
an independent
company that rates such products.
Even when the ingredients aren't risky, spending money
for a product with no proven benefit is no small harm when the
economy is bad
and people can't afford health insurance or healthy food.
But sometimes the cost is far greater. Cancer patients
can lose their only chance of beating the disease by gambling on
unproven
treatments. People with
clogged arteries can suffer a heart attack. Children can be
harmed by unproven therapies forced on them by
parents who distrust conventional medicine.
Mainstream medicine and prescription drugs have problems,
too. Popular drugs such as the painkillers Vioxx and Bextra have been pulled
from the market after serious side effects emerged once they
were widely used by consumers. But at least there are regulatory systems,
guideline-setting groups and watchdog agencies helping
to keep traditional
medicine in line.
The safety net for
alternative
medicine is far flimsier.
The latest government survey shows the magnitude of risk:
More than a third of Americans use unconventional therapies, including
acupuncture,
homeopathy, chiropractic, and native or traditional healing
methods. These practitioners are largely self- policing, with their
own schools and accreditation groups. Some states
license certain types, like acupuncturists; others do not.
Tens of millions of Americans take dietary supplements —
vitamins, minerals and herbs, ranging from ginseng and selenium to
fish oil and
zinc, said Steven Mister, president of the Council for Responsible
Nutrition, an industry trade group.
"We bristle when people talk about us as if we're just
fringe," he said. Supplements are "an insurance policy" if someone
doesn't always
eat right, he said.
In fact, some are widely recommended by doctors —
prenatal vitamins for pregnant women, calcium for
older women at risk
of
osteoporosis,
and fish oil for some heart patients, for example. These uses are
generally thought to be safe, although independent testing
has found quality problems and occasional safety concerns with
specific products, such as too much or too little of a vitamin.
Some studies suggest that
vitamin
deficiencies can raise the risk of disease. But it is not
clear that taking supplements will fix that, and
research has found hints of harm, said Dr. Jeffrey White,
complementary and
alternative medicine chief at the
National Cancer Institute. A
doctor with a big interest in nutrition, he
sees the field as "an area of opportunity" that deserves serious
study.
So does Dr. Josephine Briggs, director of the
National Center for Complementary and Alternative Medicine,
the federal agency Congress
created a decade ago.
"Most patients are not treated very satisfactorily,"
Briggs said. "If we had highly effective, satisfactory
conventional treatment we probably
wouldn't have as much need for these other strategies and as much
public interest in them."
Even critics of
alternative
medicine providers understand their appeal.
"They give you a lot of time. They treat you like someone
special," said R. Barker Bausell, a
University of
Maryland biostatistician who
wrote "Snake Oil Science," a book about flawed
research in the field.
That is why Dr. Mitchell Gaynor, a cancer specialist at
the
Weill-Cornell Medical Center in New York, said he includes
nutrition testing
and counseling, meditation and
relaxation
techniques in his treatment, though not everyone would
agree with some of the things he
recommends.
"You do have people who will say 'chemotherapy is just
poison,'" said Gaynor, who tells them he doesn't agree. He'll say: "Cancer takes
decades to develop, so you're not going to be able to think
that all of a sudden you're going to change your diet or do meditation (and
cure it). You need to treat it medically. You can still
do things to make your diet better. You can still do meditation to reduce your stress."
Once their fears and feelings are acknowledged, most
patients "will do the right thing, do everything they can to save
their life," Gaynor
said.
Many people buy supplements to treat life's little
miseries — trouble falling asleep, menopausal
hot flashes,
memory lapses, the need to
lose weight, sexual problems.
The Dietary Supplement and Health Education Act of 1994
exempted such products from needing
FDA approval
or proof of safety or
effectiveness before they go on sale.
"That has resulted in consumers wasting billions of
dollars on products of either no or dubious benefit," said
Silverglade of the public
interest group.
Many hope that President Barack Obama's administration
will take a new look. In the meantime, some outlandish claims are drawing a
backlash. The industry has stepped up self-policing — the
Council for Responsible Nutrition hired a lawyer to work with the
Council of
Better Business Bureaus and file complaints against
problem sellers.
"We certainly don't think this is a huge problem in the
industry," Mister said, but he acknowledges occasionally seeing infomercials "that
promise the world."
"The outliers were making the public feel that this
entire industry was just snake oil and that there weren't any
legitimate products," said
Andrea Levine, ad division chief for the business bureaus.
The FDA
just issued its first guidelines for
good manufacturing
practices, aimed at improving supplement safety. Consumer groups say the
rules don't go far enough — for example, they don't set
limits on contaminants like lead and arsenic — but they do give the FDA more
leverage after problems come to light.
The
Federal Trade Commission is filing more complaints about
deceptive marketing. One of the largest settlements occurred last August
— $30 million from the makers of Airborne, a product marketed with
a folksy "invented by a teacher" slogan that claimed to ward off
germs spread through the air.
People need to keep a healthy skepticism about that
magical marketing term "natural," said Kathy Allen, a dietitian at
Moffitt Cancer
Center in Tampa, Fla.
The truth is, supplements lack proof of safety or
benefit. Asked to take a drug under those terms, "most of us would
say 'no,'" Allen said.
"When it says 'natural,' the perception is there is no harm.
And that is just not true."
Courtesy http://news.yahoo.com
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