- The Washington Times - Tuesday, September 17, 2002

When Dr. Arthur Kleinman, a psychiatrist and anthropologist, went to medical school in the 1960s, future doctors were taught zilch about alternative and complementary medicine. In fact, not even the importance of good nutrition was taught.

"Everything was downplayed then not only alternative therapies, but also nutrition and vitamins," says Dr. Kleinman, a professor of social anthropology at Harvard University. "Now, I don't think you can find a major pain clinic that doesn't provide acupuncture."

The pendulum certainly has swung when it comes to alternative therapies. Not only have medical schools incorporated certain alternative and complementary therapies into their curricula, but the public spends tens of billions of dollars each year in search of treatments and cures.

"I think there is a kind of cynicism and disbelief in conventional medicine," Dr. Kleinman says. "At the same time, people think alternative therapies won't hurt them."

Dr. Kleinman is one of several speakers at a lecture series on alternative and complementary medicine at the National Center for Complementary and Alternative Medicine. He will speak at noon Nov. 7 in the Lipsett Amphitheater, Building 10, 9000 Rockville Pike in Bethesda, home of the National Institutes of Health Clinical Center.

His lecture is titled "The Global Transformation of Health Care: Cultural and Ethical Challenges to Medicine."

Alternative therapies are those used "instead" of conventional medicine (such as when a cancer patient chooses to eat certain foods instead of undergoing radiation therapy to become healthier), while complementary therapy is used "in addition to" conventional therapy, such as when a person with arthritis pain uses acupuncture in addition to painkillers.

Sometimes people report good outcomes when using alternative and complementary therapies, sometimes bad ones. Because these therapies are considered supplements not medications in the conventional sense they are not covered by regulations. Many of them are readily available at health-food stores and can be bought without a prescription.

"They are regulated as foods which gives people a real opportunity to make decisions about their health care," says Dr. Stephen E. Straus, director of the National Center for Complementary and Alternative Medicine.

"The challenge is that we're not always armed with information to make the good choices," Dr. Straus says.

Sometimes people pay a price for the freedom to choose among the many herbs and other supplements on the market, he says.

In the 1970s, laetrile, a cyanide-containing extract from apricot pits, was touted as beneficial in treating cancer.

"There was a huge clamor for it. Americans were trying by the thousands to get it," Dr. Straus says. By 1978, more than 70,000 Americans were reported to have been treated with laetrile.

Once studies were done on the substance, however, it turned out that side effects included liver damage and difficulty walking because of damaged nerves. As a result of the findings, sales of laetrile fell dramatically.

Another alternative or complementary medicine that can have adverse side effects is St. John's Wort, touted as having anti-depressant properties. However, it also may lessen the positive effects of other conventional medications, such as oral contraception, when used alongside these conventional medications.

Women who take birth-control pills and St. John's Wort at the same time have an increased chance of becoming pregnant compared with women who take oral contraception alone.

Kava, an herb that has been used for insomnia, stress and anxiety, has been linked to liver damage.

And the list goes on.

"There is no such thing as a free lunch. Some of these natural products are not safe. Some are even contaminated," Dr. Straus says.

So why do so many Americans embrace alternative and complementary medicine when research is still limited and several negative side effects are known?

"Americans have this idea that Chinese medicines are mild and soft, but there are plenty of herbs [used in Chinese medicine] that are very powerful," Dr. Kleinman says.

One example is ephedrine, which contains amphetaminelike chemicals and is an ingredient in several diet products.

"I don't think it's just the absence of research," Dr. Kleinman says. "It feeds into this ethos, this idea of Western spiritism and mind/body holism in combination with Eastern religion We don't think these products can hurt us."

Also, many Americans are skeptical of doctors, especially since managed care entered the picture, Dr. Kleinman says. This skepticism benefits manufacturers of alternative medicines, he says.

"People think doctors are more loyal to the managed care companies than they are to their patients," he says.

Another reason that alternative and complementary therapies are popular is a wish to self-medicate and avoid the doctor's office altogether, Dr. Kleinman says.

"Most health matters don't ever reach the doctor's office," he says. "We treat ourselves through sleep, diet and exercise."

Some alternative therapies are beneficial, but it is important for the consumer to be as well-informed as possible, Dr. Straus says.

Good ways to become informed are to contact government agencies such as the U.S. Food and Drug Administration and the National Center for Complementary and Alternative Medicine as well asking one's own primary care doctor about alternative and complementary therapies.

There are times when a consumer may be duped even after trying his or her best to obtain knowledge about a certain treatment. Sometimes the products are mislabeled or contaminated.

"It may say American ginseng, and it may not be," Dr. Straus says.

The Federal Trade Commission may be a good place to check for possible consumer complaints about products.

"There are downsides to using alternative and complementary medicines," Dr. Straus says. "You might be choosing that instead of something that we know works."

Along with the bad news on such alternative therapies as St. John's Wort, there is good news, too, about alternative and complementary medicines.

"Areas that are encouraging include acupuncture in the treatment of certain kinds of pain," Dr. Straus says. "And glucosamine for arthritis pain."

These are therapies on which the National Center for Complementary and Alternative Medicine is conducting studies. However, there are thousands of herbs in supplements that can't and won't be studied.

"It's impossible to test everything," Dr. Straus says. "We have to prioritize."

The National Center for Complementary and Alternative Medicine is studying how a placebo works, which will help clarify the relationship between physical well-being and emotional and mental attitude.

"We want to find out how our beliefs and expectations affect our outcomes." Dr. Straus says. "We may think that our mind is limited in its ways of affecting our body," Dr. Straus says, "but it's possible that the mind can make a difference."

Popular interest in alternative and complementary medicine is bound to continue, both Dr. Straus and Dr. Kleinman say. People simply won't give up until they're 100 percent healthy, whatever that means.

"Our health is so much better than ever before in history," Dr. Straus says. "We have come to expect that all our children will survive and grow up and live productive lives That's a lot."

And yet, we're not satisfied.

"People want that last bit," Dr. Straus says. "We can afford to go out and search for the last increment and won't give up until we achieve optimal health."

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