As Western medical technology and knowledge grows, a funny transformation is taking place: More and more Americans are retreating from this high-tech world and seeking help from alternative therapies.
In fact, according to a 1993 survey published in THE NEW ENGLAND JOURNAL OF MEDICINE, Americans spent $13.7 billion on alternative treatments in 1990, and most of it was paid for out-of-pocket.
What is alternative medicine? By strict definition, it refers to treatments not widely taught or practiced in the United States. These range from familiar therapies such as chiropractic, acupuncture, and biofeedback to lesser known ones such as homeopathy, naturopathy, and herbal remedies. The common link between most of these therapies is that they have not undergone the rigorous scrutiny of scientific research. In recent years, however, Western researchers have taken a fresh, if skeptical, look at alternative medicine. We are just finding out about its uses as a complement to conventional medicine and its limitations. So far the results are mixed: Some therapies seem to have merit, although they may be much more limited than practitioners claim. Other therapies appear to be useless at best and dangerous at worst. And for some, we just don't know enough to draw conclusions. However, with the newly formed Office of Alternative Medicine at the National Institutes of Health, well-designed clinical trials may slowly clear up the mystery behind these treatments and shed light on what's good, what's bad, and what's a waste.
A Growing Interest
Why, in the face of our vast medical knowledge, are we looking elsewhere for help? Much of the interest stems from our perceptions. Conventional medicine tends to regard humans as a collection of parts, rather than as a whole being. For many, the holistic approach of many alternative practitioners seems less intimidating and more empathetic. People might also feel these therapies are safer (though they are not), less expensive, and more "natural."
Another reason people seek out other therapies is frustration. When difficult-to-diagnose chronic conditions resist cures, many people look outside conventional medicine for help. This is especially true for chronic pain such as arthritis, headache, and back pain, and for insomnia, fatigue, and digestive problems.
Whatever the reasons, Americans are using these therapies in record numbers. Moreover, doctors, researchers, and the insurance industry are taking interest, which means some alternative therapies are edging toward the mainstream. Still, it is important to remember that alternative remedies are not a replacement for conventional medicine.
Western medicine is necessary for treating acute illnesses and infections, trauma, and injuries. And it is the first step in treating diseases such as diabetes, cancer, and AIDS. However, some alternative therapies have use as complements to Western medicine and can promote a healthier lifestyle and relaxation and ease some chronic conditions.
Changes in Coverage
One of the most significant changes in the world of alternative medicine is its coverage by insurance providers. In response to consumer demand, insurance companies are beginning to include selected alternative treatments to their plans. The first company to pay for alternative care was American Western Life, which began coverage in 1982. Others soon followed suit: Already, Prudential covers acupuncture for pain, and Blue Cross of Washington and Alaska offer AlternaPath, a plan that covers both conventional and alternative treatments. Meanwhile, in 1993, Mutual of Omaha instituted its Reversal Program, which provides instruction in diet, exercise, and stress reduction aimed at reversing heart disease. And Oxford Health Plans, a large Northeastern insurer, just added complementary therapy coverage in October 1996. Now their 1.4 million members can choose to see credentialed practitioners of acupuncture, chiropractic, yoga training, naturopathy, massage therapy, and nutrition counseling.
State governments are joining in, too: Washington and Nevada both require that insurers cover acupuncture, and 41 states now require coverage for chiropractic.
What's out there?
Alternative medicine comes in many forms. While many therapies employ one very specific mode of treatment that can be applied to a range of medical complaints, there are some general fields that use a variety of treatments.
Naturopathy. The basic tenet of naturopathy is that sickness is rooted in a disharmony with nature. To treat illness, naturopathic doctors--really, the generalists of alternative medicine--use herbs, homeopathic medicines, dietary advice, massage, and meditation. In some states, naturopathic doctors can act as primary-care doctors and use standard Western diagnostic tools, such as x-rays, blood and urine tests, Pap smears, and breast exams. The difference is that naturopathic doctors spend more time asking questions about diet, sleep, stress, mental outlook, family history, and symptoms. They use fewer drugs, and instead devise health routines that involve different alternative treatments to prevent or cure illness.
Naturopathy does have its downside. Critics worry that naturopathy may underplay the importance of certain proven Western practices, such as immunizations. Another concern is that because people are counseled to give treatments time to work, they may delay seeking diagnostic tests and treatment for serious illnesses. Responsible naturopathic practitioners have a healthy respect for the limits of their medicine.
If you visit a naturopathic doctor, check his or her credentials, because licensing regulations vary from state to state. Ideally, your doctor should have traditional Western medical training and use alternative therapies to complement conventional medicine. There are three accredited universities of naturopathy, as well: Bastyr University in Seattle, Washington; The National College of Naturopathic Medicine in Portland, Oregon; and Southwest College of Naturopathic Medicine in Scottsdale, Arizona.
Ayurvedic medicine. This ancient, holistic approach to health is based on the theory that life experiences (including factors such as diet, lifestyle, stress, work, and relationships) affect health and can cause illness. Practitioners believe that through meditation, massage, aromatherapy (therapy using scented oils), and herbs, people can tap into their body's own natural defenses and heal themselves.
To a degree, as a complement to Western medicine, Ayurvedic medicine works: Recent studies have shown that stress and depression have close links to heart disease and hypertension. Relieving that stress can only help. Other studies suggest that massage and herbs may help to counteract some of the nausea that comes with chemotherapy. Still, while this approach can enhance your health, it is no substitute for conventional treatments.
A Primer on Specialties
If you decide to look into alternative therapy, there are a number of different treatments to choose from. Some have demonstrated usefulness that has earned them the respect of conventional doctors. Others offer questionable claims and possible risks.
Chiropractic. Spinal manipulation has become a common form of complementary therapy. Over the years, a large body of evidence has accumulated showing that for lower back pain, chiropractic treatment can be effective. In fact, a large study done in 1994 by the United States Department of Health and Human Services determined that spinal manipulation was better for treating lower back pain than surgery, bed rest, and drugs. Other studies lend further support: One study published in BRITISH MEDICAL JOURNAL in 1995 found that of 741 people with back pain, those who saw a chiropractor felt better faster and resumed their normal activities sooner than those who visited a medical doctor.
Some chiropractors make further claims that this treatment can cure ills ranging from ulcers to allergies to cancer. These claims are entirely unfounded, however, so stay away from any practitioner who says otherwise. If you visit a chiropractor, remember the limitations of this treatment and make sure your chiropractor does too.
The underlying belief in chiropractic is that pain comes from a misalignment of the spine. To fix this, the chiropractor will "adjust" or pop your spine back into position. In addition, most chiropractors will massage tense muscles and advise you on exercise and nutrition.
Adjustments should never hurt: If you feel pain, stop treatment immediately. Also, avoid any chiropractor who asks you to come for repeated visits, takes multiple x-rays, or claims to cure disorders that are not musculoskeletal. And always check with your doctor before seeing a chiropractor. Acupuncture. In the 1970s, when Americans were allowed entry into China, visitors brought back amazing stories of people undergoing major surgery without anesthetics. Thus, acupuncture made its way into the Western world.
Acupuncture, and its cousins, acupressure and electrostimulation, are based on the belief that channels of energy, which the Chinese call Qi (pronounced "chee"), flow throughout the body. Acupuncturists insert needles at specific points along these channels or meridians to unblock obstructions in the energy flow. Western researchers theorize that acupuncture really works by stimulating the nervous system to release chemicals called endorphins to the brain, spinal cord, and muscles, where they can numb pain and elevate mood.
Although researchers have only recently begun looking at acupuncture in earnest, a few studies have shown that it does have some use. In the 1970s, Dr. Michael Smith, Director of the Substance Abuse Division of Lincoln Hospital in New York, used acupuncture to treat drug addiction. Participants preferred it to methadone and tended to become more cooperative and better able to continue counseling. In another study done in 1991 at Queens University in Belfast, Northern Ireland, 75 out of 100 people undergoing chemotherapy felt relief from nausea after having electrostimulation along their acupuncture points.
Although it looks painful, acupuncture hurts very little because very fine needles are used. Some say it hurts less than having blood drawn or receiving an injection. Symptoms may intensify at first; the Chinese call this a "healing crisis" and take it as a sign that your body is fighting the illness.
As long as you visit a licensed practitioner who maintains a sterile practice, acupuncture is quite safe: A literature review done at the University of Tromso in Norway found only 193 reports of mishaps out of 125 papers, which is remarkably few considering the thousands of people who use acupuncture. It does carry some risks, however. The most serious risks are infections from unhygienic needles, and punctured organs. More common side effects include lightheadedness, scarring, and a temporary increase in pain.
Practitioners should be licensed by the American Academy of Medical Acupuncture or by the American Association of Acupuncture and Oriental Medicine. If you are shy of needles or if you are pregnant, acupressure (in which points on the body are pressed and massaged) is a better choice. Check with your doctor before starting therapy. For a list of certified practitioners, send $3 to The National Certification Commission for Acupuncture and Oriental Medicine, P.O. Box 97075, Washington DC 20090 or call (202) 232-1404.
Hypnosis and Biofeedback
A particularly intriguing branch of alternative medicine uses the link between the mind and the body. Hypnosis and biofeedback both use relaxation and mental focusing to bring about physiological and behavioral changes and healing. Hypnosis is used to reduce pain, lessen swelling and bleeding after surgery, overcome habits, and treat anxiety, phobias, and depression. Usually a psychiatrist, psychologist, or other therapist will lead you through hypnosis, although some people can learn to hypnotize themselves. Techniques vary, but in general, the therapist will ask you to close your eyes and think a relaxing thought, while he or she guides you into further relaxation until your outside thoughts and images disappear. In this state of focused relaxation, it is thought that people are more open to suggestions.
So far, several studies have shown that hypnosis does have a number of uses, including pain management. A study at Case Western Reserve University in Cleveland, Ohio, used hypnosis to treat migraine in children. They found that children who used hypnosis felt better after treatment than those who took drugs or placebos.
Biofeedback also uses focused relaxation, but it adds feedback in the form of heart monitors, thermometers, or other instruments to actually measure whether you are reaching your goals. Using this method, the therapist guides you in picturing a relaxing scene, such as a warm beach, and asks you to concentrate on changing your physical responses, such as slowing your heart rate or warming your toes. The monitors tell you if your body is indeed responding this way. Biofeedback allows people to learn what the correct physical response actually feels like so they can achieve it later without the biofeedback machine.
Studies have shown that biofeedback is an effective tool for controlling bodily processes such as heart rate and circulation. In a study presented at the American Association of Diabetes Educators in 1996, researchers provided standard care to 32 people who had diabetes or peripheral vascular disease and chronic foot ulcers. Half of this group was told to relax for 15 minutes each day on their own. The other half listened to a special tape to guide their relaxation periods, and they measured their toe temperature using a special thermometer. At the end of the study, the people who used biofeedback experienced faster healing as well as increased hair growth on their legs and a stronger pulse than those who relaxed on their own. To find a therapist for hypnosis, or to find a biofeedback treatment center, ask your doctor for a referral. Most pain clinics offer biofeedback as well.
Vitamins and Supplements
Most of the vitamins, minerals, and other nutrients we need are found in the food we eat or produced by our own bodies, but supplement manufacturers would have you believe otherwise. According to the claims printed in newsletters and pamphlets and spread by word of mouth, vitamins, minerals, amino acids, and hormone supplements can build muscles; restore vigor; treat angina; AIDS; and diabetes; promote weight loss; and boost brain power. Of course, this isn't the case, but because these supplements are considered nutrients, not drugs, the Food and Drug Administration (FDA) cannot regulate their sale.
While a handful of vitamins are a useful addition to your diet, most of these supplements are unnecessary expenses at best. So what should you choose? Certain vitamins are necessary and we don't always get enough of them from our diets. Evidence is mounting that we could use three supplements, in particular: calcium, folate, and vitamin E. Calcium is vital to preserving bone strength. The recommended dosage is 1200 to 1500 milligrams per day, and more if you are pregnant. Studies have shown that the B vitamin folate can reduce the risk of neural tube birth defects, which cause spina bifida and anencephaly. The United States Public Health Service now recommends that all women of childbearing age get 0.4 milligrams of folate each day. Taking regular doses of the antioxidant vitamin E is safe and inexpensive, and it appears to reduce the risk of heart disease and cancer. The optimal dose for vitamin E seems to be 400 IU per day; studies suggest that the body doesn't process more than that amount.
You can have too much of a good thing, however, so taking megadoses of these vitamins is a dangerous idea. For instance, the maximum safe dose of folate is 1 milligram per day. Beyond that, folate can mask pernicious anemia, which is a serious condition.
Recently, zinc has made headlines for its ability to soften the blow of winter colds. In a study done at Cleveland Clinic in Ohio, 50 people took zinc lozenges and 50 did not. People who took ColdEeze brand zinc lozenges felt relief from fevers, headaches, and coughing about four days sooner than those who didn't take the lozenges. However, for some people, nausea and a metallic taste offset the benefits. If you take zinc, remember that despite what the package says, its benefits are not clinically proven. Also, high doses of zinc can have toxic effects, so don't take the lozenges for more than a week.
Other supplements do not merit regular use. For instance, coenzyme Q-10 supplements, which are touted as a wonder drug for everything from obesity to AIDS, are really just a weak antioxidant that our bodies already make. No studies have found evidence to support manufacturer claims.
Another purported wonder cure is the hormone melatonin. Although studies suggest it may help insomnia, those tests are inconclusive. In the meantime, little is known about proper dosage and timing; so by taking melatonin, you could throw off your sleep cycle even more. Other hormones such as DHEA (dehydroepiandrosterone) and human growth hormone have been touted as elixirs of youth that can restore strength and vigor, beef up muscles, and ward off illness. So far, studies are inconclusive; but the side effects, such as increased risk of some cancers, make taking these hormones riskier than they are worth. (For more on supplements, see "Elixirs of Youth: Which Work, Which Don't Which Might?" in the September/October 1996 issue of Diabetes Self-- Management.)
For people who have diabetes, chromium picolinate is an especially popular supplement, thanks to reports that it can control blood glucose levels and aid in weight loss. So far, though, studies have shown that this mineral only lowers blood glucose levels in people who have a chromium deficiency (which is uncommon in this country), and it doesn't lower blood glucose levels enough to stop other treatments. Now the Federal Trade Commision has taken issue with the claims made by chromium picolinate distributors, and put the kibosh on further unsubstantiated health claims for this product.
The bottom line is that very few dietary supplements are necessary. Vitamin E, folate, and calcium are safe, and research shows they can help. Beyond that, unless you have a particular deficiency, a regular multivitamin will do you. To cut your risk of disease and boost your strength, save your money and try to eat right and exercise instead.
Herbal Medicine
Plants and flowers have been used for medicinal purposes since early civilization. This major component of Chinese medicine is used to treat all sorts of symptoms, from pain and stomach upset to depression and sleep disorders. Herbs can be drunk as teas, smoothed on as lotions, or swallowed as pills. Some herbal remedies, such as echinacea for colds, can be found in health-food stores and pharmacies. Others must be prepared by herbalists who know what each herb is meant to do.
It is true that plants do contain active ingredients that can treat symptoms; in fact, many standard drugs, such as aspirin, originated as plant-based remedies. However, just because something is natural does not mean it is safe. After all, hemlock is natural, but you would never swallow a spoonful of it! The problem with herbal remedies is that it is hard to know what you are really getting.
Herbs can cause allergic reactions, interact with other herbs, and vary widely in potency--not only between brands or mixes, but between individual plants. The FDA does not regulate their production, so it is up to manufacturers and sup pliers to make sure their products are correctly labeled and safe-a task that often goes awry. Herbs can interact dangerously when taken with other drugs, too. Take what happened in Belgium in the early 1990's, for example: A number of young women took several herbs in combination with modern weight-loss drugs at a diet clinic and suffered kidney failure as a result.
If you use herbs, talk to your doctor to be sure the ones you take are safe and won't interact with your other drugs. And if you see an herbalist, make sure you see someone who is knowledgable. But to stay safe, it's generally best to forgo this type of treatment altogether.
Homeopathy
This novel approach to medicine was developed in the late 1700's by a German doctor named Samuel Hahnemann in an effort to find a gentler alternative to the bloodletting, blistering, and purging that was used at the time. The basic belief behind homeopathy is that the body's responses to illness indicate healing and therefore should be enhanced, not suppressed. Homeopathic drugs contain a single substance that induces symptoms similar to the illness. These potions and pills are substantially diluted- -so much so that often you get little more than a sugar pill or a water and alcohol solution. The mixture of active ingredient (or what's left of it) and the base are vigorously shaken so that the water "picks up energy" from the active substance. The resulting "imprint" of the active ingredient is supposed to spur your body to heal itself.
This form of therapy is controversial, and the few studies that have been done have been inconclusive. However, since homeopathic drugs contain infintesimally small amounts of active ingredients, they are generally safe to take as long as you don't substitute them for necessary medical care.
Gadgets, Gizmos, and Potions
The last group of alternative treatments includes the many devices, potions, and treatments that can best be described as "snake oil." Many of these therapies sound openly outlandish. For instance, you can order magnetic earrings, mattresses, and "polarizers" that claim to treat asthma, obesity, arthritis, and any other disease you can think of. However, the theory that magnets can cure ills was discarded 200 years ago, and today the FDA regularly confiscates shipments of these fraudulent devices.
Aromatherapy is another popular treatment that is purported to aid in healing. While it is true that certain smells can evoke memories, help you relax, or put you in a good mood, don't waste your money trying to cure any diseases with these scented oils.
What about bee pollen? Proponents say these little pills can treat obesity, high blood pressure, and rheumatism. No evidence appears to support these claims.
Some bogus treatments do come cloaked in medical terms that make them seem legitimate. Take, for example, chelation therapy as a treatment for heart disease. Researchers hypothesized that since chelation therapy can clear away heavy metals from the blood, it might also be able to remove the plaques that accumulate along artery walls. It was a nice idea, but study after study showed it didn't work. Still, many people swear by it, even though numerous organizations, including the National Institutes of Health, the American Heart Association, and the Centers for Disease Control warn against it. According to the American Heart Association, this treatment can cause kidney failure and death. Furthermore, it is very risky to avoid proven treatments for heart disease in favor of this one.
Making Distinctions
Alternative medicine is a popular option, but it is still a mysterious world we know little about. Some therapies can form an effective complement to Western medicine. Others may be useless or flat-out dangerous. You need to keep a few points in mind to ensure a safe, effective experience with alternative therapies:
Make sure you receive an accurate diagnosis from conventional doctors before you go. Cancer, diabetes, infections, broken bones, and other acute illnesses respond better to conventional care.
Keep your doctor informed. The 1993 survey from THE NEW ENGLAND JOURNAL OF MEDICINE found that 72% of Americans who use alternative therapies do not tell their doctors about it. This is a mistake. Alternative therapies usually will have some effect on you. Some therapies may improve the way you feel, and your doctor can then adjust your conventional treatment to match. Or your alternative therapies may interact with or even counteract your conven- tional care. Certain vitamins, supplements, and herbs can interact with drugs, heightening or diminishing effects or causing toxic combinations. Your doctor can advise you on what to take and what to avoid. Also, some treatments should be avoided if you are pregnant, or if you have a condition that could be worsened by the new therapy.
Be wary of miracle cures, exaggerated claims, and treatments that purportedly have no side effects. Trust your instincts: If it sounds too good to be true, it is. If a treatment is legitimate, practitioners will be open about discussing its uses, limitations, and side effects. Read up on any new therapy to learn about its appropriate uses and its limitations. What are the disadvantages? What are the benefits? Is there scientific evidence, in the form of clinical studies, to back up the claims for these treatments. Do the claims make sense? If it sounds odd to you, it probably is.
Check credentials before choosing an alternative practitioner. Your local department of health or the national association for that specialty can give you information about licensing regulations in your state. Make sure your practitioner was educated through an accredited program, not a phony diploma mill. Talking with doctors, nurses, diabetes educators, family,. and friends can help you learn about a practitioner's reputation as well.
Don't be fooled by jargon. Using technical medical terms such as endorphins," "serotonin," and "neurotransmitters" to beef up dubious claims is a special skill of snake oil salesmen. Look for scientific proof in the form of clinical studies.
Don't judge a therapy by testimomals alone. Remember, the people who peddle alternative treatments will only use the stories of people who believe they had success, not the ones who found the therapies useless. Moreover, while anecdotes may sound convincing, it is difficult to tell if the treatment was a success or if another explanation could account for the change. Some illnesses clear up on their own. Other times, people undergo several therapies at once, so it is hard to tease out the ones that worked. Finally, the placebo effect, in which an ineffective treatment works because the person believes it will, may be enough to get an effect. If you don't see improvement in a reasonable amount of time, check with your medical doctor.
The mysteries that cloud alternative therapy are only starting to lift in the United States. The best option is to use those remedies that have value as an adjunct to conventional care. If you tread carefully and do your research, you should be able to choose treatments that can work effectively and avoid the pitfalls of useless or dangerous treatments. Making Distinctions Alternative medicine is a popular option, but it is still a mysterious world we know little about. Some therapies can form an effective complement to Western medicine. Others may be useless or flat-out dangerous. You need to keep a few points in mind to ensure a safe, effective experience with alternative therapies: Make sure you receive an accurate diagnosis from conventional doctors before you go. Cancer, diabetes, infections, broken bones, and other acute illnesses respond better to conventional care.
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