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MEDICINE, MAGIC, AND MUMBO JUMBO:

Exploring Alternative Care

by Melissa Glim

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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