A CAPSULE A DAY...

We're Usine More Herbs, Vitamins - But Not Telling Docs

Half of Queens residents use some form of alternative medicine, a rate
higher than seen nationally, and many have not told their doctors, a
practice some experts say may put them at risk.

These are the central findings of a Newsday-Hofstra University poll that
also determined that most people use alternative therapy as preventive
medicine, not to cure a chronic ailment, and that herbs are the most
popular treatment used in Queens, a finding that differs from national
studies.

And the percentage may, in fact, be even higher, experts suggest. With the
borough's extraordinary ethnic diversity comes "a lot of folklore and
traditions, and there are people doing all kinds of things under the guise
of medical cures-so many I couldn't even estimate," said Dr. Jeffrey Cole,
chairman of the department of physical medicine and rehabilitation at The
New York Hospital Medical Center of Queens in Flushing.

Many may not even consider these to be "alternative" therapies, Cole and
other experts said.

Sheila Kushnick 62, of Flushing is typical of many of the 600 borough
residents polled who say they use alternative medicines to stay healthy.
Kushnick says she will take echinacea when she feels a cold coming on. Her
husband, meanwhile, takes saw palmetto for an enlarged prostate as well as
vitamin E, vitamin C, selenium and a multivitamin because "he's been having
a little problem with his memory." But she said neither has told their doctor.

Although she said she "could use a little more information ... I've heard a
lot of bad raps about herbal medication and I don't think it's true.
Everything has to be done in moderation." Like Kushnick, more than one-half
who use herbal medicine said their doctor did not know they use herbs, and
half said they had not done any research before they began using them, the
poll found. About the same percentage said they began using herbs based on
recommendations from family and friends. The finding was similar for those
taking megavitamins.

In the Newsday poll, 3 in 10 herb and/or megavitamin users said they did
not know whether their herbs or vitamins could interact unfavorably with
other medicines. Those who had informed their doctor of what they are
taking are twice as likely to be aware of potential interactions.

The fact that so many people don't tell their doctors what they're
taking-and doctors don't ask-mean that doctors are often left not knowing
why a patient may be having a problem or is feeling better. Nor do they
know whether a drug they are prescribing might interact with the patient's
herbs and supplements, a key issue, some experts say.

The New York State Society of Anesthesiologists, for instance, said its
members are reporting "significant changes in heart rate or blood pressure
in some patients who have been taking herbal medications." They warn that
patients need to tell their doctors everything they are taking to ensure
there are no interactions with the anesthesia.

Dr. Carole Agin, an anesthesiologist and director of Long Island Pain
Management at John T. Mather Memorial Hospital and St. Charles Hospital and
Rehabilitation Center in Port Jefferson, said she is seeing more and more
patients "on a tremendous amount of herbs. It's almost scary." And "around
the coffee pot," she said, doctors are sharing stories of patients coming
into the operating room with erratic blood pressure and excessive bleeding
problems that they suspect-but don't know-are caused by supplements.

Not only are there concerns about potentially blood-thinning herbs, but
there are also worries about psychotherapeutic herbs. St. John's wort can
potentially intensify or prolong the effect of narcotics or anesthesia.
Indeed, Dr. Brian Hainline, chief of neurology at ProHealth Care Associates
in Lake Success, said he had two patients on anti-depressants who became
manic: they were also on high doses of St. John's wort, he later discovered.

Additionally, experts point out that some laxative herbs, such as senna,
can interfere with the body's ability to absorb other drugs or food.

But many also point out that most herbs appear to be fairly benign and that
the potential for dangerous reactions or interactions seems to remain just
that: potential.

Dr. Richard Stein, a spokesman for the American Heart Association, called
the issue "a worrisome possibility" and Dr. Jerry Cott, a
psycho-pharmacologist at the National Institute of Mental Health, said it
was "a potential rather than a real problem." Dr. Adriane Fugh-Berman of
the George Washington University School of Medicine and Health Sciences in
Washington, D.C., recently co-authored an article in the journal
Psychosomatic Medicine looking at use of herbs and supplements in treating
psychiatric disorders. She agrees "there's not an epidemic of people
falling over in the streets, although," she adds, "there are some
well-documented interactions you need to be aware of." While the issue of
potential side effects and drug interactions is key, according to most
experts, Newsday's poll also uncovered ways in which Queens mirrors or may
even slightly exceed what is going on nationally with alternative medicine:
About 50 percent of Queens residents use some form of alternative therapy.

Twenty-eight percent use two or more therapies. This is slightly higher
than findings from two national telephone polls done at Harvard Medical
School, which are cited as landmark studies on alternative medicine use and
served as the model for Newsday's poll. In the most recent Harvard study,
published last November, 42 percent used one of 16 alternative therapies
surveyed.

Moreover, experts point out that a telephone poll done in an ethnically and
economically diverse area such as Queens is likely to underestimate actual
usage: People without phones would not be surveyed; some surveyed who were
not native-born English speakers might feel uncomfortable answering
questions (although Spanish-speaking pollsters were available); or cultural
differences in what is considered "alternative" medicine might make some
discount non-mainstream therapies they grew up with.

Herbal medicine is the most popular alternative treatment: About 38 percent
of those who use alternative medicine say they have used herbs in the past
year. After herbal medicine, relaxation techniques (such as meditation),
megavitamins (defined as taking more than a daily multiple vitamin),
massage therapy, chiropractic care and spiritual healing by others (prayer)
were most popular. By contrast, the most recent Harvard poll found a huge
increase in herbal medicine use, but it was not the most widely used
alternative treatment.

Queens also mirrors national trends. For instance: As with the rest of the
country, alternative medicine appears to be a growing phenomenon in Queens.
Although there is a sizable percentage who have been using some alternative
treatments for 10 years or more, many surveyed are fairly recent users.
More than half of herb users and megavitamin users began using them within
the past five years. Seventy-eight percent of those using energy healing,
such as magnets, have been using them 2 years or less; almost half of those
using hypnosis have used it less than a year.

The use of alternative therapies cuts across economic, racial, gender and
age lines with few exceptions: Those in the workforce are more likely to
use alternative medicines than are those who are unemployed; those 55 and
older are less likely to use alternative therapies than younger ones.
African-Americans are slightly more likely to use an alternative therapy,
although they use fewer methods on average than whites, and Hispanics are
somewhat less likely to use alternative medicine than whites. There's no
difference in usage rates between men and women.

Queens residents use most alternative treatments (except for chiropractic,
acupuncture, commercial diets, biofeedback and self-help groups) to stay
healthy. The number of annual visits to doctors is about the same among
those who use one or two alternative therapies as among those who use none.
Those who use three or more therapies make far more visits to the doctor.

Although 76 percent of Queens residents rated their health as good to
excellent, Dr. Lawrence Scherr, chief medical officer and chief academic
officer for the North Shore-Long Island Jewish Health System, said he was
not surprised by the percentage using some form of alternative medicine.

"I don't think it relates to having smarter or dumber doctors. I don't
think it relates to biases against conventional medicine. I think we're
dealing with a population that is a lot more sophisticated and concerned
over maintaining their health," Scherr said. "... I think we're dealing
with a select population ... I want to be better; I want to be healthier.'
I don't see it as a wholesale rejection or migration away from mainstream
medicine." The poll supports Scherr's contention that Queens residents are
using alternative treatments as a kind of health insurance. Except for
chiropractic, acupuncture, commercial diets, biofeedback and self-help
groups-used to treat specific conditions like back pain or weight
problems-most people use most alternative therapies to prevent illness or
stay healthy. More than 60 percent of herb users and close to 90 percent of
megavitamin users, for instance, say they use them for that reason.

Yet while there doesn't appear to be a "wholesale rejection" of mainstream
medicine, many interviewed conveyed an underlying frustration with or
ambivalence about their doctors-which may be in part fueling the recent
boom in use of alternative medicine mirrored in the rest of the country.
For 10 of the 16 therapies surveyed, half of the users have been using the
therapies 5 years or less.

Although the poll showed 57 percent considered doctors the most reliable
source of health information (followed by 17 percent who cited other health
professionals) many interviewed depicted doctors as not supportive or not
aware of other approaches.

Claude Lewis, 45, of Jamaica said he suffered back problems as a result of
a job-related accident-he's a bus driver-but the conventional treatments
offered by his doctor didn't help.

"These guys hand out muscle relaxants and painkillers but they don't help
the pain enough," said Lewis. "I took them for a couple days but I really
don't like taking drugs, so I thought I would try something else." Since
then, he's been going two times a week on and off for the past year to a
chiropractor and "it seems to help." He's also willing to consider other
alternative approaches-he's been thinking about trying hypnosis, he
said-anything noninvasive or not harsh.

"I think the doctors are in league with the pharmaceutical companies and
they also do operations that are unnecessary. I want to try a gentler
approach," he said.

Like Lewis, John Pullows, 21, a student and freelance stagehand who lives
in Flushing, said he almost has a "fear or phobia of prescription drugs,"
preferring instead a "holistic approach" that stresses mind-body treatments.

Calling himself a "struggling Buddhist," Pullows says he meditates every
day and will occasionally use echinacea and goldenseal to fight off a cold,
or ginseng when he needs a tonic.

When he's deeply into his martial arts training, Pullows will also
"sporadically" use sports supplements, such as DHEA precursors, supplements
that turn into or boost production of the so-called anti-aging hormone DHEA.

Like other Queens residents interviewed, who are saturated by the media and
close to major medical institutions, both Pullows and Lewis consider
themselves fairly savvy and will read about or research other treatments.

Yet about half of those polled said they get much of their initial
information about various alternative treatments from friends and
relatives, not from their doctors. Interestingly, only 7 percent of all
those polled in Queens said they used the Internet to seek information
about their health.

While both said the doctor was aware of their alternative approaches, it
was clear the doctor's approval was not necessary. Speaking of his parents,
Pullows said, "they go to a mainstream doctor and they seek the approval of
society-not the approval of whether it works for them." Others appear to
have some regard for their doctors but still don't tell them what other
approaches they are using.

John Chin, 49, of Flushing, said he is "comfortable with western
medications" but he or other family members will occasionally take the
Chinese herbs and teas his mother, from mainland China, gives the family
"for maintenance of health." He and his wife also regularly go to a
chiropractor. He has told his doctor about neither, he said.

This apparent disconnect between what people are doing for their health and
what they feel comfortable telling their doctors is abundantly apparent in
the poll. For eight of the 16 treatments surveyed, less than half had told
their doctors they were using the treatment.

Among those using herbs, 55 percent had not told their doctors and among
those using megavitamins 34 percent said their doctors were not aware. Yet
the majority of herb and vitamin users in the poll said their herbs and
vitamins helped: About 58 percent said their herbs and vitamins helped
somewhat; about 23 percent said they helped more than anything else they
had tried.

The fact that doctors are apparently so often unaware of what their
patients are taking "worries me greatly," said Cole, who works with an
acupuncturist also knowledgeable about herbs and has been doing his own
study on the use of magnets for back pain.

Why don't people tell their doctors? Dr. Shibani Ray-Mazumder, head of
research at the State University at Stony Brook's Center for
Complementary/Alternative Medicine, said people may not think their
"alternative" treatment is so alternative and thus not worth mentioning.
Or, rushed in their 15-minute visit with their conventional doctor, they
discuss only specific physical symptoms and don't think to bring other
aspects associated with their well-being into the exam room.

"The focus of conventional medicine has been on the illness and not on the
patient, so they leave the rest outside the door"-an occurrence she has
often seen in her work with cancer patients, she said.

And, she said, often people "will not mention certain things because they
don't think they are going to be validated." At least in somes cases,
according to interviews, Mazumder is right. Kushnick said she had not told
her doctor she and her husband were taking some herbs and supplements. "I
don't think he would approve of it," she said.

The fact that people believe a doctor will not be supportive explains some
of the "schism" in medicine today, said Dr. Samuel Benjamin, director of
Stony Brook's Complementary/Alternative Medicine Center.

"We have divorced ourselves from understanding our role as servants of the
society. I'm not implying that our expertise is not cherished but maybe it
needs to be tempered somewhat," Benjamin said.

And, he said, from a public health perspective, researchers and health
policy makers should be looking at how people like Lewis or Kushnick might
be saving money by not resorting to expensive prescription drugs.

Benjamin said he was "delighted" by the poll findings that indicated Queens
residents are not spending large amounts of money out of pocket for their
alternative therapies.

Most people spend $60 or less a month out of pocket on the five most
expensive treatments: lifestyle diet (such as macrobiotics or
vegetarianism), massage therapy, commercial diet (such as Weight Watchers),
homeopathy, megavitamins and herbs. The typical megavitamin user and
typical herb user each spends $20 a month. People said they paid no money
for nine of the 16 alternative therapies surveyed. About three-quarters of
those using chiropractic say it is covered by health insurance; half of
those using a chiropractor say they spent nothing out of pocket for it.

Ravi Chandnani, 36, of Bellerose, who works in advertising, thinks many
doctors are opposed to alternative medicine because they "don't want to
rock the boat. That's why I pay attention to it-when you see any new
phenomenon that has changed the way things are done, it rocked the boat and
it went against the grain." Chandnani grew up in an Indian-American
household that regularly practiced transcendental meditation. He said he
knows little about traditional Indian Ayurvedic medicine but "I would
consider it if I thought it would help." And he said he was about to start
the high-protein, low carbohydrate Atkins diet.

Stella Wilson, 64, of College Point, a retired registered nurse, echoed
some of what Chandnani said. Although careful to research anything she
takes-she says she will take echinacea and megadoses of vitamin C when she
feels she is coming down with a cold and has tried St. John's wort-she said
she is open to other ways of healing.

In her youth, Wilson said she found the use of imagery helpful "for
de-stressing." And in the 1980s, she said, she visited China, where she
watched people being successfully treated by acupuncture for asthma in the
smoggy cities of Beijing and Hong Kong.

Her own doctor, Wilson said, was open to using alternative therapies. But
her fellow nurses, she found, were typically more open than many other
mainstream doctors she encountered.

Not surprisingly, those with chronic problems not easily cured by
mainstream medicines appear more willing to try a variety of alternative
treatments. For three of the five treatments people used primarily to cure
an ailment-chiropractic, acupuncture and biofeedback-back pain is the most
often cited ailment.

Florinda Archie, 31, a security guard from Far Rockaway, has
scoliosis-curvature of the spine-and a related muscle disorder in her neck
and back which keeps her in constant pain.

Instead of taking prescription medications which left her drowsy and which
she feared might be addictive, Archie has been seeing an Orthodox Jewish
herbalist who has given her valerian tea to help her sleep and reduce
anxiety. He has also given her a megavitamin designed to help build bone
and muscle. She meditates and is looking into trying acupuncture and
aromatherapy, as well as taking a stress management class. Her neurologist
and orthopedic doctor are aware she is seeing the herbalist and don't
object, she said.

Although experts interviewed said most alternative treatments are fairly
benign, many worry that some people will go overboard and lethally mix
herbs and drugs or herbs and herbs.

Indeed, a former heroin addict now on methadone who has chronic hepatitis C
says she spends "a good $100 to $150" a month on a slew of herbs, including
a weight loss supplement of "all-natural herbs" that she says increases her
metabolism and acts as a diuretic. Her herbs appear to interfere at times
with her methadone and she gets the sweats, she said, which she simply
ignores.

Yet she says that as a former addict she is more afraid of prescription
drugs her doctors want to give her, which she said "can kill you worse." On
the other hand, a young woman from Queens Village who battles manic
depression said she is very careful about what herbs she takes, limiting
herself to ginseng and camomile tea, for fear of interfering with her
medications. She-like many interviewed-said she wanted to see more studies
done on herbs and megavitamins.

Benjamin says that while there are far too many people who take herbs and
vitamins willy-nilly, most people are sensible-just as most are sensible
about taking potentially dangerous over-the-counter medications. Yet,
unlike over-the-counter medications, most herbs and vitamins, which are not
classifed as drugs, have few warning labels and little information about
proper dosage.

Scherr also worried that if people rely too much on self-medication and
avoid the doctor, serious illnesses may go undiagnosed. "We don't want to
be lulled into a false sense of security, because we know that early
detection is one of the best forms of ensuring a cure," he said.

Regardless, all experts agreed that alternative medicine plays and will
continue to play a real role in health care in Queens.

"I don't believe it's going away," said Benjamin. "It's not like the Hula
Hoop."