ALTERNATIVE MEDICINE, SAFE OR NOT, LURES MORE PEOPLE

In a time when mainstream medicine often stands accused of greed,
indifference and worse, more and more Americans are putting their
faith and health in alternative forms of health care.

* In Idaho, for example, people flock to a nonmedical doctor selling a
topical lotion alleged to alleviate everything from pain to paralysis.

* In Orange County, an orthopedic surgeon exposes patients to
electromagnetic beams, contending they help regenerate tissue, melt
away scars and cause "dysfunctional limbs to recover function."

* And everywhere -- from supermarkets to the Internet -- pills,
potions, therapies and lotions are being marketed as remedies, if not
cures, for virtually all that ails us.

In 1997, more than 40 percent of the adult population in the United
States used some form of alternative medicine, spending $21 billion,
more than half of that out of pocket.

What to do -- or not do -- about the surging popularity of these forms
of so-called alternative medicine has become a sort of chronic
conundrum for conventional medical doctors and government regulators.

Next week, for example, the federal Food and Drug Administration will
hold the first of two public hearings on establishing new regulations
governing dietary supplements, a comparatively free-wheeling
industry whose sales exceed $7 billion annually.

"We're looking at new limits on dosages, the labeling of side effects,
what is an allowable claim," said an FDA spokeswoman who asked not to
be identified. "This is a priority for this year. I can't tell you
when exactly we'll have new law, but it's definitely not on the back
burner."

The FDA has tried before to regulate dietary supplements, but these
efforts have largely failed, leading in fact to Congress voting in
1994 to weaken the FDA's ability to control dietary
supplements.

It is difficult to say what will happen at the FDA's June 8 hearing in
Washington, D.C. The FDA representative said the agency believes the
dietary supplement industry as a whole will be cooperative, but some
industry representatives say they are wary, fearful that the FDA's
idea of appropriate regulation will prove unreasonable and
overreaching.

The science of safety

Much of the debate, of course, will revolve around a couple of
questions fundamental to any discussion of alternative medical practice:

Is it safe?

Does it work?

For most of this century, medical science has been highlighted by
astounding progress. Doctors have learned how to treat and cure a wide
range of medical conditions and diseases. What's left, though, seems
harder to cure.

The frustration of that reality, combined with broad disenchantment
over the state of America's health care system, prompts millions of
Americans to seek alternative forms of medicine, many of which tout
their "natural" origins.

But "natural" doesn't necessarily mean "safe," says William Jarvis,
founder of the National Council for Reliable Health Information, a
watchdog group.

"I think the American people are in the dark about this. People assume
all of this alternative stuff must be safe because it's out there,
that the government or somebody is guarding their interests. But the
fact is, we've largely abandoned the idea of broad-based social
protections for health and medicine.

"Predatory commercial interests now rule. It's buyer beware. If you
get hurt by a quack remedy now, it rips you off or causes medical
harm, there's very little chance of legal redress because current law
says you should've known better."

Critics of alternative medicine complain that it is largely unproven,
at least by Western scientific standards. "What most sets alternative
medicine apart," write Dr. Marcia Angell and Dr. Jerome P. Kassirer in
a 1998 editorial in The New England Journal of Medicine, "is that it
has not been scientifically tested and its advocates largely deny the
need for such testing."

To be sure, many conventional medical treatments have not been
rigorously tested either, but Angell and Kassirer note that the
scientific community recognizes this as something that needs to be
addressed.

"Many advocates of alternative medicine, in contrast, believe the
scientific method is simply not applicable to their remedies. They
rely instead on anecdotes and theories."

Of course, some alternative medical therapies have been rigorously
tested. The millennia-old practice of acupuncture, for example, has
been shown in various studies to be therapeutic for behavior
modification, addiction and relieving some kinds of pain.

Likewise, certain herbal medicines have been proven beneficial. The
herbs echinacea and ginkgo biloba, for example, have been shown to
improve resistance to respiratory infections and blood flow to the
brain, respectively.

But full-fledged clinical studies of herbal medicines and other forms
of alternative therapy are relatively scarce.

The National Center for Complementary and Alternative Medicine, part
of the National Institutes of Health, has awarded approximately 30
research grants to study alternative medical therapies in the last
seven years.

Twenty-eight of these studies have resulted in "final reports," but
only nine have produced peer-reviewed, published papers -- and five of
the nine appeared in two very obscure journals.

Untested miracles

Without substantial clinical trials or scientifically sound research,
skeptics say, there is no way to know with any certainty whether a
therapy or medicine is safe, and whether it works as its advocates say
or believe.

Take magnet therapy.

A few reputable studies have shown that exposure to powerful,
pulsating electromagnets can spur healing in damaged bone. The problem
is that some proponents claim far more expansive achievement, often
with little or no scientific substantiation.

Dr. David Stokesbary is an orthopedic surgeon who also operates a
clinic in Laguna Niguel using electromagnets to allegedly regenerate
damaged tissue, eliminate scars and restore function to disabled limbs.

Despite his conventional medical training at Stanford University and
the University of Southern California, Stokesbary says he is not
unduly bothered by the lack of scientific evidence to support his work
or, in fact, most forms of alternative medicine.

"It takes a lot of money to do research," he said, "and it's often
very hard to do. You'll find in alternative medicine that some of us
have great faith in results, not process. We don't care how you (the
patient) got there as long as you got better. It's very difficult to
prove the pathway through which some of these medical miracles occur."

The level of government oversight in areas of alternative medicine is
surprisingly limited.

"You have more protection from economic scams than you do from
nutritional scams," said Dr. John Renner, head of the Consumer Health
Information Research Institute. "Lie to the Securities and Exchange
Commission and you go to prison. Lie to the public and there's rarely
any penalty at all."

Consider again those rows of herb-based pills and potions sold almost
everywhere. Many of these products -- goldenseal, cat's claw,
astragalus, dong quai and grape seed extract, to name five of the most
popular kinds -- have never been subjected to controlled clinical
study. No government health agency monitors their production, quality
or marketing.

That's because in 1994, at the behest of the dietary supplement
industry, Congress exempted these products from FDA regulation,
declaring them to be foods rather than drugs.

Since then, so-called dietary supplements have flooded the market,
"subject only to the scruples of their manufacturers," said Angell and
Kassirer in The New England Journal of Medicine.

Dietary supplement companies are still prohibited from claiming that a
product can treat or cure a specific disease. The result, said Jarvis
of the Reliable Health Information group, has been an ongoing game of
deceptive wordplay.

"For example, it's illegal to claim something can cure arthritis, but
it's OK to say it's a `bone and joint rebuilder.' People equate one
with the other. They buy the stuff thinking it will help with their
arthritis, even if there's no scientific proof."

As difficult as regulating dietary supplements might be, it pales
compared to the freewheeling market of alternative medicine on the Internet.
Here, alternative treatments, remedies and cures are touted with
virtual abandon, protected by the relative anonymity and ever-
changing nature of the medium.

Example: A recent one-day survey of the Internet by health authorities in
the United States and Canada turned up more than 400 Web sites marketing
suspect medical treatments and products.

"The Internet is extolled as the `information highway,' " said Renner,
"but just as in the days of stagecoaches, the road seems to be plagued
by highwaymen who are out to rob passengers. Even worse may be the
harm done by well-meaning people who spread the word about the latest
health fad that they have tried with imagined success."

Beyond the fringe?

Alternative medicine isn't so alternative anymore.

Percentage of American adults who used an alternative therapy: 1990 --
33.8 percent 1997 -- 42.1 percent

Estimated visits to alternative medicine practioners: 1990:
427,120,000 1997: 628,825,000

Estimated visits to primary care physicians: 1990: 387,558,000 1997:
385,918,000

Therapies increasing most: * Herbal medicine * Massage * Megavitamins
* Self-help groups * Folk remedies * Energy healing * Homeopathy

Conditions most often treated: * Back and neck problems * Allergies *
Fatigue * Headaches * High blood pressure * Sprains or strains * Insomnia

Did you know...?

* 39.8 percent of patients inform their physicians that they are
pursuing alternative therapies as well

* In 1969, there were 15 massage schools. Last year, there were
800.

* Estimated $21.2 billion spent on alternative medical services, up 45
percent from 1990, with at least $12.2 billion paid out of pocket.
This exceeds the 1997 out-of-pocket expenditures for all
hospitalizations in U.S.

Top-selling herbs in 1997 (in millions of dollars) Echinacea $310
Ginseng $270 Ginkgo biloba $240 Garlic $200 St. John's wort $200
Goldenseal $160 Saw palmetto $130