BETTER ALTERNATIVE?

Last week, some 80 studies about alternative medicine were published in 10
of the American Medical Association's peer-reviewed professional research
journals. Each one was a lift for the acceptance of alternative health
therapies -- for allowing such therapies to shed the "alternative" label.

Even the studies showing unsuccessful outcomes for therapies may be
valuable, as some researchers contend they supply credence to a largely
still skeptical American medical community by acknowledging that some
alternative treatments don't work.

Skepticism bordering on cynicism is a common obstacle for researchers
interested in alternative health topics.

"It was difficult to convince my institutional review board that we should
do this study," said Dr. Steven B. Heymsfield, a physician at the Obesity
Research Center of St. Luke's-Roosevelt Hospital in New York, of his
research on an Indian herb. "My boss didn't like it. Senior scientists tend
to just dismiss alternative therapies. Their approach is, `We'll get our
Nobel Prizes for discovering the next important genes. Let somebody else
find out what alternative treatments don't work.' "

What Heymsfield proposed was a randomized, double-blind, placebo-controlled
study to evaluate whether hydroxycitric acid, the active ingredient in the
herb Garcinia cambogia, is a factor in losing weight. In animal
experiments, investigators have demonstrated appetite suppression and
reduced body weight; limited human studies have produced conflicting
results.

Keen interest among consumers, including his own patients, is what
motivated Heymsfield to design the study. There are at least 14 commercial
weight-loss products with hydroxycitric acid, according to Heymsfield, and
they are highly popular at health-food stores and other outlets for dietary
supplements.

"I often ask people to do a `show and tell' for me with whatever products
they tried," said Heymsfield.

Everyone in his study of 135 overweight but healthy adults lost weight,
with no significant statistical difference between the experimental and
control groups after a 12-week dose plan. The control subjects dropped nine
pounds on average, while the people in the experimental group averaged a
seven-pound reduction. Score one for the placebo effect, sort of.

"What it shows is people tend to lose pounds when they come regularly to a
medical office to get weighed," said Heymsfield. "(Losing weight) is the
typical response when people are supervised by doctors in some fashion."

Designing a placebo-controlled study can be challenging for researchers who
want to target alternative medical therapies. It's not always as easy as
swallowing medicine or a sugar pill placebo.

Alan Bensoussan, a researcher from the University of Western Sydney
Macarthur in Australia, had a study on Chinese herbal medicine treatment
for irritable bowel syndrome in last week's Journal of the American Medical
Association. His problem: Chinese physicians might prescribe various
combinations of more than 80 different herbs to help the pain, bloating,
constipation or diarrhea associated with irritable bowels.

The solution was to appoint three categories of patients: One group took
benign capsules, a second took a standard Chinese herbal formulation, and
members of a third group received personalized formulations. All subjects
went through the same exams and follow-up visits.

In the study of 116 participants, the active treatment groups reported
significant improvements in quality-of-life issues over the control group.
Three-quarters of the individualized-treatment group said they felt
improvement over the 14-week trial, while 63 percent of the standard
formulation group said the same. A third of the control group said they
felt better.

Bensoussan said the results could have been even more dramatic, as boiling
Chinese herbs into a tea brew -- not swallowing capsules -- is the
preferred treatment method. He also noted that although Australian doctors
might be more open-minded than their American counterparts about herbal
medicines, there is still "much room for improvement to discover the
effects of potent herbs."

The growing body of medical research will help consumers of alternative
therapies sort out the good from the dangerous. The U.S. Food and Drug
Administration issues warnings about certain herbal and natural remedies
for cancer and HIV/AIDS, along with several arthritis "cures" that have no
proven basis.

Another plus to increased research will be increasingly less reliance on
anecdotal information. For now, there are the requisite horror stories,
easily found while surfing on the Internet: an Idaho woman who allegedly
trusted a herbal salve to treat skin cancer only to find it severely burned
her face -- and later discovered she didn't have cancer in the first place.
Then there is the Oregon health food store owner with a breast tumor who
vowed to prove that the natural route is better than modern medicine; she
is said to have tried a macrobiotic diet, herbs and Laetrile (made from
apricot pits) at a Mexico clinic before finally consulting with an American
doctor. By then, however, the cancer had metastasized, and she died five
days later.

More thoroughly documented are the FDA's reports on cases involving toxic
doses of herbs such as chaparral, which caused extensive liver damage in a
reported seven patients before manufacturers voluntarily pulled it off the
market in 1992. More recently, the herb ephedra, also called ma huang and
marketed for weight control among other uses, has been cited as potentially
dangerous to the cardiovascular and central nervous system.