Acceptance of Alternative Medicine on a (Slow) Upgrade.

By Jane Schwanke
WebMD Medical News

Dec. 28, 1999 (Minneapolis) -- Like children trying to gain acceptance, complementary and alternative therapies have meekly but steadily gained approval this year with a few bumps and bruises along the way. Now, optimistically poised on the edge of the new millennium, alternative methods of therapy are positioned to enter 2000 on a positive note.

Complementary and alternative medicine (CAM) includes a broad range of healing philosophies and approaches. Generally speaking, a therapy is called complementary when it is used in addition to conventional treatment and alternative when used instead of conventional medicines. Data about just how many people use CAM varies from 9% to 42%. But like it or not, CAMs have exploded onto the American scene. While cost issues swirled and health plans debated who should pay for complementary therapies, Americans managed to spend more than $22 billion on CAMs in 1997 -- mostly out of pocket.

During 1999, debate about the safety and efficacy of CAMs has boosted as well as hindered the credibility and acceptance of alternative medicine, which includes herbs, amino acids, botanical extracts, and pseudo vitamins, to name a few. Though CAMs were reeling from negative publicity in 1998 after home-run slugger Mark McGwire's admitted use of the steroid hormone androstenedione, this year researchers were making strides in the lab with the development of new supplements.

One such success was glucosamine -- a supplement that has shown amazing decreases in the symptoms of knee osteoarthritis, or wear-and-tear arthritis. In one of the first well-designed medical studies, 22% of patients who took 1,500 mg oral glucosamine sulfate daily had X-ray evidence of joint structure deterioration, compared with 38% of those who took placebo.

But whether the media attention was positive or negative this year, policy heads kept right on turning toward complementary therapies. In March, congressional supporters of the multibillion-dollar dietary supplement industry went head-to-head with the FDA about whether the agency undermined supplement makers' ability to deem their products beneficial. In May, President Clinton's drug policy adviser urged the federal government to investigate the health effects of androstenedione.

Factors propelling alternative medicine toward a more respected status this year included a number of high-ranking institutions that launched complimentary medicine or 'healing' clinics. Endorsements by universities and medical centers that had previously shunned alternative medicine signal changes that are creating ripple effects from coast to coast.

Earlier this year, Memorial Sloan-Kettering Cancer Center unveiled plans to open an Integrative Medicine Service in the department of medicine to recognize "the unique emotional and psychological needs of cancer patients." In a statement released to WebMD, center President Paul A. Marks, MD, says "Memorial Sloan-Kettering physicians and staff pioneered the field of psycho-oncology by recognizing the unique emotional and psychological needs of cancer patients. [This] program is an extension of that tradition." The service includes art and music therapy, meditation, massage, acupuncture, and hypnosis.

"The whole [alternative therapy] movement is about patient choice -- choice of approaches, techniques, and interventions that fit best with a person's lifestyle and view," Gregory A. Plotnikoff, MD, tells WebMD. He warns that self-diagnosis and self-treatment can put consumers at risk for error, and encourages people to "partner with an informed health professional." In the past, there was a don't-ask-don't-tell mentality, he says, but today, clinicians are becoming more aware that patients are using alternative medicines and are more willing to talk about it. Plotnikoff is medical director of the Center for Spirituality and Healing at the University of Minnesota.

The National Cancer Institute maintains that while "conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process, often less is known about the safety and effectiveness of complementary and alternative methods." Yet, they say, many therapies once considered unorthodox, "are finding a place in cancer treatment -- not as cures, but as complementary therapies that may help patients feel better and recover faster."

Still, alternative medicine took some hard knocks this year. In January, a dietary supplement known as GBL or Blue Nitro was found to be the cause of one death and severe reactions in others. The chemical was touted for building bigger muscles, enhancing sexual performance, and inducing sleep. In May, the FDA was asked to consider a recall of the chemical.

In June, a study in The New England Journal of Medicine found that women with breast cancer who began to use alternative therapies actually reported worse quality of life.

This summer, the Cancer Advisory Panel on Complementary and Alternative Medicine, which offers high-level advice to the National Institutes of Health on how to invest research dollars in this area, met to help separate the inferior CAMs from those worth further research. Two NCI-sponsored trials -- one of oral shark cartilage, the other on pancreatic enzymes -- have garnered more than $1 million in government support. While it's still too early to tell which treatments will work, the panel is looking more seriously at them, says Michael Hawkins, MD, a panel co-chairman and oncologist at the Washington Hospital Center.

"There's a need for physicians to be aware of the fact that people are using [alternative] medicines, [and] for patients to be aware that they should tell their physicians," says Bruce Bacon, MD, a professor of internal medicine at St. Louis University School of Medicine. "

There really isn't all that much known about whether or not what [patients] are taking is effective or potentially harmful."

It's not only patients who are turning to alternative medicines to complement their medical regime. William Fair, MD, of Memorial Sloan-Kettering Cancer Center, himself a recovering cancer patient, is a convert to alternative treatment, saying, "You can't just say 'we don't believe this stuff.' Let's look at the data."

So where are CAMs headed in the new millennium? According to Stephen E. Straus, MD, director of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health, "Several therapeutic and preventative modalities currently deemed elements of CAM will have proven effective, and the term 'complementary and alternative medicine' will be superseded by the concept of 'integrative medicine'" by the year 2020.

In their optimistic projection, NCCAM maintains that the biological and pharmacological basis for effectiveness of selected herbal and nutritional supplements will be clarified, leading to their standardization.

"The field of integrative medicine will be seen as providing novel insights and tools for human health," Straus says in a statement issued to WebMD, "and not as a source of intellectual and philosophical tension that insinuates itself between and among practitioners of the healing arts and their patients."

Whether the talk was positive or negative this year, there's no doubt that most of us were paying attention. And according to Mary Ann Richardson, DrPH, director of the University of Texas Center for Alternative Medicine Research, "This is just the beginning. [Alternative medicine] is not going away. It has infiltrated every aspect of health care. Research needs to take place, more programs need to be integrated ... and [physician-patient] communication needs to increase."

Well, hold on. Indications are that it's going to be a bumpy ride.