TESTING THE TREND

November 26, 1998
		More than four out of ten people in the United States visited alternative medicine practitioners last year. Susan Dentzer of the health unit reports on a recent study as a partnership with the Henry J. Kaiser Family Foundation.

Participate in a Forum on this topic. Aug. 27, 1998: More hospitals are offering alternative treatments. June 19, 1997: The mixed bag of estrogen hormone replacement.. Browse the NewsHour's Health Spotlight.	MARGARET WARNER: Earlier this month, the Journal of the American Medical Association devoted an entire issue to the subject of alternative medicine. The magazine reported a sharp increase in the number of Americans using it, from 61 million in 1990 to 83 million last year, even though many alternative therapies aren't covered by insurance. The number of visits were up too, from 427 million in 1990 to 629 million last year. And patients' spending on alternative therapies nearly doubled from 9.4 billion dollars in 1990 to 17 billion dollars last year. The magazine also presented research studies on the effectiveness of several treatments. For perspective on all this I spoke earlier this week to Susan Dentzer, the correspondent of our health unit in partnership with the Henry J. Kaiser Family Foundation.
	A vague definition.
	MARGARET WARNER: First, Susan, what do we mean by the term "alternative medicine?" SUSAN DENTZER: That's part of the problem, Margaret, because it's a vague term, and it means a lot of things to a lot of people. In essence, what the most commonly used definition is, is that it's all medical treatments that are not generally taught in US medical schools, not generally practiced in US hospitals, all those we could see from the earlier piece that are exceptions, and not generally covered by insurance. But a lot of different products and therapies fit into that very big market basket. We have a graphic now that lists some of the most prominent ones. For example, relaxation techniques, herbal medicine - this would be such things as St. John's Wart for treatment of depression - massage, chiropractic care, spinal manipulation, so on, mega vitamins, imagery, and so forth. And it ranges all the way to a number of other things that we think of as being more traditionally say oriental types of practices, such as biofeedback and acupuncture, also, hypnosis, folk remedies, even commercial diets fall into that category. So it's a very broad range of things. MARGARET WARNER: And who are these 83 million Americans who are now turning to this? Is there a profile of sort of the typical user? SUSAN DENTZER: They tend to fall into one of two camps. A lot of users tend to be people who are healthy, who are turning to these therapies basically as a kind of a lifestyle choice. It tends to be people who are say ages 35 to 49, tends to be surprisingly very well-educated people who might be in a position to want to know whether these things actually produce the results that they produce. And it tends to be affluent people with incomes of about $50,000 a year. That's one set of people. The other set is people who are sick. And, in fact, seven out of ten cancer patients turn to an alternative therapy, probably as a means of maximizing their hopes of seeing a cure.
	Does it work?
	MARGARET WARNER: So what - in this Journal of the American Medical Association, this whole issue, they had several research studies. What did they find? Do these therapies work? SUSAN DENTZER: It all depends. It all depends on the therapy. And, in fact, even the conclusions published in JAMA were rather controversial. A number of researchers have been dismayed about the prominence that they received by virtue of being published in JAMA. Let's take one example, which was a procedure known as Maxobustion. This sounds strange, but, in fact, what it means is taking a certain herb called mugwart, burning it, and holding that burning herb near the acupuncture points on the toe of a pregnant woman. This is done in order to, it is hoped, reverse a breech birth. That is when a fetus is in a woman's womb as she nears delivery and the fetus is not presenting in a head-down position, which is the desired position of delivery, and, instead, the fetus is head up. The Chinese have widely used the practice of Maxobustion to induce a spontaneous turning around of the fetus. And when this procedure was done on 200 - a pool of 260 patients, half of them were given Maxobustion, half were not, and, in fact, a very large portion of those who were given Maxobustion did see the fetuses turn around. Now, researchers are the first to admit, and they did in the JAMA study, that they had no idea why this had happened; they didn't know whether it was a consequence of the mothers being particularly relaxed, could you have gotten the same effect if a spouse had massaged your toes, we just don't know. They also admitted that this was a very small sample of patients to perform this on. So much more work remains to be done until we see how valid these results really are. MARGARET WARNER: Well, is it fair to say that most of these alternative therapies and medicines have not been subjected to the same kind of rigorous testing as say a new drug that may be coming on the market or wants FDA approval, and if that's true, why is it true, given that so many people are using - spending so much money for it? SUSAN DENTZER: By and large, it is true that they have not received the critical scrutiny, but it's also important to say that much of what we think of as conventional medicine has not received that scrutiny either. Drugs are subject to FDA approval, but there is a lot of - there are a lot of things done to patients in hospitals typically, whether it's cardiac bypass surgery and so forth, that has not been scrutinized to the degree that it perhaps should be. And we know from studies that about a third of conventional medicine is probably inappropriate as well. The reason that alternative medicine has not gotten as much attention and scrutiny as it deserved and been subjected to these rigorous clinical scientific trials is partly cultural, it's partly a sense that it's weird, it's strange, it's in some cases from another culture. It's native American medicine. It's oriental medicine. In some instances there's just been a lack of an economic incentive to scrutinize it. And in some cases it might be hard for people who are selling these products to admit to the fact that they may not, in fact, work. And if you subject them to critical scrutiny, in fact, it may be proven that they don't work.
	The medical mainstream.
	MARGARET WARNER: Does the fact that JAMA, the Journal of the American Medical Association, devoted an entire issue to it, does it suggest, though, that these alternative medicine treatments are becoming mainstream to some degree? SUSAN DENTZER: They're coming into the medical mainstream in this sense. Doctors recognize that their patients want these therapies for whatever reason. With almost one out of three Americans seeking some form of alternative treatment, such as the ones we showed, that's a lot of patient demand. So it has to be met, and it has to be met responsibly. What mainstream medicine is now doing is recognizing that the attention given to alternative medicine, that scientific attention is overdue, and that if we're going to be giving patients things that really work, and, more important, if there's going to be ongoing pressure to cover these in insurance, which, indeed, there is, then they have to be subjected to the same kinds of critical scientific studies that ideally we will subject all medicine to before we decide to pay for it. MARGARET WARNER: Well, thanks very much, Susan. SUSAN DENTZER: Thanks, Margaret.