A DAY WITH WALLY SAMPSON
ALAN ALDA (NARRATION) America the melting pot is
also America the crossroads for ideas about healing.
We have a huge range of alternatives for medical
treatment available to us. That presents people
like Wally Sampson with all kinds of difficulties.
He's a retired oncologist and Stanford Medical School
professor, but he's still hard at work.
ALAN ALDA Hi. Good morning…
WALLY SAMPSON Ah, good morning, Alan. Come on in.
ALAN ALDA Thanks.
ALAN ALDA (NARRATION) Wally started a journal to
do what he says we all should - look at alternative
medicine with a cool, scientific eye. But given
human nature, that's easier said than done.
ALAN ALDA I know people who started out thinking,
for instance, that acupuncture was foolishness.
I mean, how could there be these meridians in the
body and Qi coursing through your body? How could
needles have any effect on it? Then they got desperate
because they're in pain. Then they went to an acupuncturist
and felt relief from their symptoms. And they went
from being highly skeptical to now recommending
it to their friends. What happens there? What's
going on there?
WALLY SAMPSON That's a very deep experience for
people. It's almost like having a transcendent or
a religious discovery experience. When two events
occur in close proximity, one beforehand is always
interpreted as having something to do with the second
one. Now the trick is to tell the difference between
what really was the cause and what was the natural
history of what was going to happen anyway. And
most of the time, what was going to happen anyway,
when you're really sick, is you get better. Eighty
percent of the time, no matter what it is, whether
you have back pain or whether you have the flu,
whether you have even a pneumonia -- most people
get better from pneumonia, not everybody dies. Even
some cancers seem to stop growing for awhile or
may remit. But the natural way to think about these
things is to tie up whatever you did just beforehand
with the results. So, that's the way people are.
ALAN ALDA (NARRATION) How to solidly connect cause
and effect is the central question in a scientific
approach to healing.
ALAN ALDA Shall we see what's in here?
WALLY SAMPSON Sure.
ALAN ALDA Hello.
DENNIS ZENG Hi.
ALAN ALDA Hi.
ALAN ALDA.
DENNIS ZENG Dennis.
ALAN ALDA Hi Dennis. Nice to meet you.
DENNIS ZENG Yeah.
ALAN ALDA (NARRATION) This is a typical Chinese
herbal medicine shop, as you'll find all over China
and the Far East. It's stocked with around 300 different
herbal remedies.
DENNIS ZENG You want me to make a package for you?
ALAN ALDA Yeah, why not? It can't hurt me, can
it?
ALAN ALDA (NARRATION) Dennis Zeng, the doctor and
pharmacist, is making me up a package to treat back
pain. He follows a traditional prescription he learned
during several years of training in China. The ingredients
will be boiled to make a strong herbal tea, as it's
known. The result will be a complex mixture of over
a hundred different plant chemical components. This
particular mixture, like most that Dennis prescribes,
has never been studied by science. That's not to
say it doesn't work - it's just that we can't be
sure, because of the way people often confuse cause
and effect, as Wally described.
ALAN ALDA ...two, three, four, five, six, seven,
eight, nine, ten ingredients?
ALAN ALDA (NARRATION) Traditional Chinese medicines
come mainly from the tropical forests of southern
China. They're part of an ancient folk medicine
system - with features that scientists find hard
to recognize.
DENNIS ZENG Tsong Kay Sa...
ALAN ALDA (NARRATION) Each leaf, or fruit, or tree
bark has a specific effect in re-directing the body's
energy flows, or Qi.
ALAN ALDA And this over here?
DENNIS ZENG Yeah. Mu Gua. Mu Gua.
ALAN ALDA (NARRATION) Disease is caused by imbalance
between Yin and Yang. The way to re-establish the
balance - and restore health - is by re-directing
the Qi. Although no western-trained doctor would
recognize the system, patients don't care. In China
most people combine western and traditional cures,
and many in the west do the same.
ALAN ALDA Do you find that your customers also
use western medicine or do they mainly come for
traditional? DENNIS ZENG They also use western medicine,
together.
ALAN ALDA Together?
DENNIS ZENG Yeah.
ALAN ALDA Yeah. How would you be treated with…
DENNIS ZENG I just take the herbal tea.
ALAN ALDA Herbal tea?
DENNIS ZENG Yeah, when I got sick, you know?
ALAN ALDA And what if that doesn't work? What do
you do then?
DENNIS ZENG Doesn't work? Every time it works.
ALAN ALDA That's good. I'm glad you're healthy.
ALAN ALDA (NARRATION) The popularity of herbal
remedies has spread far beyond Chinatowns. There
are now thousands of shops like these all over America.
They're part of a $17 billion industry for what
are called "dietary supplements."
ALAN ALDA What kind of things do people tend to
buy when they come in?
SUKHEE YOO Nowadays, in the winter season, a lot
of people have the flu. Usually the people take
Echinacea and Goldenseal. Or a combination.
ALAN ALDA Wally, do you know about, what would
you say about Echinacea?
WALLY SAMPSON It's had an interesting history because
there's some evidence in test tube work that it
can stimulate certain immune cells in the immune
system. But, in clinical trials, it hasn't worked
as well.
ALAN ALDA (NARRATION) Unlike prescription drugs,
supplements don't have to have proven effects. Most
of the huge array of products on the market either
haven't been tested, or show vague results. For
example, a popular cancer treatment - IP-6, derived
from plant fiber - may affect mouse cancer cells,
but has shown no effects in humans.
ALAN ALDA "Natural substance, IP-6, offers hope
as cancer therapy."
SUKHEE YOO This is for good immune systems, so
your body will be able to fight against cancer.
ALAN ALDA And do you have people coming in? Is
that popular?
SUKHEE YOO Even I take it. Even I take it.
ALAN ALDA Yeah?
SUKHEE YOO Yeah.
ALAN ALDA What if somebody came in and said, "I
have a pain in my shoulder. Or I have a muscle pain.
Or I have arthritis."
SUKHEE YOO Yeah, those are the products… ALAN Chondroitin?
SUKHEE YOO Yeah, glucosamine-chondroitin combination.
ALAN ALDA Glucosamine-condritin.
SUKHEE YOO Yes, this is one of the most popular
products we sell.
ALAN ALDA Really?
SUKHEE YOO Yes.
ALAN ALDA And, do people feel it works?
SUKHEE YOO Even I take it.
ALAN ALDA You take this, too?
SUKHEE YOO Yeah, I take it.
ALAN ALDA We haven't found yet you don't take.
You take more than ten pills a day.
SUKHEE YOO Yeah, probably. I take it.
WALLY SAMPSON Do you have anything that people
come in asking for for their heart?
SUKHEE YOO Yeah, we have Co-Enzyme Q-10 over here.
ALAN ALDA (NARRATION) There really is no ailment
for which you can't find something to spend your
money on. SUKHEE YOO Here. Co-Enzyme Q-10 is a very
expensive product.
ALAN ALDA Co-Enzyme Q-10.
WALLY SAMPSON Right.
ALAN ALDA What is this? That's a very scientific
name. It doesn't sound very natural. It doesn't
sound like it comes from a Co-Enzyme Q-10 tree or
anything. What is this Wally, what is this?
WALLY SAMPSON It's a simple chemical, organic chemical
compound. It's also known as ubiquinone. It's present
in everybody's body. But it became a little famous
because it's slightly antioxidant but it also has
an effect in dog hearts. And a lot of people say
it has effect on human heart for heart failure and
so forth. But again, a recent study reported in
the Annals of Internal Medicine showed that it didn't
really help humans.
ALAN ALDA (NARRATION) Maybe what they're really
selling here is hope. In our next story, we'll look
at a cancer remedy that offered exactly that.
HERBAL HOPE
ALAN ALDA (NARRATION) This is about a remedy made
here, called PC-SPES.
BARRE RORABAUGH PC-SPES is a nutritional supplement.
It's for prostate cancer, although we cannot make
that kind of a claim. The only claim we can make
is that it's for healthy prostate.
ALAN ALDA (NARRATION) So long as supplements do
not make specific claims of treatment or cure, they
are only loosely regulated. The FDA does not assess
vague statements like "for prostate health," but
it's usually pretty clear what the message is. In
this case, PC means prostate cancer, and SPES is
Latin for hope - and people surely want that.
BARRE RORABAUGH A neighbor of mine put his house
up for sale one day and I asked him, "why are you
putting your house up for sale?" He says, "Barry,
I have prostate cancer and I'm going to die in six
months." And he said, "I've tried every treatment
in the world. I've been to fifteen different doctors
and I have nowhere to go." And he was selling his
house and moving to a less expensive house so his
wife wouldn't have a mortgage. And over the six-month
period he literally just became a shell of a man.
And he discovered PC-SPES. He was doing some research
and started taking PC-SPES. And this was in the
'95-'96 time frame and at that time he said, "Barry,
this is an interesting company and with this product,
my PSA counts are coming down." And so it was about
a year later he says, "You know Barry, I'm gonna
have to find a job," he says, "I'm going to live."
And of course today he's alive and doing very very
well. And that is a story that is compounded probably
a couple thousand times over.
ALAN ALDA (NARRATION) George Dutra was diagnosed
with prostate cancer in 1992. He would eventually
take PC-SPES, but not before a long struggle.
GEORGE DUTRA When the surgery was performed I was
told that we would take out the cancer, put it in
the bottle, put it on the shelf, and that's it,
forget about it. But after surgery they found there
were still some traces that had gotten into a lymph
node. So that wasn't going to be a problem. We could
then go to, have some radiation and that would zap
it, so. We did the thirty-five treatments of radiation
and the count stayed down for a very short time.
ALAN ALDA (NARRATION) George's treatment followed
the standard course. First surgery, then radiation,
then hormone therapy to suppress testosterone, chemotherapy,
and finally second-line hormone therapy. You always
hope each new level will defeat the cancer. When
the second-line hormones failed, PC-SPES came up.
GEORGE DUTRA My family doctor had read about it
and he had called my attention to it. He said you
might look into it but it's expensive. And when
you're running out of options, yes you do try it.
And that's one of the things we were told, too --
we're running out of options.
ALAN ALDA (NARRATION) George's PSA levels - a test
which measures the cancer's activity - came down.
As Wally Sampson says, diseases can fluctuate on
their own, but George believes the PC-SPES was responsible.
GEORGE DUTRA It gave me 8 months or 9 months of
PSA that didn't take off, because I had been higher
earlier. I have no, ah…I'm glad I tried it.
ALAN ALDA (NARRATION) George's PSA levels eventually
started to climb, and he's now back on a conventional
second-line hormone therapy. By the mid-1990s, so
many prostate cancer patients were taking PC-SPES
that urologists here in San Francisco decided they
had to conduct a study. For a complex disease, with
many treatments, that's quite a challenge.
ERIC SMALL We studied PC-SPES, on the one hand,
in patients who had never before had hormones, and
were therefore hormone-sensitive. The other group
was patients who had already gone through the hormones,
had already been treated with drugs that lowered
their testosterone to a very low level and despite
that, had developed progressive disease. By their
very nature, those patients tended to be, to have
more advanced disease.
ALAN ALDA (NARRATION) The 33 patients in the first
group showed dramatic results. Everyone had PSA
drops of at least 80%. Even the second group - patients
with advanced disease - did well, with more than
half showing PSA drops of at least 50%. PC-SPES
was performing at least as well as a standard hormone
therapy. It could be a terrific extra weapon in
the fight against prostate cancer. So how did it
work? One test, to measure testosterone levels in
the first patient group, came back with intriguing
results. ERIC SMALL We found that, lo and behold,
the testosterone level in all of them had fallen
dramatically, suggesting that at least one of the
mechanisms of action in this group of patients was
that PC-SPES was acting as some form of a hormone,
eliminating the male hormone testosterone.
ALAN ALDA (NARRATION) This is where things get
confusing. PC-SPES is a mixture of 8 natural herbs
- 7 from China, one from America. Among the many
chemicals in that mixture, was there one which acts
like a hormone? Or, somewhere along the supply chain,
had someone introduced a hormone like DES? DES,
a synthetic form of the female hormone, estrogen,
has long been a standard prostate cancer therapy.
An analysis had not found DES, so Eric Small's team
decided PC-SPES was promising enough for a large-scale
trial. In the spring of 2000, 90 men with advanced
disease were enrolled at three centers. The aim
was to compare PC-SPES to DES. As the trial proceeded,
rumors were flying among PC-SPES consumers. Some
patients said it had stopped working. Had the formula
changed? Two labs hired by consumers reported finding
DES. Then the FDA did an analysis but found no DES.
Eric Small's team tested the PC-SPES they were using
in the trial, and found a small amount of DES in
three of their four batches. So now the trial might
just be comparing DES to DES.
ERIC SMALL We've been told by our chemists that
this looks like synthetic DES. But what we don't
know, I certainly don't know, is whether that could
result as a process of the manufacturing of the
herbs, of the processing of the herbs, whether it's
a supplement -- we just don't know. And in point
of fact, we don't know what that small amount of
DES does. It's entirely possible that it does nothing.
ALAN ALDA (NARRATION) Nevertheless they decided
they had to halt the trial. Meanwhile, Botanic Lab
denied having added anything synthetic to PC-SPES.
But a few days after we filmed here, analysis of
samples by the California Health Department came
up with traces of a second prescription drug. The
manufacturer finally halted production. The PC-SPES
story shows what a challenge it is to get scientifically
rigorous results, working with herbal remedies.
It's hard to control quality, because plants vary
depending on conditions. You don't know what ingredients
might be active, and you don't even know exactly
what's in them. PC-SPES might still be a useful
therapy, but we may never know. And that applies
to most herbal remedies on the shelves. Wally Sampson
is back at the hospital where he worked. As part
of his constant advocacy of clarity and logic in
medicine, he now hopes to interest doctors in learning
about how to assess alternative therapies.
WALLY SAMPSON Good afternoon. I'm Wally Sampson
and I used to do oncology here. I've given grand
rounds and another noon conference earlier this
year on the subject of alternative medicine. Alternative
medicine is alternative at this time because it
is not supported by adequate scientific information.
I would like to start a small seminar series specifically
concentrating on the analysis of information.
ALAN ALDA (NARRATION) I took the opportunity to
ask how the growing interest in alternatives affected
their work.
ALAN ALDA What do you think is the most important
reason for people to be cautious about taking herbal
medicines and other alternative cures?
CLIFFORD WANG Drug interactions is what we would
worry about the most. Um, you know, we…a lot of
the times the patients are taking multiple medications,
especially in the elderly population. And then they
go to the store and they will buy some herbal product.
GARY VIALE A lot of the times they don't tell us
what they're taking because they feel they're buying
it in a store, that it must be quite benign. And
we, in the medicine side, don't know if it's totally
benign. Don't know, in fact that it can or cannot
interact. And so we're in a learning curve also
to understand these new compounds. They're new to
us. They're certainly not new to the world. They're
just new to us in medicine.
ALAN ALDA (NARRATION) There are some notorious
examples of bad interactions -- causing liver damage,
or even transplant rejections. But overall this
area is a big unknown. Alternatives do offer hope
to patients, but there's false hope too. These doctors
see a serious problem with patients ignoring conventional
therapies.
STEPHANIE CHEN I think that is one of the harms
of the medications, is people see it as an either/or
sort of situation. So as an example, I had a patient
who was 49 years old diagnosed with early prostate
cancer, who… I was trying to convince him to undergo
either curative surgery or curative XR-T and he
refused and is on herbal medicine and has been doing
that for about a year and is doing okay. But I'm
pretty concerned about him, you know. And I think
that's not only giving him false hope, but probably
could lead to him dying from the prostate cancer.
ALAN ALDA Has anybody else had an experience where
a patient has turned away from conventional medicine
in favor of herbal things and that kind of thing?
PAMELA VIALE Absolutely. Cancer patients. I've
had some that have gone to Mexico, gone to clinics
down in San Diego, gone for sweat therapy, I mean,
colonics, and have absolutely given up chemotherapy
in order to try to pursue those avenues. And then
come back after they've exhausted that, exhausted
their money, found out that they were just getting
sicker and that their cancer wasn't going away,
and then they came back to us for conventional therapy.
It's very sad.
DEANNE YAMAMOTO Sure. I had a very young 25-year-old
woman with active rheumatoid arthritis who came
in and she wanted to know her diagnosis. So we did
blood tests and x-rays and we gave her the diagnosis.
And she said, "Well, I prefer to not use any of
the traditional medicines. I want to do it herbal."
And I just simply said to her, "What can I do to
keep the door open?"
ALAN ALDA (NARRATION) It's hard to see how that
uneasy relationship between conventional and alternative
medicine can change any time soon. Perhaps 60 million
people in America use alternative ways to heal,
and the number's growing. In our next story, what
science has to say about one of those ways - healing
through the spine.
ADJUSTING THE JOINTS
STEPHEN ROWE Drop that shoulder…there we go.
JOHN BADANES And we have a patient here, Paul.
ALAN ALDA Hello Paul. PAUL Hello.
JOHN BADANES And, er, what's your complaint today?
PAUL Oh, my neck hurts.
JOHN BADANES Okay, very good.
ALAN ALDA (NARRATION) John Badanes is conducting
a chiropractic examination. He compares the lengths
of Paul's legs, and finds a difference. Next, he
makes adjustments in the alignment of Paul's skeleton.
Paul's leg lengths should become even, with his
neck pain cured. John Badanes is a fully trained,
experienced chiropractor. But he left the business
after 7 years when he realized he had to face up
to his profession making no sense.
JOHN BADANES This is an activator. It doesn't involve
bone cracking or joint-popping. If I activate it,
there is a…
ALAN ALDA It's just a little tap.
JOHN BADANES That's a little tap. In fact, I can
adjust that down to…
ALAN ALDA I can't even feel that.
JOHN BADANES That's correct.
ALAN ALDA (NARRATION) Chiropractors adjust "subluxations."
ALAN ALDA A subluxation, is that some kind of displacement
of bones in the spine?
JOHN BADANES A subluxation is what a chiropractor
defines as a problem.
ALAN ALDA In other words, it's a term that's used
in many, many different ways.
JOHN BADANES Correct.
ALAN ALDA Now, historically, when Palmer invented
this, introduced this term…
JOHN BADANES Right.
ALAN ALDA …he was talking, was he about some kind
of blockage of some life force that was coming in
from the universe?
JOHN BADANES Correct. What he called nerve interference.
It was a life force expressed through the nerves
and, er that was blocked -- what he called nerve-interference
-- and usually by a bony displacement.
ALAN ALDA (NARRATION) Chiropractic - which literally
means, "done by hand" - was invented by Daniel Palmer
in Davenport, Iowa in 1895.
PALMER'S VOICE Do you want the cause of your disease
removed, and get permanently cured in the quickest
possible time? Chiropractic relieves pressure on
nerves, the cause is removed, and perfect health
established.
ALAN ALDA (NARRATION) Palmer, a spiritualist and
magnetic healer, said that chiropractic was revealed
when he cured his office janitor of deafness. The
janitor said his deafness had started when something
gave way in his back. Palmer takes up the story:
PALMER'S VOICE An examination showed a vertebra
racked from its normal position. I reasoned that
if the vertebra was replaced, the man's hearing
should be restored. With this object in view…I racked
it into position…and soon the man could hear as
before. In that adjustment originated the art of
replacing vertebrae.
ALAN ALDA (NARRATION) Subsequently a large theoretical
structure, and industry, have been built on the
basic idea that pressure on spinal nerves causes
disease. Palmer believed the pressure interrupts
the flow of what he called "innate intelligence,"
or "life power," from the brain. Nowadays the language
may be a little different, but the basic idea is
the same.
GERALD CLUM We are concerned about the relationship
of the ability of the nervous system to express
itself fully throughout the body as it particularly
can be interfered with at the spinal level. The
chiropractor is concerned about aberrations in the
spine, minor misalignments that may not seem consequential
to other providers, that have profound impact from
our experience as chiropractors on the health and
well being of the patient.
ALAN ALDA (NARRATION) Thirty years ago an anatomist
tried twisting cadaver spines around, but couldn't
figure out how to obstruct the nerves -- short of
actually breaking something. In fact, our vertebrae
give the spinal nerves plenty of room. So now, chiropractors
say the effect is indirect.
GERALD CLUM The pressure may not be on a spinal
nerve route, or the pressure may not be on a spinal
cord. But it may a disturbance that changes the
musculature, that changes the pattern of cervical
spinal fluid movement. It may be a change in the
positioning of a vertebra, that begins to compromise
and swell, excuse me, compromises a joint level,
produces swelling that in turn produces pressure
on a nerve route. So the early concepts of chiropractic
of being direct nerve pressure have given way to
concepts of indirect pressure.
STEPHEN ROWE Hi Kimberley.
KIMBERLEY MAH Hi Doctor Rowe.
STEPHEN ROWE Nice to see you again today.
KIMBERLEY MAH Nice to see you, too.
STEPHEN ROWE So tell me, how did you respond to
our last visit?
KIMBERLEY MAH Ah, really good, actually. I was
feeling really good after, thank you.
STEPHEN ROWE And since then you've been feeling…?
KIMBERLEY MAH I've been a little sick for about
the past week. I've been sick.
STEPHEN ROWE You've been sick? Tell me about that.
KIMBERLEY MAH Um, I've got sinus congestion, a little
headaches, and fatigue.
STEPHEN ROWE And how are you feeling now?
KIMBERLEY MAH The same. I've still got some sinus
congestion, and I'm still tired. It's not really
getting any worse or any better. It's staying the
same.
STEPHEN ROWE OK, well, I'm glad you're here, and
we'll take a look at your spine and see how you're
really doing. OK, now we're just gonna feel how
your spine is moving so I'm just going to arch,
and you can let me feel the motion here. There we
go. I'm feeling for her spine to have a free, even
motion between each segment. And if I get to a segment
like that one right there that's not moving freely…
KIMBERLEY MAH It's tender.
STEPHEN ROWE I then I'm going to ask her if it's
tender -- well she just volunteered that -- but
that would indicate to me that that's very likely
subluxated.
ALAN ALDA (NARRATION) Stephen Rowe now confirms
the subluxation with his Nervo-Scope. It compares
skin temperatures across the spine, and has a long
history in chiropractic.
STEPHEN ROWE I'm looking for subtle differences
at specific levels.
ALAN ALDA (NARRATION) Palmer said disturbed nerves
can show up as imbalances in heat. It's reminiscent
of the Chinese concept of Yin and Yang, and has
equally little basis in anatomy. Having located
Kimberley's subluxation, Stephen Rowe now uses an
X-ray to plan the adjustment procedure.
STEPHEN ROWE I'm looking for factors like whether
she has a proper curve, proper neck curve, a proper
thoracic curve, and a proper lumbar curve. Then
I'm looking intersegmentally, between each segment
intersegmentally, as to how they align. She has
what's called a base posterior sacrum, where her
sacrum is misaligned in relationship to the fifth
lumbar. And that's what we'll be adjusting on her.
JOHN BADANES This for a chiropractor would be a
curve that needs to be fixed. It needs to be straightened
out.
ALAN ALDA Now, is it possible to straighten it
out with…
JOHN BADANES With the methods that people do?
ALAN ALDA With adjustments using people's hands?
JOHN BADANES Well, like I say, I don't think that
it is. I don't think the major changes in spinal
configuration can be made. But that's not the point.
The point is is that it's never been demonstrated
that the shape of the spine has anything to do with
disease or health.
STEPHEN ROWE Good, just bring your pelvis a little...
ALAN ALDA (NARRATION) Nevertheless, in a procedure
repeated many times over in chiropractors' offices
across the country, Kimberley gets her spine adjusted.
STEPHEN ROWE OK Kimberley, just relax, nice and
easy. Let that belly go forward. There we go.
KIMBERLEY MAH I feel great.
ALAN ALDA (NARRATION) The popping noise that joints
can make is often interpreted by chiropractors and
patients to mean the bones have moved. In fact,
it's just dissolved gas being released in the joint
fluid.
JOHN BADANES These joints are similar to the joints
in my finger. My finger is two little bones and
there is wrapped, there's a space between it, like
this, and that's wrapped in a joint capsule with
fluid. And when you pull them apart, as I did there,
it makes that popping sound. But, of course, my
finger hasn't changed its position at all. Well,
the same thing happens when you manipulate the spine.
Patients believe that the bone was out of place
and that noise signals…
ALAN ALDA ...snapped back into place...
JOHN BADANES ...into alignment.
ALAN ALDA ...into alignment.
JOHN BADANES Exactly, because that's what the chiropractor...
ALAN ALDA But you're saying you really can't change
the position of the bone by this procedure that
results in a crack.
JOHN BADANES Not by that. Not by that. Otherwise,
you know, every time you cracked it you might be
in danger of coming apart.
STEPHEN ROWE Lift up your right arm...
ALAN ALDA (NARRATION) Kimberley gets a second adjustment.
STEPHEN ROWE …attach it right there. OK, just right
there, there you go. Drop that shoulder. Excellent.
As a result of this, I would expect some of the
symptoms that she initially talked about -- her
congestive sinuses, the heaviness in her neck and
in her head -- to be reduced.
KIMBERLEY MAH Chiropractic is a regular way to
stay healthy. I get adjusted on a regular basis.
Approximately every two weeks to three weeks, depending
on how I feel and on how everything's going, if
my adjustments are holding well, then we can make
the time between adjustments last a little bit longer.
ALAN ALDA (NARRATION) Robert Baratz is a physician
who believes, with Wally Sampson, that patients
like Kimberley are confusing cause and effect. The
treatment is unconnected to health, he says -- chiropractic
bears no relation to reality.
ROBERT BARATZ The chiropractic theory of manipulation
as being curative of disease or in terms of diagnosing
disease, is based on a false premise. The premise
is that there's some kind of vital force flowing
around the body, as yet undefined and unquantified
and undetectable, that they claim they can manipulate
by manipulating the spine.
ALAN ALDA (NARRATION) Here's the leg-measuring
procedure again.
DAVID DONALDSON By comparing the like surfaces
here, I get a right short leg. That tells me that
there's an imbalance in the system, and it's a go-ahead
to keep analyzing the patient and I know where to
go with that now.
ALAN ALDA (NARRATION) The imbalance needs adjustment.
DAVID DONALDSON This is an Activator 3. It's the
third generation of development. And what we've
done here is made an instrument that has an ultra-fast
thrust. And we know that if we can activate the
nervous system faster, then we don't have to push
it as hard. We don't have to get the cracking noises
that are often associated with the chiropractic
adjustment. But we're accomplishing the same thing.
And then I go ahead and check the leg length again,
and the legs are now even. It tells me that I've
made a good correction.
ROBERT BARATZ If someone says they can measure
leg lengths as being different, and that's the basis
for their diagnosis, what is the diagnosis? First
of all, it's normal to have leg lengths that are
of different lengths. That's true in almost everyone.
DAVID DONALDSON Lift your head up. Back down.
ROBERT BARATZ The length of the leg is not determined
by the spine, it's determined by the bones of the
leg. And by manipulating the spine or the back,
you're not going to change that, because those bones
aren't going to change their length by any form
of manipulation, unless you break them.
ALAN ALDA (NARRATION) It's easy not only for the
patient to be fooled, but the chiropractor too.
JOHN BADANES Small changes in this position like
this can fool the practitioner if their expectation,
if…
ALAN ALDA It's longer over here than it is over
there.
JOHN BADANES Correct.
ALAN ALDA (NARRATION) It's fair to ask if it really
matters if chiropractic makes sense. After all,
people do illogical things all the time. But there
is one problem - some forms of chiropractic involve
violent manipulation. Many techniques concentrate
on the nerves of the neck, including this one, called
"toggle recoil".
DAVID BROWNING The upper cervical spine specifically,
which is what this technique focuses on, is the
only area of the body where you can directly access
the nervous system. It's got -- and this is just
physiology and neurology -- it's got four to five
hundred times the amount of mechano-receptors, proprio-receptors,
things of that nature that go directly into and
effect the way your brain stem function. So if there's
a problem in that area, we want to know about it.
ALAN ALDA (NARRATION) The chiropractor believes
this patient's neck bones are at the wrong angle.
They must be adjusted.
DAVID BROWNING ...you can see some lines drawn
in here, and there's a number, it says twenty-six
degrees. That's giving me an idea of the Atlas Plane
Angle.
ALAN ALDA (NARRATION) Chiropractors have always
maintained that neck manipulation is safe, with
maybe one in a million procedures causing injury
- no worse that many other health treatments.
DAVID BROWNING ...scoot right into my contact.
We're gonna set the headpiece...and that's it.
ALAN ALDA (NARRATION) But beginning in the mid-1990s
with this book by an injured patient, the safety
of neck manipulation has been increasingly questioned.
ROBERT BARATZ Going to a chiropractor and having
your neck manipulated is extremely dangerous. Now,
can many people have it done and not have a bad
outcome? Sure they can. Do you want to take that
risk?, is the question. Do you want to be the one
who gets the paralysis? Because every year there
are hundreds of people who get their necks manipulated,
have their vertebral arteries torn by chiropractors
and end up paralyzed.
JOHN BADANES Many chiropractic adjustments are
made by first laterally flexing the head and turning
it like this.
ALAN ALDA (NARRATION) This manipulation puts a
severe strain on one of the two vertebral arteries
leading to the brain.
JOHN BADANES When you move the neck suddenly, when
you take it to tension and then move it suddenly,
you're giving that little extra tension pull on
the vertebral artery and you can create a little
tear which repairs itself with a blood clot. And
that blood clot can then dislodge and go up to the
brain and deprive the brain of oxygen and that's
called a stroke.
ALAN ALDA (NARRATION) It's very hard to know how
often this type of stroke is caused by chiropractors
-- good statistics don't exist. But a recent Canadian
study estimated that 20% of all strokes caused by
artery damage could be a result of neck manipulation.
That translates into more than 1300 strokes a year
in the US. There are many types of chiropractors,
with many different techniques, but they are all
based on one idea.
ALAN ALDA It's your position that it doesn't matter
what kind of chiropractor you get, what special
way he or she might have of dealing with your problem
-- none of them is gonna work.
JOHN BADANES It's my position that they're all
self-referential. In other words, they define a
particular problem that incidentally has never been
verified to be a problem, and then they have their
methods of locating that problem, and then they
have their specific methods of fixing it. So it's
like a closed loop, and so it always works because
you're just talking to yourself.
ROBERT BARATZ There is no scientific basis for
what chiropractors allege they are doing. It is
totally based on a religious belief system. And
as long as you call it that, fine, but don't call
it health care, and don't call it a form of science
because it is not.
NEEDLES AND NERVES
ALAN ALDA (NARRATION) China International Medical
University is a small company that offers an increasingly
popular service - acupuncture. Dr. Jiang, who trained
in China, will treat the young man for insomnia.
DR. JIANG The patient is suffering from insomnia.
Maybe due to stress, maybe due to heart Qi deficiency.
Because he is a student he has a lot of stress.
ALAN ALDA (NARRATION) She measures down to the
two Hsinshu, or heart back points. She inserts fine
needles, no thicker than a human hair, and then
uses an up and down movement to "tonify the heart
Qi." Qi, in Chinese medicine, is the body's basic
life energy. Now she moves down to the Kanshu, or
liver back points, where she will relieve "stagnation
of the liver Qi." The patient later reported his
insomnia cleared up. Of all the alternative medical
practices, acupuncture is probably the most widely
accepted. It's often covered by insurers. In America,
interest in acupuncture really took off after Nixon
went to China in 1971. A New York Times reporter,
James Reston, had been in Beijing during Henry Kissinger's
preparatory visit. Reston had to have his appendix
out, and after conventional surgery at the Anti-Imperialist
Hospital, he was given acupuncture for post-surgical
pain. He ended his glowing account of the experience
by writing that the hospital,
JAMES RESTON VOICE … like everything else in China
these days…is on its way toward some different combination
of the very old and the very new.
ALAN ALDA (NARRATION) Acupuncture is very old -
the first descriptions date back 4000 years. These
illustrations are about fifteen hundred years old,
but the dense maps of meridian lines and acupuncture
points that you see nowadays are from the nineteenth
century. Depending on who you ask, there are up
to a thousand usable points on the body. Bill Stroud
gets acupuncture from Dr. Jiang every two weeks.
Bill's got heart problems and diabetes, and he says
these visits help. What science says, right now,
is maybe -- there could be something happening,
but it's not clear what.
BILL STROUD When they hit the mark, I get a tingle.
ALAN ALDA What do you mean, hitting the mark?
BILL STROUD When she hits the nerve.
ALAN ALDA After it reaches a certain depth and
it gets to the nerve, that's when you feel it tingle?
BILL STROUD That's it.
ALAN ALDA I see.
BILL STROUD Then it goes down to my fingertips.
ALAN ALDA Yeah.
BILL STROUD And my toes.
ALAN ALDA Is it similar to the pins and needles
you feel when your foot goes to sleep?
BILL STROUD No.
ALAN ALDA What about…is it like…I'm trying to try
out some feelings that I'm aware of...is it like
a little electric shock?
BILL STROUD Yeah, that's more like it.
ALAN ALDA Yeah?
BILL STROUD Yeah, it's a little shock.
ALAN ALDA (NARRATION) We're observing Bill's treatment
with a cardiologist who's a leading acupuncture
researcher.
JOHN LONGHURST ...so the Neikuan is right here.
This is along the so-called pericardial meridian.
ALAN ALDA This is what Bill is getting now?
JOHN LONGHURST Yes. They're stimulating here, Neikuan,
and then up here, at the Hsimen.
ALAN ALDA This corresponds to a nerve identified
by western medicine...
JOHN LONGHURST Yes.
ALAN ALDA ...that's actually in everybody's arm.
JOHN LONGHURST What we've found is this, is that
most meridians overlie major neural pathways. Most
of them do -- not 100%, but most of them do. And
then the acupuncture points would be sticking the
median nerve at various different levels.
ALAN ALDA (NARRATION) The central belief in acupuncture
is that stimulating specific points can affect particular
body functions. One of the few scientific demonstrations
of this came when colleagues of John Longhurst used
a brain scan to detect activity while stimulating
a traditional, vision-related point on the toe.
JOHN LONGHURST They showed that the visual cortex
up in the brain lit up. So, that's kind of provocative.
ALAN ALDA And that has been considered for centuries
by the Chinese as a way to affect vision.
JOHN LONGHURST Exactly.
ALAN ALDA (NARRATION) Bill's Hsimen point is stimulated
in order to help his heart Qi. It's not language
scientists understand, but that doesn't mean nothing's
happening. DR. JIANG Heavy thrusting -- light lifting,
heavy thrusting -- light lifting. This is to build
up the heart Qi.
ALAN ALDA How do you know you've got the heart
Qi? How do you know you've got the right spot for
that?
DR. JIANG I feel some heaviness under my fingers.
I feel the Qi. I feel I've captured…
ALAN ALDA You feel some resistance?
DR. JIANG Yeah, I captured the Qi.
ALAN ALDA I see, so you're responding to the Qi
in his body, and that's how you know you've got
it.
ALAN ALDA (NARRATION) Twenty minutes later and
Bill's happy.
ALAN ALDA How you doing Bill?
BILL STROUD Fine.
ALAN ALDA Yeah?
BILL STROUD Yeah. Real good.
ALAN ALDA Do you feel relaxed? You said you often
feel relaxed.
BILL STROUD Real relaxed, yeah.
ALAN ALDA Why don't you…
BILL STROUD I think I almost dropped off to sleep
while you fellows were talking.
ALAN ALDA (NARRATION) We're going to look at one
of John Longhurst's experiments involving blood
pressure.
ALAN ALDA Does the act of measuring somebody's
blood pressure alone have an effect on the blood
pressure?
JOHN LONGHURST Uhuh. And if you wear a white coat,
it increases it even more.
ALAN ALDA (NARRATION) The background to this experiment
is some key results John Longhurst has found in
animals. Stimulating the Hsimen and Neikuan heart
points released natural opiates in the brain. These
opiates were able to reduce the animal's response
to stress, suppressing blood pressure. He's sure
this is real. He could stop the effect when he blocked
the opiates, and animals, of course, don't have
any ideas or beliefs about acupuncture.
ALAN ALDA Were you surprised when you came across
this confirmation that it stimulates the body's
opiates?
JOHN LONGHURST Let me just say that I, like most
western scientists and western physicians, had absolutely
no belief that acupuncture had any validity to it.
I didn't believe it worked. It was only after I
read the literature and started to do my own studies
that I started to believe in it. But I did not come
at this from the viewpoint that, a priori, that
it worked.
ALAN ALDA (NARRATION) Eric, our experimental subject,
is having his Hsimen and Neikuan points located
by Peng Li, Longhurst's Chinese collaborator.
PENG LI Any feeling now?
ERIC A little. Yeah.
ALAN ALDA When you leave here after one of these
trials, do you feel any different from the way you
did when you came in? ERIC I don't feel much different.
And that's not normal after a workout like what
I'm going to be doing.
ALAN ALDA (NARRATION) They're going to use electric
acupuncture to stimulate the nerves, because it's
more controllable than the manual method.
PENG LI Switch on.
ALAN ALDA (NARRATION) The twitching shows Eric's
median nerve, which runs from neck to fingertips,
is being stimulated.
TECHNICIAN Eric we just shut the light, OK?
ERIC OK.
ALAN ALDA (NARRATION) Eric gets 30 minutes of acupuncture
in a low stress setting, which won't elevate his
blood pressure. For comparison, other subjects get
the same thing, but without the acupuncture. Now
the test. Eric has to peddle until he can peddle
no more. At that point, his blood pressure will
be at its peak.
JOHN LONGHURST 105 over 70.
ALAN ALDA (NARRATION) It's the first number that
matters.
JOHN LONGHURST 120 over 65. 128 over 68. 140 over
60. 148 over 60. 150 over 58.
ERIC Uncle.
JOHN LONGHURST OK. Let me get a last blood pressure.
ALAN ALDA You do want to get his blood pressure
before he's lying on the floor, right?
JOHN LONGHURST Yes, I do.
ALAN ALDA You can do it, Eric.
TECHNICIAN Come on.
JOHN LONGHURST 158 over 55.
TECHNICIAN Thank you.
ALAN ALDA (NARRATION) The results of the study
were a surprise. Subjects who got acupuncture at
the Hsimen and Neikuan heart points, as expected
showed significantly lower peak blood pressure,
compared to the no acupuncture group. But as an
additional control, another group received acupuncture
at the Hoku point, which is supposed to affect the
intestines, not the heart. And that point turned
out to be just as good at lowering blood pressure.
JOHN LONGHURST We found that that was as potent
as our cardiovascular active one.
ALAN ALDA For a cardiovascular response?
JOHN LONGHURST For the cardiovascular response
to exercise, exactly.
ALAN ALDA So now what will you do? You'll have
to pick another spot.
JOHN LONGHURST Exactly. We do have another comparison
and that is no acupuncture whatsoever.
ALAN ALDA Yeah.
JOHN LONGHURST And there, both of them seem to
be better than no acupuncture whatsoever.
ALAN ALDA But at the moment, that seems to indicate
that if you stick a pin in a person anyplace, you're
liable to get this cardiovascular response.
JOHN LONGHURST At least in two places.
ALAN ALDA At least in two places.
ALAN ALDA (NARRATION) So acupuncture has effects,
but not in the way Chinese theory describes. That's
where John Longhurst's research stands right now,
but his conclusion that acupuncture stimulates the
body's own opiate system opens up some intriguing
ideas. Scientists are now coming to believe that
most alternative therapies, where they have any
effect, operate through that same opiate system.
There's another name for this. It's the placebo
effect, and it can be triggered by many things -
belief, expectation, habit, discussion, touch. Acupuncture
is a kind of double dose of placebo.
JOHN LONGHURST Some of my colleagues in alternative
medicine would not like me saying this, but almost
any sort of alternative medicine that is being used
today, a significant portion of its effect is through
a placebo. Whether you're talking about healing
touch or aromatherapy or herbal medications or acupuncture.
Just any of these things, transcendental meditation,
any of them, there is a potential for a placebo
effect. But I will go one further step and say that
I think despite this, I think that some of these
alternative therapies , including acupuncture, there
is a real effect over and above placebo. It's just
the window between what is placebo and what is real
is somewhat narrow.
ALAN ALDA What do you look forward to finding out
as time goes on? What are you really trying to...what
do you want just to narrow down to?
JOHN LONGHURST OK. I would like to see it -- acupuncture
and complimentary therapies that have proven to
be beneficial -- to be taught in medical schools
today. Because certainly, when I went to medical
school, we didn't even talk about this form of therapy.
Yet we know that as many people see an acupuncturist
or a physician who is going to give soma form of
complimentary therapy, as see primary care physicians
today. And most people don't realize that so many
patients are accessing this other form of therapy.
So don't we need to know something about it? Don't
our physicians need to be able to ask questions?
HEALING TOUCH
ALAN ALDA (NARRATION) This is Columbia-Presbyterian
Hospital in New York City. It's one of the country's
leading medical institutions. Here patients with
serious heart problems are receiving some surprising
treatment. It's called therapeutic touch, although
there's no actual touching involved. Ellen McMahon,
a nurse, is following procedures based on traditional
Chinese medicine.
ELLEN McMAHON It's our belief that your body goes
beyond your skin.
ALAN ALDA (NARRATION) Ellen is manipulating what
the Chinese call Qi.
ELLEN McMAHON Using your hands, you might want
to call them kind of like geiger counters, you just
keep going over it, working with the areas where
you feel need, and then smoothing it. It's our belief
that underneath, if we can make you balanced, that
it can help the whole of your body. And if you're
in a state of restfulness, healing will proceed.
ALAN ALDA (NARRATION) A few years ago, they set
out to study whether therapeutic touch can help
heart bypass patients. For comparison some patients
received a sham treatment. The placebo effect, that
John Longhurst believes is at work in alternative
therapies, was obviously a possibility.
LORISSA KLAUS The sham therapeutic touch practitioners
don't have the training for one, in therapeutic
touch, and they also don't have, hopefully, the
knowledge of what therapeutic touch is.
ALAN ALDA (NARRATION) Some patients get trained
practitioners, some get the sham version, some get
nothing. How the three groups do after surgery will
be compared. All three groups get the same surgical
treatment. While the operating room staff goes about
their normal duties, they're regularly joined by
a new team member at the head of the table, working
on the patient's energy balance. That's how the
study was supposed to work. But they ran into problems.
LORISSA KLAUS The sham practitioners have come
and done their treatment and then they come back
and report to me and they say, well, I think I felt
something. How do you account for that?
ALAN ALDA (NARRATION) A key component of therapeutic
touch is a conscious intention to heal. If the sham
practitioners are feeling something, maybe they're
healing, too. You'll never know if the trained practitioners
are doing any better, or if it's all just placebo
effect. So then they tried another approach. This
is a lab culture of live cancer cells. Eric Liu
is preparing them for treatment. Frank Huo is an
expert in Yuan Qi, one of the Chinese energy therapies
that therapeutic touch is based on. In his own practice,
Frank treats cancer patients. By having him fight
cancer cells they can directly measure any effect
he has, and there shouldn't be any placebo effect
to confuse the results.
ERIC LIU Left hand up on the belly button, right
hand over the plate.
ALAN ALDA (NARRATION) The cell study still requires
sham practitioners for comparison. That part's played
by medical students.
ERIC LIU While you're holding the poses, I want
you to count back in your mind from 100, down to
zero by sevens, and the reason I'm doing that is
because I want to eliminate any intention. Because
with your mind occupied, doing subtraction, you
won't be thinking about the cells, you'll just be
thinking about the math.
ALAN ALDA (NARRATION) Assuming the sham practitioners
don't spontaneously acquire any healing intentions
with cells, as they did with heart patients, then
this study stands a better chance of obtaining scientifically
valid results. But the results showed no identifiable
effects - by therapeutic touch practitioners, shams,
or Frank Huo, the Yuan Qi expert. There are no further
therapeutic touch trials planned at Columbia-Presbyterian.
The foundation of therapeutic touch is the practitioner's
ability to sense a patient's supposed energy. This
is how practitioners describe the experience.
PRACTITIONER There's like a pulsing, or sometimes
there's a temperature change, or sometimes it literally
feels like energy, like if you've ever kind of zapped
your hand when you've turned on a light or something.
PRACTITIONER There's just a thickness as I move
past an area...
PRACTITIONER A warmth emanating from the person's
body in that particular area, an area of imbalance
in the total body.
ALAN ALDA (NARRATION) In 1996 Linda Rosa, a nurse,
and her husband, Larry, worked on a terrific science
project with their daughter, Emily -- to see if
therapeutic touch practitioners could detect her
energy field.
EMILY ROSA The only way that I could really find
out if they really could feel my energy field is
if they couldn't see.
ALAN ALDA (NARRATION) The hands belong to a trained
therapeutic touch practitioner. A coin toss determines
where Emily will position her hand. Then the practitioners
have to say where the hand is.
EMILY ROSA OK.
PRACTITIONER Left.
PRACTITIONER Right.
ALAN ALDA (NARRATION) To generate reliable statistics,
14 practitioners each get 10 trials.
EMILY ROSA OK.
PRACTITIONER Left.
EMILY ROSA I got 4.1 for an average of correct
guesses. Five is chance and they got below chance.
ALAN ALDA (NARRATION) The practitioners failed
to detect Emily's supposed energy, so it's hard
to see how therapeutic touch can work - except,
that is, through the placebo effect. Emily's study
caused quite a stir when it was judged rigorous
enough to be published in the Journal of the American
Medical Association. At 11, she was the youngest
author ever to appear in those august pages. That's
it for our program on alternative medicine.
KIMBERLEY MAH I feel great.
