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				A Day with Wally Sampson A retired doctor shows Alan what herb shops are really selling.
		Select text to jump ahead in the clip: ALDA: 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. ( doorbell rings ) Hi, good morning. Ah, good morning, Alan. Come on in. ALDA: Wally started a journal to do what he says we all should do, look at alternative medicine with a cool, scientific eye. But given human nature, that's easier said than done. 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 chi coursing through your body, and how could needles have any effect on it? Then they got desperate because they were 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 in those... what's going on there? 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. 80% of the time, no matter what it is-- whether you have back pain or whether you have the flu or 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. ALDA: How to solidly connectcause and effect is the central question in the scientific approach to healing. ALDA: Shall we see what's in here? Hello. MAN: Hi. Hi, Alan Alda. Yeah, Dennis. Hi, Dennis. Nice to meet you. ALDA: This is a typical Chinese herbal medicine shop, the kind you'll find all over China and the Far East. It's stocked with around 300 different herbal remedies. You want me to make a package for you? Yeah, why not? It can't hurt me, can it? ALDA: 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 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. One, two, three, four, five, six, seven, eight, nine, ten ingredients? ALDA: 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. Tsong Kay Sa... ALDA: Each leaf or fruit or tree bark has a specific effect in re-directing the body's energy flows, or chi. ALDA: And this over here? Yeah, mu qua, mu qua. ALDA: Disease is caused by imbalancbetween yin and yang. The way to reestablish the balance and restore health is by redirecting the chi. Although no Western-trained doctor would recognize this system, patients don't care. In China most people combine Western and traditional cures, and many in the West do the same. ALDA: Do you findthat your customers also use Western medicine or do they mainly come for traditional? They also use Western medicine, together. Together? Yeah, mm-hmm. How would you be treated with... I just take the herbal tea. Herbal tea? Yeah, when I got sick, you know? ( both chuckle ) And what if that doesn't work? What do you do then? Doesn't work? Every time it works. Oh. ( laughs heartily ) That's good, I'm glad you're healthy. ( laughing ) ALDA: The popularity of herbal remedies has spread far beyond Chinese-American communities. 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. What kind of things do people tend to buy when they come in? Nowadays, in the winter season, a lot of people have the flu. Usually the people take echinacea and goldenseal, or a combination. Wally, do you know about... What would you say about echinacea? 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. ALDA: 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. ALDA: "Natural substance, IP-6, offers hope as cancer therapy." YOO: This is for good immune systems, so your body will be able to fight against cancer. ALDA: Right. And do you have people coming in? Is that popular? Even I take it. Yeah? Yeah. What if somebody came in and said, "I have a pain in my shoulder," or, "I have, uh, muscle pain," "I have arthritis." Yeah, those are the products... "Chondroitin"? Yeah, glucosamine- chondroitin combination. Glucosamine-chondroitin. Yes, this is one of the most popular products we sell. Really? Yes. And, uh, do people feel it works? Yeah, I even take it. You take this, too? We haven't found anything yet you don't take. You take more than ten pills a day. Yeah, probably, I take it. Do you have anything that people come in asking for for their heart? Yeah, we have Co-Enzyme Q-10 over here. ALDA: There really is no ailment for which you can't find something to spend your money on. YOO: Yeah, Co-Enzyme Q-10 is a very expensive product. Co-Enzyme Q-10. Right. What is this? This has a very scientific name. It doesn't sound very natural. It doesn't sound like it comes off the Co-Enzyme Q-10 tree or anything. What is this, Wally? What is this? 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. ALDA: 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 Was PC-SPES an herbal cancer cure, or a prescription drug in sheep's clothing?
		Select text to jump ahead in the clip: This is about a remedy made here called PC-Spes. PC-Spes is a nutritional supplement. It's for prostate cancer, although we cannot make that kind of a claim. It's, uh, the only claim we can make is the... that it's for a healthy prostate. ALDA: As long as supplements do not make specific claims of treatment or cure, they're 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 surely people want that. 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, "Barre, I have prostate cancer and I'm going to die in six months." And he said, "You know, I've tried "every trement in the world. "I've been to 15 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, "Barre, this is an interesting company, and this product, my PSA counts are coming down." And so it was about a year later, he said, he says, "You know what, Barre? I'm going to 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. ALDA: George Dutra was diagnosed with prostate cancer in 1992. He would eventually take PC-Spes, but not before a long struggle. When the surgery was performed I was told that it 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 was still some traces that had gotten into a lymph node. So that wasn't going to be a problem. We could then go to, uh, have some radiation and that would zap it, so... We did the 35 treatments of radiation and the count stayed down for a very short time. ALDA: 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. DUTRA: My family doctor had read about it and he had called my attention to it. "You might look into it," he said, "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 were running out of options. ALDA: 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. DUTRA: It gave me eight months or nine months of PSA that didn't take off, because I had been higher earlier. I have no, uh... I'm glad I tried it. ALDA: 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. MAN: 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. ALDA: Taking PC-Spes, the patients in the first group with early cancer 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. 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. ALDA: This is where thingget confusing. PC-Spes is a mixture of eight natural herbs-- seven 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 been 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 they found a small amount of DES in three of their four batches. So now the trial might just be comparing DES to DES. 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. ALDA: 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. 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. ALDA: I took the opportunity to ask how the growing interest in alternatives affected their work. What do you think is the most important reason for people to be cautious about taking herbal medicines and other alternative cures? Drug interactions is what we would worry about the most. You know, a lot of times patients are taking multiple medications, especially in the elderly population. And then they go to the store and they will buy some herbal product. A lot of times they don't tell us what they're taking because they feel that 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. ALDA: 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. 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 XRT 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 will... could lead to him dying from the prostate cancer. Has anybody else had an experience where a patient has turned away from conventional medicine in favor of... of herbal things and that kind of thing? WOMAN: 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 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. Sure, I had a 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 "not to use any of the traditional medicines. I want to do herbal." And I just simply said to her, "What can I do to keep the door open?" ALDA: 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 is growing. In our next story, what science has to say about one of those ways-- healing through the spine.

				Adjusting the Joints A one-time chiropractor challenges the claims of his former colleagues.
		Select text to jump ahead in the clip: Drop that shoulder. ( crack ) There we go. We have a patient here-- Paul. Hello, Paul. Hello. And... what's your complaint today? Oh, my neck hurts. Okay, very good. ALDA: 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. According to the theory, Paul's leg lengths should become even, with his neck pain cured. ( device clicks ) John Badanes is a fully trained, experienced chiropractor, but he left the business after seven years when he realized he had to face up to the fact that his profession made no sense to him. BADANES: This is an activator. ALDA: Yeah. It doesn't involve bone cracking or joint-popping. If I activate it, there is a... ( device clicks ) It's just a little tap. That's a little tap. In fact, I can adjust that down to... I can't even feel that. That's correct. ALDA: Chiropractors adjust "subluxations." A subluxation-- is that some kind of displacement of bones in the spine? A subluxation is what a chiropractor defines as a problem. In other words, it's a term that's used in many, many different ways. Correct. Now, historically, when Palmer invented this, introduced this term... Right. ...he was talking, was he, about some kind of blockage of some life force that was coming in from the universe? Correct, what he called "nerve interference." It was a life force expressed through the nerves and, uh... that was blocked-- what he called nerve interference-- and usually by a bony displacement. ALDA: Chiropractic-- which literally means "done by hand"-- was invented by Daniel Palmer in Davenport, Iowa, in 1895. READER: 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. ALDA: 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 ( dramatized ): 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. ALDA: Subsequently a large theoreticastructure 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. That's your contact point, okay? We are concerned about the relationship or 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. ALDA: 30 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. The pressure may not be on a spinal nerve route, or the pressure may not be on a spinal cord, but it may be a disturbance that changes the musculature, that changes the pattern of cerebro-spinal fluid movement. It may be a change in the positioning of a vertebra that begins to compromise and swell... excuse me, compromise 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. Hi, Kimberley. Hi, Doctor Rowe. Nice to see you again today. So tell me, how did you respond to our last visit? Really good, actually. I was feeling really good after, thank you. And since then, you've been feeling... I've been a little sick for about the past week. You've been sick? Tell me about that. I've got sinus congestion, a little headaches, and fatigue. And how are you feeling now? About the same, I've still got some sinus congestion, and I'm still tired. It's not getting any worse or any better. It's staying the same. Okay, I'm glad you're here. We'll take a look at your spine and see how you're really doing. Okay, now we're just going to feel how your spine is moving, so I'm just going to arch. You can just 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... It's tender. And 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. ALDA: Stephen Rowe now confirms the subluxation with his Nervo-Scope. It compares skin temperatures across the spine, and has a long history in chiropractic. ROWE: I'm looking for subtle differences at specific levels. ALDA: 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. 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. BADANES: This, for a chiropractor, would be a curve that needs to be fixed. It needs to be straightened out. Now, is it possible to straighten it out with, with... With the methods that people do? With adjustments using people's hands? Well, like I say, I don't think that it is. I don't think that major changes, you know, 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. ROWE: Good, just bring your pelvis a little... ALDA: Nevertheless, in a procedure repeated many times over in chiropractors' offices across the country, Kimberley gets her spine adjusted. ROWE: Okay, Kimberley, just relax, nice and easy. Let that belly go forward. ( crunch ) There we go. I feel great. ALDA: 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. BADANES: These joints are similar to the joints in my finger. My finger is two little bones and 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... ( snap ) 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. ( crunch ) BADANES: Patients believe that the bone was out of place, and that noise signals... ALDA: It snapped back into place... ...back into alignment. Yeah, into alignment. Exactly, because that's what the chiropractor... But you're saying you really can't change the position of the bone by this procedure that results in a crack. Not by that, not by that. Otherwise, you know, every time you cracked it you might be in danger of... of, you know, of coming apart. Lift up your right arm, please. ALDA: Kimberley gets a second adjustment. Okay, just right there, there you go. Drop that shoulder. ( crunch ) Excellent. ROWE: 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. 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 how everything's going. If my adjustments are holding well, then we can make the time between adjustments last a little bit longer. ALDA: 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, and chiropractic bears no relation to reality. 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. ALDA: Here's the leg-measuring procedure again. MAN: 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. ALDA: The imbalance needs adjustment. DONALDSON: This is an Activator III. 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. ( device clicks ) 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. 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. Lift your head up, back down. 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. ALDA: It's easy not only for the patient to be fooled, but the chiropractor, too. BADANES: Small changes in this position like this can fool the practitioner if their expectation, if... It's longer over here than over there. Correct. ALDA: If patients feel relief, it's fair to ask if it really matters if chiropractic makes sense. 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." MAN: 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 400 to 500 times