San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Monday, December 9, 1996 - Page C1
Carl T. Hall, Chronicle Staff Writer

"You have to go with all your feelers out," warned Jnani Chapman, a registered nurse at Mount Diablo Medical Center in the East Bay who also practices massage therapy to alleviate stress.

Even in her own gentle discipline, "there are people out there who can hurt you," she said.

More and more people are turning away from the standard options offered by American-style medicine, particularly for chronic pain and other conditions that pills and surgery often can't cure.

The field includes traditional Asian healing arts -- acupuncture, meditation and herbalism -- as well as more New Age approaches ranging from aromatherapy to biofeedback training.

Unlike traditional drugs and medical treatments, which can have dangerous side effects, the biggest risk from most alternative medicine is that it might prevent you from seeking a real cure. And if you aren't careful your pocketbook may never recover.

"It's easier to buy a used car," said Jeanne Finberg, senior staff attorney in the West Coast office of Consumers Union.

Independent researchers are having a hard enough time evaluating traditional HMOs and hospitals nowadays. Attempts to rate alternative medicine have barely begun.

Used-car dealers, Finberg noted, "are better regulated" than alternative realth-care providers. Top bastions of the U.S. medical-research establishment are only now beginning to kick the tires.

The latest to jump on the bandwagon was the University of California at San Francisco, which last week said it was finally adding the study of unconventional treatments, including art therapy and yoga, to its top-rated medical-school curriculum.

The announcement should come as welcome news to many of UCSF's patients -- and even some employees -- who have been using unproven treatments for years.

Sandra Dagnino, a UCSF labor-and- delivery nurse, used a pressure-point wrist bracelet to control nausea during her first pregnancy.

"I really felt it helped," she said. "It took the edge off. I just didn't want to be on any medications when I was pregnant."

Michael Lerner, president of Commonweal, a health and environmental research institute in Bolinas, said that an "ideology of rigorous research" is finally beginning to sweep through the burgeoning universe of diet-based therapy, manipulative bodywork treatments and New Age counseling approaches.

Dr. Dean Ornish, a Sausalito-based nutrition expert, for example, has won widespread acceptance of his theories by amassing solid scientific evidence. Studies now show that lifestyle changes really can help keep your heart beating longer.

Some major insurers and HMOs, including Kaiser Permanente's Northern California region, lately have begun offering acupuncture and some other alternative treatments, usually as a supplemental option in treating chronic pain.

Studies show a clear trend "in favor of acupuncture as having some overall effectiveness," Kaiser physician Mark Souza said.

Scientific conclusions are all tentative. The only thing that the medical community can agree on is that a lot of money is involved.

That much was pretty well proven in 1993, when the New England Journal of Medicine published a pioneering study led by Dr. David Eisenberg, a well-known Harvard Medical School physician.

His survey team found that Americans in 1990 spent about $13.7 billion on unconventional treatments. Most experts suspect the figure may have been understated, since the survey relied on phone interviews with English speakers. For many immigrants, Western medicine is considered the alternative.

Patients in the survey typically said they paid for these options out of their own pockets, without their regular doctor's knowledge. Eisenberg's conclusion -- that Americans were resorting to unconventional treatments far more routinely than anyone suspected -- forced mainstream practitioners to finally pay close attention.

A five-year follow-up study is in the works. Many experts predict it will show continued rapid growth, propelled in part by such celebrities as actress Cloris Leachman, who recently posed nude, her skin painted in an all-over vegetable motif, on the cover of Marin-based Alternative Medicine Digest magazine. The point: to show off her 70- year-old, naturally preserved body.

Retired football legend Ronnie Lott, a regular on sports-talk television, is another believer.

He signed on recently as "director of product testing" at Bio Magnetics International, a Southern California company that offers magnetic pads and belts to speed recovery of aching muscles and bad backs.

Asked what proof he had that the magnets worked, Lott demurred.

"I don't know," he said. "All I can tell you about that is it worked for me."

That may be good enough for a lot of 49er fans, but it's clearly a whole new ballgame for Western medical experts, who must now confront the fact that people want this stuff, proof or not.

Commonweal's Lerner, among other experts in the field, now prefer to call it "complementary" rather than "alternative."

Despite the general lack of accepted quality standards, he said, "many of the people involved now are serious researchers."

Unfortunately, that won't do much good for people already desperate for help that their regular doctors can't seem to offer.

There's little or no scientific evidence to recommend such things as deep-tissue massage or therapeutic use of aromas and boiled flower petals. But if nothing else has worked, you may still decide to experiment.

After all, said Dr. James Gordon, author of the newly published book "Manifesto for A New Medicine," many conventional drugs and procedures haven't been fully proven, either.

Skeptics dismiss claims of the faithful as either self-promotion or simply the well-documented but still poorly understood "placebo effect." That is, if you think something works, and take an active role in helping to make it work, chances are you just might benefit. That could be true even if you are taking nothing but New Age candy pills.

"I love placebos," Gordon said, arguing that one's own attitude often makes the difference no matter what the method.

The problem is consumers with limited finances -- and perhaps limited time -- have few places to turn to for help.

If you want to know what are the best gambles and which practitioners can be trusted, your first stop should be your regular doctor. But mainstream physicians may know less than their patients about treatments rarely taught, at least until now, in medical school.

Bookstores are full of self-help guides. Many purport to be "definitive" encyclopedias, if not the "bible" of the field.

Reputable doctors who have studied alternative medical practices warn against taking the cover claims too seriously.

"There's a lot of crap out there," said Dr. Adriane Fugh-Berman, a physician in Washington, D.C.

Fugh-Berman's own new book, "Alternative Medicine: What Works," gathers the best scientific evidence available on some of the more popular forms of unconventional treatment.

Some things came out reasonably well. Besides acupuncture and some chiropractic procedures, biofeedback techniques appear to help some people with chronic pain problems.

Otherwise, there's precious little beyond anecdotes to sway a skeptic.

The upcoming book "Five Steps to Selecting the Best Alternative Medicine," from Novato-based New World Library, offers plenty of common-sense guidelines such as checking each practitioner's references and asking friends who or what helped them.

But like most other publications and Internet sites, the sound advice is often undermined by a cheerleading tone for just about every option out there.

Helping to lead the cheers is Tiburon-based Future Medicine Publishing Inc., publishers of "Alternative Medicine" magazine and a weighty directory by the same title. The company bills itself as the "voice of alternative medicine."

That may be, but it's hardly an objective voice.

The magazine recently depicted outgoing Food and Drug Administration chief David Kessler as a "mad dog" on its cover, mainly because he was always demanding more proof of safety and efficacy than some people thought necessary.

Independent experts said the four-pound encyclopedia is weighed down with self-promoting hearsay.

"It doesn't contain research," said Anita Greene, spokeswoman for the National Institutes of Health's Office of Alternative Medicine. "It's anecdotes."

Her agency was created to begin sponsoring that research.

Ten academic centers have been set up around the country, including one at Stanford University and another at the University of California at Davis, to put "alternative modalities" through rigorous evaluation.

But the NIH office has a tiny budget of only $12 million this year. Individual research grants have begun to creep up into the $1 million range, but it's still a pittance considering the expense required to conduct full-blown clinical trials with human subjects.

Until then, consumers are essentially forced to rely on their own instincts.

"Quality control isn't there yet," Greene said. ------------------------------------------------------------

AN ALTERNATIVE HEALTH SAMPLER

-- Acupuncture: Ancient Chinese method, gaining acceptance in Western hospitals, involving insertion of thin needles at specific pressure points in the body.

-- Aromatherapy: A branch of herbal medicine that uses certain essential oils from many plants, including lavender and sandalwood, to affect the body or vanquish an infection.

-- Biofeedback training: Users learn how to regulate vital functions or relax muscles they usually can't control by means of flashing or beeping devices.

-- Bodywork: Includes therapeutic massage and deep-tissue manipulation. Advocates claim it can reduce pain, stimulate circulation and promote the body's natural healing power.

-- Chelation therapy: Controversial method of drawing toxins from the body by means of a "chelating" agent called EDTA. Although conventional practitioners use EDTA only to treat lead poisoning, some claim it can treat arteriosclerosis, scleroderma and arthritis.

-- Detoxification: Therapeutic cleansing of toxins from the body.

-- Homeopathy: A branch of traditional medicine involving use of dilute natural substances matched to particular ailments.

-- Magnetic-field therapy: Uses magnets to help ease muscle pain and speed recovery of broken bones, among other claimed benefits.

-- Naturopathic medicine: An approach to healing that emphasizes knowledge of the complete person and uses an array of techniques, including herbs, diet and lifestyle modifications.

-- Qigong: Chinese exercises incorporate movement, meditation and breath regulation.

-- Yoga: Ancient system of physical postures and movements said to promote both physical and spiritual well-being.

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RESOURCES FOR ALTERNATIVE MEDICINE

There's not much out there to guide you through the world of alternative medicine. Much of the information that does exist is sponsored by commercial interests, practitioners of the various forms of medical treatment or believers in a particular medical philosophy.

So be careful. Check with your doctor or another health-care provider you trust before acting on any information received from strangers or through the Internet.

Here are some places worth checking:

Government:

-- National Institutes of Health, Office of Alternative Medicine, 9000 Rockville Pike, Bldg. 31, Room 5B-38, Bethesda, Md. 20892 (301)- 402-2466, fax (301) 402-4741.

Web Sites:

-- www.pitt.edu/cbw/ oam.html: Sponsored by the University of Pittsburgh's Falk Library of the Health Sciences. Offers links to research centers and other sites.

-- www.bastyr.edu/index.html: Home page of Bastyr University in Seattle, which offers training for those interested in becoming a naturopathic physician.

-- www.hir.com: Holistic Internet Resources provides a directory of practitioners, who pay a fee to be listed. Site also includes links to related publications and resources.

Books and Periodicals:

-- Future Medicine Publishing Inc., 21 1/2 Main St., Tiburon, Calif., 94920. (415) 789-8700, or on the Web at www.alternativemedicine.com. Publishes "Alternative Medicine Digest," a bimonthly magazine, and various books and directories.

-- POZ magazine, a general-interest monthly for people living with HIV, 349 W. 12th St., N.Y., N.Y. 10014-1721.

-- "Natural Health, Natural Medicine," by Dr. Andrew Weil, 1995, Houghton-Mifflin Co. Updated version of a classic in the genre of wellness guides.

-- "Five Steps to Selecting the Best Alternative Medicine," by Mary and Michael Morton. New World Library, Novato. (Publication date: Feb. 4, 1997.) Upcoming shopper's guide includes useful appendixes, including lists of Internet resources and specialty organizations.
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