Alternative "medicine"

[claidheamhmor]

This was a pretty interesting and insightful article:

Boost for alternative medicine

2009-06-08 11:15
Marilynn Marchione

Baltimore - At one of the top US trauma hospitals, a nurse circles a patient's bed, humming and waving her arms as if shooing evil spirits. Another woman rubs a quartz bowl with a wand, making tunes that mix with the beeping monitors and hissing respirator keeping the man alive.

They are doing Reiki therapy, which claims to heal through invisible energy fields. The anaesthesia chief, Dr Richard Dutton, calls it "mystical mumbo jumbo". Still, he's a fan.
"It's self-hypnosis" that can help patients relax, he said. "If you tell yourself you have less pain, you actually do have less pain."

Alternative medicine has become mainstream. It is finding wider acceptance by doctors, insurers and hospitals like the shock trauma centre at the University of Maryland Medical Centre. Consumer spending on it in some cases rivals that of traditional health care.

People turn to unconventional therapies and herbal remedies for everything from hot flashes and trouble sleeping to cancer and heart disease. They crave more "care" in their health care. They distrust drug companies and the government. They want natural, safer remedies.

But often, that is not what they get. Government actions and powerful interest groups have left consumers vulnerable to flawed products and misleading marketing.

Dietary supplements do not have to be proved safe or effective before they can be sold. Some contain natural things you might not want, such as lead and arsenic. Some interfere with other things you may be taking, such as birth control pills.

'Cell-to-cell communication'

"Herbals are medicines," with good and bad effects, said Bruce Silverglade of the consumer group Centre for Science in the Public Interest.

Contrary to their little-guy image, many of these products are made by big businesses. Ingredients and their countries of origin are a mystery to consumers. They are marketed in ways that manipulate emotions, just like ads for hot cars and cool clothes. Some make claims that average people can't parse as proof of effectiveness or blather, like "restores cell-to-cell communication".

Even therapies that may help certain conditions, such as acupuncture, are being touted for uses beyond their evidence.

An Associated Press review of dozens of studies and interviews with more than 100 sources found an underground medical system operating in plain sight, with a different standard than the rest of medical care, and millions of people using it on blind faith.

How did things get this way?

Fifteen years ago, Congress decided to allow dietary and herbal supplements to be sold without federal Food and Drug Administration approval. The number of products soared, from about 4 000 then to well over 40 000 now.

Unconventional therapies

Ten years ago, Congress created a new federal agency to study supplements and unconventional therapies.

But more than $2.5bn of tax-financed research has not found any cures or major treatment advances, aside from certain uses for acupuncture and ginger for chemotherapy-related nausea. If anything, evidence has mounted that many of these pills and therapies lack value.

Yet they are finding ever-wider use:

1) Big hospitals and clinics increasingly offer alternative therapies. Many just offer stress reducers like meditation, yoga and massage. But some offer treatments with little or no scientific basis, to patients who are emotionally vulnerable and gravely ill.

The Baltimore hospital, for example, is not charging for Reiki but wants to if it can be shown to help. Other hospitals earn fees from treatments such as acupuncture, which insurance does not always cover if the purpose is not sufficiently proven.

The giant HMO Kaiser Permanente pays for members to go to a Portland, Oregon, doctor who prescribes ayurvedics - traditional herbal remedies from India.

2) Some medical schools are teaching future doctors about alternative medicine, sometimes with federal grants. The goal is educating them about what patients are using so they can give evidence-based, nonjudgmental care.

Cutting deals

But some schools have ties to alternative medicine practitioners and advocates. A University of Minnesota programme lets students study non-traditional healing methods at a centre in Hawaii supported by a philanthropist fan of such care, though students pay their own travel and living expenses.

A private foundation that wants wider inclusion of non-traditional methods sponsors fellowships for hands-on experience at the University of Arizona's Programme in Integrative Medicine, headed by well-known advocate Dr Andrew Weil.

3) Health insurers are cutting deals to let alternative medicine providers market supplements and services directly to members.

At least one insurer promotes these to members with a discount, perhaps leaving an incorrect impression they are covered services and medically sound. Some insurers steer patients to internet sellers of supplements, even though patients must pay for these out of pocket.

There are networks of alternative medicine providers that contract with big employers, just like HMOs.

A few herbal supplements can directly threaten health. A surprising number do not supply what their labels claim, contain potentially harmful substances like lead, or are laced with hidden versions of prescription drugs.

'Gambling on unproven treatments'

"In testing, one out of four supplements has a problem," said Dr Tod Cooperman, president of ConsumerLab.com, an independent company that rates such products.

Even when the ingredients aren't risky, spending money for a product with no proven benefit is no small harm when the economy is bad and people can't afford health insurance or healthy food.

But sometimes the cost is far greater. Cancer patients can lose their only chance of beating the disease by gambling on unproven treatments. People with clogged arteries can suffer a heart attack. Children can be harmed by unproven therapies forced on them by parents who distrust conventional medicine.

Mainstream medicine and prescription drugs have problems, too. Popular drugs such as the painkillers Vioxx and Bextra have been pulled from the market after serious side effects emerged once they were widely used by consumers. But at least there are regulatory systems, guideline-setting groups and watchdog agencies helping to keep traditional medicine in line.

The safety net for alternative medicine is far flimsier.

The latest government survey shows the magnitude of risk: More than a third of Americans use unconventional therapies, including acupuncture, homeopathy, chiropractic, and native or traditional healing methods.

Dietary supplements

These practitioners are largely self-policing, with their own schools and accreditation groups. Some states license certain types, like acupuncturists; others do not.

Tens of millions of Americans take dietary supplements - vitamins, minerals and herbs, ranging from ginseng and selenium to fish oil and zinc, said Steven Mister, president of the Council for Responsible Nutrition, an industry trade group.

"We bristle when people talk about us as if we're just fringe," he said. Supplements are "an insurance policy" if someone doesn't always eat right, he said.

In fact, some are widely recommended by doctors - prenatal vitamins for pregnant women, calcium for older women at risk of osteoporosis, and fish oil for some heart patients, for example.

These uses are generally thought to be safe, although independent testing has found quality problems and occasional safety concerns with specific products, such as too much or too little of a vitamin.

Some studies suggest that vitamin deficiencies can raise the risk of disease. But it is not clear that taking supplements will fix that, and research has found hints of harm, said Dr Jeffrey White, complementary and alternative medicine chief at the National Cancer Institute. A doctor with a big interest in nutrition, he sees the field as "an area of opportunity" that deserves serious study.

'They treat you like someone special'

So does Dr Josephine Briggs, director of the National Centre for Complementary and Alternative Medicine, the federal agency Congress created a decade ago.

"Most patients are not treated very satisfactorily," Briggs said. "If we had highly effective, satisfactory conventional treatment we probably wouldn't have as much need for these other strategies and as much public interest in them."

Even critics of alternative medicine providers understand their appeal.

"They give you a lot of time. They treat you like someone special," said R Barker Bausell, a University of Maryland biostatistician who wrote Snake Oil Science, a book about flawed research in the field.

That is why Dr Mitchell Gaynor, a cancer specialist at the Weill-Cornell Medical Centre in New York, said he includes nutrition testing and counselling, meditation and relaxation techniques in his treatment, though not everyone would agree with some of the things he recommends.

"You do have people who will say 'chemotherapy is just poison'", said Gaynor, who tells them he doesn't agree. He'll say: "Cancer takes decades to develop, so you're not going to be able to think that all of a sudden you're going to change your diet or do meditation (and cure it). You need to treat it medically. You can still do things to make your diet better. You can still do meditation to reduce your stress."

Once their fears and feelings are acknowledged, most patients "will do the right thing, do everything they can to save their life", Gaynor said.

Many people buy supplements to treat life's little miseries - trouble falling asleep, menopausal hot flashes, memory lapses, the need to lose weight, sexual problems.

'Wasting billions of dollars'

The Dietary Supplement and Health Education Act of 1994 exempted such products from needing FDA approval or proof of safety or effectiveness before they go on sale.

"That has resulted in consumers wasting billions of dollars on products of either no or dubious benefit," said Silverglade of the public interest group.

Many hope that President Barack Obama's administration will take a new look. In the meantime, some outlandish claims are drawing a backlash. The industry has stepped up self-policing - the Council for Responsible Nutrition hired a lawyer to work with the Council of Better Business Bureaus and file complaints against problem sellers.

"We certainly don't think this is a huge problem in the industry," Mister said, but he acknowledges occasionally seeing infomercials "that promise the world".

"The outliers were making the public feel that this entire industry was just snake oil and that there weren't any legitimate products," said Andrea Levine, ad division chief for the business bureaus.

The FDA just issued its first guidelines for good manufacturing practices, aimed at improving supplement safety. Consumer groups say the rules don't go far enough - for example, they don't set limits on contaminants like lead and arsenic - but they do give the FDA more leverage after problems come to light.

The Federal Trade Commission is filing more complaints about deceptive marketing. One of the largest settlements occurred last August _ $30 million from the makers of Airborne, a product marketed with a folksy "invented by a teacher" slogan that claimed to ward off germs spread through the air.

People need to keep a healthy scepticism about that magical marketing term "natural," said Kathy Allen, a dietician at Moffitt Cancer Centre in Tampa, Florida.

The truth is, supplements lack proof of safety or benefit. Asked to take a drug under those terms, "most of us would say 'no,"' Allen said. "When it says 'natural,' the perception is there is no harm. And that is just not true."

- AP

Source: News24

Some interesting points raised:

• "Dietary supplements do not have to be proved safe or effective before they can be sold. Some contain natural things you might not want, such as lead and arsenic. Some interfere with other things you may be taking, such as birth control pills." "Fifteen years ago, Congress decided to allow dietary and herbal supplements to be sold without federal Food and Drug Administration approval."
  

  In other words, alternative medicine does not have to be demonstrated to be safe, never mind proven to work. I remember passing a "health shop" in Sandton City a few years ago, and they were asking people to sign a petition to have herbal remedies excluded from pending legislation that would have required all such medicines and remedies to undergo testing for safety. I couldn't figure out why anyone would want something like that able to be sold with no safety testing at all.



• "But more than $2.5bn of tax-financed research has not found any cures or major treatment advances, aside from certain uses for acupuncture and ginger for chemotherapy-related nausea. If anything, evidence has mounted that many of these pills and therapies lack value."
  

  Well, yes, no surprise there. Something I've often seen from alternative medicine fans is that the big money-grubbing pharmaceutical companies are trying to shut down the little herbal/homoeopathic suppliers; of course, it should be obvious that if any of the remedies did actually work, the money-grubbing pharmaceutical companies would have got hold of the remedies, patented them, and would be trying to sell them.



• "Even when the ingredients aren't risky, spending money for a product with no proven benefit is no small harm when the economy is bad and people can't afford health insurance or healthy food. But sometimes the cost is far greater. Cancer patients can lose their only chance of beating the disease by gambling on unproven treatments. People with clogged arteries can suffer a heart attack. Children can be harmed by unproven therapies forced on them by parents who distrust conventional medicine."
  

  There have been some cases recently of people dying or being at great risk of dying because they (or their parents) resorted to alternative remedies instead of medicine. (Let's not even get started on Jenny McCarthy, whose anti-vaccination campaign has led to several deaths from things like measles).

Comments

[arthwollipot.livejournal.com]

You know what they call alternative medicine that has been demonstrated to work?

Medicine.

[claidheamhmor]

Precisely. :)

Devil's Advocate

[jtggodqos.livejournal.com]

one argument I've heard in favour of "alternative medication" is how corrupt the FDA has become. there are many people who believe that the FDA approves things more based on how it will help them and their interests versus the actual quality and functionality of the product. as such, they see that there "natural remedies" are not contaminated by the greed and manipulation of the bigger businesses.

O_o

personally, I don't care too much either way. nevertheless, I like presenting a variety of POV's. suppose I'm a wee-bit of a devil's advocate.

Re: Devil's Advocate

[claidheamhmor]

I agree, I do believe there are issues with the FDA, especially where time and cost are involved. As for natural remedies not being tainted - many of them *are* sold by huge corporates, who use the FDA exclusion as a nice loophole to avoid that time and cost.

[openmindedmale.livejournal.com]

I remember passing a "health shop" in Sandton City a few years ago, and they were asking people to sign a petition to have herbal remedies excluded from pending legislation that would have required all such medicines and remedies to undergo testing for safety. I couldn't figure out why anyone would want something like that able to be sold with no safety testing at all

of course, it should be obvious that if any of the remedies did actually work, the money-grubbing pharmaceutical companies would have got hold of the remedies, patented them, and would be trying to sell them

Herbals can't be patented. The drug companies in general would prefer herbals and the like to be regulated, because in effect, that would mean that they would be banned, because no farmer is going to spend the many thousands (millions?) of $ to bring it to market. I have other objections too, but in a basic sense, it limits options for the consumer.

It is important for someone taking this stuff to do a bit of self-education. They can conflict with existing meds that you take, if you aren't careful. They may also provide benefits that existing meds don't necessarily provide, for a bunch of reasons. For that matter, sometimes new meds are derived from (discovered) herbal sources.

Ultimately, I think it's important to distinguish herbals from quackery.

[claidheamhmor]

Herbal remedies certainly can be and are patented.

Doing the self-education can be problematic; with FDA-approved medicine, you have a leaflet stating all ingredients, known side-effects and ingredients, and pharmacological action. With many (or even most) unregulated natural/herbal remedies, you're lucky if you have an ingredients list, never mind data on action, interactions and side-effects.

As for regulating herbal remedies - there's obviously money in it, and they'd certainly be *able* to pay for the required regulation; they don't have to, though, so why would they want to? (Especially since they might actually have to demonstrate efficacy).

[openmindedmale.livejournal.com]

Herbal remedies certainly can be and are patented

I don't think you are correct (at least as far as the USA is concerned), but you may be right. I've never seen a patented herbal however.

Certainly derivatives from herbals are (and have been) patented, ASA being a very early example, but that's not the same thing.

As for regulating herbal remedies - there's obviously money in it, and they'd certainly be *able* to pay for the required regulation; they don't have to, though, so why would they want to? (Especially since they might actually have to demonstrate efficacy)

More to the point, the process of testing (and thus patenting) for a drug is expensive and time consuming. Drug companies make up for this by charging a lot of money, an option that is not there for herbals, thus no economic incentive.

[claidheamhmor]

Patents - a quick Google search got me these in the first 10 hits:
http://www.patentstorm.us/patents/6630176/claims.html
http://www.freepatentsonline.com/7329420.html

As for the economic incentive - have you *seen* the cost of herbal remedies? Some are quite a bit more expensive than conventional medicines! That money goes somewhere, and it's not into expensive ingredients.

[openmindedmale.livejournal.com]

Those links you provided gave me links for basically packaging of combinations of herbals, not the herbals themselves, which isn't the same thing. I admit to surprise that one could get patents for such blatantly obvious things however.. it'd be like getting a patent for 1/2 can of coke combined with 1/2 can of pepsi in order to provide a better tasting cola.

Sure, herbals can have a certain cost associated to them, and obviously people make money at it, but I really doubt this would usually negate the very high costs of testing, when they wouldn't be able to recoup such costs (+ very substantial profit!) through monopoly (as is currently the system for meds).

Meds can have unforseen side-effects too.. herbals aren't alone in being dangerous. All this stuff is toxic, question is, does the benefit for an individual outweigh the downside. I think that as long as the info is out there, so people can make an informed decision about what to consume, they should be allowed to consume it.

[claidheamhmor]

The patents cover the combinations, but after all, that's how the majority are sold. Only some are sold as "just one herb". And it's perfectly reasonable that such combinations ate patentable - after all, that's what pharmaceutical companies sell, combinations of different substances.

Current pharmaceuticals are certainly not in a monopolistic situation - there's a lot of competition in the industry - except of course where patents are concerned; the same would apply to any patents obtained by anyone, so it's not an unfair monopolistic situation.

I agree with you on people making informed decisions; I believe that manufacturers of any products in that arena, conventional or herbal or whatever, should be obliged by law to provide that information with their product - stuff like ingredients, side effects, action, and so forth. If food manufacturers are required to, anyone making medical remedies or supplements should too.

[openmindedmale.livejournal.com]

I think where we disagree, where there's some confusion, is exactly what is patented. Let me try and restate:

When a new drug is invented, it goes through a long and extremely expensive testing process. If it passes that stage, and if the company that invented it thinks they can make enough of a profit to justify this expense, it is sold, and it is granted an exclusive licence to manufacture this med (monopoly!) for, I believe, 20 years (in the US), after which point generics can be produced.

A company cannot get a patent to exclusively produce a specific herbal. A company cannot make claims that a herbal will have certain medical benefits, without that testing, and so there isn't sufficient financial incentive to do so.

[claidheamhmor]

To get a patent, you have to demonstrate a new product, or combination, or whatever, and in that respect, herbals are no different from pharmaceuticals (especially since you could patent a new way of preparing some herbal, like drying it and storing in oil, or whatever). It'd be no problem for a herbal to be patented, providing it's not already in use. See my earlier example.

The reason new drugs go through the expensive testing process is because they're obliged to, by law. Herbals conveniently slip through disguised as food supplements. Naturally there's no incentive to undergo testing.

This bit from the Wikipedia entry on "Patent" was interesting:
In response to these criticisms against pharmaceutical patents it has been pointed out that less than 5% of medicines on the WHO’s essential drugs list are subject to patent protection[26] and that countries who believe that intellectual property is impeding health care may not be aware that the medicines in question, particularly for HIV/AIDS related drugs, are not patented in their country.[26] Also, the pharmaceutical industry has contributed US$2 billion in healthcare efforts in developing countries, providing HIV/AIDS drugs at lower cost or even free of charge in certain countries and has used differential pricing and parallel imports as a means to provide medication to the poor.[26]

Take a look at the Bad Astronomer's recent post. I'll post more tomorrow.

[suburban-bliss.livejournal.com]

I do think that some supplements are good. I take quite a few of them and I can see the difference in myself when I don't. The supplements that I have found to really make a difference are : Cranberry for perpetual bladder infections - you CAN'T live on antibiotics; fish oil for my eczema - contizone is very bad for you long-term; pro-biotics for IBS - can't live without this, quality of life just improves with it; Benfotiamine (fat-sol. form of Vit B1, Thiamine), which helps enormously with my diabetese. If I do not take this my eye-sight immediately deteriorates. This has been used for the last 50 years in Japan and Germany and users claim that it helps to prevent/protect against and can sometimes even reverse retinopathy, neopathy and neuropathy. A friend of mine who has just recently been diagnosed with fibromyalgia says that Benfotiamine help her so much that she will NEVER stop taking it.

Often, when "conventional" medicines don't work you are so desperate that you start experimenting with alternative treatments and sometimes you are lucky and they actually work!

[claidheamhmor]

Most of what you've listed there are supplements - like vitamins and food supplements that help, rather than remedies, as such. Plenty of support out there for such things.

[suburban-bliss.livejournal.com]

Yes, I know what you are saying. My friend down the road, with 4 children, is always taking them to her homeopath - with the result that her children are ALWAYS sick. I don't think that they get adequate treatment when they really need it and then she takes them to a conventional doctor when the homeopathy fails to work and they are REALLY sick and it takes so much longer for them to get well - by that time the sick child has passed whatever they have to the rest of the family!